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Ethics

Ethics Forum: Medical Ethical Considerations for COVID-19

David Y. Chen, MD, PhD, & Eric J. Gapud, MD, PhD, on behalf of the ACR Committee for Ethics & Conflicts of Interest  |  

Prescribing stewardship is just one ethical consideration facing rheumatologists during the COVID-19 pandemic.

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How Ageism Hurts Physicians & Patients

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Ageism is defined as stereo­typing, prejudice or discrimination against individuals on the basis of their age. According to the American Medical Association (AMA), 43% of all physicians and surgeons are 55 or older. Specialists are, on average, older than primary care doctors. In addition, around 30% of the current U.S. population is older than 55,…

Patient Sexual Orientation & Gender Identity: Do You Need to Know?—Ethics Forum

Nayimisha Balmuri, MD, Jacob Spitznagle, MD, & Karen Onel, MD  |  

A 17-year-old girl presents to the pediatric rheumatology clinic for follow-up of recently diagnosed systemic lupus erythematosus (SLE) characterized by class IV lupus nephritis, photosensitive rash and antiphospholid antibody positivity. She is currently being treated with prednisone, mycophenolate mofetil, and hydroxychloroquine. She is accompanied by her mother, who has been very involved in the patient’s…

Ethics Forum: 3 Ways to Resolve Conflict When Children Refuse Treatment

B. Anne Eberhard, MBBS, MSc, FRACP, FRCPC  |  

In the middle of a busy clinic I go to see my next patient, a 16-year-old girl with a swollen knee. I had seen her the week before and, after discussing the options regarding treatment of her arthritis, had organized a joint injection for today. As I walk in the door she emphatically informs me,…

Ethics Forum: Are We Ethically Bound to Support Access to Rheumatologic Care for All?

Bernard Hildebrand, MD  |  

A 43-year-old woman is establishing care in your new urban clinic after her previous rheuma­tologist stopped accepting her Medicaid insurance more than a year ago. Since that time, she has been trying to find a new rheumatologist who will accept Medicaid. She lives 90 miles away in a small town without a rheumatologist. Seven years…

Bending, Not Breaking

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“And of course, I am not telling you to do it. That would be illegal.” As a general rule, I try not to instruct my patients to break the law. My business model depends on repeat customers, so placing a patient at risk of getting arrested—even if that risk is remote—doesn’t seem like a good…

Ethics Forum: Beware Your Intellectual Conflicts of Interest

Evan Mulvihill, MD, MPH  |  

A senior rheumatologist with extensive experience in the management of systemic lupus erythematosus is asked to help draft clinical guidelines for the treatment of lupus nephritis. Neither she nor her family members receive grant funding nor does she consult with any pharmaceutical or biotechnology companies. She does have strong clinical opinions based on current evidence…

Social Conflict Seeps into Medical Societies

Tamara Mathias  |  

In U.S. medical society boardrooms, far from legislative chambers, social conflict is forcing board members to deal with laws that raise issues of medical ethics. Take the Association of University Radiologists (AUR), a group of more than a thousand medical school radiology faculty whose stated mission is to “inspire and educate the academic radiology community.”…