10 must-read bioethics articles published in 2024

The AMA Journal of Ethics^® is an editorially independent, peer-reviewed journal devoted to helping medical students and physicians navigate ethical decisions in service to patients and communities. Each monthly issue focuses on a specific theme topic. 

This year’s monthly themes were:

• “Critical Pedagogies in Health Professions Education,” January.
• “Health Ecology and Disease Transmission,” February.
• “Psychiatric Inpatient Environmental Architecture,” March. 
• “Global Medical Supply Chain Security,” April.
• “Antimicrobial Resistance,” May.
• “Antimicrobial Stewardship,” June.
• “Harm Reduction and Opioid Use Disorder,” July.
• “Standards in Medical-Legal Partnerships,” August.
• “Nonhuman Animal Research,” September.
• “Sleep Stewardship,” October.
• “Peace in Health Care,” November.
• “Evidence-Based Design in Health Care,” December.

While each issue is well worth medical students and physicians’ time to explore in full detail, some articles published in the journal this year brought more readers than others. Here is the top 10 list of articles published in AMA Journal of Ethics in 2024.

1. “How Inpatient Psychiatric Units Can Be Both Safe and Therapeutic.”

   1. Inpatient psychiatric units should be therapeutic environments that support dignity and recovery. When adverse outcomes happen in these settings, physicians and administrators can face litigation and other pressures to prioritize risk management over supporting patients’ access to personal belongings, exercise equipment and private spaces. 
   2. This article describes these downward pressures toward sparser, controlling environments in inpatient psychiatric settings as a “safety funnel” and suggests strategies for balancing safety, humanity and recovery in these contexts.

2. “A Brief History of Antimicrobial Resistance.”

   1. Despite mounting attention in recent years, health threats posed by antimicrobial resistance are not new. Antimicrobial resistance has dogged infectious disease treatment processes since the first modern antimicrobials were discovered.

3. “Which Drugs Should Be on the Essential Medicines List?”

   1. The World Health Organization (WHO) published its first Essential Medicines List in 1977, and it is updated biennially. One might reasonably think drugs on the EML are there because they are critical to effective, evidence-based patient care and intervention. One might not reasonably guess, however, that a particular drug’s supply-chain vulnerabilities that make it a shortage risk would contribute to a drug’s listing. 
   2. This commentary on a case first describes why the WHO makes the Essential Medicines List and suggests reasons why it might be important to consider a drug’s shortage risk when revising and updating it. This commentary also suggests how distinguishing “essential” drugs from “vulnerable” drugs could bolster supply-chain resiliency and mitigate drug shortages’ disruptions to patient care.

4. “How Should We Approach Faculty Who Create Hostile Learning Environments for Underrepresented Students and Trainees?”

   1. Faculty members who demonstrate resistance to—or lack of skill in—addressing negative bias in practice and learning environments can erode safety, especially among students from historically excluded racial and ethnic groups. 
   2. This commentary on a case suggests how educators and leaders should respond to problematic behaviors of unwilling or unskilled faculty, prevent mistreatment of students and colleagues, and facilitate continuous faculty development.

5. “AMA Code of Medical Ethics’ Opinions Related to Global Medical Supply Chain Security.”

   1. Global medical supply chain security is essential for the health care system to run efficiently and allow physicians to effectively treat patients. When the global medical supply chain fails, as was seen during the COVID-19 pandemic, physicians are put in the difficult position of not having enough resources and being required to put themselves at risk to provide care for sick patients. The AMA Code of Medical Ethics provides opinions giving guidance to physicians regarding this issue.

6. “Should Patients’ Boredom in Locked Inpatient Psychiatric Units Be Considered Iatrogenic Harm?”

   1. Patients often report experiencing boredom during inpatient psychiatry stays. Because patients’ vulnerabilities and conditions can be exacerbated when they feel bored, this article considers ethical dimensions of inpatient units’ designs that limit patients’ autonomy or access to activities or interactions with others. This commentary on a case also considers whether and how boredom should be considered an iatrogenic harm and influence discharge planning.

7. “Aspiring to Disability Consciousness in Health Professions Training.”

   1. Lack of disability-competent health care contributes to inequitable health outcomes for the largest minoritized population in the world: persons with disabilities. Health professionals hold implicit and explicit bias against disabled people and report receiving inadequate disability training. While disability competence establishes a baseline standard of care, health-professional educators must prepare a disability conscious workforce by challenging ableist assumptions and promoting holistic understanding of persons with disabilities. 

8. “When Should Patients at the End of Life Get Antimicrobials?”

   1. Although antimicrobial medications are commonly prescribed to patients at the end of life, physicians might not discuss the benefits and harms of antimicrobials with their patients in the advance-care planning process. This commentary on a case discusses challenges and strategies in antimicrobial decision making for patients at the end of life.

9. “Cultivating Critical Love to Improve Black Maternal Health Outcomes”

   1. Testimonial injustice is an expression of prejudice that uses identity to undermine individuals’ credibility as authoritative “knowers” of their own bodies, selves and experiences. Among Black women, experiences of testimonial injustice in health care encounters are common and likely contribute to inequities in Black maternal health. 

10. “How Racism and ‘Tropical Medicine’ Built the Panama Canal.”

    1. At the turn of the 20th century, Dr. William Gorgas led work that substantially mitigated mortality from mosquito-borne diseases among workers building the Panama Canal. The waterway launched the United States to political and economic superpower status by eliminating the need for risky maritime travel around the southern tip of South America, expediting exportation of US goods in international markets. Yet, as this article explains, innovations that curbed malaria and yellow fever were deeply rooted in racist foundations of capital and empire.

Another top 10 list well worth diving into is this exploration of the top 10 ethical issues that medical students should be taught.

Along with articles, the journal also publishes a variety of multimedia, including author interviews and the “Ethics Talk” podcast. 

Also, CME modules drawn from each issue are collected at the AMA Ed Hub™ AMA Journal of Ethics webpage.