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Background/Objective: Historically, Trisomy 13 (T13) and Trisomy 18 (T18) have been considered “lethal” diagnoses with a limited life expectancy. Due to extensive comorbidities and perception of low quality of life (QOL), most T13 and T18 neonates have not been offered (or families have not pursued) neonatal intensive care or surgical interventions. With the observation of longer term survival in some T13 and T18 infants, in addition to changing societal attitudes toward people with disabilities, there is advocacy …

Background Impaired physician health can have a direct impact on patient health care and safety. In the past, problems of alcoholism and substance abuse among physicians have received more attention than other conditions-usually in the form of discipline. While patient safety is paramount, the medical profession may be more successful in achieving the required standards by fostering a culture committed to health and wellness as well as supporting impaired physicians. Objective To develop ethical guidelines regarding physician health and wellness. Methods The American Medical Association's (AMA's) Council on Ethical and Judicial Affairs developed recommendations based on the AMA's Code of Medical Ethics, an analysis of relevant Medline-indexed articles, and comments from experts. The report's recommendations were adopted as policy of the Association in December 2003. Results Individually, physicians can promote their personal health and wellness through healthy living habits, including having a personal physician. The medical profession can foster health and wellness if its members are taught to identify colleagues in need of assistance and initiate appropriate methods of intervention, including referrals to physician health programs. Conclusions Physicians whose health or wellness is compromised should seek appropriate help and engage in honest self-assessment of their ability to practice. The medical profession should provide an environment that helps to maintain and restore health and wellness. Physicians need to ensure that impaired colleagues promptly modify or cease practice until they can resume professional patient care. In addition, physicians may be required to report impaired colleagues who continue to practice despite reasonable offers of assistance.

Increasing numbers of people are seeking genetic testing and uncovering information that directly concerns their biological relatives as well as themselves. This familial quality of genetic information raises ethical quandaries for physicians, particularly related to their duty of confidentiality. In this article, the American Medical Association's Council on Ethical and Judicial Affairs examines the informed consent process in the specific context of genetic testing, giving particular consideration to the handling of information that has consequences for biological relatives. Furthermore, it addresses the question of whether physicians' obligation to warn biological relatives ever should override the obligation to protect patient confidentiality.

Approximately 6,000 patients per year, or 16 per day, with end-stage organ failure die because of the lack of available organs. Each year only 35% to 50% of potential donors consent to donation (1). During the last 20 years, vigorous educational campaigns, both voluntary and legislative, designed to increase organ donation have failed to increase donation rates significantly. The need for organs has grown nearly five times faster than the number of cadaveric donors: the annually compounded rate (1990–2000) of increase in number of patients on waiting lists has averaged 14.1% a year, whereas the rate of increase of donors has averaged 2.9% a year (2). The American Medical Association (AMA) has been concerned about this problem for many years and has developed several policies addressing it in the past decade (3). AMA policy has supported certain forms of financial incentives for cadaveric organ donation since 1993 (Policy E-2.15, AMA Policy Database), but they have never been implemented because federal law prohibits them. AMA policy specifically prohibits payment to living donors (4). Most initiatives to increase organ donation have focused on what motivates or hinders the decision to donate. Programs to improve organ donation rates have been aimed at public and professional groups. These have included widespread educational campaigns aimed at motivating individuals to become donors. They also have included mandated choice legislation, the establishment of the Organ Procurement and Transplantation Network (OPTN), donor card programs, donor registries, and the creation of specialized organ donation teams within hospitals that discuss organ donation with families and patients. Despite these efforts, cadaveric donation rates have remained nearly stable during the past decade. This report encourages the medical and scientific communities to reexamine the motivation for cadaveric organ donation. Building on the work of the Council on Ethical and Judicial Affairs (CEJA) in 1993, which led to Opinion E-2.15, “Financial Incentives for Organ Donation,” this report identifies reasons why ethical objections to financial incentives, for cadaveric organ donation only, should be reexamined. In particular, this report considers the need to study the impact of financial incentives through limited research trials. Such studies would help measure the effect of incentives not only on donation rates but also on public perception of the transplant enterprise and of the meaning of organ donation. For the purposes of this report, donation and procurement of organs are considered completely independent from the allocation of organs. The report neither suggests nor supports any change in the current system of organ distribution, as developed and administered by the United Network for Organ Sharing (UNOS). Even if financial incentives were found to have a positive impact on cadaveric organ donation rates, allocation algorithms developed by the OPTN would continue to govern organ distribution and transplant recipients would continue to be selected according to ethically appropriate criteria related to medical need rather than ability to pay. Physicians have an obligation to hold their patients’ interests paramount and to support access for all patients to medical care (Principles VIII and IX) (5). To discharge these obligations, physicians should participate in efforts to increase organ donation, including education of their patients and the general public regarding the importance of organ donation and promotion of voluntary donation of organs. Beyond educational programs, however, physicians should support innovative approaches to encourage organ donation. Such efforts include encouragement and, if appropriate, participation in the conduct of ethically designed research studies of donor motivation. A potential impetus for cadaveric organ donation that has not been adequately explored (because of federal prohibition) is financial incentives. Such incentives are not intrinsically unethical; AMA policy has supported them since 1993. Whether a particular incentive is ethical or not depends upon the balance of benefits and harms that result, and these are currently unknown because they have never been investigated.

The trend toward casual address and dress in the medical profession could reinforce the power differential that already exists between patient and physician and adversely affect the patient-physician relationship. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

The AIDS quilt memorializes those who lost their lives to AIDS and helps increase public awareness of the disease and methods of HIV prevention. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Media stories about individual cases of human suffering encourage society to bring health care to geographically remote areas by investing in telemedicine technologies. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

The case of Nancy Cruzan, a 25-year-old woman whose injuries from an automobile accident resulted in a persistent vegetative state, helped to empower people with end-of-life choices. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Physicians need to educate patients about nutrition to counter the plethora of media images that promote poor dietary habits. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Readers are referred to an article by Reg Green in a 1995 issue of JAMA to consider the experience of health care from the patient’s perspective as told by the father of an organ donor. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Andy Levine’s postage stamp design highlights efforts to raise visibility and increase awareness of the need for organ donation. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

The trend toward casual address and dress in the medical profession could reinforce the power differential that already exists between patient and physician and adversely affect the patient-physician relationship. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Physicians should take a graduated approach to including children in their health care decisions to improve their overall medical experience. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Based on a general review of international, representative tissue banking policies that were described in the medical, ethics, and legal literature, this paper reviews the range of standards, both conceptually and in existing regulations, relevant to four main factors: (1) commercialization, (2) confidentiality, (3) informed consent, and (4) quality of research. These four factors were selected as reflective of some of the major ethical considerations that arise in the conduct of tissue banking research. The authors emphasize that any policy or ethical guidelines designed to regulate tissue bank research should address all four factors. Whenever this sort of research is conducted between several institutions or several countries, the paper suggests that the relevant entities work collaboratively to harmonize their standards.

The media helps shape the general public's perception of the American Medical Association as the emblem of organized medicine. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Cassio Lynm, JAMA's medical illustrator, describes the role of the illustrator and how his artwork evolves from concept to finished product. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

While the advent of direct-to-consumer marketing of prescription drugs makes them known to the general public, the physician is the gatekeeper for legally prescribing medications and can help the patient better understand the costs and benefits of different treatment options. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Placing a black band across the face of a patient's photo published in a medical publication does not adequately protect the patient's privacy and anonymity, as evidenced by the image of Leonardo da Vinci's Mona Lisa with a black band across her eyes. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Many surgeons listen to music while performing surgery, a practice that should be implemented with respect to all who will be present in the operating room. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

The practice of infertile couples offering to pay large sums of money to female college students for egg donations of superior quality raises many ethical concerns. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Vignettes of three real patients who face end-of-life decisions, excerpted from a four-part television series on PBS. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

The journal recognizes Nov. 16 as the American Cancer Society's 24th annual Great American Smoke Out with a 19th century image conveying the ill effects from the use of tobacco products. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.