Objective The implementation of medical aid-in-dying (MAID) poses new challenges for clinical communication and counseling. Among these, health care providers must consider whether to initiate a discussion of MAID with eligible patients who do not directly ask about it. Norms and policies concerning this issue vary tremendously across jurisdictions where MAID is legally authorized, reflecting … Read more

Hospital systems commonly face the challenge of determining just ways to allocate scarce drugs during national shortages. There is no standardised approach of how this should be instituted, but principles of distributive justice are commonly used so that patients who are most likely to benefit from the drug receive it. As a result, clinical indications, … Read more

The increased risk of harm from COVID-19 infection in pregnancy highlights the importance of including pregnant people in COVID-19 vaccine development and deployment. Promising vaccines being developed include replication-competent platforms, which are typically contraindicated during pregnancy because of theoretical risk. However, replicating vaccines are administered in and around pregnancy, either inadvertently because of unknown pregnancy … Read more

When patients are too ill to make their own health care decisions and lack a previously designated decision maker, identifying the appropriate surrogate can be a complex process. For example, clinicians may use surrogacy ladders (hierarchical lists of individuals who could serve as decision makers), which are delineated in state statutes.1 Although patients with incapacitating … Read more

Genetic analysis has become integral to many large cohort studies. However, little is known about longitudinal cohort study participants’ attitudes toward genetics and genetic testing. We analyzed data from a survey of participants in the Jackson Heart Study (n = 960), Framingham Heart Study (n = 955), and Framingham Heart Study–Omni Cohort (n = 160). … Read more

Mechanical circulatory support (MCS) such as extracorporeal membrane oxygenation, left ventricular assist devices and total artificial hearts have altered the natural history of heart failure, and specialists in the fields of cardiology and cardiothoracic surgery are faced with more complex ethical considerations than ever before. Residency and fellowship training programs, however, do not have formal … Read more

In the United States, about 6.5 million adults are living with heart failure, and about half of those patients will die within 5 years of diagnosis.1 For patients with advanced chronic heart failure or acute unrecoverable decompensation, heart transplantation offers a cure. However, the number of patients with end-stage heart failure is increasing while the … Read more

The legal landscape for medical aid-in-dying (AID) in theUSA has shifted dramatically over the past 5 years. Vermont(2013), California (2015), Colorado (2016), the District ofColumbia (2016), and Hawaii (2018) have joined Oregon(1997), Washington (2008), and Montana (2009) in permittingphysicians to prescribe a lethal dose of medication to a termi-nally ill adult patient, provided that certain … Read more

In a fraction of a second, trauma changes us. Trauma injures organs, fractures bones, and makes us bleed, but it also leads to suffering, demoralization, and fear. While physical injuries can often be neatly classified, emotional and spiritual injuries cannot. These burdens are shouldered by many, not just those who are physically injured. Families, friends, … Read more

With 2.2 million incarcerated people, the United States imprisons more people than any other country in the world.1 This mass incarceration is recent, arising from the war on drugs and punitive sentencing policies that began in the 1970s.1 Ethnic minorities and the poor have been disproportionately affected by this increase: more than half of the … Read more