Invisible Vulnerables
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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.

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.

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World Congress of Bioethics and FAB

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

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World Health Organization warns no country offers children a healthy future environment

A recent report by the WHO, the United Nations Children’s Fund (Unicef) and the Lancet Commission, ranked the probability of children being able to “flourish” in 180 countries, examining factors such as education, nutrition and child mortality and carbon emission levels.

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.

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Gender pay disparities amongst medical faculty
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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.

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Substance Use Disorder By Pregnant Persons Should be Treated as a Complex Medical Condition, Not Punished as a Moral Failing
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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.

As would be expected given the trend in the general population, opioid use is also on the rise among pregnant individuals. Opioid use disorder was four times higher in 2014 than in 1999, with a concomitant four-fold increase in rates of neonatal abstinence syndrome (NAS). At a time when the United States is attempting to come to grips with our appalling maternal mortality rate, this increase in substance use disorder is quickly becoming recognized as a significant contributor to maternal deaths. Despite the growing recognition that substance use disorders are chronic, relapsing brain diseases with underlying biological, genetic, and psychosocial mechanisms, substance use disorder in pregnancy is increasingly treated as an individual failing with potentially criminal implications.

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.
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IJFAB BLOG IS BACK FROM BREAK!
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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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Climate change puts women at risk of early labor

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.

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African scientists and ethicists lead the way in developing ethical guidelines on handling data
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In case you missed it, in June of 2019, Nature covered efforts by the multinational African Academy of Sciences (AAS), founded in 1985, to develop ethical guidelines on handling data. Their goal: to make sure that Africans benefit from research done in Africa, and to protect study participants from exploitation.


While the guidance has no legal heft–just as the U.S. National Academies of Science reports are advisory–it will provide nations throughout Africa with a common resource for developing and revising legal requirements for human subject/participant research.

So what are you waiting for? Go ahead and consider all these factors so that it viagra discount india becomes easier for you to track the progress and provide guidance wherever required. generic viagra without prescriptions What we see is proof that bin Laden the Brave was not living the life of a rough and tumble world of PPC advertising. Unfortunately, such drugs often lead to inflammation and other side cialis 10 mg effects. These meetings help to deal with stress, lack of concentration, lack of buy soft cialis energy, sexual dysfunction, anxiety, depression and many other emotional conditions.

If you want to follow up, the Nature article also links to other community and national guidelines developed within Africa’s many nations and cultures. It closes with a commentary from Collet Dandara that will ring true with anyone who takes community-based participatory research seriously:

The situation is compounded by Africa’s lack of research infrastructure, including quality data repositories and equipment such as gene sequencers. Collet Dandara, a geneticist at the University of Cape Town in South Africa, largely blames African governments for failing to provide such infrastructure for genomics research, which forces the continent’s scientists to send samples abroad for analysis.

Even initiatives designed to strengthen African expertise rarely cover basic infrastructure, Dandara says. That means African scientists can’t keep studying data that they have helped to collect once the initial round of projects — on which they usually work with international partners who have the analysis capabilities — finishes. Dandara says this happened with the MalariaGEN project, which collected genomic data from malaria parasites, mosquitoes and people. Several UK and US health agencies and charities started it in 2005. “A whole lot of studies were done in Africa, but to interrogate the data is difficult for African scientists,” he says.

However the AAS committee guidelines address the practical challenges of data sharing, it’s important that they also uphold African values, says Dandara. Communities that take a group-centred approach to participation in research projects, such as the San people in southern Africa, can run into problems with the individualized approach to data ownership and benefit sharing that is common in Western science. Deciding how to proceed would involve working closely with communities that have some claim to the information being gathered, Dandara says, including asking members how they think the work should be done.

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Poland’s policy on frozen embryos violates autonomy, discriminates against single women

A recent article has brought attention to a troubling policy in Poland surrounding the use of surplus frozen embryos left over from in-vitro fertilization treatment (IVF). IVF requires fertilization of an egg outside of the womb, and embryos not used are frozen. What to do with surplus frozen embryos is a debate within bioethics: some argue they should be “adopted” for use by other couples, others argue they should be used in research. Most laws or policies on the issue, however, allow the woman or couple to make the final choice, unless they waive that right.

But under a Polish law passed in 2015, women who are separated from their husbands are then considered “anonymous donors” whose embryos can be adopted to a married couple after 20 years–without their consent.

Because Barbara is separated from her husband, as a single woman, she is now treated as an “anonymous donor” under a law passed in Poland in 2015.

“If the embryos are taken away from me physically, I know that after 20 years they will no longer be mine [they will be] taken away against my will,” Barbara says sadly.

Her embryos — with the same genetic material as her two daughters — could become babies raised by a couple she will never meet, and she may never know what becomes of them.

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When the regulations around IVF in Poland happened four years ago, putting Barbara in this situation, it was too late for single women who already had some of their embryos stored in dozens of clinics across the country.

They are no longer able to have their embryos transferred unless they have a male partner to help raise the child, Dr Magdalena Radkowska-Walkowicz says.

There are several ethical issues at stake– not only is adopting someone’s embryo to a married couple without consent a violation of one’s autonomy, but the law contains moral judgments about what the “ideal” family should be: clearly favoring married couples at the expense of the rights of single women. Further, the requirement that one must have a “male partner” in order to have access to one’s own embryos valorizes heterosexual relationships and reflects patriarchal norms.

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On this International Day to End Violence Against Women, keep the WHO mantra of “RESPECT” in mind
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Today is International Day to End Violence Against Women.

The World Health Organization has a very helpful Twitter thread on the topic. One of their tweets links to this RESPECT framework for preventing Violence Against Women. It may be valuable to keep it in mind today and all days, and to ask how medical care can help women and families do better, as well as how our governments around the world can do better to protect women and change culture.

R – Relationship skills strengthened. This refers to strategies to improve skills in interpersonal communication, conflict management and shared decision-making.

E – Empowerment of women. This refers to economic and social empowerment strategies including those that build skills in self-efficacy, assertiveness, negotiation, and self-confidence.

S – Services ensured. This refers to a range of services including health, police, legal, and social services for survivors of violence.

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P – Poverty reduced. This refers to strategies targeted to women or the household, whose primary aim is to alleviate poverty.

E – Environments made safe. This refers to efforts to create safe schools, public spaces and work environments, among others.

C – Child and adolescent abuse prevented. This includes strategies that establish nurturing family relationships.

T – Transformed attitudes, beliefs and norms. This refers to strategies that challenge harmful gender attitudes, beliefs, norms and stereotypes.

You can read more about this framework here.

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Māori Theorists Working in Bioethics and Justice Spotlighted at Australasian Association of Bioethics and Health Law and New Zealand Bioethics Conference
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Ongoing 21-23 November of 2019, the Australasian Association of Bioethics and Health Law / New Zealand Bioethics Conference is spotlighting work by Māori thinkers. IJFAB Blog readers might want to look more closely at their work, which makes important contributions to interdisciplinary bioethics and philosophical bioethics. Short bios including links to a few of their pieces of work are below each of their images.

A sturdy woman with jaw-length curly brown hair and rectangular black glasses smilles slightly toward the camera.  She is wearing a bright red blazer and black shirt. Her necklace appears to be traditional Māori carved bone art.
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The first highlighted theorist is Dr. Krushil Watene (PhD, MA) of the College of Humanities and Social Sciences at Massey University in New Zealand. Her work on how we get a very different result when we put the capability approach into cross-cultural conversation with Māori philosophies is worth taking a look at. The links provided here are only a few of Dr. Watene’s many pieces on the subject of justice, and on how Māori justice concepts can contribute to global justice theorizing. Her work also bears on environmental philosophy which has sweeping implications for health, and she works on Māori and Pasifika health and development policies.

A man with short-cut hair, dark on top and greying on the sides, smiles widely toward the camera.  He is wearing a white button down collared shirt and wearing what appears to be a traditional Māori necklace.

The second highlighted theorist is Māui Hudson of the faculty of Māori and Indigenous Studies at the University of Waikato in New Zealand. Professor Hudson works on Māori research ethics, traditional medicine, the interface of Māori knowledge-making and western traditions of inquiry, and Māori health, among other topics.

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Measles epidemics news: DR of Congo, Samoa
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So far in 2019, a measles outbreak in the DR of Congo has killed nearly 5,000 people. A September vaccination initiative by the Congolese government vaccinated an additional 800,000 people.

In Samoa, 15 people have died and the government has closed schools, instituted mandatory vaccination, and prohibited the presence of children at public gatherings.

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Earlier this year, in April of 2019, the UN reported that measles cases had quadrupled globally.

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