Matthew Wynia, MD, MPH, and Kayhan Parsi, JD, PhD, MedPage Today; In Memoriam: The Sudden Demise of the AMA Journal of Ethics — A great loss for physicians, the profession, and the public
"Bioethics is a small field, but we punch above our weight when it comes to writing. Professional journal articles, reports, and policies are arguably our primary written products, since the main job in bioethics is to help clinicians and others navigate ethical challenges in their work. But we also write for the public, in forums like blogs and editorials, since many of the issues we write about have broader implications. Consequently, learning to write for publication is a key skill for bioethicists, and professional journals are critical for the field. One particular journal -- the AMA Journal of Ethics -- has been a stalwart in giving a voice to newcomers to the field...
Why Did the AMA Kill its Journal of Ethics?
The AMA is the nation's largest and most influential medical professional organization, and its Journal of Ethics held the mission of, "illuminating the art of medicine" by being an open access journal, freely available to all, with no advertising, focusing each month on an important ethical issue in healthcare, and, most uniquely perhaps, each issue was edited by health professional trainees and their mentors. Only the AMA, with its mission, resources, and reach, could have produced this journal.
One possible reason for its elimination might be financial. But if financial returns were to be a metric for success, then the AMA JoE had a bad business model from the start: no fees, no subscriptions, no advertising. As Kao argued, a guiding premise for the journal was that "ethics inquiry is a public good" -- hence no fees or subscriptions and no ads (avoiding conflicts of interest is critical in ethics inquiry).
For the AMA, the business case for AMA JoE could never have been about profit; rather, it was about demonstrating the AMA's integrity, altruism, and service to physicians from very early in their careers. The journal aimed to build goodwill, bolster the AMA's reputation, improve ethical deliberation within the profession and, most importantly, entice students and trainees to engage seriously with the organization. By these metrics it has succeeded. Over its more than 25 years in existence, the journal drew innumerable medical students, residents, and fellows into the AMA. It also provided a crucial training ground for young people in medicine who wanted to learn about bioethics and about writing and editing, and it helped build the credibility and presence of the AMA and its ethics group nationally and internationally.
So, if it wasn't about profit, perhaps it was the political environment. The journal encouraged medical trainees to explore some of the most contentious challenges facing medicine and society, so it inherently provided opportunities for controversy. Issues this year have addressed themes of private equity in medicine, regret and surgical professionalism, and evidence-based design in healthcare. Meanwhile, issues in prior years have addressed some currently inflammatory topics, like ethical issues related to transgender surgical care and segregation in healthcare. Remarkably, the journal still very rarely caused public relations problems for the AMA, perhaps because its editorial staff were highly qualified professionals, but also because its approach to controversy was civil, inquisitive, and exploratory.
As Kao wrote in a farewell essay this month: "For over a quarter of a century, the AMA Journal of Ethics has striven to publish insightful commentaries, engaging podcasts, and provocative artwork that help medical students, physicians, and all health care professionals reflect on and make sound ethical decisions in service to patients and society." In fact, the journal often demonstrated exactly this spirit of respectful discussion about challenging ethical issues that we need to rekindle today, making its loss even more tragic and difficult to explain.
AMA JoE: A Value-Added Offering
In a recent opinion piece in MedPage Today, "Medical Societies Are Facing an Existential Crisis," the authors exhorted medical societies, facing declining memberships and engagement among young physicians, to reimagine their role by offering "free basic memberships supplemented by value-added services [that] could attract early-career physicians who might otherwise remain disengaged." AMA JoEwas exactly this type of value-added offering that not only served students and trainees, but also educators across health professions. Anecdotally, many health profession educators we know routinely use pieces from AMA JoE in their teaching and now lament its demise.
The AMA has reportedly promised to keep the historical content of the journal accessible on the AMA JoE website. This is no consolation for the students, residents, and fellows who were working on future issues, but it means the legacy of the journal will live on. Someday, we'd like to believe it might even be revived.
For now, we mourn the loss of AMA JoE for the field of bioethics. Even more, we mourn what the AMA's sudden elimination of its ethics journal might mean for physicians, the profession, and the public."
