AMA journal of ethics最新文献

This article assesses research on private equity ownership's influence on health care quality. A review of several prominent studies supports the conclusion that private equity ownership does not have a universally positive or negative effect. Past research has found that providers backed by private equity generally have mixed quality outcomes post acquisition, depending on the sector and measures evaluated. This article outlines ways in which research findings are misconstrued and cautions against drawing conclusions from a narrow sample of literature about private equity based on studies in one sector.

Physicians have fiduciary duties to respond with care to patient's clinical needs and vulnerabilities, whereas private equity (PE) companies have no such ethical or legal duties to patients and strive to maximize financial returns for their investors. This commentary on a case considers ethical conflicts of interest that arise when physicians sell their practices to PE firms and describes what physicians should consider when selling to fundamentally profit-driven entities.

As private equity (PE) funds acquire a growing share of America's health care system, their focus has expanded to include not only hospitals and nursing homes but also physician practices. Some PE acquisitions have infused much-needed capital into resource-starved entities, but others have led to higher prices, diminished quality of services, and billing fraud. Some PE acquisitions have also forced viable entities into bankruptcy by stripping their real estate and other assets. This article explains how legal and regulatory responses to these outcomes can be impeded by corporate structures that PE funds commonly use to obscure responsibility. It also suggests reforms that could strengthen enforcement capacity.

Patients who are incarcerated experience severely restricted autonomy and are thus extremely vulnerable. This commentary on a case offers longitudinal, long-term postsurgical trauma-informed care recommendations and starts with a working assumption that, when injuries sustained during incarceration require surgery and hospitalization, patients' rights to evidence-based standard of care that would be given to any other patient should not be compromised. Yet surgical care of traumatically injured patients who are incarcerated can be ethically and clinically complex due to their status as wards of the state, which abrogates their liberty to make their own health decisions. Patients who are incarcerated also have preexisting trauma and are at risk for violence and persistent traumatic stress.

The US has the most individuals who are incarcerated worldwide. This article offers five recommendations for what surgical trainees should think about and know about when providing perioperative care for patients who are incarcerated.

Hospital inpatients who are incarcerated spend most of their time alone, are not permitted to have visitors while hospitalized, and are handcuffed to their beds. This story describes an ethics consultation about one such patient's surgical care.

This article considers AMA Code of Medical Ethics opinions relevant to the care of patients who are incarcerated.

Surgical research involving patients who are incarcerated is fraught with ethical, logistical, and practical questions. This article first considers important moments in the history of research with people who are incarcerated and suggests how they have contributed to evolution in human subject research ethics and regulation. This article also examines the problem of limited data about surgical disease burden and describes barriers to enrolling individuals who are incarcerated in surgical clinical trials, including study exclusion criteria and clinician-investigator bias. Finally, this article recommends strategies for balancing human research subject protections with the need for equitable enrollment in surgical clinical trials, especially later-phase trials in which benefit is more likely than in early-phase trials.