The goal of this study was to determine if the level of preservice teachers’ economic literacy might serve as a gatekeeper to teaching economics competencies. The participants ( n=84) were teacher candidates in an elementary education program in their final methods courses prior to their teacher internship. The findings supported the intuitive belief that elementary teachers lack the economic literacy and confidence needed to teach economics concepts in the elementary curriculum. This deficit can serve as a gatekeeper to teaching economics (...) competencies leading to curricular disjuncture between the established curriculum and actual practice in the classroom. (shrink)

The ethics of providing health care in resource-poor environments is a complex topic. It implies two related questions: What can we do with the resources on hand? Of all the things we can do, which ones should we do? “Resource-poor” environments are situations in which clinicians, organizations, or healthcare systems have the knowledge and skills, but not the means, to carry out highly effective and beneficial interventions. Determinants of a population’s health often rely less on disease and injury management than (...) on recognizing and meeting their basic needs. Many of the world’s people with the greatest health problems live in fragile contexts and remote areas. Their access to food, safe water, personal safety, improved sanitation facilities, and health care remains elusive, with availability often based on socioeconomic status, gender, ethnicity, or geography. Of course, ethical international healthcare work also requires an understanding of the illnesses and injuries that most frequently plague the population. To function ethically and to know both what can and what should be done with available resources, individuals and organizations involved in international healthcare must be experienced, adaptable, culturally sensitive, inspired, situationally aware, beneficent, courageous, honest, and fair. (shrink)

The ethics of providing health care in resource-poor environments is a complex topic. It implies two related questions: What can we do with the resources on hand? Of all the things we can do, which ones should we do? “Resource-poor” environments are situations in which clinicians, organizations, or healthcare systems have the knowledge and skills, but not the means, to carry out highly effective and beneficial interventions. Determinants of a population’s health often rely less on disease and injury management than (...) on recognizing and meeting their basic needs. Many of the world’s people with the greatest health problems live in fragile contexts and remote areas. Their access to food, safe water, personal safety, improved sanitation facilities, and health care remains elusive, with availability often based on socioeconomic status, gender, ethnicity, or geography. Of course, ethical international healthcare work also requires an understanding of the illnesses and injuries that most frequently plague the population. To function ethically and to know both what can and what should be done with available resources, individuals and organizations involved in international healthcare must be experienced, adaptable, culturally sensitive, inspired, situationally aware, beneficent, courageous, honest, and fair. (shrink)

The world awaits a SARS-CoV-2 virus vaccine to keep the populace healthy, fully reopen their economies, and return their social and healthcare systems to “normal.” Vaccine safety and efficacy requires meticulous testing and oversight; this paper describes how despite grandiose public statements, the current vaccine development, testing, and production methods may prove to be ethically dubious, medically dangerous, and socially volatile. The basic moral concern is the potential danger to the health of human test subjects and, eventually, many vaccine recipients. (...) This is further complicated by economic and political pressures to reduce government oversight on rushed vaccine testing and production, nationalistic distribution goals, and failure to plan for the widespread immunization needed to produce global herd immunity. As this paper asserts, the public must be better informed to assess promises about the novel vaccines being produced and to tolerate delays and uncertainty. (shrink)

In situations with limited medical resources, be they personnel, equipment, or time, clinicians use “triage” to determine which patients receive treatment. What type of treatment a patient receives depends on the triage “lottery” rules in place. Although these rules for sorting patients and distributing resources are standardized for most situations, they must be somewhat altered after overwhelming, nonstandard disasters.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to feature editor Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to feature editor Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to feature editor Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will igve you an opportunity to respond in the letters section. Your input is desired and anticipated.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to feature editor Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.

This section is meant to be a mutual effort. If you find an article you think should be abstracted in this section, do not be bashful—submit it for consideration to Kenneth V. Iserson care of CQ. If you do not like the editorial comments, this will give you an opportunity to respond in the letters section. Your input is desired and anticipated.

This paper describes the Antarctic environment, the mission and work setting at the U.S. research stations, the general population and living conditions, and the healthcare situation. It also dispels some common misconceptions that persist about this environment and about the scope and quality of medicine practiced there. The paper then describes specific ethical issues that arise in this environment, incorporating examples drawn from both the author’s experiences and those of his colleagues. The ethics of providing healthcare in resource-poor environments implies (...) two related questions. The first is: What can we do with the available resources? This suggests that clinicians must not only know how to use all available equipment and supplies in the standard manner, but also that they must be willing and able to go beyond standard procedures and improvise, when necessary. The second question is: Of all the things we can do, which ones should we do? This paper addresses both questions in relation to Antarctic medical care. It describes the wide range of activities required of healthcare providers and some specific ethical issues that arise. Finally, it suggests some remedies to ameliorate some of those issues. (shrink)

Magical thinking, distortions of reality based on fantasy, are pervasive in society and may influence patients’ healthcare decisions. These distortions can “nudge” people to make decisions using System 1 thinking (a heuristic and error-prone decisional pathway that is always “on”), rather than a slower, deliberative, and more labor-intensive process that evaluates evidence (System 2). Physicians have been castigated for subtly nudging their patients toward evidence-based decisions. Yet when patients demonstrate magical thinking in their decision making, physicians have a professional responsibility (...) to do more than nudge; they should shove patients toward decisions that will most likely achieve the healthcare goals they seek. (shrink)

:The available treatments for disorders affecting large segments of the population are often costly, complex, and only marginally effective, and many have numerous side effects. These disorders include dementias, debilitating neurological disorders, the multiple types of drug addiction, and the spectrum of mental health disorders.Preliminary studies have shown that a variety of psychedelic and similar U.S. Drug Enforcement Administration Schedule I drugs may offer better treatment options than those that currently exist and pose potentially the same or even less risk (...) than do legal psychoactive and nonpsychoactive substances. The pharmaceutical industry and academia, however, have largely avoided this avenue of research.Fairness to the affected populations demands that these drugs be adequately studied and, if they or their congeners are shown to be effective, made available with the proper caveats, instructions, and protections that other potentially abused medications receive. These substances may prove to relieve patients’ struggles with less effective treatments and decrease mortality from nontreatment of some conditions. (shrink)

From an ethical standpoint, the goal of clinical research is to benefit patients. While individual investigations may not yield results that directly improve patients’ evaluation or treatment, the corpus of the research should lead in that direction. Without the goal of ultimate benefit to patients, such research fails as a moral enterprise. While this may seem obvious, the need to protect and benefit patients can get lost in the milieu of clinical research. Many advances in emergency medicine have been based (...) upon the results of research studies conducted both within the specialty and by others outside of the field. But has this research benefited patients? Has it followed the Hippocratic commitment “to do good or at least do no harm”? The answer is: yes, and no. This paper attempts to demonstrate this: first by citing advances from applied research that have benefited emergency department patients over the past three decades, and follows with some aspects of emergency medicine research that makes one question both its safety and its efficacy. While enormous gains have been made in patient care as a result of emergency medical research, ethical considerations complicate this rosy picture, and point to future areas of concern for researchers. (shrink)