Human trafficking victims frequently present to physicians who fail to recognize the signs of forced sex or labor. And when physicians do suspect a patient has been trafficked, they can struggle with the ethical, clinical and legal complexities of responding to the patient’s needs.

This month’s AMA Journal of Ethics features numerous perspectives on how physicians can respond more effectively and sensitively to this uniquely vulnerable population. It also includes lessons on how to identify trafficking victims, practice trauma-informed care and take leadership roles in promoting legislative and organizational efforts to better respond to the problem of human trafficking.

Take a moment to consider this question: From a health care perspective, what should be the legal status of commercial sex?

  • Legalized and regulated
  • Decriminalized for sellers of sex only
  • Decriminalized for both sellers and buyers of sex
  • Remain illegal for both sellers and buyers

Give your answer and find responses to this poll in the January issue of the AMA Journal of Ethics, which explores strategies for identifying and caring for victims and survivors of human trafficking.

Articles include:

Physician encounters with human trafficking: Legal consequences and ethical considerations.” There is growing recognition and evidence that health care professionals regularly encounter—though they may not identify—victims of human trafficking in a variety of health care settings. Explore three areas of law that are relevant to this case scenario: criminal law, with a focus on conspiracy; service provider regulations, with a focus on mandatory reporting laws; and human rights law.

Caring for the trafficked patient: Ethical challenges and recommendations for health care professionals.” Human trafficking is an egregious human-rights violation with profound negative physical and psychological consequences, including communicable diseases, substance-use disorders and mental illnesses. Consider the ethics-of-care model as a trauma-informed framework for providing health care to human trafficking victims and survivors.

Human trafficking, mental illness and addiction: Avoiding diagnostic overshadowing.” This article reviews an emergency department-based clinical vignette of a trafficked patient with co-occurring pregnancy-related, mental health and substance-use disorder issues. The authors, including a survivor of human trafficking, draw on their backgrounds in addiction care, human trafficking, emergency medicine and psychiatry to review the literature on relevant general health and mental health consequences of trafficking and propose an approach to the clinical complexities this case presents. Investigate the deleterious role of implicit bias and diagnostic overshadowing in trafficked patients with co-occurring addiction and mental illness.

Who is in your waiting room? Health care professionals as culturally responsive and trauma-informed first responders to human trafficking.” Evidence-based practice standards are not yet well defined for assisting potential victims of human trafficking. Nevertheless, health care professionals are learning to be first responders in identifying, treating and referring potential victims. Find out how adopting a public health lens and using the “National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care” can guide critical decision-making.

In the journal’s January podcast, Ranit Mishori, MD, professor of family medicine and director of the Department of Family Medicine’s Global Health Initiatives at Georgetown University School of Medicine, discusses how to respond to incidents of suspected human trafficking in health care settings.

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

Upcoming issues of the AMA Journal of Ethics will focus on legitimacy and authority, language and hierarchy, moral psychology and "difficult" patient-clinician dyads, mental health and oncology, and moral distress. Sign up to receive email alerts when new issues are published.

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