"The benefit of drug-gene testing is a reduction of people becoming ill due to an adverse reaction to a prescription and dosage."
Viewing entries in
health
"Dutch government officials have proposed a new law that would allow elderly people who are considered physically and psychologically healthy to choose to end their lives via assisted suicide."
"Hopefully developments will likely provide important information about how the public deals with issues of reproductive ethics."
"Recently, paramedics and doctors alike have been encountering an uptick in the use of this little-known substance, and unlike opioids such as heroin, overdose reversal medication has proved ineffectual when needed the most."
"It is also, however, plagued by controversy."
"The direct physiological effects of obesity are well documented, but what often gets swept under the rug is the indirect sociological effects that obese patients face in a clinical setting."
"A five-month-old baby is living healthily after an incredibly unique birth."
I was created, framed and pristine.
A trophy of cells, of carbon and stardust of perfect geometry. The perfect shell and automaton.
Machinery, creaking aluminum cogs and wheels, gears that whirl
in unison – Man.
Sinew and elastic rubber bands, our extensions flushed.
A body of artifice, of false truths and illusory fog.
I learned to be made of actual steel,
for skin and muscles, even bone, decay. Cold to
touch, reflective, impenetrable.
But
You melted my soul, freed my newfound beating heart, the sacred flame
burned away the arm and leg He gave me, leaving my
Humanity to escape from its temporary prison.
Love and kindness, hatred and despair, creativity and inspiration. I felt it all – liberated.
The essence of human life beyond the steel.
I bared my ribs, titanium white and color burst forth from the prism.
Showering down in a pitter-patter of eternal rain drops that left
my body corroded in the scrap heap.
I was sculpted by Him in His image. I am free and omniscient.
Yet why am I broken?
"The significance of a revision of bioethical principles does not lie in its ability to entirely rectify practical issues; this conquest seeks to advance the current and continued relevance of the field."
"The Wall Street Journal reported that almost two-thirds of the world’s population lack access to safe, affordable surgical care."
"We must recognize and celebrate the efforts of humanitarians, public health workers, lawyers, doctors, teachers, janitors and the many others who work day-in and day-out to leave the world a little better than they found it."
Female Genital Mutilation (FGM), also known as Female Genital Circumcision (FGC) or “cutting” to those who practice it, is the intentional partial or total removal of a female’s genitalia. The World Health Organization (WHO) estimates that over 200 million women have undergone this practice in 30 countries, mostly in the Middle East, Asia, and Africa. In the past three weeks, two major world players made bold comments regarding FGM, attracting the attention of international media. On September 15th, a committee of British MPs in the House of Commons declared in their report Female Genital Mutilation: Abuse Unchecked, “it is beyond belief” that while about 137,000 girls were subjected to FGM in 2011 in just Wales, there has not been one successful prosecution. FGM was made illegal in the UK 30 years ago[1]. According to the scathing report, when this “horrific crime” and “violent child abuse” is inflicted, it causes “severe physical and psychological pain and leaves survivors with lifelong health consequences.”
On the opposite end of the spectrum, an Egyptian MP stated on September 7th that women must undergo female circumcision in order to limit their “sexual appetites” and help curb men’s “sexual weakness” due to the widespread impotence of Egyptian men[2]. Though the practice was made illegal in 2008, the MP’s remark is indicative of the widespread cultural imperative within Egyptian society that demands female circumcision in return for societal acceptance. According to a 2015 Egyptian’s Health survey, 87% of women reported being cut[3]. Though Egyptian FGC has existed since the Pharonic period, there has recently been a slight decline among younger women, possibly in response to the 2008 prohibition.
FGC is thousands of years old and is practiced across thousands of unique cultures and tribes. The techniques and symbolic meanings vary drastically, therefore the the physical and emotional implications on the lives of women do as well. According to some proponents, female circumcision is used to promote the health, beauty, and protect the virginity of a woman. As reported by Dr. Moges, many supporters claim medical benefits, such that FGC, “enhances fertility, controls and prevents waywardness of girls... the clitoris is dangerous and hinders intercourse, creates impotency, and kills baby at delivery”[4]. Those who oppose female genital mutilation cite that this practice is a massive violation of human rights, resulting only in lifelong harm. Western feminists critique that FGM is an extreme form of control over a woman’s sexuality. WHO (an organization that values Western medicine) recently released a report stating that FGM causes, “severe bleeding, pain with urination, later cysts, as well as complications in childbirth and associated with death of the newborn”[5].
Bettina Shell-Duncan is anthropology professor who specializes in FGC and speaks on the need to clarify cultural misconceptions. First and foremost, emphasizing that this practice is largely done by and for females. Unbeknownst to those unfamiliar with nuances of the practice, a great number of women feel pride partaking in this cultural tradition and in joining the ranks of their mothers, sisters, and ancestors. Even if a father does not wish to subject his daughter to “cutting”, his personal opinion is largely irrelevant as cutting is a collective decision made by a community, deeply embedded in societal function. Shell-Duncan believes that fostering a contextual understanding of motive is the first step the West should take to eradicate FGM. She claims it is imperative to realize that parents subject their daughters to the practice because they want the best possible future for their children – like most parents do – and they believe cutting will ensure this.
Shell-Duncan notes that when many refugees come to Europe they, “very quickly realize that … the future for their girls might not be best secured by being circumcised any longer”[6]. This is reflected in a recommendation from the MP’s House of Common’s report. The report calls for a commitment from those who come into contact with children- especially those trained in health, education, and social work – to identify and report FGM. They assert that, “prosecutions will not be possible if we wait for daughters to report their parents to the police, which is unlikely to happen”[7]. Studies have found that many community workers ignore FGM when they see it. It is vital that community workers are properly educated so that they will to foster a commitment to identification and reporting.
The report admits that new policies on education and even the practices of targeting girls and their parents through the legal system has proven to be ultimately unsuccessful. Shell-Duncan goes further in identifying that eradication programs need to reach out to extended families and authority figures in these communities who have influence over the acceptance of the practice within their cultural enclave. Female circumcision is a sacred cultural tradition that allows a girl to enter into the realm of womanhood. The Egyptian MP comments speak to how deeply embedded this tradition remains in the social order. If the West wants to eliminate the practice, it will require a massive shift in the way a culture understands women, physicality, and rites of passage.
___
In America there have been no prosecutions under the federal anti-FGM law since 2012, and only one criminal prosecution of FGM related activity[8]. According to the Center for Disease Control and Prevention, at least 150,000 to 200,000 girls have undergone FGM in the United States and these numbers remain in an upward trend. A recent report released by FBI estimated that at least 500,000 women in America are at risk of undergoing the procedure[9]. Both the UK and America publicly condemn FGM as a serious legal offense, whereas Egypt and other similar countries recognize FGM as a legal offense, but fail to publically condemn it. The UK is the primary Western country beginning to recognize the realistic challenges in actually prosecuting FGM. This may lead anti-FGM cultures to creatively implement more effective policies that mustbegin with the refusal to see FGM as reductively barbaric, rather as a diversely practiced and deeply embedded social act.
References:
[1] United Kingdom, Parliament, House of Commons. (2016). Female Genital Mutilation: Abuse Unchecked. London.
[2] Egyptian MP: Women must undergo FGM to control men's desires. (2016, September 7). Middle Eastern Monitor. Retrieved September 20, 2016, from https://www.middleeastmonitor.com/20160907-egyptian-mp-women-must-undergo-fgm-to-control-mens-desires/
[3] Egypt, Ministry of Health and Population. (2015). 2015 Egypt Health Issues Survey. Cairo.
[4] Moges, A. (2003, September 15). FGM: Myths and Justifications. Lecture presented at Eighth International Meropolis Conference in Austria, Vienna.
[5] New WHO guidelines to improve care for millions living with female genital mutilation. (2016, May 16). World Health Orginazation. Retrieved September 20, 2016, from http://www.who.int/mediacentre/news/releases/2016/female-genital-mutilation-guidelines/en/
[6] Khazan, O. (2015, April 8). Why Some Women Choose to Get Circumcised. The Atlantic. Retrieved September 20, 2016, from http://www.theatlantic.com/international/archive/2015/04/female-genital-mutilation-cutting-anthropologist/389640/
[7] United Kingdom, Parliment, House of Commons. (2016). Female Genital Mutilation: Abuse Unchecked. London.
[8] Female Genital Mutilation in the United States: Protecting Girls and Women from FGM and Vacation Cutting [Scholarly project]. (2013). In Sanctuary for Families. Retrieved September 20, 2016, from http://www.sanctuaryforfamilies.org/wp-content/uploads/sites/18/2015/07/FGM-Report-March-2013.pdf
[9] FBI Reaching Out About Female Genital Mutilation (13 May 2016). In Federal Bureau of Investigation. Retrieved September 21, 2016, from https://www.fbi.gov/news/stories/fbi-reaching-out-about-female-genital-mutilation
In a meeting today I was reminded of how pragmatism and futility of care collide. A colleague pulled me aside and asked for my opinion on a case. I agreed to listen and as I listened I began to understand how experiences, the truth, and hope collide with the concept of futility of care.
The case, an older patient, diagnosed with an aggressive form of cancer, refuses to follow medical recommendations. The patient is at a point where radiation and chemotherapy will not help. There is no cure. After much discussion, the patient agreed to palliative care and receiving intravenous feeding. The patient, despite the prognosis, believes this treatment will help strengthen them so they may receive chemotherapy. The family and the medical team understand the intravenous feeding will not bring about a recovery. There is no reprieve, no beating this form of cancer but the patient believes otherwise. My colleague’s query was: Is there an ethical obligation to intervene and stop any care which is futile? My answer was: there is an ethical obligation to understand the patient’s truth and respect their decision for treatment. To do this, we must examine the concepts of pragmatism and futility of care.
What we perceive, form judgments on, and then mold into our belief system comes from external experiences. William James, a Pragmatist, describes how, in the normal case, we have an established body of views and opinions, and issues about what to believe arise when a new experience puts them under strain. We will accept a new opinion when “[I]t preserves the older stock of truths with a minimum of modification, stretching them just enough to make them admit the novelty, but conceiving that in ways as familiar as the case leaves possible.”1 It is the patient’s experience and therefore their truth that treatment of any kind will strengthen the body allowing for further treatments which address the cause of the patient illness. In this case, the patient believes intravenous feedings will help them in their goal to fight cancer. They don’t have any reason not to think this because previous experiences with medical care have made them better. For the patient, medical care represents hope, and this is a form of truth which makes the patient comfortable. While the family and the medical team understand intravenous feeding is futile because the cancer is aggressive and will not let the patient heal enough to fight, the patient, despite the prognosis, remains faithful to an older form of truth. Forming truth out of experience creates a problem because, while, the patient has experienced better health through medical intervention facts gathered by the family and medical team has shown all care is futile.
Richard Rorty, a philosopher, may have the answer to the dilemma the family, patient and medical team are facing. Rorty said: “What pragmatists teach us about the truth is that there is nothing very systematic or constructive to say about truth at all. In particular, this concept does not capture any systematic or metaphysical relation between our beliefs and utterances, on the one hand, and reality on the other….sometimes we might find it useful to express our fallibility by saying that some of our beliefs may not be true”1 We are fallible.
We want our beliefs to be true because the truth we believe in gives us hope. In this case, the patient’s belief in intravenous feeding gives hope despite the growing realization there is none. Is the care futile? No. The intravenous feedings provide comfort to the patient who is coming to terms with their prognosis of death. Futility of care exists if there is harm done to the patient. There is no harm, and one could argue there is a benefit to the intravenous feedings because they’re providing hope to the patient, however, false it may be in the family and medical team’s opinion. There are times when if there is no harm to the patient and care is benefitting the patient, in this case allowing the patient to hold onto hope, care must continue. To remove treatment is to remove hope, and once removed, care becomes futile.
References:
1. Pragmatism (Stanford Encyclopedia of Philosophy), http://plato.stanford.edu/entries/pragmatism/ (accessed October 03, 2016).
"However, a recent study suggests that drinking beer and exercising are positively correlated."
Sperm preservation, primarily in the form of sperm donation, has moved into the American mainstream in recent years. Yet its counterpart, egg preservation, has generally remained off the radar, despite the fact that the first pregnancy as a result of cryopreserved eggs dates back to 1986 (Chen, 1986). The procedure is primarily used as a starting point for future in vitro fertilization, and has played a role in allowing women to gain more control over their reproductive futures. However, cryopreservation of eggs is expensive, impeding widespread development and use. Even today, over 30 years after the inception, procedures cost upwards of 15,000 (Hamblin, 2016). Fortunately, a new fertility clinic, through lower costs and improved safety, might be reshaping the field.
The clinic, called Extend Fertility, was founded by a group of entrepreneurs and physicians with efficiency in mind. Utilizing a process dubbed “super-specialization,” the scientists can focus solely on egg cryopreservation, and avoid much of the overhead cost that would be associated with a more general fertility clinic (Hamblin, 2016). This economic efficiency has led to a bold business model: if a woman is young and in good health, she pays a flat sum (a little under $5000) and the clinic promises at least a dozen eggs (Hamblin, 2016). That is, even if the procedure does not work the first time, it will be repeated until it is successful for no additional charge.
However, claims of lower costs have been somewhat unfounded. In reality, the egg retrieval process is only a piece of the cost. The hormone therapy and longer term storage, which are required for the success of the procedure and for the practical use of the eggs in the future, drive up the actual price of the process to somewhere near the current market price (Hamblin, 2016). Regardless, the group has stated that its method will eventually decrease costs and improve outcomes.
The establishment of such a clinic, beyond its specific purpose and outcomes data, presents a set of interesting and important questions for the medical community. Primarily, when steep prices are involved, the medical field must ask itself whether or not economic inaccessibility may lead to differential health outcomes. Specifically, it has been well documented that younger women, and younger eggs, have better IVF success rates (Wang, 2011). If this model is successful in lowering prices, it could help equalize IVF opportunity. Additionally, this hyper-specialized form of health care, where providers become incredibly well-versed in a single procedure or small subset of procedures, has been seen in other branches of the healthcare field, especially with specific orthopedic surgeries, and suggests a direction the field field as a whole might be moving in (Hamblin, 2016). There are, of course, field specific implications, including a need for additional, rigorous research about the effects of egg cryopreservation, donor age, and IVF success, but only time will tell what this small clinic means for the field as a whole.
Resources:
Chen, C. (1986, April 19). Pregnancy After Human Oocyte Cryopreservation. The Lancet, 327(8486), 884-886. doi:10.1016/s0140-6736(86)90989-x
Hamblin, J. (2016, September 15). One Clinic Is Promising to Cut the Cost of Egg Freezing in Half. Retrieved September 16, 2016, from http://www.theatlantic.com/health/archive/2016/09/how-one-clinic-is-cutting-the-cost-of-egg-freezing-in-half/500144/
Wang, Y. A., Farquhar, C., & Sullivan, E. A. (2011). Donor age is a major determinant of success of oocyte donation/recipient programme.Human Reproduction, 27(1), 118-125. doi:10.1093/humrep/der359
It’s early in the morning, and I receive the alert to meet a potential client in court. As I stand outside of the courtroom, I watch the chaos of confused people and attorneys quickly consulting with each other. Then I am called over by the attorney for the Department of Family and Children, DCF, to meet their new client. The client is scared, confused, and unsure of what is going on. All she knows is her children are in the custody of DCF, and she now must go through the prescribed steps to have them back with her. I introduce myself, explain my program, and ask if she wants to sign on to Dependency Drug Court. She nods and is hustled into the courtroom to hear what the judge has to say. When asked if she has spoken to a representative of the Dependency Drug Court program she says yes and consents to become a part of the program. After this a time to meet with me is arranged, attorneys swarm nearby while, in some cases, concerned family members appear like ghostly apparitions to take my new client home. Her life has changed immeasurably because of one positive test or one anonymous phone call, and there is no going back to what it once was.
During the first appointment with the client, I explain the program and how successful completion of each section will grant her more rights and access to her children. There are no forms for her to sign, nothing for her to read and no further explanation on my side of what Dependency Drug Court fully entails and how it will impact her life for at least the next 18 months. Her consent in court placed her in my office and the program. We briefly discuss her concerns with addiction, both DCF- and life-based, and work on setting up a treatment plan. It all seems straightforward, but I often wonder how a person can consent to a program when in all likelihood one does not have the full capacity of their facilities at that time?
People thrust into the court system are often unprepared and, as is the case for many of my clients, often undereducated. The information, the timing of the consults, and the lack of pamphlets create an ethical dilemma: was informed consent to join the program given when asked by the judge? I don’t believe it was. The confusion, barrage of questions and information, and the shock of being in a courtroom are overwhelming for anyone, but for someone charged with child endangerment and neglect due to drug use it can be sensory overload. There is no time to stop, think, and consider all the options, and there is no pamphlet to read later. Ethically, it is impossible to contend the new client was aware of the possible consequences of the program or had full knowledge of the risks and benefits. To give permission means to understand, and in the case of those ushered into a Dependency Drug Court program, full knowledge is often lacking due to the circumstances surrounding their enrollment.
Instead of consent while facing a judge, the potential client should meet with the Dependency Drug Court Clinician, have the program re-explained, a brochure given and a second appointment set up to go over any questions they may have. It is only at this point a consent form of their rights and responsibilities in the program should be signed, and the new client is then a part of the program. Informed consent is imperative for both the client and the program. Giving the potential client time to gather their thoughts, talk to people, and read the information before consenting to be in a rigorous program helps to ensure their success within the program and in establishing their sobriety.
The Centers for Disease Control and Prevention (CDC) has placed strict guidelines on who can be tested for Zika virus. Labs all over the country are backed up with the increased demand for Zika testing because the test is a lengthy three-step procedure (Rabin). While these tests may not be very invasive, and may not require multiple samples, the process is dependent on many different factors (travel history, date of onset, immunization record) (Memorandum). First, a test is done for active virus in the blood or urine; however, this is only effective within the first two weeks after contraction (Rabin). Next, a test for antibodies is done. Since many people don’t show symptoms, these two tests are effectively useless because negatives results do not conclusively show that the patient was never exposed to the virus (Rabin). Lastly, a Plaque Reduction Neutralization Test (PRNT) is conducted, which is a test used for many different types of mosquito born illnesses, including Chikungunya and Dengue (Alvarez, Memorandum, Rabin). At the moment though, this last test is only being conducted by a small number of labs, including the CDC itself (Rabin).
The problem many women are now facing is the lack of preemptive testing. Women will not be tested unless they are pregnant, but women don’t want to get pregnant until they are tested. With over 70 cases reported in Florida, it seems reasonable that women trying to conceive would be apprehensive about fetal health because they could have been exposed to the virus, yet remain unaware of their status (Alvarez). Florida in particular has been backlogged with tests (Alvarez). In response, the CDC has sent down technicians to help move the testing along, as testing is time sensitive (Alvarez). However, the tests take 4-5 weeks to analyze, so speed may be difficult to come by (Rabin). As a result of their efforts, over 2,500 pregnant women have received free testing thanks to the CDC, but they are running out of funds quickly (Alvarez).
References:
Alvarez, Lizette. "Florida Gets Help to Deal With Backlog of Zika Tests." The New York Times. The New York Times, 14 Sept. 2016. Web.
"Memorandum." Linguistics 9.66 (2016): n. pag. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 7 Feb. 2016. Web.
Rabin, Roni Caryn. "Want a Zika Test? It’s Not Easy." The New York Times. The New York Times, 19 Sept. 2016. Web.
The Journal of the American Medical Association (JAMA) published documents on Monday, September 12th, 2016, revealing how the sugar industry misguided the American public’s understanding of the role of sugar in heart disease.
In 1965, the Sugar Research Foundation (SRF) funded research to study the dietary causes of Coronary Heart Disease (CHD). This study identified fat and cholesterol as the dietary causes of CHD, successfully casting doubt about the harms of sucrose on heart health.1 The SRF-funded study then targeted previous research that showed possible links between sugar consumption and heart disease. They attempted to discredit the previous research for their use of epidemiological and animal studies by labeling them as “limiting” and saying that this kind of research was not relevant to humans. In this same review, however, the same researchers referenced literature that linked saturated fat to heart problems, without critiquing the study for using the same methods.3 At the time of this publication, there was no disclosure on who funded the research because it was not a requirement for the SRF-funded research to do so until the 1980s.2 I find it to be questionable that a study funded by the sugar industry itself was able to discredit the evidence that sugar did indeed have an effect on overall health. It is only now, in more recent years, that public health sectors have been able to bring attention to the fact that low fat diets with large amounts of sugar are not really aiding, but instead impeding, our health.
However, this is not the only instance of large industries and companies paying off researchers to guide evidence in a favorable direction. Last year, The New York Times published an article unveiling how Coca-Cola gave millions of dollars to downplay the link between sugary drinks and obesity.2 In June, the Associated Press reported that candy makers had been funding studies stating that children who eat candy have a tendency to weigh less than children who do not eat candy. One of the scientists that was paid in the original SRF-funded study went on to become the head of nutrition for the United States Department of Agriculture. He then went on to assist in the drafting of the forerunner of the federal government’s dietary guidelines.2 While I do not mean to discredit any valuable work that he may have contributed to the field of health, I would like to draw attention to the fact that it’s not always clear that published research is intended to improve the health of the public; sometimes, the motive may be more politically and economically driven. Studies that are given media attention are not always those with our health in mind as the primary target.
Indeed, my intention in writing this piece is to share that we cannot always trust that what we are being told is true evidence. Politics and money sometimes also play a role in an area that should be strictly limited to science. We should not live in paranoia that we are being lied to about what should be common knowledge on the topic of our shared health, but sometimes research has not be conducted in the most ethical of ways. As a result of some of the research studies discussed above, as well as other societal factors, we have seen an immense increase in the rates of obesity, diabetes, and heart disease. About 80% of the 600,000 food products sold in the United States contain added sugars. The average woman should consume a max of about 25 grams of sugar a day while the average man should consume a max of 38 grams a day. But the majority of us are well over this limit. As a nation, we cannot afford to take this kind of risk when it comes to the health of the public. Money, on many different levels, should not be the determinant of our collective well-being.
References:
MBA, Cristin E. Kearns DDS. "Sugar Industry and Coronary Heart Disease Research." : A Historical Analysis of Internal Industry Documents. 2016. Accessed September 16, 2016. http://archinte.jamanetwork.com/article.aspx?articleid=2548255.
2. O'connor, Anahad. "How the Sugar Industry Shifted Blame to Fat." The New York Times. 2016. Accessed September 16, 2016. http://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-fat.html?_r=0.
- 3. Sifferlin, Alexandra. "How the Sugar Industry Shaped Heart Disease Research." Time. Accessed September 16, 2016. http://time.com/4485710/sugar-industry-heart-disease-research/?xid=homepage.
Jerika Bolen, a 14 year old from Wisconsin who suffers from type 2 spinal muscular atrophy, made headlines in July when she made the decision to end her life this fall by pulling the plug on her life-sustaining ventilator.1 The disease causes her constant pain and erodes all of her muscular ability. It is also fatal by mid to late adolescence, and she had been told that her pain would only increase in the years to come before ending in an inevitable death.1 Rather than endure this suffering, Jerika believes that a life after death would grant her freedom from her current pain. “I have been realizing I’m going to get to walk and not have this pain anymore and not have to, like, live this really crappy life” she said.1
In addition to ethical implications stemming from Jerika’s age, her decision also opens up a larger discussion on end-of-life decisions outside of euthanasia. Euthanasia is often a heated ethical issue, and Americans are deeply divided over it. Polls show that about half, 53%, of Americans believe that it is morally acceptable,2 and it is currently legal in only five states. However, conversations about end-of-life decisions rarely widen outside of euthanasia (physician-assisted suicide), to include ones like Jerika’s, which is a refusal of medical services that results in death.
Despite euthanasia’s high-profile nature, terminally ill patients have long chosen to end their lives by means other than lethal drugs. Some make decisions similar to Jerika’s, removing themselves from life-sustaining devices, while others choose palliative sedation, in which patients are medically sedated until death. Sometimes patients request that food and water be withheld during sedation, causing death by dehydration.
Perhaps discussion mainly focuses on euthanasia because it is more direct than other life-ending measures: the action to take lethal drugs is clear, and death comes quickly. Those who choose palliative sedation slip away in a matter of days, and there are no legal complications: no one is required to accept food or water, and death is inevitable if they choose to refuse it. The core issue, however, remains the same: in what case, if any, do terminally ill patients have the right to choose death?
Proponents of euthanasia claim that it is a more humane alternative to sedation. Though sedative drugs can be used to make a patient more comfortable, no one can be sure of how much a patient is able to feel while under their influence. An underlying principle is also at stake: proponents believe that a painless and intentional death should be available to those who feel that this world has caused them unbearable suffering.
On the other hand, proponents of palliative sedation view it as a more natural means of death. Sedation is a path often chosen when death is near, and sedation is simply a means of reducing discomfort and ushering in its arrival. It also does not carry the same risk of abuse, as is only available in truly terminal cases. Proponents argue that sedation upholds the principle of preserving life until it is no longer possible. Advocates of both means however, believe in a merciful answer to suffering at the end of life.
Jerika’s choice to end her life was one made under heartbreaking conditions, and one that will not easily be forgotten. It was not, however, without its share of public controversy and legal complications that must have added to her already-heavy burden. For her sake, and for others like her, it is the responsibility of society to continue dialogue that leads to ethical and legal decisions about what constitutes a compassionate end to life. This means opening up conversations to take a wide look at options beyond the often-discussed euthanasia to include palliative sedation, refusal of medical services, pain management, and other methods of easing suffering at the end of life. In doing this, we take a step towards securing a more just end for ourselves and those around us.
References:
1 May, Ashley. “Q&A: What you should know about right to die.” USA Today, 8 Sep. 2015, http://www.usatoday.com/story/news/nation-now/2016/09/07/q-what-you-should-know-right-die/89959838/.
2 Swift, Art. “Euthanasia Still Acceptable to Solid Majority in U.S.” Gallup Polls, 24 June, 2016, http://www.gallup.com/poll/193082/euthanasia-acceptable-solid-majority.aspx?g_source=CATEGORY_HEALTHCARE&g_medium=topic&g_campaign=tiles.
The health of presidential candidates has been the topic of conversation on both sides of the political spectrum, as of late. Hillary Clinton (D) has been under intense scrutiny ever since her syncopal episode at a 9/11 memorial ceremony. Ms. Clinton was rushed into her private vehicle and taken to her daughter’s nearby apartment. Later, a campaign spokesperson revealed that Ms. Clinton had been diagnosed with pneumonia, two days prior. This incident, combined with recent coughing fits, has raised the eyes of the public as to the overall health of the Democratic presidential candidate.
There have been popular conspiracy theories for years regarding the health of Hillary Clinton. I do not plan discussing or even acknowledging these assertions. Rather, I believe it is more important to discuss a change in current political traditions. Presidential candidates should provide some form of confirmation by a group of physicians demonstrating that they are physically and mentally fit to serve as President of the United States.
Obviously, amending laws to make this proposition mandatory is incredibly involved and generally unlikely. However, this change can still result from a shift in the social standard, if the candidates are pressed by the people and media.
Why is this important from a bioethical standpoint? A sudden illness displayed to the public should not be the incident that prompts a release of medical records. The personal health of a presidential candidate is equally important as his policies. Trade negotiations, international crises, and other aspects of foreign policy suffer when a president is physically or mentally unfit to meet with other world leaders. At home, the sudden death or incapacitation of a president would rock the American political structure to its core.
As an American citizen, it seems almost morally wrong to elect a president who may fall into the aforementioned health category. I recognize that every citizen has a right to his privacy, and HIPPA laws do not allow healthcare workers to share private information regarding a patient’s health. However, Hillary Clinton’s recent medical episodes have prompted the need for change. All major presidential candidates should be assessed by a group of doctors in order to confirm that the candidate is fit to serve. An unhealthy candidate’s condition could worsen throughout the election cycle considering the intensity of the campaign trail, risking the safety of the candidate themself. The findings of these professional assessments should be released to the public for the sake of the people, the candidate, and the country.