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AMA Journal of Ethics

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https://www.readbyqxmd.com/read/28225702/the-idea-of-legitimate-authority-in-the-practice-of-medicine
#1
Arthur Isak Applbaum
Legitimate authority is the normative power to govern, where a normative power is the ability to change the normative situation of others. Correlatively, when one has the normative power to govern others, these others face a normative liability to be governed. So understood, physicians do not have legitimate authority over their patients, and patients do not have legitimate authority over their physicians. An authority is legitimate only when it is a free group agent constituted by its free members. On this conception, associations of physicians sometimes have legitimate authority over individual physicians, and physicians sometimes count as members subject to the legitimate authority of these associations...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225701/the-case-of-dr-oz-ethics-evidence-and-does-professional-self-regulation-work
#2
Jon C Tilburt, Megan Allyse, Frederic W Hafferty
Dr. Mehmet Oz is widely known not just as a successful media personality donning the title "America's Doctor(®)," but, we suggest, also as a physician visibly out of step with his profession. A recent, unsuccessful attempt to censure Dr. Oz raises the issue of whether the medical profession can effectively self-regulate at all. It also raises concern that the medical profession's self-regulation might be selectively activated, perhaps only when the subject of professional censure has achieved a level of public visibility...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225700/seeking-legitimacy-for-dsm-5-the-bereavement-exception-as-an-example-of-failed-process
#3
James E Sabin, Norman Daniels
In 2013 the American Psychiatric Association (APA) published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Even before publication, DSM-5 received a torrent of criticism, most prominently over removal of the "bereavement exclusion" for the diagnosis of major depression. We argue that while the APA can claim legitimate authority for deciding scientific questions, it does not have legitimacy for resolving what is ultimately a question of ethics and public policy. We show how the "accountability for reasonableness" framework for seeking legitimacy in health policy could have been used to achieve a better resolution of the conflict than actually occurred...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225699/what-is-the-relevance-of-procedural-fairness-to-making-determinations-about-medical-evidence
#4
Govind Persad
Approaches relying on fair procedures rather than substantive principles have been proposed for answering dilemmas in medical ethics and health policy. These dilemmas generally involve two questions: the epistemological (factual) question of which benefits an intervention will have, and the ethical (value) question of how to distribute those benefits. This article focuses on the potential of fair procedures to help address epistemological and factual questions in medicine, using the debate over antidepressant efficacy as a test case...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225698/reasonableness-credibility-and-clinical-disagreement
#5
Mary Jean Walker, Wendy A Rogers
Evidence in medicine can come from more or less trustworthy sources and be produced by more or less reliable methods, and its interpretation can be disputed. As such, it can be unclear when disagreements in medicine result from different, but reasonable, interpretations of the available evidence and when they result from unreasonable refusals to consider legitimate evidence. In this article, we seek to show how assessments of the relevance and implications of evidence are typically affected by factors beyond that evidence itself, such as our beliefs about the credibility of the speaker or source of the evidence...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225697/who-should-ration
#6
Philip M Rosoff
A principal component of physician decision making is judging what interventions are clinically appropriate. Due to the inexorable and steady increase of health care costs in the US, physicians are constantly being urged to exercise judicious financial stewardship with due regard for the financial implications of what they prescribe. When applied on a case-by-case basis, this otherwise reasonable approach can lead to either inadvertent or overt and arbitrary restriction of interventions for some patients rather than others on the basis of clinically irrelevant characteristics such as ethnicity, gender, age, or skin color...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225696/what-to-do-when-there-aren-t-enough-beds-in-the-picu
#7
Michael A Rubin, Robert D Truog
The concepts of medical futility and rationing are often misunderstood and lead to significant consternation when resources are stretched and pediatric intensive care unit (PICU) beds are unavailable. While the two concepts overlap, each has its own distinct application and moral justification. Most importantly, we should avoid using one to justify the other. Bioethics professionals should assist critical care clinicians in clarifying when each rubric should be applied as well as how to develop policies to standardize the approach...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225695/how-should-therapeutic-decisions-about-expensive-drugs-be-made-in-imperfect-environments
#8
Leonard M Fleck, Marion Danis
Clinicians must inevitably make therapeutic decisions under nonideal conditions. They practice in circumstances that involve incomplete evidence. They deliver care in health care systems that are complex and poorly coordinated. Each of the patients that they take care of is unique while research offers evidence regarding relatively homogeneous populations of patients. Under these circumstances, many parties-medical scientists, reviewing agencies, insurers, and accountable care organizations-can and should contribute to optimizing the development, approval, funding, and prescription of therapies-particularly expensive and marginally beneficial therapies...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225694/polarities-in-clinical-thinking-and-practice
#9
John Z Sadler
This analysis of a case of a bereaved patient that poses two treatment options-watchful waiting or medication-focuses on five "polarities" in clinical practice: (1) the normal and the pathological, (2) the individual and the diagnostic collective, (3) the primary care physician and the consultant, (4) the expert and nonexpert, and (5) the moment and the process. These polarities can accentuate ethical problems posed by this case, for example, by creating stark contrasts that mask the complex contexts of care and characteristics of patients...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28107164/decreasing-human-trafficking-through-sex-work-decriminalization
#10
Erin Albright, Kate D'Adamo
In order to decrease human trafficking, health care workers should support the full decriminalization of prostitution. Similar to trafficking in other forms of labor, preventing trafficking in the sex trade requires addressing the different forms of marginalization that create vulnerable communities. By removing punitive laws that prevent reporting of exploitation and abuse, decriminalization allows sex workers to work more safely, thereby reducing marginalization and vulnerability. Decriminalization can also help destigmatize sex work and help resist political, social, and cultural marginalization of sex workers...
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28107163/should-us-physicians-support-the-decriminalization-of-commercial-sex
#11
Emily F Rothman
According to the World Health Organization, "commercial sex" is the exchange of money or goods for sexual services, and this term can be applied to both consensual and nonconsensual exchanges. Some nonconsensual exchanges qualify as human trafficking. Whether the form of commercial sex that is also known as prostitution should be decriminalized is being debated contentiously around the world, in part because the percentage of commercial sex exchanges that are consensual as opposed to nonconsensual, or trafficked, is unknown...
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28107162/out-of-darkness-light-drawing-and-painting-by-margeaux-gray
#12
Margeaux Gray, Mary Richards
No abstract text is available yet for this article.
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28107161/art-therapy-exhibitions-exploitation-or-advocacy
#13
Terri Davis
Promoting awareness of human trafficking by sharing trauma survivors' art and summaries of their life stories suggests ethical complexities that have been typically neglected by bioethicists. Although these survivors voluntarily share the objects they created during art therapy sessions, they are still at risk of harm, including further exploitation, due to their vulnerability, high rates of victim sensitivity, and the mental health consequences of their traumatic experiences. While some argue that the benefits of sublimation and art therapy for human trafficking survivors make sharing their art worth the risk, anti-trafficking organizations and supporters of such art exhibitions have responsibilities to be trauma informed...
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28107160/groupthink-how-should-clinicians-respond-to-human-trafficking
#14
William Polk Cheshire
Human trafficking is a pervasive problem that exceeds the capacity of social and organizational resources to restrain and for which guidelines are inadequate to assist medical professionals in responding to the special needs of victims when they present as patients. One obstacle to appropriate disagreement with an inadequate status quo is the lure of group cohesion. "Groupthink" is a social psychological phenomenon in which presumed group consensus prevails despite potentially adverse consequences. In the context of the medical response to human trafficking, groupthink may foster complacency, rationalize acquiescence with inaction on the basis of perceived futility, create an illusion of unanimity, and accommodate negative stereotyping...
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28107159/caring-for-the-trafficked-patient-ethical-challenges-and-recommendations-for-health-care-professionals
#15
Wendy L Macias-Konstantopoulos
Human trafficking is an egregious human rights violation with profound negative physical and psychological consequences, including communicable diseases, substance use disorders, and mental illnesses. The health needs of this population are multiple, complex, and influenced by past and present experiences of abuse, neglect, and exploitation. Effective health care services for trafficked patients require clinicians to consider individual patients' needs, wishes, goals, priorities, risks, and vulnerabilities as well as public health implications and even resource allocation...
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28107158/human-trafficking-in-areas-of-conflict-health-care-professionals-duty-to-act
#16
Christina Bloem, Rikki E Morris, Makini Chisolm-Straker
Given the significant global burden of human trafficking, the ability of clinicians to identify and provide treatment for trafficked persons is critical. Particularly in conflict settings, health care facilities often serve as the first and sometimes only point of contact for trafficked persons. As such, medical practitioners have a unique opportunity and an ethical imperative to intervene, even in nonclinical roles. With proper training, medical practitioners can assist trafficked persons by documenting human trafficking cases, thereby placing pressure on key stakeholders to enforce legal protections, and by providing adequate services to those trafficked...
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28107157/who-is-in-your-waiting-room-health-care-professionals-as-culturally-responsive-and-trauma-informed-first-responders-to-human-trafficking
#17
Rochelle Rollins, Anna Gribble, Sharon E Barrett, Clydette Powell
Evidence-based practice standards are not yet well defined for assisting potential victims of human trafficking. Nonetheless, health care professionals are learning to be first responders in identifying, treating, and referring potential victims. As more public and private sector resources are used to train health care professionals about human trafficking, more evaluation and research are needed to develop an effective standard of care. Adopting a public health lens and using the "National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care" can guide critical decision making and actions...
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28107156/mandatory-reporting-of-human-trafficking-potential-benefits-and-risks-of-harm
#18
Abigail English
Human trafficking, including both sex and labor trafficking, has profound consequences for the safety, health, and well-being of victims and survivors. Efforts to address human trafficking through prevention, protection, and prosecution are growing but remain insufficient. Mandatory reporting has the potential to bring victims and survivors to the attention of social service and law enforcement agencies but may discourage trafficked persons from seeking help, thereby limiting the ability of health care professionals to establish trust and provide needed care...
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28107155/ethical-considerations-in-mandatory-disclosure-of-data-acquired-while-caring-for-human-trafficking-survivors
#19
Patrick L Kerr, Rachel Dash
Accurate data on the prevalence and psychological effects of human trafficking as well as treatment outcomes for survivors are essential for measuring the impact of interventions and generating better understanding of this phenomenon. However, such data are difficult to obtain. A legal mandate for health care professionals to report trafficking opens opportunities for advancing our work in the field of human trafficking but also poses risks to survivors seeking services. In this article, we provide an analysis of some critical ethical considerations for the development and implementation of a mandatory reporting policy and offer recommendations for the ethical implementation of such a policy...
January 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28107154/taking-up-the-mantle-of-human-trafficking-education-who-should-be-responsible
#20
Carrie A Bohnert, Aaron W Calhoun, Olivia F Mittel
Human trafficking is a global human rights issue with long-range health consequences about which physicians are largely uneducated. Medical schools are uniquely positioned to address this gap. All future physicians, regardless of specialty, must learn to identify victims and refer them to trauma-informed treatment. Research and advocacy are needed to address the lack of rigorously evaluated curricula in this area, impact policy, and improve services for victims of this heinous form of exploitation.
January 1, 2017: AMA Journal of Ethics
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