Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Injustice. Show all posts
Showing posts with label Injustice. Show all posts

Sunday, July 16, 2023

Gender-Affirming Care for Cisgender People

Theodore E. Schall and Jacob D. Moses
Hastings Center Report 53, no. 3 (2023): 15-24.
DOI: 10.1002/hast.1486 

Abstract

Gender-affirming care is almost exclusively discussed in connection with transgender medicine. However, this article argues that such care predominates among cisgender patients, people whose gender identity matches their sex assigned at birth. To advance this argument, we trace historical shifts in transgender medicine since the 1950s to identify central components of "gender-affirming care" that distinguish it from previous therapeutic models, such as "sex reassignment." Next, we sketch two historical cases-reconstructive mammoplasty and testicular implants-to show how cisgender patients offered justifications grounded in authenticity and gender affirmation that closely mirror rationales supporting gender-affirming care for transgender people. The comparison exposes significant disparities in contemporary health policy regarding care for cis and trans patients. We consider two possible objections to the analogy we draw, but ultimately argue that these disparities are rooted in "trans exceptionalism" that produces demonstrable harm.


Here is my summary:

The authors cite several examples of gender-affirming care for cisgender people, such as breast reconstruction following mastectomy, penile implants following testicular cancer, hormone replacement therapy, and hair removal. They argue that these interventions can be just as important for cisgender people's mental and physical health as they are for transgender people.

The authors also note that gender-affirming care for cisgender people is often less scrutinized and less stigmatized than such care for transgender people. Cisgender people do not need special letters of permission from mental health providers to access care whose primary purpose is to affirm their gender identity. And insurance companies are less likely to exclude gender-affirming care for cisgender people from their coverage.

The authors argue that the differences in the conceptualization and treatment of gender-affirming care for cisgender and transgender people reflect broad anti-trans bias in society and health care. They call for a more inclusive view of gender-affirming care that recognizes the needs of all people, regardless of their gender identity.

Final thoughts:
  1. Gender-affirming care can be lifesaving. It can help reduce anxiety, depression, and suicidal thoughts.  Gender-affirming care can be framed as suicide prevention.
  2. Gender-affirming care is not experimental. It has been studied extensively and is safe and effective. See other posts on this site for more comprehensive examples.
  3. All people deserve access to gender-affirming care, regardless of their gender identity. This is basic equality and fairness in terms of access to medical care.

Saturday, December 18, 2021

U.S. judge tosses $4.5 B deal shielding Sacklers from opioid lawsuits

Brendan Pierson & Mike Spector, Maria Chutchian
Reuters
Originally posted 16 DEC 21

A federal judge overturned a roughly $4.5 billion settlement that legally shielded members of the Sackler family who stand accused of helping fuel the U.S. opioid epidemic, a decision that threatened to upend the bankruptcy reorganization of their company, OxyContin maker Purdue Pharma LP.

U.S. District Judge Colleen McMahon said in a written opinion on Thursday the New York bankruptcy court that approved the settlement did not have authority to grant the Sacklers the legal protection from future opioid litigation that formed the linchpin of Purdue’s reorganization.

Purdue said it would appeal the decision.

"While the district court decision does not affect Purdue’s rock-solid operational stability or its ability to produce its many medications safely and effectively, it will delay, and perhaps end, the ability of creditors, communities, and individuals to receive billions in value to abate the opioid crisis," Purdue Chairman Steve Miller said in a statement.

The Sacklers had insisted on the legal shields, known as nondebtor releases because they protect parties that have not filed for bankruptcy themselves, in exchange for contributing $4.5 billion toward resolving widespread opioid litigation.

The Sacklers threatened to walk away from the settlement absent the guaranteed legal protections.

Representatives for the Sacklers did not immediately respond to a request for comment late on Thursday.

Attorney General Merrick Garland said in a statement he was pleased with the ruling.

"The bankruptcy court did not have the authority to deprive victims of the opioid crisis of their right to sue the Sackler family," Garland said.


Note: If you have not watched Dopesick on Hulu, please do.  Excellent portrayal of the level of harm and psychopathology with members of this family.

Wednesday, June 17, 2020

13th is now free on YouTube



Combining archival footage with testimony from activists and scholars, director Ava DuVernay's examination of the U.S. prison system looks at how the country's history of racial inequality drives the high rate of incarceration in America.

This piercing, Oscar-nominated film won Best Documentary at the Emmys, the BAFTAs and the NAACP Image Awards.

 US Rating: TV-MA For mature audiences. May not be suitable for ages 17 and under.

Tuesday, August 13, 2019

The arc of the moral universe won't bend on its own

Adam Fondren
Rapid City Journal
Originally posted August 11, 2019

Here are two excerpts:

My favorite Martin Luther King Jr. quote -- one of 14 engraved on a monument to his legacy in Washington, D.C. -- is, "We shall overcome because the arc of the moral universe is long, but it bends toward justice."

I like that quote because I hope he was right. But do we have evidence to support that?

A man just drove for hours in order to kill people whose skin is a little darker and food a little spicier than his culture's. He opened fire in a mass shooting inspired by the words or politicians and pundits who stoke racist fears in order to win votes for their side. Calling groups of refugees invasions, infestations, or criminals and worrying about racial replacement are not the sentiments of a society whose moral arc is bending toward justice.

(cut)

Racism isn't solved. White nationalists are not a hoax, and they are a big problem.

There are no spectators in this fight. You either condemn, condone or contribute to the problem.

Racism isn't a partisan issue. Both parties can come together to make these beliefs unacceptable in our society.

Another King quote from his Letter from a Birmingham Jail sums it up, "Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly."

Rev. King was right about the moral arc of the universe bending toward justice, but it won't bend on its own. That's where we come in. We all have to do our part to make sure that our words and actions make racists uncomfortable.

The info is here.

Monday, October 29, 2018

We hold people with power to account. Why not algorithms?

Hannah Fry
The Guardian
Originally published September 17, 2018

Here is an excerpt:

But already in our hospitals, our schools, our shops, our courtrooms and our police stations, artificial intelligence is silently working behind the scenes, feeding on our data and making decisions on our behalf. Sure, this technology has the capacity for enormous social good – it can help us diagnose breast cancer, catch serial killers, avoid plane crashes and, as the health secretary, Matt Hancock, has proposed, potentially save lives using NHS data and genomics. Unless we know when to trust our own instincts over the output of a piece of software, however, it also brings the potential for disruption, injustice and unfairness.

If we permit flawed machines to make life-changing decisions on our behalf – by allowing them to pinpoint a murder suspect, to diagnose a condition or take over the wheel of a car – we have to think carefully about what happens when things go wrong.

Back in 2012, a group of 16 Idaho residents with disabilities received some unexpected bad news. The Department of Health and Welfare had just invested in a “budget tool” – a swish piece of software, built by a private company, that automatically calculated their entitlement to state support. It had declared that their care budgets should be slashed by several thousand dollars each, a decision that would put them at serious risk of being institutionalised.

The problem was that the budget tool’s logic didn’t seem to make much sense. While this particular group of people had deep cuts to their allowance, others in a similar position actually had their benefits increased by the machine. As far as anyone could tell from the outside, the computer was essentially plucking numbers out of thin air.

The info is here.

Monday, January 29, 2018

Go Fund Yourself

Stephen Marche
Mother Jones
Originally published January/February 2018

Here is an excerpt:

Health care in America is the wedge of inequality: It’s the luxury everyone has to have and millions can’t afford. Sites like YouCaring have stepped in to fill the gap. The total amount in donations generated by crowdfunding sites has increased eleven­fold since the appearance of Obamacare. In 2011, sites like GoFundMe and YouCaring were generating a total of $837 million. Three years later, that number had climbed to $9.5 billion. Under the Trump administration, YouCaring expects donations to jump even higher, and the company has already seen an estimated 25 percent spike since the election, which company representatives believe is partly a response to the administration’s threats to Obamacare.

Crowdfunding companies say they’re using technology to help people helping people, the miracle of interconnectedness leading to globalized compassion. But an emerging consensus is starting to suggest a darker, more fraught reality—sites like YouCaring and GoFundMe may in fact be fueling the inequities of the American health care system, not fighting them. And they are potentially exacerbating racial, economic, and educational divides. “Crowdfunding websites have helped a lot of people,” medical researcher Jeremy Snyder wrote in a 2016 article for the Hastings Center Report, a journal focused on medical ethics. But, echoing other scholars, he warned that they’re “ultimately not a solution to injustices in the health system. Indeed, they may themselves be a cause of injustices.” Crowdfunding is yet another example of tech’s best intentions generating unseen and unfortunate outcomes.

Sunday, October 22, 2017

A Car Crash And A Mistrial Cast Doubts On Court-Ordered Mental Health Exams

Steve Burger
Side Effect Media: Public Health/Personal Stories
Originally posted September 26, 2017

Here is an excerpt:

Investigating a lie

Fink was often hired by the courts in Indiana, and over the last ten years had performed dozens of these competency evaluations. His scene-of-the-crash confession called into question not only the Loving trial, but every one he ever worked on.

Courts rely on psychologists to assess the mental fitness of defendants, but Fink’s story raises serious questions about how courts determine mental competency in Indiana and what system of oversight is in place to ensure defendants get a valid examination.

The judge declared a mistrial in Caleb Loving’s case, but Fink’s confession prompted a massive months-long investigation in Vanderburgh County.

Hermann led the investigation, working to untangle a mess of nearly 70 cases for which Fink performed exams or testing, determined to discover the extent of the damage he had done.

“A lot of different agencies participated in that investigation,” Herman said. “It was a troubling case, in that someone who was literally hired by the court to come in and testify about something … [was] lying.”

The county auditor’s office provided payment histories of psychologists hired by the courts, and the Evansville Police Department spent hundreds of hours looking through records. The courts helped Hermann get access to the cases that Albert Fink had worked on.

Thursday, March 2, 2017

Jail cells await mentally ill in Rapid City

Mike Anderson
Rapid City Journal
Originally published February 7, 2017

Mentally ill people in Rapid City who have committed no crimes will probably end up in jail because of a major policy change recently announced by Rapid City Regional Hospital.

The hospital is no longer taking in certain types of mentally ill patients and will instead contact the Pennington County Sheriff’s Office to take them into custody.

The move has prompted criticism from local law enforcement officials, who say the decision was made suddenly and without their input.

“In my view, this is the biggest step backward our community has experienced in terms of health care for mental health patients,” said Rapid City police Chief Karl Jegeris. “And though it’s legally permissible by statute to put someone in an incarceration setting, it doesn’t mean that it’s the right thing to do.”

This is the second major policy change to come out of Regional in recent days that places limits on the type of mental health care the hospital will provide.

The article is here.