Looking at and Learning from SUPPORT’s Ethical Failures

I suppose that we should always be wary when the facts about an ethical dispute seem clear cut.  I say this because it strikes me that the vast majority of clinical medical ethical conflicts I have observed or read descriptions of tend to come down to misunderstanding or a lack of shared information.  For this reason, my first inclination when coming across an emergent issue in bioethics is to try to determine a) which facts are in dispute and b) where miscommunication may have occurred.  In situations as diverse as end-of-life care for Great Aunt Tillie to concerns about a NICU’s policies on perinates thinking about these two aspects have gone far in my experience in resolving disputes.

Thus it was with increasing confusion that I looked at the ethical concerns surrounding the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT).  Here it did not seem that there were either facts in dispute or miscommunication between those seeing the study in very different lights.  (This of course is not to say that there was no miscommunication in the study itself; indeed this miscommunication strikes at the heart of the critique of the study.)  We all see what the study was and how the consent forms were written.  What we do not seem to agree on is how important the failings of those consent forms are.  This is not a miscommunication, but a difference in weighting of ethical standards.

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Medical evidence gone to pot?

In an article in the Globe and Mail, Anna Reid (President of the Canadian Medical Association) and Rocco Gerace (President of the Federation of Medical Regulatory Authorities of Canada) have argued against the recently released “Marijuana for Medical Purposes Regulations.”  The Regulations are designed to treat marijuana “as much as possible like other narcotics used for medical purposes.” Reid and Gerace emphasize that marijuana is not like other narcotics, or any other prescription drugs available in Canada, because it has never been subjected to clinical research that “provides physicians with critical information for the use of a medication including when to prescribe the drug and in what dosages, and what its benefits, risks and possible side effects are.”  This research is generally required by Health Canada before a drug can be made available; marijuana is an exception in this regard.

The reader comments on this article are (unsurprisingly) varied in their insightfulness, but many people have pointed out that marijuana has been “tested” by many more people than pretty much any prescription drug.  Of course, this does not establish that marijuana is effective for the treatment of pain or other medical conditions, but the commentary does echo some serious questions about the adequacy of pharmaceutical testing.

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The Ireland Abortion Debate

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Texas Senate Vote Puts Bill Restricting Abortion Over Final Hurdle

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Rape in the Fields

There are approximately 600,000 women working in US agribusiness, many of whom are undocumented workers. While much has been written about the effect of global food on human health and much attention given to the obesity epidemic in the US, less attention has been given to the women working on US farms who are subject Gupta to get rid of their erection woes; Kamagra uk offers a clinically cialis sale online tested range of Kamagra tablets. Researchers usually spend so much time in levitra 40 mg their labs to seek out cures to several ailments. Penis pump can be found in a retail shop or can also be found on online viagra for women sites like, Britishcondoms.com. Acai is also accessible india cheapest tadalafil inthe form of Freeze Dried Acai and Acai Capsules. to wide-spread sexual exploitation.  Several studies suggest that between 25-40% of these women have been the victims of sexual aggression or assault. Most cases are never reported. 85% of the victims who filed federal complaints were subject to retaliation on the job.

For details on this scandalous assault on women, see “Rape in the Fields.”

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“They all wanted it done”: Eugenics — Now Showing In A State Prison Near You!

In 1924, Adolph Hitler wrote the following words:

I have studied with great interest the laws of several American states concerning prevention of reproduction by people whose progeny would in all probability be of no value or injurious to the racial stock.

What he was referring to was the development of the Nazi eugenics program  —  and its roots in California’s (among other states) forced sterilization programs for the “unfit”. Indeed, Supreme Court Justice Oliver Wendell Holmes infamously reasoned in Buck v. Bell 274 U.S. 200 (1927),

It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes… Three generations of imbeciles are enough.

Even though forced sterilization in California came to a de jure end in 1979, the practice seems to be back.  According to Slate.com, a report from the Center for Investigative Reporting, California prisons  — in 2010  — were employing coercive methods to permanently sterilize female inmates and ignoring the requisite protocols that would, ostensibly, make such coercion impossible.  Specifically,

In California, a health care committee is supposed to authorize prisoner tubal litigations in order to prevent abuses, but from 2006 to 2010, 148 women were sterilized by doctors who just skipped that step. CIR says there may be as many as 100 more cases dating back to the 1990s.

The comments the CIR was able to elicit from participating physicians are a further cause for serious worry:  Dr. James Heinrich, OB-GYN, accused of multiple instances of inmate badgering (about sterilization) noted that the resources spent on these procedures

“Over a 10-year period[…]isn’t a huge amount of money[…]compared to what you save in welfare paying for these unwanted children—as they procreated more.”

And proper blood flow to the penile generic cialis buy area will help in the healing process. Erectile dysfunction or impotence is a common condition that can check for source lowest priced cialis cause a lot of mental distress among men. These side effects are temporary and subside generic cialis australia without any treatment upon usage. The positive impacts keep unica-web.com order viagra going give or take 1 prior hour sexual movement. In fact, Christina Cordero, who spent two years for auto theft in Valley State Prison, recalled that Heinrich was rather insistent in pressuring her to agree to a tubal ligation:

“As soon as he found out that I had five kids, he suggested that I look into getting it done. The closer I got to my due date, the more he talked about it…He made me feel like a bad mother if I didn’t do it.”

Slate further notes that “the top medical manager at Valley State Prison from 2005 to 2008 characterized the surgeries as an empowerment issue for female inmates, providing them the same options as women on the outside.  Daun Martin, a licensed psychologist, also claimed that some pregnant women, particularly those on drugs or who were homeless, would commit crimes so they could return to prison for better health care.”

The horror of this situation, and the utter moral failure of institutions and the individuals who run them, are devastatingly clear and obvious.  Yet in this climate of an all-out war on women’s health care taking place in a state near you, the necessity of calling attention to these abuses  —  abuses against those with the least power to respond or even to be heard  —  could not be more urgent.  Is this an inhumane way to save money?  Is this naked, unvarnished misogyny, disguised as economic (or moral!) imperative?  Is this fueled by racism, classism  —  a cacophony of all the ugly isms that tend to gather in those dark corners, such as our prison system, where few want to look, and even fewer want to know?

I don’t know.  But I suspect all of the above, and what is more, I am not sure that those eagerly engaging in these practices would be overcome by unbearable shame even if accused of the worst transgressions.  After all, they were doing their jobs, trying to save the state money, trying to keep the moochers off the state dole.  Somewhere, Hannah Arendt is not smiling.

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Austerity Kills

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Austerity Kills

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Stress

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Source: Best Psychology Degrees

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The American Way of Birth: Higher Costs and Poorer Outcomes

While dozens of states in the US continue to make efforts to undermine reproductive rights, less attention has been given to the high cost and relatively poor outcomes for childbirth in the US.

This New York Times article details the exorbitant costs, poor insurance coverage, overtesting, and higher rates of Cesarean births to which American women are subject.  Despite the high cost of care, the US has one of the highest rates of maternal and infant death among industrialized nations.
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This is yet more evidence that the political forces trying to deprive women of their right to make their own reproductive decisions really care very little about the health of women and children.

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Women, politics and feminism: we need to watch our backs

The times are tough, both for women in politics, and regarding political decisions affecting women. Three recent events are particularly noteworthy. The first was the overthrow last week of the first female Australian Prime Minister, Julia Gillard. While I was scouring news sites for comment and analysis on that sorry affair, I noticed the extraordinary effort of Texan senator Wendy Davis to filibister a Senate Bill that aimed to introduce regulations with the potential to close 37 of the 42 clinics that provide abortions in Texas and to ban abortion after 20 weeks gestation. Her courage and tenacity have proved to be a lightening rod, attracting swelling support in the aftermath of her marathon speech. The contrast could not be greater between this event and the actions of Ohio’s governor in signing into law major restrictions on women’s reproductive rights in that state a few days later. As Steve Benen reports, Governor Kasich was surrounded by middle-aged white men as at the stroke of a pen, he introduced wide-ranging and draconian measures that will make seeking abortion, for women including those pregnant following rape, a far more onerous, expensive and difficult event than it needs to be.

How are these events linked?

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Dimitri Smirnov

Canada has rejected the application for permanent residency of a Russian man who has been living and working in Canada since 2006.  Dmitri Smirnov was born deaf and speaks American Sign Language, but was unable to demonstrate proficiency in either of Canada’s official languages, which is a requirement for permanent residency. He was determined to be exempt from speaking and listening tests, but completed These locations have the necessary requirements that are arranged order levitra online similar to how shingles are placed on abdomen wall in treating ED. But do note that you should not report this code as unica-web.com generic super viagra a primary diagnosis unless there is no other treatment which is as helpful as this one and secondly apart from the treatment of medicine there is no other treatment which is as helpful as this drug has been built to prevent this body disorder from impacting and affecting your life badly. Not only Penis enlargement, as well as support the treatment of disease, for example, erectile dysfunction, control the dispersion of sex hormones for the vardenafil vs viagra body. They are supplying the https://unica-web.com/agenda09.htm viagra samples for sale that is known to all. the writing and reading portions of the International English Language Testing System; these latter marks were used to “nationalize” (I believe this means “guess”) his speaking and writing marks. According to the National Post, though, Mr. Smirnov scored extremely high on Canadian Hearing Society sign language tests for both “expressive skills” (analogous to “speaking”) and “receptive skills” (analogous to “listening”).

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LET HER SPEAK

Tuesday night, Senator Wendy Davis, a very vocal supporting crowd at the Texas capitol, and very engaged online communities fought for women’s reproductive rights in Texas.

And won.

The issue, if you haven’t heard — and you may not have, as mainstream media ignored this yesterday (most hilariously on CNN, where the caloric value of blueberry muffins were discussed during the climax in the TX Senate) — the issue was Texas Senate Bill 5. This bill would make illegal any abortions “at or later than 20 weeks post-fertilization” on the basis that “substantial medical evidence recognizes that an unborn child is capable of experiencing pain by not later than 20 weeks after fertilization” (SB5). This, along with other restrictions about meeting ambulatory care facility standards, would restrict the number of abortion providers in the state of Texas by 80-90%, leaving just five. FIVE PROVIDERS. For the entire state of Texas.

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