Hot Topics: Justice
STUDENT VOICES | A Reflection on The 2019 National Conference on Ethics in America at West PointBy Marla Hasin Imagine being stuck in a coffin-like box, with just enough room to feel the rise of your chest as you inhale. You attempt to look at your chest, but you are halted by the thump of […]Full Article
by Keisha Ray, Ph.D.
Like others in our WebMd culture I often go to the internet to research my symptoms, looking for possible solutions.…Full Article
by Craig Klugman, Ph.D.
Last week I became a Jewish-American. No, I did not change my citizenship. No, I did not change religions.…Full Article
Reproduction is generally associated with women and consequently men’s reproductive is often neglected. One clear example of this is the discrepancy in female and male contraceptives. Women have over a dozen types of contraceptives, including hormonal, nonhormonal, barrier, and long-acting reversible contraceptives. In contrast, men have only 2 options: vasectomy and condoms. Men do not have hormonal methods, nor do they have long-acting reversible contraceptives, both of which tend to be the most effective and often the easiest to use (e.g. methods like the IUD you can “set and forget” for years). This discrepancy in options means that most heterosexual couples rely on female methods, an arrangement not only burdens women, but it also reduces men’s reproductive autonomy. I have argued that we need more and better male contraceptives as a matter of “contraceptive justice.”
Unfortunately, in the field of reproductive medicine, this discrepancy in options between women and men is not limited to contraception. There is also a similar injustice at play with infertility treatment. There are various options for women with female factor infertility, including medications to stimulate ovulation, intrauterine insemination (IUI), and IVF. All these treatments target women’s bodies: causing ovulation, facilitating meeting of an egg and sperm, and increasing the probability of implantation. For IUI and IVF, men need to contribute sperm and therefore are also affected bodily for these interventions. However, the vast majority of men provide sperm via masturbation, which is typically not understood as a medical procedure. (For men who cannot produce sperm via masturbation, medical intervention may be necessary such as electroejaculation.) While it may be awkward for men to masturbate in a medical office in order to produce semen, it does not carry the same degree of physical harm as the procedures required for women (though there can be psychological harms for both). For instance, there are a variety of unpleasant side effects, such as bloating and nausea, that are common with hyperstimulation drugs and there can be more serious and even deadly side effects, though they are rare.
Currently, the only type of infertility treatment that directly addresses male factor infertility is intracytoplasmic sperm injection (ICSI) in which a sperm is directly inserted into an egg. In order to perform ICSI, a woman must first undergo hyperstimulation followed by egg retrieval. As previously mentioned, these medical treatments are invasive, often have negative side effects, and target women’s bodies. There are no medical treatments for male factor infertility that directly targets men’s bodies. The fact that women need to undergo medically invasive and unpleasant procedures to treat male factor infertility raises justice concerns. Some may object and claim that of course women must undergo treatments since (cis)women are the ones who experience pregnancy. However, we can imagine medications and treatments that directly target men’s bodies to address male factor infertility. While women have hyperstimulation medications available to them if they are “sporadic” ovulators, there is no equivalent medication for men who is not producing adequate sperm or have problems with sperm motility.
Part of the reason we do not have infertility treatments that target men’s bodies is the same reason we do not have male contraception – reproduction and women are generally conflated, and men’s reproduction is frequently overlooked. Elsewhere I have discussed the various gender norms at play in why we do not yet have hormonal or long-acting reversible male contraceptives. I believe some of the same reasons are at play here. For instance, the field of andrology did not emerge until the late 1960s and scientists did not start investigating male hormonal contraceptives until the 1970s, about 50 years after they began researching female hormones contraceptives. Without a strong foundation in men’s reproductive biology, and without money invested in this research, it is difficult for scientists to discover infertility treatments at target men’s bodies. Also, there was a historical belief that if men were virile (i.e. they could maintain an erection and ejaculate), then they were fertile. Women were assumed to be the cause of infertility and we can see this reflected in our language. We see references to a “barren womb,” but I’ve never encountered an equivalent for men, such as a “barren scrotum.” The idea of barrenness is closely associated with women because reproduction is considered a “women’s issue.” And this explains and perpetuates the lack of attention paid to men’s reproduction.
Until we can explicitly recognize that men also experience infertility – and at similar rates of women – and that this is a topic worthy of research, we will continue to not have options for men with male factor infertility. As with contraception, without infertility treatments that target men’s bodies, women will continue to bare the various, particularly the physical, burdens of infertility treatment and men’s reproductive autonomy will be diminished.Full Article
Can algorithms show racial bias? That is the conclusion of a recent article published in Science by Obermeyer, et al., entitled, “Dissecting racial bias in an algorithm used to manage the health of populations.” According to Science, the algorithm’s goal is “to predict complex health needs for the purpose of targeting an intervention that manages those …Full Article
by Craig Klugman, Ph.D.
In late August 2019, BuzzFeed reported that, “The Trump administration wants to enable Customs and Border Protection officials to collect DNA samples from undocumented immigrants in its custody”.…Full Article
by Suzanne van de Vathorst
In 2018, 6126 cases of physician aid in dying (PAD) (4.4% of all deaths) were reported in the Netherlands.…Full Article
by Keisha Ray, Ph.D.
The story of Flint, Michigan’s water crisis, beginning in 2014 is a story that most people are familiar with.…Full Article
by Craig Klugman, Ph.D.
In the 2019 BBC/HBO fictional near-future mini-series Years and Years, people deemed by a totalitarian U.K.…Full Article
Yesterday’s Child: How Gene Editing for Enhancement Will Produce Obsolescence—and Why It Matters
Impartiality and infectious disease: Prioritizing individuals versus the collective in antibiotic prescription
Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008–2016
Serious Ethical Violations by Physicians: What’s the Solution?
Physician Sexual Assault: The Moral Imperative for Gender Equity in Medicine
Abusive Doctors: How the Atlanta Newspaper Exposed a System That Tolerates Sexual Misconduct by Physicians
Shrinking Poor White Life Spans: Class, Race, and Health Justice
Performance-Enhancing Drugs, Sport, and the Ideal of Natural Athletic Performance
Ethical Dilemmas in Protecting Susceptible Subpopulations From Environmental Health Risks: Liberty, Utility, Fairness, and Accountability for Reasonableness
Former billionaire and pharmaceutical executive John Kapoor has been sentenced to five years and six months in prison. His sentencing is the culmination of a months-long criminal trial in Boston’s Moakley U.S. Courthouse that resulted in the first successful prosecution of pharmaceutical executives tied to the opioid epidemic.Full Article
Letters to FTC, CMS, health care companies follow disturbing revelations of flawed algorithms impacting care for black patientsFull Article
The new owner of a consumer DNA database that has powered a revolution in forensics vowed to resist attempts by police to circumvent the site’s privacy rules.Full Article
The specialty of emergency medicine is firmly grounded in social justice and providing access to expert care to everyone who comes in. That means treating anyone, with any condition, at any time. And yet, embedded into emergency department operations is a system that might be perceived as unjust: the concept of triage.Full Article
State officials stripped Stuart Copperman of his medical license almost 20 years ago. Armed with a new law, his former patients hope to file civil lawsuits.Full Article
A judge in Australia said a couple had left their baby “severely malnourished” on a strict vegan diet. Yet, experts say that, with proper guidance, children can be on a totally plant based diet.Full Article
Lawyers for the state of Oklahoma urged a judge Monday to find health-care conglomerate Johnson & Johnson culpable for the consequences of the state’s opioid epidemic and assess the company as much as $17.5 billion to help clean up the damage.Full Article
As their minivan rolled north, they felt their nerves kick in — but they kept on driving.
At the wheel: Lija Greenseid, a rule-abiding Minnesota mom steering her Mazda5 on a cross-border drug run.
Her daughter, who is 13, has Type 1 diabetes and needs insulin. In the United States, it can cost hundreds of dollars per vial. In Canada, you can buy it without a prescription for a tenth of that price.Full Article
Normally, parents make decisions about their children’s health care. But when it comes to the prevention of sexually transmitted diseases and cancer, kids should have the right to protect themselves. That is why Senate Bill 3899A, which would allow teenagers, in consultation with their physicians, to receive vaccines against HPV (human papilloma virus), ought to become the law in New York.Full Article