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De-stigmatization of the disgraceful mark of stigma in the opioid crisis

After attending Albany Government Law Review’s symposium, Script to Street: Opioids and the Law in the Capital District this past Thursday, there was several issues addressed but the one overarching concern was about the role of stigma in this opioid crisis. Many different types of stigma were identified and the different ways our negative judgments have impacted society. As one speaker during the first panel discussion stated, addiction is not a new problem. He described one historic painting that showed different reactions of society to addiction: disgust, numbness, shock, or simply ignoring the problem. All of these reactions illustrate stigma and shows how despite all our social advancements, we still have not eliminated (or destigmatized) stigma of the addiction problem. 

Some definitions of stigma include a mark of disgrace, society disapproval of something, or a negative set of beliefs society has about something.  All definitions include this perceived negativity and describe stigma as bad. Stigma is not something one like to face and usually, a judgment one tends to try avoiding. 

The issue with stigma our current opioid crisis is that it is not just one type of stigma, it is layers of stigma on top of one another. There is the stigma of being a drug user and the stereotypes of who is a drug user (the poor, African American, Hispanic). Drug-users are perceived to be “bad” people who only care about drugs.  This perception becomes a barrier to treatment as individuals do not want to seek treatment in fears they will be labeled as a drug user, even if these individuals are suffering from chronic pain. There is a list of characteristic behaviors of a drug-seeker based on our own judgments, even though there is a consensus that these behaviors do not accurately capture or describe drug-users. There is also the stigma of that those who are using mediated assisted treatment as still drug-users and that this medication is just going to back into the illegal drug market.  This goes into the ethical debate of harm reductionist approaches and whether this still violates non-maleficence. There is the stigma that physicians face for their role in prescription opioids and the stigma methadone clinics face. One physician speaker described the negative reactions of other business when she opened her clinic in a business area.  She was told her clinic was not in the right part of town, asked to leave, and her neighboring businesses were concerned about the type of people her clinic would treat.  There is the stigma of being mentally ill for those individuals who have a dual diagnosis or misdiagnosis of mental illness along with drug addiction.  There is the stigma of a felony for those individuals who only can get treatment through drug court.  With all these negative judgments that one person can face, it is no surprise that drug-users wish to remain unknown. 

Stigma is an ethical concern because it impacts how we treat each other in the clinical setting and in the public setting.  It impacts who gets care and how they receive that care. For example as the moderator, Professor Anthony Farley stated, when the stigma of this crisis was a "black problem," there was not the same amount of attention to this crisis as there is currently.  This racial-stigma blocked access to care. Yet, this crisis affects everyone and is not a “black problem.” Stigma influences patient autonomy, as it is an external influence that inhibits a patient’s expression of autonomy. Negative judgments are also not beneficent as stigmatized plans of care are realistically not in the patient's overall best interest.

Due to the potential negative impact of stigma in patient care, we ideally aim to eliminate it completely or reduce it. However, this may not be done. 

Societal stigma is so broad that we may not even see that it is happening. Assuming we can identity it, how then does one change someone else’s views even if it is negative or untrue about someone else? If it is a professional such as physician, we have regulations and codes of ethics to prevent judgments but what about on the broader public level? As one speaker suggested, one of the best ways to combat stigma is changing language and how we talk about addiction and drug-users. But if we can not eliminate it, the next best option is acknowledging the powerful impact these unnoticed perceptions. 

It was a powerful symposium where a diversity of professionals (lawyers, judges, nurses, physicians, and advocates) discussed our options in the opioid and heroine drug crisis. There is hope to have a follow-up meeting to continue these important conversations in order to come to a solution to address the opioid drug crisis and still treat legitimate pain needs. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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The End Of The Affordable Care Act and Its Critics’ Hollow Moral Rhetoric

From the 1940’s to the present, it’s hard to think of a major topic on the American political agenda that has been subjected to more tortured language and ideological extremism than healthcare. By no means am I saying that healthcare proposals to expand access to healthcare over the years should not have been subjected to rational scrutiny and disagreement. But it seems, by and large, disagreement over healthcare policy proposals have always been about the opponents of progressive options to expand insurance coverage tapping into a certain segment of voters’ deepest fears and biases to predispose them against any alternative for change.

All progressive leaders who have attempted reform in healthcare, like Earl Warren (Governor of California from 1943-53) and President Harry Truman (mid-late 1040’s), to President John Kennedy and Lyndon Johnson in the 1960’s, to the Clintons in the 1990’s, to Barack Obama in 2009, have been met with fierce opposition from lobbying groups representing big business, including insurance and pharmaceutical companies, and often physicians through the American Medical Association. The essential line of attack has been that government would become overly involved in medical decision-making and overshadow the influence and judgment of physicians in the care of patients. But to win this argument decisively, the hired consultants devised plans to associate expanded healthcare coverage or universal healthcare with “socialized medicine” and even the “red scare”—clear demeaning associations with undemocratic countries, unlike the United States, that quickly appeal to irrational sentiments and undermine any consensus for reform. These basic underhand, scare tactics continued to be effective against the failed Clinton proposal in 1993 and, later, President Obama’s signature achievement—the Affordable Care Act—which currently in the process of being repealed and radically scaled down in terms of benefits.

It is noteworthy that a trend developed during the Reagan administration in the 1980’s that added ideological vitality to arguments against expanded access to healthcare: not only was any move toward expanded healthcare a move toward socialism, something assumed to be inherently repugnant, but also, that government, compared to free market mechanisms, was particularly inept to bring about any desire change—as Reagan stated in his 1981 inaugural speech. Just as it is not unreasonable to question the viability of various healthcare proposals, it is not unreasonable to question the legitimate and reasonable extent government should be involved in providing public goods and services. But from the outset, Reagan’s critique of government was simultaneously an outcry of how government was providing benefits to undeserving people, like the infamous “welfare queen” who was abusing the system. It’s hard not to discern from his message clear racial overtones that were meant to appeal to crass biases and prejudices of White working people. It became easy to see government services and benefits as “free stuff” that undeserving people received because those who worked were being coerced to support with their tax dollars.

By the 1990’s government was under attack by the political right and when the Clinton healthcare reform effort began to crack in 1993, the opponents pounced. Healthcare reform was not on the public agenda during the Bush administration and many of thought it was a dead issue for at least another generation. However, the election of President Obama revived interest in healthcare reform, which resulted in the passage of the Patient Protection and Affordable Care Act (ACA). In spite of the fact that this bill was developed by Heritage Foundation, a conservative, pro-free market think tank, and implemented rather successfully in Massachusetts by a Republican governor and future Presidential candidate, the political right attacked it from the outset. The passage of the ACA gave right wing media handlers all the talking points they needed to incite public outrage on the part of many White, working Americans, most in need of healthcare coverage, not less.

The ACA was adopted and pushed through by our country’s first African American president, whose success his opponents wanted to subvert, even if they agreed with him. The ACA was predicated on the use of mandates and expanded a Medicaid program, and provided healthcare coverage for many millions of more Americans. Though it used the private insurance market, the ACA was viewed by its strongest opponents, viz. Republicans in the House of Representatives, as a new government, welfare program that provided more free stuff to non-working people on Medicaid; was paid for by those who chose to work; and interfered in the physician-patient relationship, as critic Dr. Tom Price, the new Secretary of Health and Human Services, was wont to say. There were many ways that reasonable people could have made their critiques, but for the Republican Congressional Representatives, the ACA became a bizarre obsession, attempting to repeal without success 60 times. That is, until the unexpected outcome of the 2016 presidential election. Since then, they have been somewhat like the proverbial dog who finally caught the car he had been chasing.

Now the Republicans are in control of the White House and both houses of Congress, and are unwinding of the ACA. Many on the extreme right are eager to see its full repeal in spite of the lack of any clear consensus on the plan for what will replace it and the consequences that will ensue. All along, we have heard promises that the replacement will provide healthcare that is cheaper and better quality care – but so far those promises seem to ring hollow.

At this point the Republican proposal repeals the individual and employer mandates as well as the subsidies based on a sliding scale according to income; the replacement would distribute subsidies based on age, not income, which in effect greatly benefits those in higher income brackets and harms those in lower brackets.

States would allow to cover Medicaid patients using block grants, which would give states broad discretion over how care is provided and greater emphasis would be placed on health savings accounts (which presupposes people have money to save and would only affect the fairly well-off) The new proposal would continue to guarantee that patients with preexisting conditions will not be denied access to healthcare coverage and that children can remain on their parents’ healthcare insurance until age 26.

This proposal will cause many millions of people—ironically many poor people in states that supported the current president like Kentucky and West Virginia—to lose their healthcare coverage. Moreover, with the demise of the ACA there is the real risk that millions of Americans will not only be without healthcare, many more will die unnecessarily.

Let me say again, I fully realize that rational people could disagree about the wisdom of the ACA and which healthcare policy makes the most sense. But attack on the ACA and the insistence on its repeal have been irrational. It is only in the context of a tradition of distorted information, hype, and ideological zealotry that Speaker Paul Ryan could make statements like he did on Twitter on February 21:

Freedom is the ability to buy what you want to fit what you need. Obamacare is Washington telling you what to buy regardless of your needs.”

 It is a moral tragedy that such statements about an essential human service, like healthcare, is even taken seriously by anyone who knows anything about healthcare. All human beings are vulnerable to illness and accidents and when their bodies, or the bodies of those we are caring for, fail acutely, we seek and expect help in hospital emergency rooms.  This expectation will continue and the result will be greatly increased healthcare costs and human suffering, since more people will lose access to primary care and be forced to enter the healthcare system at the acute stage with no insurance, rather than earlier on with medical problems can be more easily managed.

But Ryan’s words also offer a distorted, truncated view of freedom that likely only appeals to the well off with blinkered moral concerns about their fellow human travelers. Freedom for him and his ilk is like saying, “I got mine, let those without fend for themselves; after all, they are free.”  This is a hollow, simplistic view of freedom and our society is paying the price for decades of distorted information about healthcare policy.

We can only hope the fight for universal healthcare continues and eventually a consensus emerges to do the right thing.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.



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The ethics of conscientious objection: Caring for patients and supporting providers

Although conscientious objection arises in various areas of medicine, notably end-of-life issues (e.g. physician assisted death), it is ubiquitous in all aspects of reproductive medicine and women’s health care. Indeed, it is discussed extensively in the academic bioethics literature, clinical practice, healthcare law and policy (e.g. the Hobby Lobby Supreme Court case), and in the popular press. Part of the reason conscientious objection is so commonplace in reproductive medicine and women’s healthcare is because of the controversial nature of abortion and emergency contraception.

The topic of conscientious objection forces us to confront the boundaries of professional obligations and individual rights. Which should be prioritized when they conflict? The common stance of most professional medical organizations is that providers have an obligation to refer if they oppose a practice/prescription based on personal beliefs (e.g. providers should provide a referral if a patient requests an abortion and they oppose abortion due to philosophical or religious reasons), but not if they believe the practice/prescription doesn’t align with standard of care (e.g. providers don’t have to provide a referral if a patient requests antibiotics for the common cold).

The position of most medical organizations on conscious objection raises some concerns. First, there are logistical and feasibility concerns. While it may be easier to uphold providers’ conscientious objection in densely populated areas, in rural areas where there may only be one provider, thereby making it difficult to find someone to refer patients to. It is burdensome for patients to travel far away to receive medical care that they could receive locally if the provider did not have a conscientious objection.  

Second, there are concerns about violating the beliefs of individual providers. Some providers may believe that a certain medical practice/prescription, such as abortion, is so evil that even making a referral violates their religious or philosophical beliefs by making them an “accomplice” in what they see an immoral act. However, it may be difficult for patients to know where to go to receive care if they don’t have a referral. Furthermore, providers who intentionally withhold information about medically appropriate care (e.g. not mentioning that abortion is an accepted standard of care option for a woman carrying a fetus with a lethal abnormality) can be seen as violating the principles of nonmaleficence and informed consent.

Although there are some concerns with the position of most medical organizations on conscientious objection, ultimately it does its best to protect the interests of both patients and providers. One of the main goals of medicine is to care for patients according to the accepted medical standard of care. When providers have a conscience objection to a particular standard of care, they still have an obligation to their particular patients to ensure the patients receive the care that they need. Referring their patients to another provider safeguards the health of the patients while preventing the provider from having to participate in care that violates deeply held beliefs.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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A New Common Rule for Human Subject Research

On January 19, 2017 – one day before the expiration of President Obama’s second term – the Office of Human Research Protection (OHRP) in the Department for Health and Human Services issued a revised regulation dealing with the “Common Rule.” The final regulation is officially titled “Federal Policy for the Protection of Human Subjects (known as the “Common Rule”). 

The new regulation is the product of years of study and deliberation offered as an update of the Common Rule introduced more than 25 years ago. It’s considered a “common rule” because it applies to the clear majority of all federal agencies which fund human subjects research grants and contracts. Of course, the principal objective of the Common Rule is to have a uniform inter-agency approach to human subject protections through local institutional review boards (IRBs).

As one might expect with many federal regulations, rules quickly become outdated because they simply cannot keep up with technological advances. With the last issuance of the Common Rule in 2005, regulators probably gave little thought to the future problems that might occur with universal computerization of research data and health records, tissue banking, genomic medicine initiatives, personalization of therapies, and global privacy concerns.

The new Common Rule helps a great deal in that it: (1) clarifies the categorization of “exempted” or “excluded” research projects using risks to patients as measures; (2) improves the elements of informed consent required and mandates posting of the forms online in certain cases; (3) gives researchers broader authority in using identifiable and future deidentified biologic specimens with and without specific consent; (4) allows the use of a single IRB to oversee multi-institutional projects within the United States; and (5) specifically excludes routine and emergency public health surveillance work from human subjects research.

The OHRP, IRBs, and the Common Rule were solutions offered at a time when abuses in human subject research were public concerns that required a national response. The medical research scandals of the 1960s and 1970s are well documented. Modernizing the Common Rule makes sense. The revisions strike a necessary balance in the ongoing efforts to protect patient autonomy, assure investigator integrity, avoid unnecessary or nondisclosed risks to subjects, and provide a national uniformity and general fairness across the human subject research spectrum.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.


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Beyond the Destination LVAD

There are many forms of life sustaining treatment available to patients thanks to advances in medical technology. When a person’s physiology weakens or fails, devices may be attached or implanted to take over for organs that can no longer bear the workload of processing, moving, or taking in the elements needed to keep a body alive. Conceptually, this is appealing to a society that is as averse to death as are those of us here in the US. But we still struggle to accommodate the range of needs that crop up when function is compromised. As an ethicist, the general trend in my work suggests that the more advanced the technology, the more questions it raises when it comes time to talk about halting the mechanical support. Among the more advanced tools for sustaining physiological function is the Left Ventricular Assist Device, or LVAD, which maintains the circulatory function for persons with severe heart failure.

There is little doubt that individuals who are eligible for the device can experience remarkable quality of life gains whether they move on to receive a heart transplant or receive the implant as a destination treatment. Recipients of LVADs can typically return to their daily activities, and enjoy a level of independence not previously possible for persons with otherwise lethal heart conditions. However, these patients are not just like everyone else when complications arise. Decisions about how best to manage long term care for persons who have LVADs can be unexpectedly complex, most notably when the patient lives outside a major metropolitan city center. In particular, securing services when such patients suffer non-cardiac health complications after having the device implanted can be difficult. Consider a patient who is stable with a destination LVAD who develops end stage renal disease and requires hemodialysis. Outpatient dialysis centers can be fearful about safely managing the ongoing dialysis treatment for a patient when they do not have experience with ventricular assist devices. The same may apply to residential care centers when a patient needs a period of rehab for an injury unrelated to the heart failure diagnosis. Perhaps the most challenging circumstance involving resources for LVAD patients who experience age related cognitive decline and need nursing home level care due to confusion, impulsivity, and routine self-care deficits. There are no clear restorative goals, but the need for custodial care can quickly exceed what was once possible at home, but the LVAD is usually unfamiliar to small town nursing homes and can be a barrier to securing long term residential care.

This issue raises an important justice question for LVAD candidates. Should consent for LVADS, when known to be destination devices, include information about the limitations in assuring other types of services? If so, how do we assure that this information is delivered in a way that does not discriminate against patients from more remote areas while favoring those who live near facilities that routinely care for LVAD patients? 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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A message of hope for inclusivity and equality

For many US citizens, as well as people around the world, the last few months have been difficult and disappointing given the results of the US presidential election. As a feminist bioethicist, I am particularly concerned about how the Trump administration will treat vulnerable and oppressed groups, such as women, individuals in the LGBTQ community, people of color, individuals with disabilities, Muslims and other religious minorities in the US, and poor individuals. I am also concerned that the Trump administration will erode people’s access to healthcare and that this will disproportionately affect these vulnerable and oppressed groups. Already, we have seen that one of Trump’s first actions is to start the process of repealing the Affordable Care Act.

It is easy to be disheartened during these challenging times, but I recently attended two events that gave me hope. First, on Friday, January 20, I attended and co-organized the fifth annual Capital District Feminist Studies Consortium Conference which was held at the Albany College of Pharmacy and Health Sciences. When we chose the date for this conference in the summer of 2016, we didn’t realize that we had scheduled the conference for Inauguration Day. Had the presidential election turned out differently, this may have affected our turnout, but as it stands, we had approximately 80 people in attendance, which is great for a local conference. A feminist conference was the perfect place to be on this Inauguration Day. In order to address some of Trump’s antifeminist and other biased comments and actions, the organizers put together an invited panel titled "Feminist Work in Non-Feminist Surroundings: Survival in Challenging Times." I participated in this panel to discuss why I had created the Capital District Feminist Studies Consortium in the first place and why its existence is so important moving forward. The other panelists – a lawyer, an artist, and a historian – also spoke about the need for women in public spaces and for feminist resistance.

The following day, Saturday, January 21, I attended the Women’s March in New York City, which also gave me hope. Though tired from a full day of participating in and moderating the conference, I was invigorated by the large (over 400,000 people) and supportive crowds (filling the streets of New York City According to estimates. Furthermore, there were sister marches in all 50 states and around the world. Approximately 5 million people marched in around 670 marches, making this the world’s largest demonstration. That so many people came together surrounding a message of inclusivity and equality is incredible and powerful.

Inspired by these two events, I will continue moving forward with hope, which will strengthen and support me as I continue to work, both in my professional and personal life, towards justice for all people, and particularly those who are vulnerable and oppressed. I hope you will join me.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.


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A Necessary Retelling of the Smallpox Vaccine Story

A curious confluence of events unfolded Tuesday night. Just hours before President Obama uttered the powerful “science and reason matter” in his farewell address, Robert F. Kennedy Jr. announced that the incoming president had tapped him to head a committee on vaccine safety.

RFK Jr. is not a pediatric immunologist nor an epidemiologist, but a vocal “vaccine skeptic.” Although the PEOTUS dialed back on the purported appointment shortly after social media erupted, a tweet from March 28, 2014 makes his analysis of the history and science of vaccines clear: Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesnt feel good and changes – AUTISM. Many such cases!

As a child I devoured books on the history of medicine. One of my favorite stories was how Edward Jenner developed the first vaccine, testing an approach that had been used for centuries. Knowing his story made me understand why my little sister had to shriek her way through shots for the “childhood diseases,” while I’d suffered through chickenpox, mumps, and both types of measles. My pediatrician predicted I’d end up deaf and brain damaged after a month with measles.

Now I think the tale of Edward Jenner needs retelling, for those who may not have heard it.


A vaccine is a pathogen, or part of one, whose presence in a human body is sufficient to evoke an immune response, yet not complete or active enough to transmit the illness. When the vaccinated person encounters the wild pathogen, the protective antibody response is immediate, thanks to immune memory. Conquering polio provides a dramatic vaccine story, which DNA Science covered here.

Vaccines aren’t just biomedicine, but bioethics too. The herd immunity that arises at the population level protects us all, illustrating the principle of beneficence: action that is done for the benefit of others. Vaccinate enough people against a particular pathogen, and it can’t find enough sensitive people to rampage through a population. In practical terms, when parents refuse to vaccinate their children, other children can die. Yet vaccines are not entirely risk-free; no medical treatment or procedure is. Most reactions are due to allergy or the necessary revving up of the immune response — here’s a list from a reliable source, the CDC.


The vaccine-autism link arose from a paper published in The Lancet in 1998, in which English physician Andrew Wakefield described “a pervasive developmental disorder” in 12 children. The large, red word “RETRACTED” appears on the first page. The study had no controls and a tiny sample size, but case reports are ok in the medical literature given appropriate caveats. What wasn’t ok (among many other problems) was that Dr. Wakefield was being paid by attorneys representing allegedly harmed children. When this news surfaced, The Lancet, in February 2010, again fully retracted the paper — in case anyone missed the earlier discrediting.

Apparently the president-elect did not get that memo.

But he’s certainly old enough to remember how polio vanished after kids started lining up at school to receive vaccines. Maybe they didn’t do that at the military school his parents sent him to (see “Confident. Incorrigible. Bully: Little Donny was a lot like candidate Donald Trump” from the Washington Post.)

And so in the interest of educating the new administration on the history of vaccines, here is the story of Edward Jenner and his testing of the smallpox vaccine that has rid the world of this terrible disease. (It’s from my first textbook, with apologies to McGraw-Hill. I plagiarize myself for the greater good.)


“Vaccine technology dates back to the eleventh century in China. Based on the observation that those who recovered from smallpox never got it again, people would collect the scabs of infected individuals and crush them into a powder, which they inhaled or rubbed into pricked skin.

Dr. Edward Jenner

In 1796, the wife of a British ambassador to Turkey witnessed the Chinese method of vaccination, and mentioned it to an English country physician, Edward Jenner. Intrigued, Jenner had himself vaccinated the Chinese way, and then thought of a different approach.

It was widely known that people who milked cows contracted a mild illness called cowpox, but did not get smallpox. The cows became ill from infected horses. Since the virus seemed to jump species, Jenner wondered, would exposing a healthy person to cowpox lesions protect against smallpox?

Wrote Jenner of the horse ailment that farmers transferred to cows: ‘It is an inflammation and swelling in the heel, from which issues matter possessing properties of very peculiar kind, which seems capable of generating a disease in the human body … which bears so strong a resemblance to the smallpox that I think it highly probably it may be the source of the disease.’

A physician inspects the growth of cowpox lesions on a milkmaid.

A slightly different virus causes cowpox than smallpox, but Jenner’s approach would prove successful, leading to development of the first vaccine (from the Latin vaca for “cow”). Unable to experiment on himself because he’d already taken the Chinese vaccine, Jenner instead tried his first vaccine on 8-year-old James Phipps. On May 14, 1796, he dipped a needle in pus oozing from a small sore on a milkmaid named Sarah Nelmes, then scratched the boy’s arm with it.

Young James survived, and the smallpox vaccine was born. Eventually, the vaccine would completely eradicate the disease, although several nations maintain the virus in storage for research purposes.”


Smallpox lesions had a characteristic central dimple, and if a person survived for awhile, the lesions grew together, covering the body. Instead of that horrific and painful disfigurement, I have a scar from my smallpox vaccine on my upper left arm. My kids didn’t even need smallpox vaccines, for the last case in the US was in 1949, and the last in the world, in Somalia, in 1977, according to the CDC.

The success of vaccine campaigns is a vivid reminder that, as President Obama said, science and reason matter. Can someone please invent a vaccine against willful ignorance? Stat.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.



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The Lion in Charge: Finding Strength in Uncertain Times

Aesop is credited with the first writing the familiar phrase “United We Stand, Divided We Fall.” In my brief search to find the origins of this phrase also offered a brief writing of two of the fables, which I will share here to frame my thoughts on managing the risks of ignoring cavalier, authoritarian leaders who prey on those who fail to muster the necessary strength and group support to oppose such behavior.

“The Four Oxen and the Lion:

A lion used to prowl about a field in which Four Oxen used to dwell. Many a time he tried to attack them; but whenever he came near they turned their tails to warn anther, so that whichever way he approached them he was met by the horns of one of them. At last, however, they fell [to] quarrelling among themselves, and each went off to pasture alone in the separate corner of the field. Then the Lion attacked them one by one and soon made an end of all four.” (

Let’s not be quick to dismiss this as a mere child’s story. But let’s start there. Where did most of us first learn about bullies? Probably in grade school – either as a victim, a bystander, or as a perpetrator. Tactics for dealing with the abuse may have ranged from passivity to seeking help from persons with greater authority to intervene, though this may have had mixed results. What happens when those with authority dismiss the claim, or otherwise fail to help? The abuse gets worse. What happens when the peers stand together alongside the victim? When the bystanders become active in stating “this stops and will not be allowed here – on our playground, in our group, our community”? When the bully is ‘iced out’? The power of the perpetrator recedes. As adults, employees, citizens, and those with and without social privilege we know intuitively that we have more power as a united front counteracting threats.

So that’s the idealistic answer. Confronting and sustaining the energy to hold a careless leader accountable is not easily done. A person rarely comes to a position of power in our society without having some significant skills of persuasion. Though often superficial, it may not be readily apparent because of well-honed abilities to confidently dismiss deficits in qualifications or knowledge, build collateral support with charm and social rapport, and diverting attention away from concerns when inconsistencies emerge – all with a smile or a wave of the hand. Perhaps the most dangerous of all patterns is one in which those relying on this leader to represent the well-being of all, instead creates divides by splitting dissenters against each other. Like the lion, the oxen are easily devoured once the distracted by matters other than looking out for each other.

As a democratic society, we are at risk of becoming prey. I have devoted my career to serving others who are in crisis of some kind, and providing whatever tools I have at my disposal for navigating an uncertain future, for somehow accommodating events that cannot be undone. But, perhaps most importantly, never giving up on the inherent ability of people to come together to get the right things done…to watching out for the lion together. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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Flatulence and Elections

Approximately once a month I open my schedule and see that my first task of the day is to write a post for the Alden March Bioethics Blog, Bioethics Today. The first part of this task is to determine what to write about. Sometimes that is the most difficult part of the job. I try to give myself fairly wide discretion in choice of topics but this is a bioethics blog so I do try to be conscientious about finding some relationship between the topic of the blog and bioethics. Sometimes that is hard. Recently while perusing the venerable Washington Post I came upon an article that I felt I had to write a blog about.

It also happened that today was the day that my calendar told me it was time to write a blog. So here goes.

It was reported today that there was a fire in the operating room April 15 during a surgical procedure. An unidentified woman was undergoing a surgical procedure on the cervix with a laser. To make a long story short, the woman passed gas, the laser ignited the flatulence and the surgical draping caught fire.

I was attracted to this article because I used to be a young boy (this was a very long time ago) and all young boys believe that everything about farts is funny and entertaining. It was even more entertaining when the flatulence was ignited. Alas when I first saw the article I thought it would be funny but it was not. The woman was seriously burned.  This no longer seemed like a good topic for a blog and I left it incompletely written and unpublished.

While this happened months ago it is current again. At least in my thinking it has become current. The reason for this is that sometimes things that start out seeming funny or absurd become serious issues. I admit that only months ago I thought that the fact that a certain individual was running for president was both funny and absurd. Now he has been elected and it seems neither funny nor absurd. It seems very serious indeed.

So now in my mind the presidential election process evokes thoughts of a woman who was seriously burned in a fire ignited by her own flatulence. I hope the nation and the world are not seriously burned by this election but I fear they will be.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.



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Exercise is good for you and High Heels are not: Health Reports on the Obvious

In a quest for health news which might spark some meaningful topic worth sharing with the Bioethics community, I was repeatedly dismayed at the number of articles offering relatively little useful information at all. In fact, there seemed to be a surprising number of articles that offer scientific support for topics that might be tempting for a superficial glance, but do not add meaningfully to the much broader well-being of individuals and communities. I strongly support using any tools necessary to disseminate health information to persons who may benefit from evidence based health information, but the focus of this effort ought to address more meaningful goals of medicine and human welfare.

An article published in Substance Use and Misuse points out that of the over 15,000 individuals there was no significant relationship between alcohol consumption and physical activity (PA) study link. This article offers common sense health advice for future efforts: “Prevention programs to increase PA levels from low to moderate combined with a reduction of alcohol intake in men who regularly drink alcohol should be considered.” This conclusion is based on the finding that persons who drink heavily also have lower physical activity levels. Hardly seems groundbreaking. Yet, if there had been a correlation suggesting that heavy drinkers are also quite physically active, what would this offer as a useful nugget of health information? Don’t worry about heavy alcohol consumption?

Studying the long term effect of wearing high heel shoes has also gained attention in the media and academic literature. Though, in fairness, I suppose someone has to study it so we can provide evidence based practice considerations to persons who develop foot or ankle problems, or are required to wear high heels as part of a work uniform. “One condition known to compound the difficulty of walking is the use of high heeled shoes.”  study link #2.  I believe all who have worn high heels are likely to agree on this point. The piece does offer some considerations about blood flow to the lower extremities, which could be helpful to physicians treating patients with high heeled related ambulatory difficulties, so a relevant factor in advising patients. Nonetheless, it seems a bit startling that such research is surfacing in the media to answer this question for consumers.  A recent New York Times blog ( titled “Reducing the frequency of wearing high-heeled shoes and increasing ankle strength can prevent ankle injury in women” leads off with a critique of having a character run from Jurassic dinosaurs while she is wearing high heels, and offers evidence for negative effects of long term high heeled shoe wearing. Just in case there was any doubt, the article concludes with sound advice for not wearing high heels as the footwear of choice if escaping a fast moving deadly animal.

Media is a powerful too, and so is scientific inquiry. I believe the public can digest more meaningful discussions of health related matters than those which confirm common sense.

 The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.



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