Tag: health insurance

Bioethics Blogs

Web Round Up: Time to Chill? Egg Freezing and Beyond by Moira Kyweluk

A focus on age-related fertility decline, and exploration of ways to expand the timeline and options for biological parenthood have been consistent cultural and web-wide fixations. The $3 billion United States fertility industry was in the headlines once again this month including coverage of the launch of Future Family, a service offering  a “fertility age test” to women and negotiated-rate infertility medical care, alongside newly published research on ovarian tissue preservation, an alternative to oocyte cryopreservation or “egg freezing”, both procedures aimed at potentially extending a woman’s fertility window.

In the wake of findings presented in July 2017 at the European Society of Human Reproduction and Embryology conference in Geneva, Switzerland by Marcia Inhorn, Professor of Anthropology and International Affairs at Yale University, popular media headlines blared:  “Why are women freezing their eggs? Because of the lack of eligible men”  and “Women who freeze their eggs aren’t doing it for career reasons.” The study analyzed interviews from 150 women in their late 30s and early 40s who opted for egg freezing in Israel and the United States. Results “show that women were not intentionally postponing childbearing for educational or career reasons, as is often assumed in media coverage of this phenomenon, but rather preserving their remaining fertility because they did not have partners to create a family with. The researchers conclude that women see egg freezing as ‘a technological concession to the man deficit’, using it to ‘buy time’ while continuing their search for a suitable partner to father their children.”

The American Society of Reproductive Medicine, the regulatory board that governs the safe and ethical use of fertility technologies, reclassified egg-freezing technology from “experimental” to standard-of-care in 2012.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

‘I Am Totally Burned Out’

Patients watch health care debate with dread. The war in Congress over repealing and replacing the Affordable Care Act has brought anxiety to the people whose health insurance is at risk

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Editorial Note

by Rebecca Kukla 

I’m extraordinarily proud and excited to present this special issue of the Kennedy Institute of Ethics Journal, which focuses on ethical, social, and political reflections on the 2016 U.S. election and the early days of Donald Trump’s presidency. It is rare for a philosophy journal to take up such a current and pressing topic. When I decided to put together this issue, I was not sure what sort of submissions I would receive, or how many. I was moved and elated to receive dozens of excellent submissions on a wide range of topics. In making difficult choices about which ones to publish, I eliminated any that took an abstract or distanced approach to the material. Plenty of good-quality philosophical work uses this sort of abstract methodology, but I wanted to publish only papers that captured and grappled with the immediacy and the practical enormity of the changes and challenges that this last election posed. I also eliminated papers that were more like op-ed pieces than scholarly articles. I chose only papers that offered rigorous and deep conceptual analysis, as I wanted this issue to continue the journal’s hallmark tradition of combining philosophical sophistication with practical engagement. The submissions that made the final cut – both those that appear in the special issue itself, and those that appear in the supplement to the issue on the journal’s blog – are, in my opinion, more than just examples of excellent and ethically relevant scholarship; they are also brave.

The topics represented in this issue, including the supplement, span a wide range of the controversies raised by Trump’s victory.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Diagnostic dilemmas: When potentially transient preexisting diagnoses confer chronic harm

By Elaine Walker
Elaine Walker is the Charles Howard Candler Professor of Psychology and Neuroscience at Emory University.   She leads a research laboratory that is funded by the National Institute of Mental Health (NIMH) to study risk factors for psychosis and other serious mental illnesses.  Her research is focused on the behavioral and neuromaturational changes that precede psychotic disorders.   She has published over 300 scientific articles and 6 books. 
The diagnostic process can be complicated by many factors. Most of these factors reflect limitations in our scientific understanding of the nature and course of disorders. But in the current US healthcare climate, legislative proposals concerning insurance coverage for preexisting conditions add another layer of complexity to the diagnostic process. It is a layer of complexity that is riddled with ethical dilemmas which are especially salient in the field of mental health care. The following discussion addresses the interplay between medical practice and health-care system policy in the diagnostic process. The diagnosis of psychiatric disorders is emphasized because they present unique challenges [1]. 

Of course, some of the complications associated with diagnosis are a function of ambiguous and/or changing diagnostic criteria. For example, the criteria for designating the level of symptom severity that crosses the boundary into clinical disorder change over time as a function of scientific advances. This has occurred for numerous illnesses, including metabolic, cardiovascular, and psychiatric disorders [2]. Further, especially in psychiatry, diagnostic categories undergo revision over time, even to the extent that some behavioral “syndromes” previously considered an illness have been eliminated from diagnostic taxonomies.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Deaths from a Health Care Bill?

July 10, 2017

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House Minority Leader Nancy Pelosi has said “hundreds of thousands of people will die” if the Senate health care bill becomes law. But what does the research say about the impact of health insurance on mortality rates?

There are several studies backing up the idea that those who lack health insurance have a higher chance of dying prematurely than those with insurance, as we found when we looked at this issue in 2009.

But the research uses terms like “could” and “suggests” and “cannot definitively demonstrate a causal relationship,” not the definitive “will” favored by opponents of the bill. We can’t say whether any specific projection is a correct or valid number.

Democrats have made this a talking point. “We do know that many more people, hundreds of thousands of people, will die if this bill passes,” Pelosi said on “CBS This Morning” on June 26. In a July 2 interview on CNN’s “State of the Union,” Sen. Bernie Sanders said “tens of thousands of people every single year will die” if the Affordable Care Act were repealed entirely, without a replacement.

Later in that interview, Sanders said that “no one knows exactly the number” but that one study said “up to 28,000 people a year … will die” from the increase in the uninsured under the Republican bills. He and Pelosi are referring to an analysis by the left-leaning Center for American Progress.

We’ll explain how that study reached its conclusions, as well as what other research has found.

…Read More

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The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Never Let an Ill Child Go to Waste

The Charlie Gard saga is one about which I’ve been reluctant to say anything, not least because plenty of other people have said plenty elsewhere.  Sometimes they add heat, and sometimes they add light.

Beneath everything, the story is fairly simple: a small child is terribly ill; it is agreed by medical opinion that continued treatment is not only not in his best interests but would cause him positive harm; the courts have determined that the withdrawal of treatment is warranted.  One sympathises with his parents’ fight to keep treatment going – but it does not follow from that that their opinions should be determinative.  Indeed, the courts having decided that Charlie’s treatment should not be withdrawn immediately in order to allow his parents more time with him risks making the case about them, rather than about him.  If treatment is not medically warranted and actually is harmful, there may be something worrisome about continuing it anyway for the sake of his parents.  Their distress is not going to lessened by prolonging the child’s treatment, and even if it were, it is not the proper focus here.

So that’s my hot take on the story itself.  I don’t think it’s anything too radical.  Yet the coverage of the case has been, in places, something of a trainwreck.  Take, for example, this piece from the Chicago Tribune (with thanks to Charles Erin for the pointer).  It’s fascinating for just how much it manages to get wrong, and how mawkish it is, and for what it does with the story to such unpleasant ends.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Do Americans suddenly like Obamacare?  Contextualizing opinion polls and media narratives by Jessica Mulligan

“Repeal and replace” has been the rallying cry for opponents of the Affordable Care Act (ACA or Obamacare), the signature domestic policy of the Obama administration that expanded insurance coverage to 20 million people. Opposition to the ACA inspired populist social movements and helped elect Republicans to state and national office. Donald Trump tweeted hundreds of times that Obamacare was a “disaster” and promised to repeal and replace the health law. And yet, since he took office in 2017, public opinion polling shows that more Americans hold favorable views than unfavorable views of the law, reversing previous trends. Constituents have confronted members of Congress at rowdy town hall meetings and demanded that their health coverage be protected. Bewildered Republicans and health policy wonks are scratching their heads, trying to make sense of the sudden surge in support for what has been an unpopular law. Finally ready to make good on their campaign promises to repeal and replace, Republicans are met by desperate Americans, many with preexisting conditions, who fear their coverage will soon disappear.

Here, we explore this pendulum shift in public opinion poll results about the popularity of the ACA. We argue that, in fact, many pollsters and policy wonks never really understood the complicated assessments that people held of the ACA in the first place. A question about favorable or unfavorable views fails to capture the stakes of the ACA for those with and without health insurance. Poll data show that major reasons for disliking the health reform included increased costs, that it created too big a role for government, that it took the country in the “wrong direction” under President Obama, and that it did not go far enough in expanding coverage.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – June 2017, part two by Aaron Seaman

The first part of the In the Journals post for June 2017 can be found here. And now, for part two…

 

Medical Humanities

SPECIAL ISSUE: Communicating Mental Health

Introduction: historical contexts to communicating mental health

Rebecca Wynter and Leonard Smith

Contemporary discussions around language, stigma and care in mental health, the messages these elements transmit, and the means through which they have been conveyed, have a long and deep lineage. Recognition and exploration of this lineage can inform how we communicate about mental health going forward, as reflected by the 9 papers which make up this special issue. Our introduction provides some framework for the history of communicating mental health over the past 300 years. We will show that there have been diverse ways and means of describing, disseminating and discussing mental health, in relation both to therapeutic practices and between practitioners, patients and the public. Communicating about mental health, we argue, has been informed by the desire for positive change, as much as by developments in reporting, legislation and technology. However, while the modes of communication have developed, the issues involved remain essentially the same. Most practitioners have sought to understand and to innovate, though not always with positive results. Some lost sight of patients as people; patients have felt and have been ignored or silenced by doctors and carers. Money has always talked, for without adequate investment services and care have suffered, contributing to the stigma surrounding mental illness. While it is certainly ‘time to talk’ to improve experiences, it is also time to change the language that underpins cultural attitudes towards mental illness, time to listen to people with mental health issues and, crucially, time to hear.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Limits of Choice: Abortion and Assisted Dying

Michelle Oberman compares abortion and assisted dying and argues that focusing on the ‘right to choose’ risks ignoring the social and economic factors that shape and constrain our choices.

__________________________________________

I’ve watched the trend toward legalizing physician assistance in dying with a vague sense of alarm. My peers, healthy and wealthy, are puzzled by my response. How is this different from abortion, they ask? You’re pro-choice on abortion, so why wouldn’t you be for assisted dying?

Here’s my problem: As much as I support reproductive rights, I am weary of the rhetoric of ‘choice’ as it applies to great swaths of women who have abortions. I’ve spent the past six years studying abortion in the United States, and in countries like El Salvador where abortion is completely banned. The more I’ve learned about why many women have abortions, the less I see abortion as a choice. Abortion is often a coerced response to desperate circumstances.

When we focus on the question of choice – framing the issue as one of individual liberty – we ignore entirely the social and economic factors that shape and constrain choice. Such constraints lead many women to undergo abortions they might otherwise deeply prefer to avoid. The most common reason that women give for seeking an abortion is financial. It is expensive to have a baby, to pay for day care, to feed, clothe, and house a child. For marginally-employed women, having a baby necessarily means plunging themselves and their families deeper into poverty.

We’ve spent decades fighting over abortion, yet we have done little to offset the economic pressures that compel some women to have one.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Senate Leaders Unveil Bill to Repeal the Affordable Care Act

June 22, 2017

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WASHINGTON — Senate Republicans, who have promised a repeal of the Affordable Care Act for seven years, took a major step on Thursday toward that goal, unveiling a bill to cut Medicaid deeply and end the health law’s mandate that most Americans have health insurance.

The bill would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment.

The Senate bill — once promised as a top-to-bottom revamp of the health bill passed by the House last month — instead maintains its structure, with modest adjustments. The Senate version is, in some respects, more moderate than the House bill, offering more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance.

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The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.