Tag: government

Blog Posts (21)

March 9, 2017

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and, later, President Obama’s signature achievement—the Affordable Care Act—which currently in the process of being repealed and radically scaled down in terms of benefits.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.



December 13, 2016

Imminent Threats To Healthcare and Medical Professionalism: We Must Remain Vigilant

In a previous blog I expressed concerns about the possible direction of politics in our country and the risks it poses to the larger procedural, democratic framework, which I take to be essential to the work of contemporary bioethics. Now that the election is over and a new administration is taking shape, I have many grave concerns about the fundamentally new policy directions our nation will be taking. None concern me more than how the planned changes in our healthcare system in the United States and, if they happen, how our most vulnerable patients will be affected. This is because a top agenda for them on day one will be to repeal the Affordable Care Act (ACA), which has provided healthcare coverage for about 21 million more people since its inception in 2009.

The ACA was an imperfect healthcare plan from the start. But after decades of false starts to reform a system that does not have a close second in terms of excessive costs and inefficiencies among industrialized nations, especially in relation to outcomes, in 2009 it was the best option our country had at that time. In spite of some problems in its implementation, due largely to lack of cooperation and critics setting up obstacles, the ACA has become entrenched into our healthcare system. If it is repealed, there will be widespread suffering and chaos. Just recently the nations’ hospital industry “…warned President-elect Donald Trump and congressional leaders on Tuesday that repealing the Affordable Care Act could cost hospitals $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis.”

 The eagerness of the new administration to gut the ACA was affirmed by the appointment of Tom Price, Representative from Georgia who has been a ferocious and over the top critic of this law from its inception. A prominent orthopedic surgeon prior to running for Congress, Dr. Price seems to advocate for a system that is extricated from government as much as possible and placed in the hands of the private insurance companies. His plan, which provides for individual fixed tax credits and health savings accounts and allows insurance companies to cross state lines, may be helpful for many Americans who are relatively well off and have healthcare to start with. But for most of the sickest patient in lower income brackets, these market-based ideas will do nothing to help them and in fact make them worse off. But real world, harmful consequences are the concerns of an ideologue: All that matters is having in place a policy that accords with an ideal vision of how the world should work.

There is no practical way that a purely market based approached to providing access to healthcare to Americans will accomplish the goals of healthcare that the majority of Americans have, which is to provide some type of basic, quality healthcare to all citizens, at an affordable cost. Price’s approach will leave millions of American citizens, many already with serious health problems without access to health except via the emergency rooms. The predictable consequences will be astronomically increasing costs because healthcare will retreat to its pre-ACA days of inefficiency by focusing more on rescuing patients from acute conditions than preventing them from occurring in the first place; and physicians caring for patients with insurance will be doing more and more procedures for which they will be handsomely paid, without improving quality for patients. Which makes it all the sadder to see the American Medical Association (AMA), as it has done at prior critical historical junctures as it did in standing against the passage of Medicare and Medicaid in 1965, endorsing Price’s nomination.

Though Price’s nomination may be bad for patients, it likely represents good news for physicians in terms of their incomes from reimbursement rates. Which is the reason why the AMA supports him and why, in my judgment, it is an abdication of professional, ethical good judgment and responsibility. Their support violates the basic tenant of professionalism as stated in the American College of Physicians (ACP) Ethics Manual that require its members “…to teach and expand, by a code of ethics and a duty of service that put patient care above self-interest, and by the privilege of self-regulation granted by society. Physicians must individually and collectively fulfill the duties of the profession.”

I am heartened by practicing physicians and physicians-in-training who speak out and refuse to be a part of the AMA and its support of Price’s appointment to be Secretary of HHS.  Most notably a petition has gained over 5,000 physicians’ signatures that make it clear “The AMA Does Not Speak For Us”.  As they state in the petition:


“We are practicing physicians who deliver healthcare in hospitals and clinics, in cities and rural towns; we are specialists and generalists, and we care for the poor and the rich, the young and the elderly. We see firsthand the difficulties that Americans face daily in accessing affordable, quality healthcare. We believe that in issuing this statement of support for Dr. Price, the AMA has reneged on a fundamental pledge that we as physicians have taken?—?to protect and advance care for our patients.”


Medical professionalism always exists in relationship to the prevailing economic and political order in society. Because economic and political winds can shift, so can medical professionalism that at times can put it at risk of losing its moral compass. We do not know yet just how strong the head winds will be. But medical professionals and all citizens who care about the future of just and quality healthcare should be especially vigilant in the coming days and remain prepared to show resistance when necessary.

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.

September 27, 2016

A Concerning Time For America: No Time To Be Politically Silent

Bioethics as a field emerged in post WWII America during an era of American political stability and international economic and military dominance. Those of us working in the field of bioethics for past few decades, as beneficiaries of this setting, take for granted the American democratic political system and its traditions as the natural context and moral framework for scientific discovery and ethical decision-making. Though we might invoke normative ethical approaches at times on particular issues, from both various philosophical and religious traditions, generally speaking most major ethical dilemmas both at the broader policy level and in particular settings of individual patient care and research issues, must proceed according to well-established procedural rules and standards. The goal of ethical resolution in our democratic context is not to arrive at the ultimate, final, or “the” canonical ethical answer, but to reach a consensus between opposing moral perspectives that preserves a plurality of moral values based on well-established moral and legal democratic principles and values. Thus, bioethics as a field that deals with living, practical ethical conflicts depends on a stable, democratic political system in which people with diverse values and beliefs can find non-violent, indeed peaceful means of finding resolutions to their moral differences. It is in this light that bioethicists should find very concerning what is happening in our presidential election cycle.

Bombast and lack of substance have always been part of American political rhetoric. Normally I would see the role of bioethicists to advocate for policy positions within the political process, but try to remain relatively neutral in attacking or supporting particular political candidates and speaking out so candidly about issues. But in my judgment, this election cycle is an exception. Now is the time for all thoughtful people who value democracy and, in particular, bioethicists should speak out strongly. We are not in a position to take our political order and indeed the framework for moral decision making for granted.

For the first time in post-WWII America, we see ideas under consideration, like deporting 12 million undocumented aliens, which is not only unconstitutional, but, even if it were logistically possible, would cause untold physical and emotional suffering, not to mention in all likelihood an economic crisis; barring Muslims from entering our country, or requiring an ideological test for all immigrants; building a wall between our country and Mexico (in spite of the fact that there are as many people leaving the U.S. as entering); in general we see fabrication of information, character assassination, innuendos, shifting views and talking points, nothing resembling a test of ideas and reasonable exchange of competing views. Some may see such rhetoric and tactics as just more bombast and nothing that could fundamentally change the character of our country. On the contrary, this is one of those potentially disruptive times, much like the McCarthy era, in the life of a nation that could render our basic social and political institutions unrecognizable. 

There are growing numbers of citizens in the US with legitimate gripes, who feel their interests have been ignored. As the economy has grown in many specialized areas, as companies have become more efficient in terms of using automation and technology requiring fewer workers, the jobs that built the great middle class in post-WWII America for decades have been eviscerated. Too many of the policies of the past thirty years designed to address these issues, such as lowing taxes on the rich, which many of which these same suffering workers supported, have left them without the skills to participate in a fundamentally different kind of economy and standing little chance to achieve a similar level of wealth as their parents did with the same skills. 

This partly explains why a segment of voters are responding positively to extreme proposals even as many admit they cannot actually be accomplished. Because of their fading hope and trust in the system, some of these voters have become iconoclasts—literally someone who seeks to blow up the system regardless of the consequences. Tragically, their despair, as expressed currently in political terms, approaches nihilism. For them the message is clear, the American way of life no longer provides them meaning and purpose.

However, flagging economic conditions alone cannot account for all of what is happening politically. Another part of the explanation also involves evolving cultural and religious norms over the past few decades governing same sex marriage, women’s roles and their reproductive rights, along with greater ethnic and religious inclusion and tolerance—changes that we liberals celebrate as progress and essential to a growing democracy—that are anathema to many on the political and cultural right. 

These complex macro economic and sociocultural trends are warning signs and indicative of a vulnerable moment in our history, where a wrong outcome at the presidential level could change the character of our nation for generations, if not forever.  

I conclude that this political season is not a normal cycle in the American democratic experiment. It is not a time for thoughtful people and thought-leaders like bioethicists, to remain silent. We must speak out individually and make ourselves heard. Then we must make an effort to better understand the current political conditions and incorporate that understanding into our professional discourse and thinking. Otherwise, we will be ignoring a most fundamental concern, i.e. the very democratic character of our ethical framework grounded in the American political system. We cannot now, or ever, simply take for granted that it will remain intact for future generations. 

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.

August 9, 2016

Why Is Getting Healthcare Coverage So Hard?

For a great nation like the United States, it is not only embarrassing, but also morally reprehensible that there are still millions of American citizens who in principle could have healthcare coverage but are being denied that benefit for purely political reasons. Ideologically driven governors in Red states would rather defy the efforts of President Obama to expand healthcare coverage for all their citizens than provide this most basic human service to their citizens. I draw this conclusion simply because their alleged reason for refusing to expand Medicaid—that expanded coverage will be unaffordable—is simply not true. With Medicaid expansion, the federal government will significantly underwrite most of the costs and without states are on their own in the most inefficient healthcare system possible—they get no access to basic primary care but if they get acutely sick they can show up at an ER and utilize the system at time where cost is exorbitant and goals are limited. It is an abomination how healthcare has been a political football for decades while people with medical needs are allowed to suffer and die.


But it is not just patients without healthcare coverage who lack access to medical care—it is also millions of patients with coverage. Medicaid currently covers over 70 million Americans, yet many of these patients are not able to find a physician who will accept them. In a 2011 national survey of physicians, 31% were unwilling to accept Medicaid patients; in certain states the rates are much higher—for example, in New Jersey only 40% of physicians accepted Medicaid patients. When reimbursement rates are increased, these rates of physicians willing to accept Medicaid patients also rise. Clearly if we are going to expand healthcare coverage in the United States, we must ensure that physicians are provided a fair reimbursement for the services. But there are other barriers other than reimbursement.


Another important barrier is the fact that many poor patients live in areas of the country where there are shortages of physicians. Up to 60% of the underserved areas in need of primary care physicians are in non-metropolitan areas. Physicians’ reticence to work in areas with high concentrations of patients whose primary insurance coverage can be partly explained by lower than average compensation rates but not entirely. Other barriers may include most physicians wanting to live in metropolitan areas and not wanting to deal with more patients with complex issues, such poverty and poor education. Moreover, physician specialist simply make much higher incomes in larger metropolitan areas. In the past the choices of individual physicians coincided with the general health needs of society. It appears that in today’s society, there are serious health needs of large segments of society going unmet.


But even in Blue states like California, with Medicaid expansion, many patients have what looks like good health care coverage and yet are often unable to find a physician or qualified health care professional to meet their needs. This is particularly problematic for patients with mental health issues. A recent story on NPR about a mom with a 12 year-old son provides a great illustration. To start with this mom is forced to pay high copays of $75 per session for needed therapy for her son—for working people, living on pay check to pay check, serious health needs can easily go unaddressed. The 2008 Mental Health Parity Act and the Affordable Care Act (ACA) insurance companies attempted to fix some of the problems like preventing insurance companies from charging higher copays for mental health services than other services. But insurance companies still find ways to skirt the law “sometimes through subtle, technically legally, ways of limiting treatment.” The mom in this story discovered one of those ways when she tried to schedule an appointed with one of the therapists her insurance company would cover for a lower copays of $20. The problem was there were no therapists willing to accept her son. The insurance companies are at least superficially in compliance with the law, but there are no therapists, or very few, that are available for new patients. Part of the problem is that millions of new patients with mental health issues have signed up under the ACA, have coverage, but cannot find a qualified healthcare professional to care for them.


The problems to which I have alluded are characteristic of a healthcare system filled with inefficiencies and bloated costs. There are many reasons to account for why these inefficiencies exist, which I won’t get into here. But as a medical educator, I am reminded of the Physician’s Charter from the American Board of Internal Medicine (ABIM), which embraces a bold, robust set of professional obligations charging physicians to expand access to medical care for all patients and to promote social justice. Under the heading of Social Justice, it states: “The medical profession must promote justice in the health care system, including the fair distribution of health care resources.”


At my medical school we are teaching our new physicians they have an obligation to advocate for all patients and help expand access to healthcare. I must admit I am worried that the challenges they will face will be nearly insurmountable without significant change at the political level and many other policy changes, like greater parity in incomes between specialists and primary care physicians and tuition debt relief. But, patients, which includes all voters, must do our part too as citizens involved in the political process and support candidates that in turn support access to quality public healthcare for everyone. These concerns should weigh heavily in the choices we make at the voting booth this fall. Getting basic healthcare coverage for all citizens should not be this hard.




March 24, 2016

A Few Thoughts On Abortion and Valuing Human Life

Who could be against life? Ancient natural law theory in the Catholic tradition tells us that human beings desire to live, and that life is good, therefore humans have an obligation to live and not kill other human beings. This ancient wisdom has been instilled into western ways of moral thinking. So, who could not be prolife in terms of how we place value on all individual human life?

Who could be against human freedom? Individual human beings should be free to live peacefully in accordance with their own values and life goals. This is a basic tenet of democracy that has shaped moral and political thinking in the West for the past four centuries. So, who could not be against the exercise of free choice, especially about something so basic as having control over our bodies?

The two value perspectives contained in the prior two paragraphs, all things equal, are eminently reasonable and most ethically unproblematic. These two value positions represent two fundamental principles of ethics—the intrinsic value of all individual human lives and the right of free individuals to govern their own lives and bodies—that guide us in living an ethical life and making ethical decisions. It is when these fundamental principles come into direct conflict that a serious, a near irresolvable, ethical conflict arises. There is no greater direct conflict of these two ethical principles than right of women to have an abortion. It is commonly assumed that one is either on one side of this moral abyss or the other and the twain shall never meet. It seems to me one of the central tasks of ethical reflection on this issue is to find as much meaningful middle ground as possible. In this brief blog I’ll offer a few ideas in this regard, which advocates on either extreme will likely find unsatisfactory.


Once a fetus reaches full term and emerges at birth into the world as a separate human being, there is no question about its full moral standing—from my perspective this would include babies with the most serious birth defects, including anencephaly. Some bioethicists believe that a being must have interests to have full moral standing. Since babies with anencephaly, if they survive a short time after birth, have no brain, no capacity to experience pain or pleasure, and no future life, they have no interests. The latter may be true descriptions of babies with this disorder, but they are unequivocally individual human beings. And there is no reason, as the law currently supports, to justify killing or euthanizing the lives of these babies in my view. So can’t the same be said of a fetus from the moment of conception?

It is true that a human embryo is a biologically a distinct form of individual human life and because of that fact has moral worth and deserves respect. But there is a basic aspect of fetal life even after viability and prior to birth that is inescapable: the fetus is dependent on the mother for its life and is part of the woman’s body. There is no protecting the fetus prior to birth without controlling the bodies of pregnant women. At the same time, at the very least, abortion as I am defining my terms is morally concerning and even problematic. I realize many of my pro-choice friends will find that conclusion concerning, but it is simply a consequence of recognizing the moral humanity of fetal life. So the key question then becomes who should make this moral or ethical decision and how should abortion services be regulated under the law?

A moderate position that seeks to preserve as many values as possible in this conflict, it seems to me, will recognize elective abortion as a moral issue but will reject the notion that it should be restricted as a service under the law. For if the law seeks to protect fetal life by restricting abortions, ipso facto, it also seeks to restrict the liberty of the woman to control her body as she so desires. The idea of requiring a woman to keep an unwanted pregnancy is an assault to her dignity as free human being. We cannot pretend to live in a free society where men and women have equal moral worth if we do not extend full moral autonomy to both men and women equally.

I conclude abortion is a moral issue and like many moral issues they are decisions that individual free human people should make and should not be the business of government to regulate. But it is not trivial to recognize abortion as a moral issue. We should not only talk, but also act, like all human life as value. We can provide adequate healthcare to all people, which should include family planning, prenatal, and birth control services for woman. We should provide more day care for parents, particularly single parents and other support services to make having children easier.

In short we can be a society that acts like it values all human life, of which fetal life is a part. But the ethical position of valuing all human life in terms of ascribing full moral standing to individual human beings cannot extend individual fetal life if we are to full value women as autonomous human beings.



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.

October 16, 2015

If I Were Running the Place

<p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">I have a riddle for you.  Start with six attorneys; add three management consultants, three financial executives/advisors and a couple of bankers. Sprinkle in, one each, clothing store chain CEO and entertainment retail chain CEO. Add executives from a supermarket chain, a construction company, and a paper products company. Fold in a hedge fund manager, real estate executive, and an accountant. Finish with a reputation management expert and exactly one educator and one physician. What have you got? Perhaps you have the membership of an exclusive club, perhaps a class reunion of an exclusive prep school. No not these.  I will not make you guess any more. What you have is the Board of Directors of a large academic medical center which includes a major teaching hospital and a medical school. This academic medical center educates medical students and physicians, graduate students in science and other health professions. This teaching hospital is a major health care provider in the state capital of a large northeastern state. The academic medical center is the leading biomedical research organization in the region.</span></p> <p style="font-size: 11.2px; line-height: 19.04px;">The Board of Directors is fully responsible for the governance of this large and complex organization. This organization has a mission to educate, to conduct biomedical research, and to provide patient care services. I was expecting to see that this list of directors would include expertise from renowned educators with national reputations. I was expecting to see a list containing outstanding biomedical researchers who discovered knowledge which made the world a better place. I was expecting leaders from the field of healthcare and medicine. But that is not what I found. I was surprised.</p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">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 <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
September 10, 2015

Will America Ever Come To Terms With Its Past?

<p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">In my <a href="/BioethicsBlog/post.cfm/some-reflections-on-summer-vacation-reading">last blog</a> I wrote, what was in effect, a review of three books from my summer reading I did while on vacation. The first book covered the life of George Washington from the time of his resignation as General in the Continental Army, through his leadership in the Constitutional Convention in 1788, until his inauguration ceremony on 1789. The second book was a narrative history of the Great Migration of African Americans from the Jim Crow south to Northern and Western cities, and the hardships they endured throughout. And finally the third book was a contemporary description of what it is like to live in a black body today in the United States. I have been continuing my thoughts on the fate of blacks in America.</span></p> <p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">From the era of George Washington, we see the American political and social power structure becoming embedded into a political system filled, from the first moment with enormous hope but with equal, deeply troubling contradictions. There was eloquent language of the “many” no longer having to remain subservient to the “few” that seemed to reflect through reason the rights of human kind. Yet it was equally clear that Washington’s America was created to protect the financial interests of privileged white males as many human beings were excluded from participation in the new, fledgling nation, including women, native Americans who would be driven from the lands and basically exterminated, and African Americans, a few of whom were free but most enslaved as the property of white slave owners. </span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">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 <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
August 21, 2015

Some Reflections On Summer Vacation Reading

<p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">I love to read novels and works of non-fiction in concentrated sittings so I can really lose myself in what I am reading. Because I am so busy during the course of my work-a-day professional life I rarely have such luxury. This is why vacation for me means a time when I can find a few really interesting books on my reading list and just devour them. Having recently returned from vacation and being overdue for my AMBI Blog, I thought I would share a few thoughts on my vacation reading, and even see if there is a lesson for bioethics.</p> <p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">This summer my reading was unusual in that it was all non-fiction, which included “The Return of George Washington” by Edward J. Larson, “The Warmth of Other Suns” by Isabel Wilkerson, and “Between the World and Me” by Ta-Nehisi Coates. I really didn’t plan to be reading these books together. But as it turns out, after finishing all three, I found a theme of interesting, often disturbing, questions about the past and present treatment of African Americans in the United States—questions that challenge the moral foundation and integrity of American democracy from its origins to the present.</span></p> <p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">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 <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
April 16, 2015

Gonzales vs. Oregon

<p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">We are always pleased to support the activities of young scholars who are interested in bioethics. <a href="http://www.tiki-toki.com/timeline/entry/440733/Gonzales-v.-Oregon/">This link</a> is a timeline of the Supreme Court case Gonzales vs. Oregon. It was prepared by Ms. Maggie Kirby who attends high school at U-32 in Vermont. It does a terrific job of documenting this important bioethics case and binging awareness to the ongoing debate about physician-assisted suicide. Great work Maggie! </p> <p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">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 <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong><span style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span></p>
April 9, 2015

Ideological Struggles Old and New in America: The Inappropriate Use of Coercive State Authority

<p><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">The history of America from the beginning was a struggle of opposing ideological perspectives over the role of the state’s power vis-à-vis the consciences of individual citizens. The 17</span><sup style="line-height: 19.0400009155273px;">th</sup><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"> century Puritans in the Massachusetts Bay Colony basically transported to America the same kind of religious, state intrusion into the lives of individuals they were trying to escape in England by requiring citizens to subscribe to the official state religion. Fortunately, there were courageous individuals there at the time, like Roger Williams (1603-1683), who strongly resisted such requirements. Williams, prior to coming to America, had been educated at Cambridge and worked for Lord Chief Justice </span><a style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;" href="http://en.wikipedia.org/wiki/Edward_Coke">Edward Coke</a><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">. (1552-1634)</span><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">  </span><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Coke was the famous English jurist whose work provided much of the foundations of the Anglo-American legal system, and who famously “declared the king to be subject to the law, and the laws of Parliament to be void if in violation of "common right and reason”.</span><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">  </span><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">No doubt Williams’ prior education and influences from Coke, and from others like Francis Bacon (1561-1626) who taught him the way of learning through experiment and observation, helped temper his strong theological commitments in relation to his views about the proper relationship between the authority of the state and religion, and the extent to which the state could have control over the consciences of free individuals, what Williams called “soul liberty”. Williams himself did not have theological quarrels with the Puritans; however, he did not believe religious conviction could be coerced. It was on this moral and political basis, that Williams founded Rhode Island, the first state ever to have a constitution guaranteeing expansive freedom of conscience to individual citizens. Fortunately, the thinking of Williams became the mindset of the key founders, particularly Jefferson (1743-1826) and Madison (1751-1836), of the American constitutional system. (For a full account of Roger Williams’ life and influence, see the wonderful book, </span><em style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Roger Williams and the Creation of the American Soul: Church, State, and the Birth of Liberty</em><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"> by John M. Barry)</span></p> <p><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">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 <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong><span style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span></p>

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American Journal of Bioethics: Volume 8 Issue 11 - Nov 2008

Federalism, Federalism Everywhere

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July 12, 2012 12:29 pm

U.S. Injected Gitmo Detainees With ‘Mind Altering’ Drugs (Wired News (blog))

Prisoners inside the U.S. military’s detention center at Guantanamo Bay were forcibly given “mind altering drugs,” including being injected with a powerful anti-psychotic sedative used in psychiatric hospitals. Prisoners were often not told what medications they received, and were tricked into believing routine flu shots were truth serums. It’s a serious violation of medical ethics, made worse by the fact that the military continued to interrogate prisoners while they were doped on psychoactive chemicals.

May 16, 2012 9:35 am

The Obesity Epidemic - Two Policy Experts Speak Out (Forbes)

As part of our look into the obesity epidemic, we decided to ask two leading healthcare policy experts questions about the likelihood and potential impact of a tax on the obese and a tax on high-fat and high-sugar foods. This is the third article in a series I have written on obesity, with the previous two articles, A Fat Tax In America’s Future? and Cash As Weapon In The War Against Obesitybased on data from a proprietary survey about American’s views on obesity and what can be done about it.