[Catch up first on 4-5] Justice (Basics 6); Premonition 6
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- We wrap up our reading and discussion of Bioethics: The Basics with ch.6 on justice. The vaccination/immunization issue is raised here. Also see Eula Biss's On Immunity, below.*
- But first, on "enhancement": awhile back I saw a chilling fictional representation of how future mental/cognitive enhancements might lead to dystopia. It was episode three of the British series "Black Mirror," in which everyone is equipped with an implant called a "grain" - it's kind of a subcutaneous Google Glass, with instant access to one's entire archival memory (and with f/forward and rewind). The late David Carr on Black Mirror, MicroSoft's HoloLens, and our dwindling experience of "actual unencumbered reality"...
- And if that's not chilling enough, check out "The World of Tomorrow"...
- 1. What are the two major spheres of justice discussed by Campbell?
- 2. (T/F) Vaccination/immunization and restricted mobility are two of the measures used by preventive medicine to counter the spread of disease.
- 3. Another name for the micro-allocation of health care, concerned with prioritizing access to given treatments, is what? (HINT: This was hotly debated and widely misrepresented ("death panels" etc.) in the early months of the Obama administration.)
- 4. What "perverse incentive" to health care practitioners and institutions do reimbursement systems foster, as illustrated by excessive use of MRIs?
- 5. What is the inverse care law?
- 6. What is meant by the term "heartsink patients"?
- 7. How are Quality Adjusted Life Years (QALYs) supposed to address and solve the problem of who should receive (for instance) a transplant?
- 8. Who propounded a theory of justice that invokes a "veil of ignorance," and what are its two fundamental principles?
- 9. Under what accounts of health might we describe a sick or dying person as healthy?
- 10. Name two of the "capabilities" Martha Nussbaum proposes as necessary to ensure respect for human dignity?
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Premonition
1. What grant to Joe DeRisi led to his "Red Phone"?
2. The new coronavirus Joe's lab identified in 2003 caused what syndrome?
3. Joe went "down the rabbit hole" to talk to who?
4. Joe said analyzing genetic sequences with the Virochip was like trying to find what?
5. What is the dark matter of genomic sequencing?
6. How does Joe think science is misunderstood?
7. How was the DeRisi lab like Willy Wonka?
8. What's an example of "screwed up incentives" inside the medical-industrial complex?
9. What is the Chan Zuckerberg Biohub's "preposterous goal"?
Journalist Seth Mnookin discusses the controversy around childhood vaccines in his book "The Panic Virus: A True Story of Medicine, Science, and Fear."
1. Do you agree that health care providers are ethically obliged to promote a fair balance between the rights of the individual and the welfare of society as a whole, and a fair distribution of benefits and burdens in society? Would you say that ethos is widely shared among physicians?
2. Reflecting on the present measles outbreak and the ebola quarantines of last summer, how would you rate the current strength and effectiveness of vaccination and restricted mobility as tools of preventive medicine? How might they be improved? Do you agree that most anti-vaccers lack a degree of social conscience?
3. Are you aware of examples of unjust "queue jumping"? 150 (Does the name Mickey Mantle ring a bell?)
- 4. Are there better alternative payment systems than reimbursement? Is it possible to reign in excessive tests and costs while retaining a reimbursement system?
- 5. How would you resolve the Lifeboat Scenario? 153f.
6. Do you agree that justice requires us to remove the social disadvantages caused by ill health and disability, and support a universal right to those health care interventions that will allow everyone to pursue their "normal opportunity range"? Would you be more or less likely to agree, if you found yourself behind the "veil"? 159
7. Are there any "attainable human capabilities" on Martha Nussbaum's normative list you'd not include on yours? 163
8. Elaborate on how bioethics overlaps with environmental ethics. 165
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Eula Biss, On Immunity: An Innoculation
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Eula Biss, On Immunity: An Innoculation
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Bioethics articles... transhumanism articles... Dying while black: Perpetual gaps exist in health care for African-Americans...
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Dr. Victor Sidel, Public Health Champion, Is Dead at 86
Dr. Victor Sidel, a leading public health specialist whose concerns ranged from alleviating the effects of poverty in the Bronx, where he worked for many years, to raising alarms about the potential impact of nuclear war, died on Jan. 30 in Greenwood Village, Colo. He was 86.His son Mark confirmed the death.
As a founding member of Physicians for Social Responsibility and International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985, Dr. Sidel voiced his apprehensions about nuclear proliferation as a public health issue for more than 50 years. He served as president of the former organization and co-president of the latter.
In a paper in The New England Journal of Medicine in 1962, Dr. Sidel, Dr. H. Jack Geiger and Dr. Bernard Lown painted a grim picture of fatalities and injuries in the Boston area from a nuclear attack and posed ethical questions for surviving doctors.
“Does the physician seek shelter?” they asked, adding, “If the physician finds himself in an area high in radiation, does he leave the injured to secure his own safety?”
And in speeches beginning in the mid-1980s, Dr. Sidel (pronounced sy-DELL) used a metronome to stress what he described as the imbalance between worldwide spending on arms and health care. With the metronome set at one beat a second, Dr. Sidel explained that with every beat, a child died or was permanently disabled by a preventable illness, while $25,000 was spent on weaponry... (continues)
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Dr. Victor Sidel, Public Health Champion, Is Dead at 86
Dr. Victor Sidel, a leading public health specialist whose concerns ranged from alleviating the effects of poverty in the Bronx, where he worked for many years, to raising alarms about the potential impact of nuclear war, died on Jan. 30 in Greenwood Village, Colo. He was 86.His son Mark confirmed the death.
As a founding member of Physicians for Social Responsibility and International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985, Dr. Sidel voiced his apprehensions about nuclear proliferation as a public health issue for more than 50 years. He served as president of the former organization and co-president of the latter.
In a paper in The New England Journal of Medicine in 1962, Dr. Sidel, Dr. H. Jack Geiger and Dr. Bernard Lown painted a grim picture of fatalities and injuries in the Boston area from a nuclear attack and posed ethical questions for surviving doctors.
“Does the physician seek shelter?” they asked, adding, “If the physician finds himself in an area high in radiation, does he leave the injured to secure his own safety?”
And in speeches beginning in the mid-1980s, Dr. Sidel (pronounced sy-DELL) used a metronome to stress what he described as the imbalance between worldwide spending on arms and health care. With the metronome set at one beat a second, Dr. Sidel explained that with every beat, a child died or was permanently disabled by a preventable illness, while $25,000 was spent on weaponry... (continues)
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 | Mother Jones (@MotherJones) |
We are this close to "designer babies" mojo.ly/1W5QtTe pic.twitter.com/KTO0VDpNHl | |
 | New Republic (@NewRepublic) |
What’s wrong with Craig Venter? bit.ly/1UWRU65 pic.twitter.com/F3b8scr06N | |
The USDA abruptly removes animal welfare information from its website
http://wapo.st/2kBZkTy
Measuring the wonders of an empathetic ear in the doctor’s office
http://wapo.st/2k4JHTO
5. What is the inverse care law?
ReplyDeleteThe inverse care law observes that areas that need the least amount of medical care have the highest amount of healthcare workers and vice versa. This is not surprising, as the areas that need the least amount of medical care are often highly desirable areas for people, including medical personnel, to live. Medical professionals opt to leave areas where there are high patient loads and a low number of professionals because of the stress of the job. Consequently, areas with low numbers of medical professionals suffer worse medical outcomes than places with many professionals.
3. Are you aware of examples of unjust "queue jumping"? 150 (Does the name Mickey Mantle ring a bell?)
ReplyDeleteOne of the areas currently that I see unjust queue jumping is the new weight loss drugs. The drugs cost a fortune and often go to people whose weight loss is purely cosmetic in nature. I know a woman in her 80s who probably weighs about 100 pounds that got put on ozempic because she wanted to fit into a dress for her birthday. She's extremely wealthy and could afford to pay a doctor to prescribe her the medicine. She managed to attain the drug in a time when there was a shortage. What's most astonishing is not that money was able to provide her a drug she didn't need, but that money was also able to get her the drug at the expense of someone who did need it. I would say that the amount of negative utility this created was unacceptable.
The fact that the wealthy are allowed significantly greater access to healthcare is one of the saddest aspects of our nation. Hearing stories like this makes you wonder the moral justification people doing things like this must go through. I wonder if they think about the impact on others at all.
DeleteThat "World of Tomorrow" video was really sad. It raises so many questions. Who is the real Emily? Is Emily Prime the only real Emily or are the clones with some of her memories still the real Emily too? If I got hit in the head tomorrow and forgot half my memories, am I still me? What if I copy all my memories and experiences into an exact clone of myself, is that me too? We're approaching a world where these may no longer be just theoretical questions used to establish what the self is.
ReplyDeleteThere was a Star Trek episode in which Riker had to coexist for a time with his clone. They were both "persons," the clone as real to himself as the original. I forget details but do recall one takeaway: our divergent experiences really do make us different people. Priority of patent doesn't establish an ontological priority. So if we ever get to that World of Tomorrow, I think Emily 1 and 2 will both be real. But to flourish, they'll want to put some distance between them.
DeleteI’m a strong believer that our experiences make us human and without actually going through them, we are void of the human experience. Therefore, if you made a clone and updated your memories, it wouldn’t be you? Like the clone person remembers but they didn’t actually do any of the stuff you did and don’t even have the muscle memory of doing so. They didn’t go through the emotions you felt during that moment either. This debate which is coming really close to reality also raises the question of if this clone is not a “person” per se, what about the clone’s rights?
DeleteI do agree that experience is what makes a human an individual generally. However, would you fault a newborn for not having experienced things? extending the argument made here a clone is just as much a human as a newborn child (though the clone knowing far more assuming memory remains intact), therefore I would have to say both examples are indeed human. The beginning of the clone's life may be considered the moment they begin independent experience just as the child's life begins at birth. The note about muscle memory is very interesting to me as I really can't come to a conclusion whether the clone would or wouldn't have the muscle memory of its progenitor.
Delete1. What are the two major spheres of justice discussed by Campbell?
ReplyDeleteThe two major spheres are social justice and distributive justice. Campbell mentions these are the ones that relate the most to bioethics and I agree. Society has a big part of heath care access based on location, industrialization, racial and gender roles, wealth inequality and more. Distributive justice, as stated in the book, is about the balance and distribution of burdens and benefits in society.
2. (T/F) Vaccination/immunization and restricted mobility are two of the measures used by preventive medicine to counter the spread of disease.
True, these are two very popular measures that counter and prevent the spread of disease. 2. T/F) Vaccination/immunization and restricted mobility are two of the measures used by preventive medicine to counter the spread of disease. Vaccines help build immunity and by everyone (or most people) having immunity creates herd immunity meaning that even people who haven’t yet developed immunity are less likely to be infected. This is quite important especially for the anti vax people who e benefit from herd immunity without themselves being a part of the vaccinated community. However, with this increase of anti vax people, the herd immunity is dissolving since not enough people in the “herd” have immunity anymore. Restricted mobility is basically quarantine and isolation of sick people and this has been a measure since the beginning of time I feel. It feels pretty common sense to try not to be by the person who is sick.
Do you agree that health care providers are ethically obliged to promote a fair balance between the rights of the individual and the welfare of society as a whole, and a fair distribution of benefits and burdens in society? Would you say that ethos is widely shared among physicians?
ReplyDeleteI would tend to agree with this statement. The balance though, in my view, should lean more towards the welfare of society as a whole. It is the obligation of those who are able to do what they can in order to help those who are at greater risk. Vaccination is the best example I can think of but more generally things like wearing a mask when out if you are sick and not littering are things that are simple to do that benefit every individual. I think that this idea is very likely commonplace among medical practitioners of all stripes, at least I would hope.
I agree that the emphasis should be to protect the common good, and that the overemphasis on individual protections in our society has led to a societal breakdown of some sort, where people don't feel part of a connected whole and they lack close communities. I think that when the social welfare is neglected, then people inevitably become more solitary and are less willing to help each other and work together to reduce suffering in the world.
Delete9. Under what accounts of health might we describe a sick or dying person as healthy?
ReplyDeleteWe might describe a sick or dying person as healthy under a holistic health perspective that emphasizes quality of life, mental well-being, and spiritual fulfillment over just physical health. The health status of a sick or dying person might be considered healthy in the context of a terminal illness where medical treatments focus more on pain management and comfort rather than curing the disease.
6. What is meant by the term "heartsink patients"?
ReplyDeleteA "heartsink patient" is a medical term referring to a patient who frequently returns to the doctor with vague symptoms that are hard to diagnose or treat. T often leaving the doctor feeling frustrated and helpless, causing their "heart to sink" upon seeing the patient.
5. What is the inverse care law?
ReplyDeleteThe inverse care law states that the availability of good medical care tends to vary inversely with the need for it in the population served. Meaning that people who most need healthcare often have the least access to it, this concept was first described by Julian Tudor Hart in 1971.
1. I feel like health care should have that fair balance between individual fairness and common welfare. Society as a whole much be cared for but at the same time individuals may object to certain treatments such as vaccines, which provides some moral tension between what to do. If people won’t accept vaccines you cannot force them to take vaccines or medications.
ReplyDelete2. I would rate our current vaccine capacity and ability to limit spread pretty good for the type of world we live in, however I think that there are issues with getting everyone on board with a common good.
3. Bioethics overlaps with environmental ethics in a way that you must realize that to maintain environmental integrity you need to maintain the biosphere, considering life is inherently connected to the environment.
I could see hypothetical scenarios where it would be ok to mandate certain vaccines. I think if the threat is substantial enough, it is a moral imperative to prevent the mass suffering caused by disease. I don't honestly know exactly where I'd put this threshhold, but I'd have to think about it or read some more.
DeleteI think there is a pretty good balance in the perspective of doctor's between protecting the interests of the public and the individual. This can be seen in psychiatric visits, when the provider gives the patient confidentiality unless they are at risk to themselves or others.
ReplyDelete