AMA journal of ethics最新文献

Social accountability in health professions education prominently has to do with preparing students and trainees in pediatrics to do 3 key things: prioritize social and structural drivers as preconditions of children's health, work to mitigate health inequity among children by partnering with community members and families, and integrate advocacy for health system improvement for children into practice. This article suggests strategies for health justice advocacy and for strengthening cross-disciplinary teaching about how to screen children for structural drivers of health.

Despite the inclusion of health equity and public health in undergraduate and graduate medical curricula, many medical students and trainees have minimal understanding of health insurance coverage for children of families with low incomes. Since children's eligibility for Medicaid and the Children's Health Insurance Program (CHIP) significantly influence their care, this article proposes that students and trainees, especially in pediatrics, should receive formal instruction about Medicaid and CHIP in 3 key areas: program structure; eligibility determinations, redeterminations, and range of covered or partially covered services; and enrollment requirements and processes. This article also suggests the nature and scope of expertise required to responsibly offer such instruction in classroom- and clinic-based settings.

A growing body of evidence considers how addressing adverse structural drivers of health (aSDoH) can improve children's overall health, thereby reinforcing pediatricians' role in advancing health equity early in life. Yet the optimal strategy for aSDoH screening and intervention remains unclear. This article examines barriers to equitable aSDoH screening, referral, and intervention, questioning the necessity of screening tool validation when the primary goal is to connect families with necessary resources. It also explores caregiver engagement, key considerations behind documentation of results, and the need for multilingual screening.

This article problematizes the normalization of social pediatrics as extracurricular or optional rather than necessary for children's health care. Drawing on critical pedagogical frameworks like structural competency and accompaniment, this article illuminates clinical, institutional, and structural obstacles to mainstreaming social pediatrics training. This article also identifies examples of how training programs, health systems, and policymakers can facilitate and sustain care environments that support social pediatrics and advance health equity.

Screening for structural drivers or determinants of health (SDoH), as mandated by recent federal regulations, raises ethical questions about screening processes and tools. Early childhood adversity and trauma, which can influence a person's health throughout their lifespan and contribute to chronic disease and early death, can be identified through standardized screening for SDoH. However, screening without awareness of the potential interface between SDoH and trauma can retraumatize those administering or completing the screening process. This article suggests that implementation of a trauma-informed approach to SDoH screening is consistent with biomedical and public health ethics and contributes to efforts to keep clinical environments emotionally safe.

Access to health care is a key structural determinant of health, with lack of health insurance as a main barrier. In the United States, nearly half of children rely on Medicaid or the Children's Health Insurance Program for health insurance. Children's eligibility for coverage under these programs is income dependent and can vary over time, so changes in insurance status signal a need to screen for unmet structural needs. Clinicians, who are obligated to respond to what screening reveals, should be prepared to help deploy practice-based, health system, and community resources to help meet the needs of children and families.

Of all infectious disease events, pandemics could result in significant human depopulation in this Anthropocene epoch or even in the next few centuries. Existential factors that exacerbate pandemic risk include global warming, overpopulation, habitat loss, permafrost thawing, geopolitical conflict, and bioterrorism from naturally occurring or engineered pathogens. This article argues that clinicians have ethical duties to strengthen global public health systems and research on pandemic risk factors, promote proven prevention strategies (especially vaccines), and incentivize domestic and international partnerships that build capacity to respond to existential pandemic harms. Scientific literacy is an intellectual vaccine against the ... charlatans who would exploit ignorance. Neil deGrasse Tyson1.

This series of self-portraits explores relationships between one's self and possible genetic and epigenetic sources of illnesses.

Despite broad awareness of impending existential threats to humanity, protections from these threats are not yet widely recognized as human rights. This article distinguishes human rights from legal rights, considers possible domestic and international legal approaches to rights-based protection from environmental existential threats, and offers recommendations about how to motivate such protections.