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AMA Journal of Ethics

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https://www.readbyqxmd.com/read/28009251/changing-memories-between-ethics-and-speculation
#1
Eric Racine, William Affleck
Over the past decade, a debate has emerged between those who believe that memory-modulating technologies are inherently dangerous and need to be regulated and those who believe these technologies present minimal risk and thus view concerns about their use as far-fetched and alarmist. This article tackles three questions central to this debate: (1) Do these technologies jeopardize personhood? (2) Are the risks of these technologies acceptable? (3) Do these technologies require special regulation or oversight? Although concerns about the unethical use of memory-modulating technologies are legitimate, these concerns should not override the responsible use of memory-modulating technologies in clinical contexts...
December 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28009250/autism-art-and-accessibility-to-theater
#2
Blythe A Corbett
Art has the ability to entertain and educate about many vital aspects of the human experience. Recently, innovative endeavors are providing greater accessibility to theatrical productions for people with autism spectrum disorder (ASD), prompting ethical questions about how accommodations to provide access to art and culture should be made, and for whom. This article uses an attributional model of stigma to explain potential differences in knowledge, attitudes, and behavior toward people with mental illness...
December 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28009249/manipulating-memories-the-ethics-of-yesterday-s-science-fiction-and-today-s-reality
#3
Julie M Robillard, Judy Illes
The paper addresses recent advances in memory manipulation from the perspective of the four key pillars of neuroethics: the self, social policy, neurotechnology, and education and outreach. We provide examples for each pillar, assess their neuroethical implications, and conclude with a call for an ethics framework that is specifically tailored for the ethical challenges of memory manipulation.
December 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28009248/promoting-access-to-school-based-services-for-children-s-mental-health
#4
MaryKatherine Brueck
Mental health issues are widespread among children, but many never receive adequate treatment. One political solution proposed to address this disparity would be to fund mental health services through school-based programs and support collaboration among community and health organizations to address the needs of children. Regardless of whether this policy is implemented, health care professionals have a responsibility to promote access to care and patient health, which may include actively participating in the development of programs to provide services to children with mental health disorders...
December 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28009247/the-legal-implications-of-detecting-alzheimer-s-disease-earlier
#5
Joshua Preston, Jaleh McTeigue, Caitlin Opperman, Jordan Dean Scott Krieg, Mikaela Brandt-Fontaine, Alina Yasis, Francis X Shen
Early detection of Alzheimer's disease (AD) raises a number of challenging legal questions. In this essay, we explore some of those questions, such as: Is a neurological indicator of increased risk for AD a legally relevant brain state before there are any outward behavioral manifestations? How should courts address evidentiary challenges to the admissibility of AD-related neuroimaging? How should the government regulate the marketing of neuroimaging diagnostic tools? How should insurance coverage for the use of these new tools be optimized? We suggest that many voices and multidisciplinary perspectives are needed to answer these questions and ensure that legal responses are swift, efficient, and equitable...
December 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28009246/locating-risk-in-the-adolescent-brain-ethical-challenges-in-the-use-of-biomarkers-for-adolescent-health-and-social-policy
#6
Suparna Choudhury, Sheehan Moore
Technological developments in neuroscience over the last 20 years have generated excitement about the potential of neuroscientific insights for the understanding of and intervention in children's and adolescents' behavior. This article introduces some ways in which new results from developmental cognitive neuroscience have been appropriated in the context of adolescent mental health. We also consider social and interpersonal factors that drive the use of neurobiological markers of mental disorders in pediatric psychiatry...
December 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28009245/advancing-ethical-neuroscience-research
#7
B Rashmi Borah, Nicolle K Strand, Kata L Chillag
As neuroscience research advances, researchers, clinicians, and other stakeholders will face a host of ethical challenges. The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has published two reports that provide recommendations on how to advance research endeavors ethically. The commission addressed, among other issues, how to prioritize different types of neuroscience research and how to include research participants who have impaired consent capacity. The Bioethics Commission's recommendations provide a foundation for ethical guidelines as neuroscience research advances and progresses...
December 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28009244/neuroethics-and-disorders-of-consciousness-discerning-brain-states-in-clinical-practice-and-research
#8
Joseph J Fins
Decisions about end-of-life care and participation in clinical research for patients with disorders of consciousness begin with diagnostic discernment. Accurately distinguishing between brain states clarifies clinicians' ethical obligations and responsibilities. Central to this effort is the obligation to provide neuropalliative care for patients in the minimally conscious state who can perceive pain and to restore functional communication through neuroprosthetics, drugs, and rehabilitation to patients with intact but underactivated neural networks...
December 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28009243/who-should-assess-the-needs-of-and-care-for-a-dementia-patient-s-caregiver
#9
Laura N Gitlin, Nancy A Hodgson
Using a clinical case example, we examine whether health and human service professionals have a moral obligation to assess and address the needs of family caregivers of persons with dementia and, if so, the challenges in doing so under current health care and reimbursement mechanisms. We also discuss specific strategies for involving caregivers.
December 1, 2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27883308/response-to-ethical-and-clinical-dilemmas-in-using-psychotropic-medications-during-pregnancy
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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