Tag: justice

Blog Posts (12)

September 14, 2016

Fordham’s Dr. Elizabeth Yuko Address Ethics of Web Self-Diagnoses

Millions of people use websites like WebMD every day to gain insight on a range of medical issues from cancer to mental health. This practice, or “cyberchondria,” is a new digital phenomenon that has resulted from online databases of free, … Continue reading
August 31, 2016

Relying on Psychological Assessments do not Right Death Penalty Wrongs for the Intellectually Disabled

Although the death penalty is on the decline in the United States, the case of James Rhodes highlights the ethical quagmire facing forensic psychiatrists and psychologists whose evaluations contribute whether persons with intellectual disabilities convicted of murder will live or die. In addition to the increasingly familiar racial … Continue reading
August 24, 2016

Jailing for Dollars: The Federal Government Takes Steps to Eliminate a Moral Stain on Justice in the US

The United States has become the world’s leading jailer with 2.2 million people in jails and prisons across the country.  With a combination of government and privately run facilities, the nation faces the moral issues surrounding the prison-industrial complex.  As … Continue reading
August 11, 2016

RETI Fellow Examines Intersectional Stigma for HIV-Positive African American Women

While bearing the disproportionate burden of HIV/AIDs in the US, African American women also face multilevel stigma at social, community and institutional levels, which is exacerbated by their HIV-positive status. Fordham University Center for Ethics Education HIV and Drug Abuse … Continue reading
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.

 

 

 

August 1, 2016

Tennessee Inmates Sue for Hepatitis C Treatment

On July 25, 2016, inmates incarcerated in Tennessee prisons filed a class action lawsuit against the state’s Department of Corrections “asking the court to force the state to start treating all inmates who have the potentially deadly disease [hepatitis C].”


The inmates are represented by several advocacy organizations: American Civil Liberties Union, Disability Rights Tennessee, and No Exceptions Prison Collective. The gist of the lawsuit centers on a claim that failure to provide inmates with what now is believed to be standard of care treatment for hepatitis C is “cruel and unusual punishment” and unconstitutional.

            The prevalence of hepatitis C in Tennessee’s prison and adult general populations have been estimated at 23% and 4.4%, respectively.  Moreover, there are more persons incarcerated in Tennessee than just the state’s prison system. One Tennessee county jail recently reported that 92% of its detainees had hepatitis C!  Tennessee counties are usually financially responsible for the health care costs of those jailed within their jurisdictions.

            From news accounts that are reporting the story the principal issue clearly is money. The medicine – which is an extremely effective cure – costs about $1000 per pill to be taken daily for 12 weeks. The estimated cost per patient is about $84,000. The total cost to the Department of Corrections is staggering given the numbers of patients that may require treatment.

            But the unstated – the implied – more pressing issue from the story is not just cost, it is fairness and justice for all Tennesseans. The Tennessee legislature is responsible for the budget that funds both the Department of Corrections and the state’s Medicaid program. To assure treatment for Tennessee inmates and not provide full coverage for Tennessee’s Medicaid population who are also infected with hepatitis C would be clearly discriminatory, and possibly would not stand up to a constitutional challenge under the Equal Protection Clause. It may place the Tennessee legislature in the untenable position of having to provide treatment for coverage for both groups or neither group, and if it opts to provide treatment to then find the unbelievable sum of money to fund the costs.

            Some Tennessee legislators and their constituents may find it a bit hard to swallow if the state funds the costs of hepatitis C treatment for prisoners and not the poor and disabled patients covered by Medicaid. Legislators and citizens may see prisoners somehow as less worthy? But the comparisons won’t stop with prisoners v. Medicaid patients, some might question the fairness of Medicaid patients being eligible for hepatitis C treatment when working Tennesseans with health insurance provided through employer-based plans are somehow less eligible for treatment, or have to incur out-of-pocket costs for treatment when prisoners and Medicaid patients do not? With the costs of treatments coming from so many pots – Medicare, Medicaid, employer-based insurance plans, federally funded programs for the military and veterans – the fairness issues that will arise with future innovative and individualized – and undoubtedly more expensive – options will only grow.

June 21, 2016

Its not just mental health studies: Doctors rarely ask adolescent patients about their sexual orientation & LGBT youth are afraid of bias

A recent report underscores the paucity of mental health research relevant to LGBT patients.  According to Celia B. Fisher, Ph.D., Director of the Fordham University Center for Ethics Education this unfortunate situation is not unique to research studies. “In our … Continue reading
June 10, 2016

Small Minds

I have recently read an opinion piece published in the Chronicle of Higher Education by John Kaag and David O’Hara entitled Big Brains, Small Minds. In this article Kaag and O’Hara boldly assert that “We are on the verge of becoming the best trained, and least educated, society since the Romans”. In the ensuing explanation we learn that education is science is what he refers to as “trained” while education in the humanities is what he refers to as “educated”. Apparently I have been trained and he has been educated. What a crock. Because I have been trained and not educated it is probably important to clarify that I mean crock not in the sense of an earthenware jar but rather in the sense of something which is complete nonsense.

Kaag and O’Hara appear to believe that one of the primary roles of the humanities is to critique science. That is fine; everybody should critique science, it is much too important to not be evaluated in the context of all types of human knowledge and understanding. It is also fine that they suggest that humanities should not be judged by the metrics of hard science. Of note, however, is I have never heard anyone suggest that humanities should be judged by the metrics of hard science. But I think it is probably important to note, however, that if it is the job of humanities to critique science perhaps those doing the critiquing should also know some science. It should also be kept in mind that scientists are pretty good at critiquing the sciences and, in fact, we usually spend quite a bit of time and energy critiquing each other. Just for the record, Kaag and O’Hara write that Plato teaches us that part of the liberal arts enduring mission is to critique the objectives of science. Science was rather different in the time of Plato. Perhaps he should have a more recent reference. He should also remember that at the time of Plato there was really no distinct boundary between science and philosophy. The authors cite the story of Herodicus as told by Socrates as an example of a disordered mind having “been trained in the STEM fields of his time”.  Really! This took place in the fifth century BC. Again, I think we may well need a newer reference. Parenthetically Herodicus showed great insight in advocating the value of exercise in preserving health.

The job of a professional scientist is to learn what has previously been unknown. They must be able to understand and appreciate the state of knowledge in their field, identify the boundaries of knowledge, and formulate hypotheses that if proven produce new knowledge. For a scientist to be successful they assume the burden of proving or disproving that hypothesis. They must have the communications skills to present their ideas in an adequately compelling manner to be awarded resources to engage these scientific pursuits. They must communicate their findings to the world. None of these are endeavors of the small mind.

The authors of this essay state “If you’re interested in learning about justice, you don’t go to the chemistry laboratory. You go to philosophy class and travel to Plato’s Republic. Perhaps so but I am unconvinced. If the justice one seeks has to do with environmental preservation, species extinction, and biomedical innovation perhaps this is positively contributed to by those who have had their minds expanded by an education which includes science.

 

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.

March 16, 2016

Study shows that marijuana has a significant role in relieving PTSD symptoms in combat veterans, more research on the way

STUDENT VOICES By: Kyle Pritz The scantiness of marijuana research in the United States of America shouldn’t come as a surprise to anyone. The lack of research is tremendous. However, with new decriminalizing laws budding up, the role of marijuana usage … Continue reading
January 13, 2016

Professional Judgment and Justice: Equal Respect for the Professional Judgment of Critical-Care Physicians

by David Magnus, PhD and Norm Rizk, MD

This issue’s target article by Kirby (2016) raises an incredibly important and challenging set of issues: Whether, when, and how should limits be placed on patient access to intensive medical care?…

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Published Articles (16)

American Journal of Bioethics: Volume 16 Issue 10 - Oct 2016

Governance of Transnational Global Health Research Consortia and Health Equity Bridget Pratt & Adnan A. Hyder

American Journal of Bioethics: Volume 12 Issue 1 - Jan 2012

Unpredictable Drug Shortages: An Ethical Framework for Short-Term Rationing in Hospitals Philip Rosoff

American Journal of Bioethics: Volume 11 Issue 7 - Jul 2011

Fairness and the Public's Role in Defining Decent Benefits

American Journal of Bioethics: Volume 11 Issue 7 - Jul 2011

Rationing Just Medical Care

American Journal of Bioethics: Volume 11 Issue 10 - Oct 2011

Response to Open Peer Commentaries: Rationing Just Medical Care

American Journal of Bioethics: Volume 10 Issue 12 - Dec 2010

The Encompassing Ethics of Bariatric Surgery

American Journal of Bioethics: Volume 10 Issue 12 - Dec 2010

Stuck in the Middle: The Many Moral Challenges With Bariatric Surgery

American Journal of Bioethics: Volume 10 Issue 6 - Jun 2010

Response to Open Peer Commentaries on ?How to Do Research Fairly in an Unjust World?

American Journal of Bioethics: Volume 10 Issue 6 - Jun 2010

How to Do Research Fairly in an Unjust World

American Journal of Bioethics: Volume 8 Issue 10 - Oct 2008

Response to Open Peer Commentaries on A Broader View of Justice

View More Articles

News (2)

June 20, 2012 1:31 pm

Hospital Agrees to Organ Transplant for Undocumented, Hunger Strike Continues (Fox News)

Latinos who have been on a hunger strike for the last two weeks demanding organ transplants for the undocumented racked up a win Tuesday by getting one of the Chicago hospitals at the center of the protests to provide such a procedure. Mexican immigrant Lorenzo Arroyo, 36, will be given the medical attention he needs, including a kidney transplant, at the University of Illinois Chicago Medical Center, the hunger strikers said.

April 18, 2012 5:58 pm

The U.S.'s Tragic Role in Guatemala and a Chance to Make Amends (Huffington Post)

In a February 14, 2012 letter to President Obama and Secretary of State Clinton, scores of individuals and organizations (such as the AFL-CIO, Center for Constitutional Rights, CWA, Guatemalan Human Rights Commission, the National Lawyers Guild, the SEIU and the Washington Office on Latin America) implored the U.S. government to withdraw its motion to dismiss the Garcia v. Sebilius case, and to “seek a fair and amicable settement” with the victims of these grisly experiments. Bioethicists also agree that individual victims deserve a remedy for the harm they individually suffered.