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AMA Journal of Ethics

Andrew Jameton
Most physicians accept the general scientific discoveries about anthropogenic global warming and its dangers. Occasional denial by individual physicians of climate change can be readily answered by reference to the scientific consensus. But widespread, organized, political denial of climate change is hazardous to physicians' advocacy for an effective public health and health care response to climate change. This article assumes that physician climate advocacy is ethical and celebrates the many forms of health climate advocacy already under way...
December 1, 2017: AMA Journal of Ethics
Jordan Emont, Gowri Anandarajah
Residents of the island nation of Tuvalu will be among the first of the 1.7 million Pacific Islanders to be displaced by the effects of climate change (including rising sea levels, changing distributions of agriculture, and unpredictable weather patterns). Already 3,500 Tuvaluans live in New Zealand (approximately 25 percent of the world's Tuvaluan population), some of whom moved due to climate change. Immigrating to New Zealand presents several challenges for Tuvaluans, including limited job opportunities, health care disparities, and dietary changes...
December 1, 2017: AMA Journal of Ethics
Cheryl C Macpherson, Matthew Wynia
Should physicians take action in the political realm to address climate change? There are many historical examples of physician advocacy in the political sphere, both individually and as a collective, and many have argued that it is important for health professionals to advocate on a variety of issues. But which criteria should be used to determine when and how health professionals should take on particular advocacy issues, and is climate change an appropriate-or even obligatory-arena for physician advocacy? We propose a seven-part deliberative framework for making this determination...
December 1, 2017: AMA Journal of Ethics
Ali A Zaidi
This article applies various ethical frameworks to inform decision making about investment in two specific goods-strengthening public health and stabilizing the global climate. I begin by outlining how these goods traditionally competed for common and constrained resources. I then discuss how this view of competition has been rendered more problematic by emerging and compelling ethical justifications for investment in both goods based on utilitarian, Rawlsian, and communitarian analyses. I conclude by showing that these goods no longer compete head-to-head in a zero-sum way...
December 1, 2017: AMA Journal of Ethics
Lisa Soleymani Lehmann
As climate change progresses, we humans might have to inhabit a world for which we are increasingly maladapted. If we were able to identify genes that directly influence our ability to thrive in a changing climate, would it be ethically justifiable to edit the human genome to enhance our ability to adapt to this new environment? Should we use gene editing not only to prevent significant disease but also to enhance our ability to function in the world? Here I suggest a "4-S framework" for analyzing the justifiability of gene editing that includes these considerations: (1) safety, (2) significance of harm to be averted, (3) succeeding generations, and (4) social consequences...
December 1, 2017: AMA Journal of Ethics
Diana Alame, Robert D Truog
Health implications of politically charged phenomena are particularly difficult for physicians to discuss with their patients and communities. Addressing climate change and its associated health effects involves trade-offs between health and economic prosperity, necessitating that physicians weigh the potential benefits and risks of discussing climate change health effects. We argue that the potential benefits of physician communication and advocacy ultimately outweigh the potential risks. Therefore, physicians should be supported in their efforts to educate their patients and communities about climate change health effects...
December 1, 2017: AMA Journal of Ethics
Cheryl C Macpherson, Jonathan Hill
Climate change threatens health, health care, and the industries and resources upon which these depend. The growing prevalence and severity of its health consequences and economic costs are alarming health professionals and organizations as their professional obligations, grounded in the core value of health, include protecting against these harms. One means of fulfilling these obligations is to lead or support sustainability initiatives that are built upon current, reliable, accurate, and unbiased evidence and collaboratively tailored to meet specific needs and respond to specific contexts...
December 1, 2017: AMA Journal of Ethics
Benjamin P Brown, Julie Chor
Fears about the impact of family planning decisions on the environment are not new. Concerns about population growth have often been conflated with concerns about the increasing demographic influence of specific feared or marginalized groups, leading to subsequent unjust treatment of those targeted populations. In clinical encounters such as this case, in which the patient expresses concerns about having another child in light of the effect of population growth on climate change, it is not appropriate for the clinician to impose environmental protection values on a patient's reproductive decision making, as this risks undermining her autonomy as well as perpetuating injustice...
December 1, 2017: AMA Journal of Ethics
David Bryan Lackey
For the last seven years, my bride of 45 years has been working very hard to recover from a series of heart problems and two strokes. In 2015, after hundreds of therapies following her 2012 stroke, we were fortunate enough to find a therapist who understood the importance of compassion and empathy in clinical situations. Within a few months, my wife's physical, cognitive, mental, and emotional condition improved profoundly. As a photographer and author, I had been documenting her survival, recovery, and flourishing, and I was fortunate enough to recognize a moment of beauty and captured a single image that has since become my wife's inspiration for living...
November 1, 2017: AMA Journal of Ethics
Sigal Israilov, Hyung J Cho
Co-creation is health professionals' and systems' development of health care together with patients and families. Such collaborations yield an exchange of values, ideas, and priorities that can individualize care for each patient. Co-creation has been discussed interchangeably with co-production and shared decision making; this article explores co-creation through the lens of quality improvement. Although there are barriers to co-creation including physician autonomy, patient overwhelm, and conflicts of interest, co-creation has been shown to promote patient engagement, peer learning, and improved outcomes...
November 1, 2017: AMA Journal of Ethics
Guddi Singh, John Owens, Alan Cribb
Co-creation is seen by many as a means of meeting the multiple challenges facing contemporary health care systems by involving institutions, professionals, patients, and stakeholders in new roles, relationships, and collaborative practices. While co-creation has the potential to positively transform health care systems, it generates a number of political and ethical challenges that should not be overlooked. We suggest that those involved in envisioning and implementing co-creation initiatives pay close attention to significant questions of equity, power, and justice and to the fundamental challenge of securing a common vision of the aims of and agendas for health care systems...
November 1, 2017: AMA Journal of Ethics
Puja Turakhia, Brandon Combs
Unlike goods, which are concrete and easily quantified, services are intangible processes that are produced and consumed concurrently. Health care is a service that can encourage optimal health outcomes only through meaningful, collaborative partnerships between patients and clinicians. Co-production of health services can be used as a means to rethink how health care is delivered not only in the context of face-to-face encounters in which the benefits of working together are obvious, but also in designing systems that can improve patient care and enhance value...
November 1, 2017: AMA Journal of Ethics
Brian Van Winkle, Neil Carpenter, Mauro Moscucci
The article explores a digital injustice that is occurring across the country: that digital solutions intended to increase health care access and quality often neglect those that need them most. It further shows that when it comes to digital innovation, health care professionals and technology companies rarely have any incentives to focus on underserved populations. Nevertheless, we argue that the technologies that are leaving these communities behind are the same ones that can best support them. The key is in leveraging these technologies with: (a) design features that accommodate various levels of technological proficiency (e-literacy), (b) tech-enabled community health workers and navigators who can function as liaisons between patients and clinicians, and (c) analytics and customer relationship management tools that enable health care professionals and support networks to provide the right interventions to the right patients...
November 1, 2017: AMA Journal of Ethics
Satish Nambisan, Priya Nambisan
Technological innovations typically benefit those who have good access to and an understanding of the underlying technologies. As such, technology-centered health care innovations are likely to preferentially benefit users of privileged socioeconomic backgrounds. Which policies and strategies should health care organizations adopt to promote equitable distribution of the benefits from technological innovations? In this essay, we draw on two important concepts-co-creation (the joint creation of value by multiple parties such as a company and its customers) and digitalization (the application of new digital technologies and the ensuing changes in sociotechnical structures and relationships)-and propose a set of policies and strategies that health care organizations could adopt to ensure that benefits from technological innovations are more equitably distributed among all target populations, including resource-poor communities and individuals...
November 1, 2017: AMA Journal of Ethics
Alan Cribb, John Owens, Guddi Singh
How should practices of co-creation be integrated into health professions education? Although co-creation permits a variety of interpretations, we argue that realizing a transformative vision of co-creation-one that invites professionals to genuinely reconsider the purposes, relationships, norms, and priorities of health care systems through new forms of collaborative thought and practice-will require radically rethinking existing approaches to professional education. The meaningful enactment of co-creative roles and practices requires health professionals and students to negotiate competing traditions, pressures, and expectations...
November 1, 2017: AMA Journal of Ethics
Priya Nambisan
Online forums and partnerships with patients have several benefits, such as the creation of new products and services. However, as with any such initiatives, there are risks as well as benefits. Through analysis of a case of misinformation being spread through a health care provider-sponsored online support group for patients dealing with obesity, this article outlines best practices and strategies to deploy in such organization-sponsored patient support groups. These strategies would enable organizations and patients to use such forums to the fullest extent while preventing or managing their potential risks as best as possible...
November 1, 2017: AMA Journal of Ethics
Aveena Kochar, Alia Chisty
During the development of new health care policies, quality improvement teams can face the challenge of weighing differing opinions within the group that can hinder progress. It is essential in such cases to refer to the four keys principles of quality improvement (QI) as a guide to enhance group cooperation and promote development of the mutual objective. Co-production is a model that emphasizes the participation of the patient-a service receiver-in the production of services being rendered by the health care professional...
November 1, 2017: AMA Journal of Ethics
Matthew Kucmanic, Amy R Sheon
This case explores a fictitious hospital's use of co-creation to make a decision about redesign of inpatient units as a first step in incorporating stakeholder input into creation of governing policies. We apply a "procedural fairness" framework to reveal that conditions required for an ethical decision about space redesign were not met by using clinician and patient focus groups to obtain stakeholder input. In this article, we identify epistemic injustices resulting from this process that could undermine confidence in leadership decisions...
November 1, 2017: AMA Journal of Ethics
Samy A Azer
Social media channels such as Twitter, Facebook, and LinkedIn have been used as tools in health care research, opening new horizons for research on health-related topics (e.g., the use of mobile social networking in weight loss programs). While there have been efforts to develop ethical guidelines for internet-related research, researchers still face unresolved ethical challenges. This article investigates some of the risks inherent in social media research and discusses how researchers should handle challenges related to confidentiality, privacy, and consent when social media tools are used in health-related research...
November 1, 2017: AMA Journal of Ethics
Petros Ioannou
No abstract text is available yet for this article.
October 1, 2017: AMA Journal of Ethics
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