AMA journal of ethics最新文献

Most physicians do not see, or learn to see, nuclear war threat mitigation as within the scope of their professional duties. This commentary on a case argues there are 2 reasons why physicians, in particular, should draw on their unique training and expertise in medicine to help avert nuclear war: the risk of nuclear war and therefore the risk of catastrophic community, domestic, and global health consequences is presently high; and physicians today can draw on a strong history of past physicians' nuclear disarmament advocacy strategies. This commentary concludes by canvassing how those past strategies can best be applied today.

Existential ethics (extinction ethics) evokes Van Renssalaer Potter's definition of bioethics as a science of human survival that integrates biological principles, the planetary ecosystem, and wisdom. Explored here is a thesis that virtue ethics (character ethics) should supplement deontological, consequentialist, and other approaches to decision-making relevant to extinction. Advances in philosophy, social science, and neuroscience support the idea that virtues such as faith, hope, and love should complement how virtues such as wisdom, justice, temperance, and courage are expressed when deliberating about existential ethical questions in areas such as global warming, nuclear warfare, and rogue artificial intelligence applications. It has yet to be determined whether Science, as the embodiment of a mechanical force, can rule without invoking ruin…. [T]here must be a very different civilization or there will be no civilization at all. Sir William Osler1A new type of thinking is essential [in the atomic age] if mankind is to survive and move toward higher levels. Albert Einstein2.

This diptych is a satirical advertisement for a fictional face cream, inspired by and based upon a radium health craze during the early 20th century.

Since health is a crucial, if not the most important, feature of persons' well-being, we have good reasons to consider all present and future persons as members of a "league of patients." This article explores what this concept might mean, proposes how it could be applied in the emerging field of existential health care ethics, and draws upon it to better conceive of how to meet the health needs of current and future patients.

Existential ethics is the study of the ethical and evaluative implications of human extinction. This article examines 4 key concepts in this emerging field: (1) Going Extinct is different from Being Extinct; (2) extinction-causing catastrophes are different in kind, not just degree, from non-extinction-causing catastrophes; (3) "human extinction" can have multiple meanings, which, when applied, can yield multiple, even conflicting, conclusions about what might constitute best future outcomes; and (4) there are historical reasons why existential ethics has tended to be ignored until recently. One goal of this article is to launch a discussion about what existential health care ethics could look like.

Is there an important ethical difference between a global catastrophe that causes human extinction and one that does not? This commentary on a case introduces 3 approaches-equivalence, further-loss, and pro-extinctionist-in responding to this question. In particular, focus is placed on equivalence and further-loss views' implications for how clinicians, health professions, and health care organizations orient themselves ethically towards managing the risk of extinction.

This commentary on a case builds on recent literature on climate change, health, and human extinction to argue in favor of a new clinical specialty: extinction medicine. If based on precise application of scientific findings about species extinction, disaster prevention and management, and health policy, such a specialty could help reduce humanity's extinction risk. Finally, the commentary suggests extinction medicine competencies, who might become an extinction medicine clinician, and how the specialty might be launched.

This article draws a parallel between ethical reasons why people alive today have obligations to members of future generations and ethical reasons why physicians have obligations, besides helping improve patients' quality of life, to help some patients confront their own deaths and human extinction. This article argues for the view that many clinicians tend to express-daily, and one patient at a time-ethical values that support human extinction prevention as a project of medicine.

This article outlines several initiatives to optimize and expand emergency medical services (EMS) in American Indian and Native Alaskan (AI/NA) rural communities. It highlights the significance of cultural humility, cost-effectiveness, equity, and tribal sovereignty in EMS licensure and describes key infrastructure improvements (eg, roads and communication systems) to EMS responsiveness in AI/NA rural communities. This article also examines practical and financial strategies for integrating telehealth and drone-based delivery of critical medicines into rural EMS response capacity.

Critical access and other rural hospitals have struggled to remain open, which exacerbates inequity in rural residents' access to routine and emergency health services and strains already-taxed rural emergency medical services (EMS). This article discusses the recent history of rural hospital closures and their effects on rural emergency care. This article also suggests modifications to EMS policy and practice that could improve rural community members' access to health services and bolster EMS services in rural areas.