April 18, 2024

Is diversity of opinion at risk in medical journals?

A couple of years ago, a new editor was appointed to one of the world’s leading medical journals, JAMA, or the Journal of the American Medical Association, and its network of associated journals. 

Dr Kirsten Bibbins-Domingo is the 17th editor in chief. She set out her goals in an editorial entitled, “The Urgency of Now and the Responsibility to Do More”. She aspired to ensure that JAMA had “the highest standards of editorial integrity and quality independent of any special interests”. She warned against “Insularity and parochialism”; she said that “it is paramount that the voices in the room where decisions are made represent diversity of thought, expertise, and backgrounds”.

I wonder, though, how committed JAMA is to diversity of thought. Two articles in the March 4th issue of JAMA Internal Medicine are promoting a narrow and controversial approach to the beginning and the end of life. 

The first is a savage attack on Catholic healthcare in the United States by the associate editor and the deputy editor of the journal. As an “editor’s note”, it nails its flag to the mast of reproductive rights. 

“Catholic hospitals are an important source of health care in the United States for persons of all denominations. Pregnant persons [sic] may not always have a choice as to where they will deliver if their labor comes rapidly and they require emergency transport to the nearest hospital,” they write. “There must be a path to assure that pregnant persons get the care they wish regardless of what hospital they go to.”

And what might that path be? The clear implication is that Catholic hospitals should be forced to provide healthcare like abortion, sterilization, and contraception to which they have deep moral objections. 

The second is a sentimental plea to extend legal assisted suicide throughout the United States. The authors are both doctors — the wife and daughter of a distinguished physician in the state of Washington, J. Randall Curtis, who died of amyotrophic lateral sclerosis (ALS) last year. They write: “For Randy, the only end to his extreme suffering while ALS was surely killing him was the overwhelming act of hastening his own death. In his case, he was his own most compassionate physician.”

Dr Curtis’s loved ones are eloquent in describing their sorrow at losing a man they dearly loved. But their arguments for extending Washington’s law permitting assisted suicide are tendentious. Yes, physicians should be compassionate. Yes, patients should have autonomy.

But that hardly exhausts the question of the “right to die”. The authors blithely say that compassionate science will protect social welfare. But that is a dubious assumption. Just look on the other side of the border in British Columbia, where people are choosing to die because they cannot access palliative care or supportive social services.

Back to the editorial policy of the JAMA journals. Do these articles represent “the highest standards of editorial integrity and quality independent of any special interests”. No. I’d argue that they do represent a special interest – a campaign to deny the sanctity of all human life from conception to natural death.

In today’s America, of course, this is a contested proposition, with arguments on both sides. But when will the readers of JAMA Internal Medicine read a defence of Catholic healthcare? When will they read a heart-rending personal account by a doctor who cared for her terminally loved one until the very end?

Not very soon. Insularity and parochialism have triumphed at JAMA. It is looking more and more as though the world’s leading medical journals have been captured by the culture of death.

Cross-posted from Mercator