AMA journal of ethics最新文献

Health beliefs about one's own future should be clearly expressed, sincere, and enduring to be taken seriously by clinicians when assessing risks and benefits in key health decisions. This cartoon considers how clinicians' expressions of doubt about those beliefs can undermine patient-clinician relationships and a patient's epistemic authority.

Despite high incidence of endometriosis internationally and domestically, many patients wait a decade after symptom onset for an accurate diagnosis. This article suggests why diagnostic criteria should be clarified and why endometriosis screening should be incentivized among members of the public, clinicians, and health care organizations.

Non-labor and delivery obstetrics and gynecology (OB/GYN) procedures are an important and necessary part of reproductive health care. However, performing a pelvic exam or procedure, which requires entry through the pelvis, is often an uncomfortable, painful, embarrassing, and anxiety-provoking experience. Given the delicate nature of these examinations and procedures, it is imperative that physicians uphold the inherent trust placed in them that derives from the patient-physician relationship. Respecting a patient's privacy-including physical, informational, decisional, and associational privacy-is a prerequisite for ensuring that a fundamental foundation of trust exists between the patient and physician. This essay explores the ethical issues physicians face during clinical practice when performing non-labor and delivery OB/GYN examinations and procedures.

This article considers ethical, epistemic, and clinical harms of normalizing, discounting, or dismissing patients' experiences of acute pain in non-labor and delivery obstetrics and gynecology (OB/GYN) settings. Discrediting patients' accounts undermines the therapeutic capacity of patient-clinician relationships, causes unjustified suffering, and may even contribute to life-threatening delays in recognizing and treating complications. This article urges OB/GYN practitioners to consider the ways in which structural and individual factors predispose them to discredit patients' testimonies and thereby contribute to epistemic and other harms. OB/GYN practitioners are encouraged to cultivate the virtue of epistemic humility and consider the role of patient satisfaction scores in evaluating care.

Doing painful procedures is a part of obstetrics and gynecology practice. Patients' pain experiences are subjective, diverse, and based on life experiences that can include trauma, adverse childhood events, and previous labor. Learners should have opportunities to gain knowledge about pain and the informed consent process during preclinical medical education, to observe and practice informed consent exchanges that include a discussion of pain and pain management with standardized and real patients during different stages of their training, to receive timely feedback from seasoned clinicians who understand that shared decision-making is an essential component of an informed consent discussion, and to learn from every patient encounter in order to inform the next one (reflective practice).

This commentary on a case considers how to navigate a pelvic exam in the context of a patient's personal experience and suggests the clinical and ethical importance of thoughtful, intentional action and consistent, clear communication in these clinical encounters.

This commentary on a case considers recent publicity about pain with intrauterine device insertion and clinically and ethically relevant factors that influence pain and pain management strategies for this effective contraceptive method.

Pain is a recognized adverse effect of medication abortion, but its management has been understudied. This commentary on a case draws on principles of nonmaleficence, beneficence, and autonomy to consider equity in remote and in-person medication abortion pain management.

Ann Lohman, a midwife in the 1800s also known as Madame Restell, deserves our attention following the US Supreme Court decision in Dobbs v Jackson Women's Health Organization in June 2022. As abortion regulations change, it is important that health care communities learn from past experiences. This article examines the historical context in which Lohman practiced and draws out key lessons to be applied today.