Curious Bioethics: July 17-23, 2023
💊 "Mini-pill" birth control goes OTC; Texas infant mortality increase; victims sue over abortion exceptions; physician mental health; understanding ableism
In today’s curated collection, you’ll find:
🗞️Bioethics News: Texas’ increasing infant mortality
📚Recommended Reading: “Finding a New Mantra” for physician mental health
🦉Educational Opportunities: Disability and Ableism; Bioethics courses in Denver
Hey there, Curious Human!
I’ve been on a glorious vacation this week in Colorado, breathing in the mountain air and doing all the outdoor things with my family and friends. I've wanted to learn to fly fish for a long time and got this chance this week. I love how it’s meditative and intellectual. I see how anglers can spend hours and hours on the water.
It’s opening weekend for Greta Gerwig’s Barbie and Christopher Nolan’s Oppenheimer - dubbed “Barbenheimer Weekend.” I haven’t seen either yet. As a kid, I was never into Barbies, and I still don’t generally like pink, but I will definitely see the Barbie Movie. It sounds like feminist, campy satire. (There’s a fun Barbie selfie generator if you’re interested in repping one of Barbie’s many jobs)
I will likely watch Oppenheimer, but I’ll need to be in the right headspace for three heavy hours of the atomic bomb and its tragic consequences. I used to love dark, moody films, but years of doctoring have left me more reticent about how much emotional energy I can expend on something that is supposed to be entertaining.
For now, I’m enjoying my last few days of vacation away from emails and pagers.
🗞️ Bioethics in the News
Two stories from Texas:
Nearly two years after Texas’ six-week abortion ban, more infants are dying
Hearings for Zurawski vs. State of Texas - a case challenging Texas abortion law
“Infant deaths caused by severe genetic and birth defects rose by 21.6%. That spike reversed a nearly decade-long decline. Between 2014 and 2021, infant deaths had fallen by nearly 15%.”
-CNN
Infant deaths in Texas have risen by over 20% since Texas implemented severe abortion restrictions starting at six weeks (before most people know they are pregnant).
This is not a surprise.
Pregnant patients facing life-threatening complications for themselves and their fetuses no longer have access to abortion. Like the Dorbert family in Florida, whose son was prenatally diagnosed with a severe congenital condition and died shortly after birth, pregnant patients in Texas are forced to deliver their babies to die.
In March, the Center for Reproductive Rights filed a lawsuit on behalf of two physicians and 12 patients against the Texas abortion restrictions. Victims and physicians described their terrible bind in two days of hearings this week. In Texas, physicians who provide abortions face up to life in prison and a $100,000 fine. This forces physicians to be complicit in denying rational, evidence-based care to patients.
Samantha Casiano, whose fetus was diagnosed with anencephaly, testified that her doctor told her, “You have no options. You will have to go through with your pregnancy.”
Amanda Zurawski, the lead plaintiff in the lawsuit, was forced to develop sepsis before receiving a life-saving abortion. She wanted Texas senators Cruz and Cornyn to know, “I nearly died on their watch, and furthermore, as a result of what happened to me, I may have been robbed of the opportunity to have children in the future.”
Texas’ maternal mortality increased over the past two decades, from 10.3 deaths per 100,000 live births in 1999 to 21.9 in 2019. More recent data is expected to be worse.
Check out Curious Bioethics from March for a refresher on America’s abysmal maternal mortality crisis.
Opill, Over-the-Counter contraception approved
Progesterone-based “mini-pills” have been available since 1973, but recently, the pill was approved for over-the-counter access. This removes a significant barrier to contraception access for women and teenagers.
Progestin-only birth control generally creates thick cervical mucus, making it difficult for sperm to enter the uterus and fertilize an egg. Forty percent of women taking “mini-pills” will continue to ovulate. In some cases, progestin stops ovulation.
One of the challenges of progression-only birth control is it requires the pill to be taken at the same time every day to be effective. ACOG states: “If you have trouble remembering pills, use an alarm or a smartphone app to remind you. Do not skip pills for any reason. Missing pills or taking pills at different times each day makes the birth control less effective.”
Big questions remain about Opill. How much will it cost? Will insurance cover it? If the medication is too expensive, the people most in need cannot afford it. I anticipate that these pills will be locked up in drug stores, requiring shoppers to request access.
📚 Recommended Reading
Finding A New Mantra
“We get so many messages in medicine that we should tough it out, push through. Licensing and credentialing forms often inappropriately ask if we’ve ever sought treatment for our mental health. I am angry about how much that stigma has damaged our workforce. Yet even as I brace for reactions to making myself vulnerable in such a public way, this is also true:
A few months after starting medication, I felt like myself for the first time in more than a year.”
-Dr. Shireen Heidari
My incredibly talented friend and fellow storyteller, Dr. Shireen Heidari, published an excellent essay last year on reconning with her own mental health in the face of worsening work-related anxiety and depression.
🦉Educational Opportunities
No registration is required! Just go straight to YouTube for this on-demand bioethics education.
Disability and Ableism with Keah Brown
“Just Take A Class” at the University of Colorado ($$$)
I usually focus on free, open-access education. Still, if you’re looking for more in-depth bioethics education, the University of Colorado’s Center for Bioethics and Humanities offers two classes this fall that may be of interest: Foundations of Health Humanities (3 credit hours) and Introduction to Public Health Ethics (3 credit hours with my friend Daniel Goldberg, J.D., Ph.D.). These can be applied towards a bioethics certificate or take them a la carte.
That’s it!
As always, thanks for being curious!
Hit reply and let me know what ethics issues you are most curious about this week—I’d love to hear from you!
See you next week!
Be Well & Be Curious,
Alyssa