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1. Universal health care matters, but it is not the panacea for failures within public health policies, social practices, and pre-existing historical and socioeconomic injustices (note Italy, the UK, and some other countries with universal health care that are not doing as well as one might have hoped).
2. Other than health care policy, the notion of a shared public common good–as opposed to libertarian individualism–is one of the central elements that will determine how we navigate pandemics and other tragedies. The United States is in the unfortunate position of having its federal government (and its supporters) rejecting this notion outright, and pretending that bullshit, bluster, intimidation, and magical thinking are what will help us through this. They are tragically wrong.
3. The economy matters–and it matters the most to those who are not its top beneficiaries. However, civilization does not equal economy, and the loss of human life cannot be weighed against economic collapse. Both matter, but one is not like the other.
4. Medical schools must drop the we-are-an-elite-guild approach, and allow more students to enroll. The COVID-19 pandemic will not only result in fewer medical professionals for the worst of reasons, but we will also lose medical professionals who leave medical practice due to psychological trauma. We will, of course, need the wisdom and expertise of the veterans, but we will also need a wave of medical professionals who have not been (as greatly or as directly) traumatized by the pandemic. We will need all those students who do not see themselves as the image of the medical professional to change their perspectives. And those of us who teach philosophy, medical ethics, and other related disciplines better work our asses off to try to change their minds.
5. Finally, speaking of trauma….We all might be traumatized now*. Differently, of course–and definitely some more than others. Be kind. Be kinder. To quote one of my very favorite philosophers, Tove Jansson: “We take everything too much for granted, including each other.”
*it certainly doesn’t seem reasonable to presume none of the people we encounter are traumatized, and should perhaps be a default that any person we encounter could be.
The Covid-19 pandemic is currently accompanied by a parallel outbreak of bioethical and clinical ethical discussion offering guidance for the difficult decisions that healthcare professionals and others face as the pandemic develops. Right at the moment there is a strong focus on the ethics of triage. In countries affected by Covid-19, healthcare professionals are having or will have to decide which patients get access to life-saving critical care – in the case of Covid-19 that means ICU beds and ventilators — when there is not enough for everyone in need. They want guidance on how to make those decisions in the most morally justifiable way. Just as much, patients, families and the general public want to know the basis on which such decisions are being made.
In all the published guidance that has appeared over the past weeks, one thing is disturbingly clear: many of these resources have shown a worrying degree of prejudice against disabled people, or disablism. Protocols from Alabama and Tennessee have been namechecked here. While it is easy to see in these evidence of a straightforward disvaluing of the lives of people with disabilities – and at worst, the seizure of a golden opportunity to get rid of a tiresome burden — I want to suggest that something more complex (though equally unacceptable) is going on. In this blog entry, I analyze disabilist assumptions and discriminatory norms in play in these discussions, and close with a set of recommendations for constructing better clinical guidelines.
Disablist Assumptions
Three overlapping but conceptually distinct disablist assumptions critically endanger people with disabilities in a situation of clinical care triage.
First, there are assumptions about the overall health status of disabled people
Second, assumptions about disabled people’s quality of life
Finally, assumptions about disabled people’s social utility, which only becomes relevant if there is confusion about the role it plays (or shouldn’t play) in critical care decision-making.
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The World Congress of Bioethics Planning Committee, along with the IAB Board of Directors and WCB Internation Advisory Committee, is working diligently to transition the conference to a 3-day virtual meeting. With this change, a new registration structure and timeline will be announced in the upcoming weeks. The March 31 early bird registration deadline is no longer in effect and a new date will be shared when registration relaunches.
We would also like to encourage you to participate in our brief survey to share your thoughts on features of the in-person WCB most important to maintain in a virtual format.
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As the meeting continues to evolve, we will share the plans with you. The 2020 World Congress of Bioethics will take place in a new virtual format with an adjusted price structuring for all participants.
A recent article by Kimberly Seals Allers discusses how COVID-19 safety restrictions related to giving birth and breastfeeding could potentially disproportionately harm black and Native American women.
Photo courtesy of Women’s E-News
Some hospitals are now classifying not only family members of laboring women but also doulas as “visitors,” banning them from entering hospitals or assisting with births.
We are still trying to work with IAB to find a workable solution for moving the conference to a virtual format. For all those wondering what will happen with registration dates and fees, this is the only information we have right now:. https://iab2020.org/about/#FAQ Once we know anything more with any specificity, we will let you know.
We apologize for this ongoing lack of clarity.
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Being a parent of someone in an especially vulnerable group makes one feel like you are sitting on a ticking bomb–in addition to the anxiety we all feel during this time of pandemic.
I am hiding out in our lovely spacious house in the woods with my husband, hoping that COVID19 will not find us. Both of us are in the “at-risk” category as we are both in our 70’s. We are both New Yorkers, but we are upstate because our 50-year-old daughter lives in a community here. Our daughter has a rare (and recently diagnosed) genetic condition which has severely limited her cognitive and motor abilities. She lives in a house with six other people all of whom are medically fragile. An amazing and dedicated staff care for them. For the last 18 years, we have brought her to our house on weekends where we play music, listen to symphonies, watch movies, do some physical therapy exercises, take long walks, and enjoy the wonderful meals my husband loves to regale us with. Our son and his family sometimes join us, and our grandchildren have developed a beautiful relationship with their atypical, but sweet and very loving aunt.
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Next weekend will be the third in a row when we have not visited
her and she has not come home with us.
As the novel coronavirus creeps its way from country to country,
continent to continent, reminding us that as humans we share vulnerabilities
and interconnections, we understand in a way we never have before that a harm
to one can be a harm to all. The reminder is stark and painful and is turning
our world topsy-turvy, giving us a surreal sense that we are living in a movie,
in a virtual space, in anything but the world we know. The uncertainty, the
timeline, the possible havoc it can wreak makes me think of the tsunami that
washed away bartender, waitress, cleaning staff and happy tourists who were
enjoying a day at a spectacular beach resort in Bali. I recall the picture of
scores of vacationers and residents who stood at the edge of a beach watching
in amazement as the water rushed back into the ocean before it returned with a
force that swept them and thousands upon thousands away with its stunning
force. Today, I feel as if we are sitting on that sand beach watching and
waiting for tsunami.
We hear a lot about the vulnerable elderly, people in nursing facilities, in prisons, those who are fighting cancer or heart disease—conditions that weaken the body’s ability to fight the invading virus. For, in truth, that is all we have—our immune systems as we await a cure and vaccine. But one group of vulnerable people are rarely mentioned: people with disabilities and people whose disabilities ordinarily require a very high level of care, people like my beautiful daughter.
For these folks, there is no possibility of social distancing. Most would perish in a matter of days if left alone. For many, touch is the most. powerful form of communication. They remind us daily of our dependence and interdependence, of human frailty and precariousness. I might be able to explain to her why we cannot visit—why we can send only virtual kisses, not the close mushy ones she loves best. But I would not know if she understood. In likelihood, she would understand bits of it, but it would give her no coherent sense of what is happening in the world, and why suddenly what is occurring globally means she cannot come back to mom and dad on weekends, and why we are prevented from even visiting her in her house.
I feel enormous sadness for the millions and millions who will have their lives tragically disrupted by death, illness, loss of income and loss of dreams. I cannot comprehend how this could happen, much less happen in the United States.
Most of all I cannot help but fear for my daughter, for the people who live with her, and those who are similarly situated. Not only must they meet the tsunami with frail bodies, but they face an additional foe: the failure to recognize and value their lives.
The failure to speak of this vulnerable group is already an indication of how little they seem to matter to people.
Those who know people like my daughter have to make their people’s faces, their smiles, their beauty and love known to others. For those of us fortunate enough to have such a person in our lives, we know the treasure we have been granted. When you speak of the vulnerable, those most likely to suffer worst from this virus, think of grandma and grandpa, of uncle with the weak heart, the migrant in a crowded detention centers, the prisoner, but think also of those who live graceful lives of love—people like my daughter.
Please see the message from IAB below. Given the current circumstances, both WCB and FAB will be moving to a virtual platform for our 2020 conference. While we are still working out the details, let me assure you that we will be communicating with you as soon as a plan is in place. Please feel free to get in touch with the FAB2020 planning committee if you have any questions or concerns.
Best regards, Anna Gotlib FAB2020 Planning Committee agotlib@brooklyn.cuny.edu
Dear all,
With much regret, we are announcing that due to the COVID-19 pandemic the in-person meeting of the World Congress of Bioethics on the University of Pennsylvania campus has been canceled and will be moving to a virtual platform.
This Tuesday, the Perelman School of Medicine at the University of Pennsylvania prohibited any conferences and meetings from taking place on campus for an indefinite period of time due to COVID-19. On Wednesday, in addition to existing travel bans, the U.S. administration announced that any foreign visitor who had traveled to one of the 26 countries constituting Europe’s Schengen Area would be prohibited from entering the country for at least 30 days.
As the pandemic continues to unfold, the University of Pennsylvania-based Congress planning team has two main goals. First, to minimize health impacts for participants and wider communities that could be associated with attending the conference. Second, to adapt the conference planning as needed so we can showcase cutting edge bioethics research and further broaden the global network of people working in bioethics.
In consultation with the IAB Board of Directors and the WCB international advisory committee, we considered the possible paths to move forward. Proceeding as planned is now impossible, and canceling would be giving up. Therefore, we collectively decided to transition the WCB to a virtual, online-only, format.
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Of course, it is clear that many of the unique benefits that come with attending a conference in person will be hard to replicate. But we also see the challenge we are facing as a unique opportunity and believe that many core benefits of participating in the WCB can still be realized, by including a wider group of colleagues from around the globe than before.
During this time, you might have questions about how we are moving forward. A great first step is to visit the Frequently Asked Questions section of the Congress website. There you will find answers to many registration and pricing questions.
As the meeting continues to evolve, we will share our plans with you. For now, we simply wanted to communicate that the 2020 World Congress of Bioethics will take place in a new virus-proof, carbon-friendly, and affordable way for participants.
We would also like to encourage you to participate in our brief survey to share your thoughts on features of the in-person WCB most important to maintain in a virtual format.
As you know, the conference theme is ‘Autonomy and Solidarity: Bridging the Tensions’. Literally, when it comes to both COVID-19 and the WCB, we are all in this together. We need to act in solidarity to enable autonomy—despite, and because of, these new circumstances.
We sincerely hope that you will help us make the 2020 World Congress a success by sharing your work and meeting global colleagues in a new format!
Sincerely, Vardit Ravitsky, IAB President Jonathan Moreno, Conference Planning, Co-Chair Harald Schmidt, Conference Planning, Co-Chair
Norway, the Republic of Korea, and the Netherlands topped the list, while the United States came in a distant 173rd place. However, the report concluded that no country can secure a healthy and stable environment for children.
“Every child worldwide now faces existential threats from climate change and commercial pressures,” said former Prime Minister of New Zealand, Helen Clark, who co-chairs the commission.
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“Countries need to overhaul their approach to child and adolescent health to protect the world they will inherit in the future.”
The experts warned a 4C rise in global temperatures by 2100, in line with current projections, would result in “devastating health consequences” for future generations – a rise in ocean levels, heatwaves, severe malnutrition and a spike in infectious diseases such as malaria.
The report also reaffirmed that many poor countries with the lowest carbon emissions are going to suffer most from the effects of climate change, once again raising moral concerns about climate justice. Further, it documented that children’s health has been negatively impacted by harmful marketing for unhealthy foods.
The report included recommendations to immediately stop CO2 emissions, to put children’s and adolescents’ concerns as the focus of sustainable development initiatives, to invest in child health and rights, to incorporate children’s voices into policy decisions, and to strengthen regulations on harmful commercial marketing.
Inside Higher Ed recently offered a quick glance at income disparities from the American Association of Medical Colleges 2019 faculty data.
IMPORTANT: this graph is of medical faculty, not regular humanities/university professors, who make much much much less than this. So please don’t leave this graph thinking it’s what most academics make and, if you share it, please clarify that to your social network.
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ALSO IMPORTANT: arguments that there is no unfair/unjust sex /gender discrimination in income, because women just choose lower paying fields, get much much harder to make when things are as granular as salaries broken down by rank within medical schools and other institutions with medical faculty.
CAVEAT: it’s not entirely clear how much clinical income plays a role in this, as specialist faculty such as neurologists would be expected to make more in their clinical duties than would family practice faculty, and there are gender disparities in who is in these specialties.
Elizabeth Ferries-Rowe (MD; MS Medical Ethics) is Chief of Service in the Department of Obstetrics and Gynecology at Eskenazi Health and has worked to expand Eskenazi’s Centering Pregnancy program.
It is hardly breaking news that the United States is in the midst of an opioid crisis. Overdose deaths from both prescription opioids and heroin increased five-fold from 2010 to 2017. Reasons for the crisis are complex and include (among other things) trauma, genetics, generational substance use, physician prescribing patterns, socioeconomic factors, implicit bias in treatment, mental illness, insurance coverage, and access to care. Given this fact, it is no surprise that treatment is similarly complex. Effective treatment does exist, though. While many of the contributing factors are immutable or very difficult to change, medication assisted therapy (MAT) with medications like buprenorphine or methadone is the most effective approach to opioid use disorder.Psychiatric care is also valuable, particularly for patients with dual diagnosis (substance use disorder and mental illness) and for patients with non-opioid substance use disorder.
This chart from the Guttmacher Institute, which tracks reproductive health, shows the legal status of US state policies on substance use during pregnancy as of January 1 of 2020.Continue reading →
The IJFAB Blog editors have been on break to focus on family during the Northern Hemisphere’s winter holidays. We will be posting some great new content this coming week including reflections by a bioethicist obstetrician, reflections on disability and bioethics, and reflections on how an American governor’s pardon of a man convicted of child sexual assault are linked to global misinformation about women’s bodies and the concept of “virginity.”
If you ever come here and find that you miss us, seek IJFAB out on Twitter @IJFAB where we not only boost IJFAB Blog content but also new IJFAB issues and most importantly, retweet current events in bioethics and sometimes offer brief questions to get at issues that are being overlooked. This screenshot of tweets from late December 2019 gives an example of what you can expect to find.
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A recent study has shown that birth rates increase by 5% on days with temperatures over 90 degrees. Additionally, the World Health Organization notes that higher air temperatures have been linked to heat stroke and higher pollen levels, which can trigger asthma.
Researchers analyzed country-level birthrates over 20 years to make their projections, and estimated that heat exposure translated into 25,000 infants born earlier than predicted each year, approximately 150,000 hours of lost gestational time.
If current climate change trends continue unabated, the researchers project that there will be 250,000 lost gestational days per year by the end of the century.
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Evidence continues to suggest that climate change poses serious threats to human health. This will disproportionately affect vulnerable people in countries with warmer climates and fewer health resources, making it a concern of both bioethics and environmental justice.
