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AMA Journal of Ethics

Kacey Y Eichelberger, Julianna G Alson, Kemi M Doll
Racial variations in preterm birth (PTB) outcomes are well described, but causal mechanisms linking race and PTB are not. In clinical research, race is typically treated as representing fixed biological traits. In reality, race is a social construct that approximates lived experiences of historical and ongoing systematic discrimination and, in the case of PTB, particular stressors of black womanhood and reproduction. These experiences are embodied as adverse multigenerational health outcomes. Race thus presents a dilemma for researchers...
March 1, 2018: AMA Journal of Ethics
Nancy D Campbell
Using the ethical and legal concept of shared responsibility for healthy births, this article considers social, cultural, and historical contexts in which medicalization and criminalization have worked in tandem to widen surveillance in ways that intensify scrutiny of women's lives under the guise of child protection, bringing women who are pregnant, postpartum, or parenting under criminal justice control. Although pregnant and postpartum women are prime candidates for medication-assisted treatment (MAT), the expanding carceral system has not prioritized drug treatment or reproductive justice...
March 1, 2018: AMA Journal of Ethics
Claire Wendland
Maternal and neonatal mortality statistics foreground some possible causes of death at the expense of others. Political place (nation, state) and place of birth (hospital, home) are integral to these statistics; respect for women as persons is not. Using case examples from Malawi and the United States, I argue that the focus on place embedded in these indicators can legitimate coercive approaches to childbirth. Qualitative assessments in both cases reveal that respectful care, while not represented in current indicators, is critical for the health of women and newborns...
March 1, 2018: AMA Journal of Ethics
Amy G Bryant, Jonas J Swartz
Crisis pregnancy centers are organizations that seek to intercept women with unintended pregnancies who might be considering abortion. Their mission is to prevent abortions by persuading women that adoption or parenting is a better option. They strive to give the impression that they are clinical centers, offering legitimate medical services and advice, yet they are exempt from regulatory, licensure, and credentialing oversight that apply to health care facilities. Because the religious ideology of these centers' owners and employees takes priority over the health and well-being of the women seeking care at these centers, women do not receive comprehensive, accurate, evidence-based clinical information about all available options...
March 1, 2018: AMA Journal of Ethics
Christina Krudy, Kavita Shah Arora
The United States, along with other resource-rich countries, leads global health care by advancing medical care through randomized controlled trials (RCTs). While most medical research is conducted in these resource-rich areas, RCTs, including replications of previous trials, are additionally carried out in low- and middle-income countries. On the basis of positive findings from several RCTs conducted in high-income countries, the Antenatal Corticosteroids Trial (ACT) evaluated the effectiveness of antenatal corticosteroids in reducing neonatal mortality in low- and middle-income countries...
March 1, 2018: AMA Journal of Ethics
Sara Whetstone, Meg Autry
An unprecedented number of medical students and residents express the desire to participate in global health work during their training and beyond. Preparing learners for work in underserved settings makes it more likely that they will continue to work in areas of need. Training programs that focus on global health have been criticized as there is ample work to be done in the US, and often global health work becomes learner-centric, which is difficult to maintain and potentially burdensome and harmful to the host site...
March 1, 2018: AMA Journal of Ethics
Nicholas Rubashkin, Nicole Minckas
Argentina passed a law for humanized birth in 2004 and another law against obstetric violence in 2009, both of which stipulate the rights of women to achieve respectful maternity care. Clinicians and women might still be unaware of these laws, however. In this article, we discuss the case of a fourth-year medical student who, while visiting Argentina from the United States for his obstetric rotation, witnesses an act of obstetric violence. We show that the student's situation can be understood as one of moral distress and argue that, in this specific instance, it would be appropriate for the student to intervene by providing supportive care to the patient...
March 1, 2018: AMA Journal of Ethics
Marcia C Inhorn, Pasquale Patrizio
Reproductive health services, including infertility care, are important in countries with infrastructure deficits, such as Lebanon, which now hosts more than one million Syrian refugees. Islamic prohibitions on child adoption and third-party reproductive assistance (donor eggs, sperm, embryos, and surrogacy) mean that most Muslim couples must turn to in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) to overcome their childlessness. Attempts to bring low-cost IVF-ICSI to underserved populations might help infertile couples where no other services are available...
March 1, 2018: AMA Journal of Ethics
Margaret Mary Downey, Anu Manchikanti Gómez
Reproductive health disparities-particularly those experienced by racial and ethnic minority groups-are considered a persistent public health issue in the United States. Frameworks that focus on social determinants of health seek to identify the forces producing these disparities, particularly social conditions that create vulnerability to premature death and disease. Such frameworks pose challenges to health care provision, as structural factors can seem immutable to health care professionals trained to treat individual patients...
March 1, 2018: AMA Journal of Ethics
M K Czerwiec
Matthew P. McAllister wrote: "Comic books can and have contributed positively to the discourse about AIDS: images that encourage true education, understanding and compassion can help cope with a biomedical condition which has more than a biomedical relevance" [1]. With this in mind, I combined a 23-narrator oral history and my personal memoir about an inpatient Chicago AIDS hospital unit in my book, Taking Turns: Stories from HIV/AIDS Care Unit 371. In doing so, I built upon the existing rich history of HIV/AIDS in comics, which this article will briefly describe...
February 1, 2018: AMA Journal of Ethics
Hannah R Abrams
This poster represents the experience of a clinician-in-training with a diagnostic screening method typically called "review of systems." Although at times executing this method can feel onerous, it is intended to reveal key symptoms, promote inquiry, and enhance communication. It also sometimes generates unexpected and important insights, and that experience is conveyed here with a combination of text and images.
February 1, 2018: AMA Journal of Ethics
Jason Bitterman
This comic represents various clinical and ethical dimensions of the skyrocketing incidence of opioid overdose. The comic also seeks to represent the humanity of patients struggling with addiction and to highlight the importance of clinicians' roles in helping mitigate the harms of opioid dependence.
February 1, 2018: AMA Journal of Ethics
Carol Tilley
The representations of physicians and medical practice found in comic strips, comic books, and graphic novels throughout the past century reflect broader representational trends in popular visual media. Drawing on examples including Winsor McCay's Dream of the Rarebit Fiend, the superhero comics character Stephen Strange/Doctor Strange, and contemporary graphic medicine, this article outlines the shifting models for depicting physicians and medical ethics in comics. It concludes that contemporary representations are often more realistic and nuanced, although gender and racial diversity along with diversity in medical specializations remains problematic...
February 1, 2018: AMA Journal of Ethics
Linda S Raphael, Madden Rowell
This essay argues that we should judge the illustrations in a graphic novel (often a memoir) in the context of the entire work. Judging a work on its emotive effects and the values it expresses, we can consider the ways a graphic novel represents the experience of illness, disability, or injury.
February 1, 2018: AMA Journal of Ethics
Susan M Squier
Parasites!, a 2010 comic sponsored by the Wellcome Trust Centre for Molecular Parasitology, demonstrates that a graphic narrative can play a role in energizing public debate. Part of the genre known as graphic medicine-comics about illness, treatment, disability, and caregiving-Parasites! is intended to educate readers of all ages about illnesses less known in the developed world. Two visual strategies in particular enable the comic to offer an alternative and aesthetic response to questions about developing drugs to treat tropical diseases for profit...
February 1, 2018: AMA Journal of Ethics
Kimberly R Myers, Michael D F Goldenberg
Graphic medicine is a swiftly growing movement that explores, theoretically and practically, the use of comics in medical education and patient care. At the heart of graphic medicine are graphic pathographies, stories of illness conveyed in comic form. These stories are helpful tools for health care professionals who seek new insight into the personal, lived experience of illness and for patients who want to learn more about their disease from others who have actually experienced it. Featuring excerpts from five graphic pathographies, this essay illustrates how the medium can be used to educate patients and enhance empathy in health care professionals, particularly with regard to informed consent and end-of-life issues...
February 1, 2018: AMA Journal of Ethics
Mónica Lalanda, Rogelio Altisent, Maria Teresa Delgado-Marroquín
At the University of Zaragoza in Spain we developed an innovative way to teach the concept of confidentiality to medical students, which we tested by comparing the use of customized comics with more traditional methods. We proved that using comics is more attractive to students than lectures and class discussions, that it increases class participation and students' self-awareness of learning, and that it maintains the same academic results. We share our experience visually in a two-page comic.
February 1, 2018: AMA Journal of Ethics
Jared Gardner
This essay considers the ethical problems raised by a scene of diagnosis presentation in Nate Powell's graphic novel Swallow Me Whole, in which the patient is not only not engaged by the physician, but also effectively marginalized from the moment that her condition is named and medicalized. Put in the context of the book as a whole and in relationship to the unique affordances of the comics form, however, we see that though the physician made a correct diagnosis, the case did not end well due to the poor delivery of that diagnosis and the lack of support from members of the patient's extended community...
February 1, 2018: AMA Journal of Ethics
Jeffrey Monk
A comic created by a medical student allows the reader to share the student's own unique perception of the medical education experience. Through the process of comic creation, medical students have opportunities to gain insight into how their relationships with patients and supervising physicians have shaped the physician they will become. The comic itself can be a safe space for expression and provides an opportunity for students and educators to share experiences.
February 1, 2018: AMA Journal of Ethics
Gary Ashwal, Alex Thomas
Physicians who recommend patient education comics should consider that some patients might question the appropriateness of this format, especially in the US, where a dominant cultural view of comics is that they are juvenile and intended to be funny. In this case, Dr. S might have approached communication with Mrs. T differently, even without knowing her attitude toward comics as a format for delivering health information. Dr. S could acknowledge that though some people might not expect useful medical information in a comic format, it has unique aspects and new research on patient education comics shows that even adults are finding this medium to be effective, educational, and engaging...
February 1, 2018: AMA Journal of Ethics
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