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   Duke Medical Ethics Journal   

Spring 2021 Blog Highlights

The Opioid Epidemic: a Multi-Faceted Crisis

Michael Lee  •  February 22

Drug overdose is a pressing issue in the United States, being one of the leading causes of death. In 2019, more than 70,000 Americans died from drug overdose, including illicit drugs and prescription opioids(1). Overdose of opioids has adversely affected the entire country, but certain demographic groups have been affected more than others. Data has revealed that overdose is rising rapidly for minority groups in particular. In 2017, non-Hispanic Blacks had the highest percentages of opioid-related overdose deaths and total drugs deaths attributed to synthetic opioids compared to other race and ethnicities (2). These disparities are intimately linked to psychosocial determinants of health including racism, poverty, limited access to treatments and services, and socioeconomic status. Furthermore, there exist ethical problems related to prescription practices, naloxone availability, and clinician regulations. Prescription of opioids by clinicians, while used to ease the suffering of patients, is a source of potentially dangerous and addictive drugs.

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Words Matter: The Impact of COVID-19 on Gender-Affirming Surgeries

Simone Nabors  •  Feburary 28
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“Due to the COVID-19 pandemic, we have been advised to cancel all elective procedures. Your surgery will be rescheduled when conditions allow.”

This is the kind of message that millions around the world have received over the past year as the pandemic has ravaged our health systems. After reading through a list of steps to take if they find themselves experiencing life-threatening symptoms of the virus, patients are once again reminded that their care is elective and has been deemed nonessential. Expansive resources have been dedicated to determining the effects of these cancellations, but one continuously overlooked group is the transgender and gender nonconforming (TGNC) community who have had their gender-affirming procedures indefinitely postponed or even cancelled.

Madi McMichael  •  March 7

Access to health care has been a notoriously controversial topic in political and legal systems, and many inequities within health care are pervasive. In this instance, we are going to explore the relationship between healthcare and the LGBTQ+ community. There has been an extensive history of anti-LGBT discrimination within healthcare that continues to shape access to healthcare for members of this community as well as exacerbating disparities in health conditions. In fact, homosexuality was categorized as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) until 1973 and transgender identity was recently changed to “gender dysphoria” in the latest edition from 2013. 

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Priyanka Meesa  •  March 14
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“The nation is sick, trouble is in the land, confusion all around,” said Martin Luther King Junior in his final speech encouraging sanitation workers to continue fighting for better working conditions and wages. King realized that social justice could not be achieved without healthy living environments. He was fighting to end segregation, stop massive industries from harming vulnerable communities, and ensure everyone has a safe place to live, work, and play [1]. Although King made this statement in 1968, his description of the nation continues to ring true in 2021. As the coronavirus has shown us, disparities in health continue to persist. These disparities are due to the lack of healthy living conditions in black, brown, and low-income communities. As King alluded to in his quote, health and the environment are linked. This direct correlation must factor into healthcare, pandemic prevention, and other public health policies.

Empathy for the Elderly: LetterWriting in a Pandemic

Sibani Ram •  March 22

Reading letters from my sister’s eighty-something year old best friend— let’s call her Susan— always brings up an unanswerable question: is isolation an illness? On one hand, loneliness is linked to severe health conditions including increased risk of heart disease, stroke, depression, and a plethora of others. But in today’s uniquely challenging and unforgiving times, isolation is a safety measure— a way to stay away from the COVID virus we fear the most, we would think. Think again.

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Jennifer Nguyen  •  March 29
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Standing between a minority and their voice in the healthcare system is a white coat with the inclination to discredit minority experiences. “Black people feel less pain,” while “Women are too sensitive to pain.” It comes as no surprise then that black women are at three times more likely than white women to die during childbirth.

These implicit biases has remained as society weaponized health professionals to incapacitate its marginalized groups. Who else would the public trust, other than credible and esteemed physicians, to rationalize social oppression?

Historically, because health professionals were, and to this day, typically white men, they were in the unique position of power to prop up a medical model that maintained white male dominance. In the name of science, or moreso its distortion, physicians provided physiological explanations to justify a social hierarchy that refused human rights. At the rise of each social movement, medical experts mobilized to discount each group’s humanity, before their platform could gain significant public support.

Can COVID-19 Bring Visibility to Women's Invisible Chronic Illness?

Morgan Biele •  April 4

Awaiting medical test results has become a new social norm for patients and non-patients alike as a result of the COVID-19 pandemic. Perhaps for the first time, the weight of these results and their diagnostic labels have given the broader public a glimpse into the world of those who are used to it-- the world of chronic illness patients. While chronic illnesses don’t carry the weight of fearing contagion, they make up for that weight in needing proof to be recognized. Both are entirely reliant on the results to know the impact on their lives. Many chronic illnesses can be referred to as “invisible illnesses'' because they do not present themselves with identifiable presentations or symptoms, and consequently tend to be overlooked both in and out of a healthcare environment. In a New Yorker Article entitled, “What’s Wrong with Me?” by Meghan O’Rourke, who lives with chronic illness, she reports, “A 2004 Johns Hopkins study found that nearly two-thirds of doctors surveyed felt inadequately trained in the care of the chronically ill” [1]. COVID-19 has garnered an entire population’s attention on what it means to be diagnosed and how beneficial effective care can be. In contrast, COVID-19 can also demonstrate the power of when that is missing. However, Chronic COVID Syndrome may just be the means of bridging the gap between effective care and the lack thereof in chronic illness.

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Madi McMichael  •  April 16

To some extent, all of us have experienced negative mental health effects from the COVID-19 pandemic, whether that is a clinical diagnosis, the implications of less social interaction and isolation, or job loss. Students and employees all over the world have had to adapt to the new pandemic-world; such radical changes to typical life are bound to have adverse consequences on an individual’s mental health. For instance, the number of adults in the United States that have reported symptoms of anxiety or depressive disorders has increased from 11% to 41.1% [1]. In addition to the worsening of chronic conditions, a survey from June 2020 found that 13% of adults have reported new/increased substance use, 11% have suicidal ideation, and difficulty with eating/sleeping have also increased [1]. Several populations in particular face unique challenges in response to COVID-related lifestyle changes, such as low-income or working parents with school-age children enduring the consequences of school closures and lack of childcare services. Older adults are also exposed to increased mental health issues, namely elevated anxiety and depression levels due to their high vulnerability to severe complications from coronavirus and less social support in place for appropriate safety measures.

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