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AMA Journal of Ethics

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https://www.readbyqxmd.com/read/27883308/response-to-ethical-and-clinical-dilemmas-in-using-psychotropic-medications-during-pregnancy
#1
Jennifer Piel, Suzanne B Murray, Carmen Antonela Croicu
No abstract text is available yet for this article.
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27883307/informed-consent-in-the-medical-care-of-transgender-and-gender-nonconforming-patients
#2
Timothy Cavanaugh, Ruben Hopwood, Cei Lambert
Informed consent as a model of care has evolved as an alternative to the standard model of care recommended by the World Professional Association for Transgender Health's Standards of Care, version 7, which emphasizes the importance of mental health professionals' role in diagnosing gender dysphoria and in assessing the appropriateness and readiness for gender-affirming medical treatments. By contrast, the informed consent model for gender-affirming treatment seeks to acknowledge and better support the patient's right to, and capability for, personal autonomy in choosing care options without the required involvement of a mental health professional...
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27883306/lessons-from-a-transgender-patient-for-health-care-professionals
#3
Ryan K Sallans
It is not uncommon for transgender patients to avoid sharing information about their identity and medical history with health care professionals, due to past negative experiences within health care settings. Professionals who show sensitivity to the topic and express care about health record documentation can increase a transgender patient's trust. There are many opportunities to increase transgender health literacy, including consultation, conferences, webinars, books, and articles focused on transgender health care...
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27883305/understanding-transgender-and-medically-assisted-gender-transition-feminism-as-a-critical-resource
#4
Jamie Lindemann Nelson
Feminism has fought the trivialization of women's experiences, championed women's security, and insisted on respect for women's choices. In so doing, feminism has developed important perspectives on the complicated connections between what gender means as it plays itself in people's lives, and the inequalities of power and authority that structure much of human experience. Here, I put a few of these perspectives into contact with an issue where the interactions of gender and power are squarely in play: medicine's role in assisting gender transitioning generally and, specifically, the enduring controversy between medicine and many transgender people about the pathologization of transgender and the role of clinicians as gatekeepers to gender-transition interventions...
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27883304/transgender-rights-as-human-rights
#5
Tia Powell, Sophia Shapiro, Ed Stein
Arguments to support transgender rights often rely on "born that way" arguments, which assert that gender identity is innate, immutable, and unassociated with choice. These arguments are vulnerable to attack on several grounds, including on the basis of emerging scientific data. Stronger support for transgender rights arises from human rights arguments.
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27883303/transgender-reproductive-choice-and-fertility-preservation
#6
Khadija Mitu
Increasing numbers of young transgender people are now using medical technologies to achieve a physical gender transition. However, the procedures of physical gender transition might cause temporary or permanent sterility. Thus many transgender people are now using fertility preservation technologies. Nonetheless, they can experience dilemmas in making reproductive and family-building decisions and face challenges in gaining access to and utilizing fertility preservation services. Based on qualitative research conducted with transgender men and women who used reproductive technologies for preserving their fertility before or during their physical transition, this paper contributes to the discourse of reproductive choice by the inclusion of transgender people's experience...
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27883302/affirmative-and-responsible-health-care-for-people-with-nonconforming-gender-identities-and-expressions
#7
Kristen L Eckstrand, Henry Ng, Jennifer Potter
Although recent changes in health care delivery have improved routine and gender-affirming care for transgender people, common approaches to care are still often based on a binary (i.e., male/female) gender framework that can make patients with gender-nonconforming (GNC) identities and expressions feel marginalized. Binary representation perpetuates invisibility, discrimination, and victimization-and subsequent poorer health-among GNC patients. In response, clinicians and health care systems should extend their efforts to provide gender-affirming and responsible care to GNC people...
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27883301/what-s-in-a-guideline-developing-collaborative-and-sound-research-designs-that-substantiate-best-practice-recommendations-for-transgender-health-care
#8
Madeline B Deutsch, Asa Radix, Sari Reisner
Transgender medicine presents a particular challenge for the development of evidence-based guidelines, due to limitations in the available body of evidence as well as the exclusion of gender identity data from most public health surveillance activities. The guidelines that have been published are often based on expert opinion, small studies, and data gathered outside the US. The existence of guidelines, however, helps legitimate the need for gender-affirming medical and surgical interventions. Research conducted on transgender populations should be grounded in gender-affirming methodologies and focus on key areas such as health outcomes after gender-affirming interventions...
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27883300/should-psychiatrists-prescribe-gender-affirming-hormone-therapy-to-transgender-adolescents
#9
Cary S Crall, Rachel K Jackson
Gender-affirming hormone therapy is a safe and effective way to improve quality of life and mental health outcomes for transgender adolescents. Access to this treatment is limited, with the most vulnerable transgender people experiencing the greatest gaps in care. Because some psychiatrists help transgender patients receive needed medical interventions, we analyze the ethical values they must balance when deciding whether to provide hormone therapy to patients who seek it.
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27883299/should-mental-health-screening-and-psychotherapy-be-required-prior-to-body-modification-for-gender-expression
#10
Timothy F Murphy
Some people want to modify their bodies through hormonal and surgical treatments in order to resolve gender dysphoria, the distress they experience when their bodies do not align with their gender identity. The World Professional Association for Transgender Health (WPATH) offers guidelines to clinicians regarding treatment of people wanting to modify their bodies for this reason. Prior to these modifications, WPATH advises that mental health screening is needed and that psychotherapy is recommended though not a requirement...
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27883298/how-should-physicians-refer-when-referral-options-are-limited-for-transgender-patients
#11
Elizabeth Dietz, Jessica Halem
Transgender people encounter many barriers to health care, and recommendations about where their treatment would best be offered can promote or thwart good care. This case examines the care setting from the perspective of a patient whose experiences with specialists have been negative. We argue that an ethos of harm reduction and informed consent, with a strong emphasis on continuity of care within a primary care setting, should guide questions about how to refer transgender patients to caregivers and to good care settings...
November 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27780030/technical-standards-and-deaf-and-hard-of-hearing-medical-school-applicants-and-students-interrogating-sensory-capacity-and-practice-capacity
#12
Michael Argenyi
Applicants to medical schools who are deaf and hard of hearing (DHoH) or who have other disabilities face significant barriers to medical school admission. One commonly cited barrier to admission is medical schools' technical standards (TS) for admission, advancement, and graduation. Ethical values of diversity and equity support altering the technical standards to be more inclusive of people with disabilities. Incorporating these values into admissions, advancement, and graduation considerations for DHoH and other students with disabilities can contribute to the physician workforce being more representative of the diverse patients it serves and better able to care for them...
October 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27780029/why-increasing-numbers-of-physicians-with-disability-could-improve-care-for-patients-with-disability
#13
Lisa I Iezzoni
Erroneous assumptions among health care professionals about the daily lives, preferences, values, and expectations of persons with disability can contribute to documented health care disparities, faulty communication, and substandard quality of care affecting this heterogeneous population. Efforts to reduce racial and ethnic disparities have focused on expanding diversity in the physician workforce. Would expanding the numbers of physicians with disability benefit patients with disability? Increasing the number of physicians who identify as "disabled" is one strategy for proactively confronting disability-related barriers affecting patients, but such efforts will likely face substantial challenges...
October 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27780028/just-and-realistic-expectations-for-persons-with-disabilities-practicing-nursing
#14
Patricia M Davidson, Cynda Hylton Rushton, Jennifer Dotzenrod, Christina A Godack, Deborah Baker, Marie N Nolan
The Americans with Disabilities Act prohibits discrimination on the basis of disability and requires schools to provide reasonable accommodations for persons with disabilities. The profession of nursing is striving for diversity and inclusion, but barriers still exist to realizing accommodations for people with disabilities. Promoting disclosure, a supportive and enabling environment, resilience, and realistic expectations are important considerations if we are to include among our ranks health professionals who can understand, based on similar life experiences of disability, a fuller range of perspectives of the patients we care for...
October 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27780027/perspectives-on-the-meaning-of-disability
#15
Leslie Francis, Anita Silvers
The meaning of "disability" has shifted with changes in public policy. Half a century ago, Congress was convinced that narrow determinations of disability are easy for physicians to make. But with the advent of universal civil rights protection against disability discrimination in the US, deciding whether particular individuals are disabled became increasingly contentious, until Congress intervened. What should now be addressed in each case is not whether the functionally compromised person is severely disabled enough to exercise a right, but whether mitigating interventions and reasonable accommodations can together achieve equitable access for that person...
October 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27780026/competence-not-age-determines-ability-to-practice-ethical-considerations-about-sensorimotor-agility-dexterity-and-cognitive-capacity
#16
Krista L Kaups
Consideration of the effects of aging on physicians' practice is crucial to addressing aging clinicians' competence, that is, their ability to practice with reasonable skill and safety. Given physician workforce shortages even in resource abundant countries, the establishment of a compulsory retirement age in the US is impractical and unlikely. Several US hospitals and institutions have sought to address concerns about competence by establishing mandatory age-linked testing and evaluation for physicians. However, these procedures have raised questions regarding age discrimination and test validity...
October 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27780025/technical-standards-and-lawsuits-involving-accommodations-for-health-professions-students
#17
Samuel R Bagenstos
This article will discuss the legal obligations of medical schools to accommodate applicants and students with disabilities. The article begins by describing the problem of denial of medical education to such students, a problem that results from both discrimination in admissions and denial of accommodations to incumbent students with disabilities. The article then discusses the disability rights legislation that prohibits discrimination against-and requires reasonable accommodation of-qualified medical students with disabilities...
October 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27780024/learning-from-physicians-with-disabilities-and-their-patients
#18
Joel A DeLisa, Jacob Jay Lindenthal
Although progress has been made in diversifying medical school admissions and faculty, this has not extended to physicians with physical disabilities. To improve our understanding of medical students and physicians with physical and sensory disabilities, the authors propose systematically gathering information on the needs and experiences of four groups: physicians who had disabilities before beginning practice, physicians whose disabilities were incurred during their medical careers, physicians drawn from those two groups, and patients of physicians with disabilities...
October 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27780023/medical-schools-willingness-to-accommodate-medical-students-with-sensory-and-physical-disabilities-ethical-foundations-of-a-functional-challenge-to-organic-technical-standards
#19
Michael McKee, Ben Case, Maureen Fausone, Philip Zazove, Alicia Ouellette, Michael D Fetters
Students with sensory and physical disabilities are underrepresented in medical schools despite the availability of assistive technologies and accommodations. Unfortunately, many medical schools have adopted restrictive "organic" technical standards based on deficits rather than on the ability to do the work. Compelling ethical considerations of justice and beneficence should prompt change in this arena. Medical schools should instead embrace "functional" technical standards that permit accommodations for disabilities and update their admissions policies to promote applications from qualified students with disabilities...
October 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27780022/how-should-colleagues-respond-to-diminishing-capacities-of-an-aging-surgeon
#20
Peter Angelos
When an esteemed elderly colleague needs assistance completing procedures safely, fellow health professionals have the responsibility to respond in order to mitigate risk to patients. There is a strong ethical basis for bringing the surgeon's declining capacity to his or her attention as well as to the attention of others. Ongoing capacity assessments could be one method for tracking diminished capacities among surgeons so that they can stop practicing surgery before putting patients at risk.
October 1, 2016: AMA Journal of Ethics
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