Curious Bioethics: May 1-7, 2023
Vaccines, unwanted epidurals, lethal injections, engaging with difficult history
Hey there, Curious Human!
In today’s curated collection, you’ll find:
Bioethics in the News: New RSV vaccine, Oregon protects patients, capital punishment with lethal injections remain cruel
What I’m Reading: about embodiment, unwanted epidurals, and the intersection of conspiracy theories and anti-vaccination beliefs
Educational Opportunities: Teaching Hard History, How to Apologize Effectively
Bioethics in the News
New RSV Vaccine
On May 3, 2023, the FDA approved Arexvy, the first ever respiratory syncytial virus (RSV) vaccine approved for use in the United States. This is great news for older adults who can develop severe pneumonia from RSV. Each year, the infection causes 60,000-120,000 hospitalizations and 6,000-10,000 deaths among adults 65 years of age and older.
“Older adults, in particular those with underlying health conditions, such as heart or lung disease or weakened immune systems, are at high risk for severe disease caused by RSV,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “Today’s approval of the first RSV vaccine is an important public health achievement to prevent a disease which can be life-threatening and reflects the FDA’s continued commitment to facilitating the development of safe and effective vaccines for use in the United States.”
My fingers are crossed for the pediatric version to be approved early next year. Many children are hospitalized in the U.S. annually with RSV, and some die. RSV is the second leading cause of death in children globally.
Oregon plans to protect gender-affirming care and abortion access
Oregon House passes sweeping bill to guarantee access to abortion, gender-affirming care.
Under the umbrella of gender-affirming care, House Bill 2002 would require Medicaid and private insurers to cover more procedures and would allow minors of any age to get an abortion without needing to notify a parent. The bill contrasts legislation in Republican-led states blocking access to and criminalizing health care.
This Pharmacist Said Prisoners Wouldn’t Feel Pain During Lethal Injection. Then Some Shook and Gasped for Air.
A Florida pharmacist serves as an expert witness on behalf of states defending lethal injection protocols, often speaking about a drug that he has no authority to prescribe. His testimony has helped pave the way for executions across the country.
In preparation to testify in a case against Oklahoma’s lethal injection practices, Dr. Gail Van Norman - an anesthesiologist and ethicist from the University of Washington - attended the execution of a man named Gilbert Ray Postelle.
Van Norman saw him curl the fingers of his left hand and appear to try to make a fist. “This was not a reflex movement,” she said. “This was a conscious movement.”
What I’m Reading This Week
What Happened? by Rebecca Libendorfer
“For months, I waited for him to run his fingers gently along the thin white lines across my chest and ask, What happened? It seemed inevitable, until one day I realized the question wasn’t coming. He would have listened if I’d told him my story, but I didn’t want to get into it. I didn’t see the point. With Brendan, I got to pretend that the most upsetting parts of my life didn’t really exist. In a sense, I was free from the most harrowing things I’d ever endured. I could carefully excise the parts of my story that were dominated by distress, devastation, and disorientation and I could live in a body that just happened to look however it was that my body looked.”
Unwanted Epidurals, Untreated Pain: Black Women Tell Their Birth Stories
Regardless of income or education, Black mothers have worse birth outcomes.
In my current job, I don’t provide obstetric anesthesia, but when I did, I was struck by the number of times that I would introduce myself to a patient, and their partner would immediately say with an accusatory edge, “She doesn’t need you.” It was as if they thought I would not be asking if the patient wanted an epidural, I’d be telling. Reading this essay in the UpShot, I see why patients, partners, and doulas would worry about that - because women are being pushed to have epidurals they don’t want.
“Missing from mortality statistics are the many stories of mistreatment and negative experiences. In interviews with Black women who responded to a request from The New York Times to share their birth stories, they described having their pain dismissed, concerns ignored and plans disregarded while giving birth. They recalled walking a fine line between speaking up for themselves but feeling nervous to push too hard.”
I recall how often nurses or doctors would roll their eyes when a patient said they didn’t want an epidural. Being pregnant is scary, and delivering a baby is scary. There are a lot of things that marginalize women patients from making decisions for themselves. Now I teach medical students about obstetric ethics issues, and we talk about consent, misogyny, misogynoir, and the risk of obstetric violence.
As an anesthesiologist, I finessed my reply over time - “I’m more than happy not to provide an epidural - it’s totally up to you. I’m guessing you want what most people want - to be healthy and deliver a healthy baby. I’m just introducing myself in case you have questions or if there is an emergency during your delivery. Is it ok if I share a little information?” With this approach, I was much more successful in meeting patients’ needs. Some ultimately decided they wanted an epidural, but many others achieved their goal of avoiding an epidural.
When Lesley Hu wanted to vaccinate her young son, her conspiracy-obsessed ex-husband went to unimaginable lengths to stop her.
This long-form essay from Eric Page at Atavist Magazine captures a harrowing tale about the intersection of parents with conspiracy theories, anti-vaccination ideas, and mental illness and the impact it can have on children.
“Hu and O’Loughlin, both of whom relocated to San Francisco, communicated sparingly and established a handoff routine that ensured they didn’t have to see each other. Still, at the beginning of each school year, Hu would try to change her ex’s mind about vaccines. He wouldn’t budge and warned Hu that if she vaccinated Pierce without his consent, he would fight her in court. Hu and O’Loughlin kept using Hulstedt’s waiver, even though, since their visit to his office, the Medical Board of California had placed Hulstedt on probation and required that he take refresher courses in record keeping and professional ethics. Pierce turned six, seven, then eight without getting any shots beyond those he’d received when he was very little.”
Educational Opportunities
Teaching Hard History
Learning for Justice has so many resources for educators. I first learned about their work through the Teaching Hard History Podcast. They also have a number of interactive learning opportunities.
The Teaching Hard History 101 Spring 2023 Virtual Workshops begin next week. Learning for Justice has lots of other educational options as well - especially for educators and parents.
Restoring Relationships through Real Apologies
One of the many things I teach to medical students, residents, and fellows is how to apologize when they have made an error or there’s been an unfortunate outcome.
While I teach specifically about apologizing for healthcare issues, I believe all of us benefit from understanding that saying the word “sorry” is not enough.
When my kids were toddlers, we adopted the four-part apology in our house. As they’ve gotten older, we have added the fifth part: keeping your word.
In Leaving Evidence, Mia Mingus divides accountability into four main parts:
Self-Reflection
Apologizing
Repair
Behavior Change
Restorative Justice Community Action states that an effective apology letter should contain the following:
A clear and valid acknowledgment of the behavior that led to the charge. It is important not to be defensive or put the responsibility on someone else.
A clear statement that the behavior will not happen again.
A clear and honest expression of regret that is not arrogant and shows that you recognize how others were affected by your behavior.
A clear statement of how you plan to make amends through changes in behavior, community service, donations, etc.
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
