Health and Medicine

Ethics Quiz And Poll: The Nurse Practitioner’s Dilemma

/ Jack Marshall / 58 Comments

Sure.

It is seldom that I strongly disagree with NYU philosophy professor Kwame Anthony Appiah, “The Ethicist” of the New York Times Magazine’s long-running advice column. A month ago I did, and emphatically so.

The question posed to him involved a professional ethics dilemma, and “The Ethicist” was so certain he had the correct answer that he was uncharacteristically terse about it. I’m pretty certain about the answer too, except that my certainty is that he’s wrong. But I have some doubts, based on my ethical positions in related situations.

The inquirer was a a nurse practitioner working at a primary care clinic for low-income patients. She said that a 16-year-old patient told her that she had stopped coming by the clinic to have her birth control pills replenished because she and her partner were trying to have a baby together. She had been having unprotected sex for  a while, and she was concerned that she might have some physical problem preventing her from conceiving. The nurse practitioner asked,  “Would it be ethical for me to steer her away from trying to get pregnant? …Or, as her health care provider, do I have an ethical duty to try to help her conceive?”

Appiah doesn’t see any wiggle room. He says,

“You’re her health care provider. You should certainly tell her about the medical consequences of pregnancy. But the social and economic consequences don’t fall within your professional competence. An intervention about her life choices may seem moralizing and intrusive to her, and it could drive her away; and then she’d be losing your guidance on the things you are trained to help her with.”

Really? Continue reading →

Evening Ethics Cool-Down, 4/28/2020: Ethics Clouds In My Coffee

/ Jack Marshall / 18 Comments

Good evening.

1. Here’s an ethics quote I need to use more often…I was watching the 1941 film “The Devil and Daniel Webster,” about a jury trial to determine whether the Devil will get a farmer’s soul as contracted.  It reminded me of a quote by Kurt Vonnegut: “A soul is the part of you that let’s you know when your brain isn’t working properly.”

A better definition of an ethics alarm you could not devise.

2. So where were the souls of the judges who voted for this? Thousands of prisoners have been released from incarceration to protect them from the outbreak of the Wuhan virus inside jails and prisons.  The theory is that subjecting prisoners to this special peril is cruel and unusual punishment. The theory’s not wrong, but it’s a bit unbalanced. Their peril is not entirely  society’s fault, after all.

There are activists at the extreme end of the progressive spectrum —a division getting larger all the time, it seems—who seem to want to eliminate penal punishment completely.  Not letting a crisis go to waste, a group of them , Columbia Legal Services, began pushing for inmates over 50 years old in Washington state to be released as a compassionate act to save them from the virus.

Among the intended beneficiaries: Gary Ridgeway, the Green River Killer, and Isaac Zamora,  serving a life sentence for going on  a shooting rampage and killing six  people. Ridgeway is one of the nation’s most frightening serial killers, eventually confessing to 71 murders. Over the three decades of the 1970s, ’80s and ’90s, Ridgeway captured women and girls, raped them, and  strangled them. He loved watching the life go out of their eyes as they died by his hand, though sometimes he used a  rope. Then he  would pose with the corpses. If he really liked his victim,  he’d have post mortem sex with her body. His first victims were found in the Green River, giving him a catchy name.

Ridgeway was sentenced to 500 years in prison with no possibility of parole. The victim’s families were promised that he would never be released. Ah, but poor Gary is 71 now, and thus at risk of succumbing to the pandemic, and presumed to be too feeble to be a threat. That, at least, is what Columbia Legal Services argued. (You know, I’m not much younger than Ridgeway, and I’m pretty certain I could murder someone. In fact, I’m getting ideas…)

Q13 News reported  that prosecutors protested that “the Petitioners [Columbia Legal Services] demand that 2/3 of the prison population be released into the community, a number which includes serial killers and capital murderers.” You would think that their argument would be a slam dunk. You would be wrong. Continue reading →

Comment Of The Day: “Observations On A Tender, Obnoxious, Unethical Screed”

/ Jack Marshall / 11 Comments

Bill Weir’s nauseating open letter to his newborn son River—GACK! ICK! BLECHHH! —- was so unethical in so many ways that I almost needed a ventilator to finish reading it. When I had finished posting on the monstrosity, I was awash with regret that I hadn’t the space nor the time to write the letter Weir should write, and was hopeful that one of the many acid-penned bards among the talented  commentariate here would take up the challenge. I was not disappointed.

Here is Steve-O-In-NJ’s Comment of the Day, one of his finest, on the post, “Observations On A Tender, Obnoxious, Unethical Screed”:

The article is utter garbage, written by someone untrained in science, but trained in making up stories. One day when River is grown up, assuming he makes it there and isn’t driven off the deep end by constant teasing, I hope he reads this article and asks him, just like Greta, “how dare you?” How dare you use my birth to push your own agenda and your employers’ agenda? How dare you plaster pictures of me as a newborn infant all over the internet where anyone can see them? How dare you reveal the circumstances of my conception to the world? I’m an individual. I am not an accessory to flash around like a new pair of sustainable dockers. I am not a prop for your causes. I am not an illustration to make a point next to pictures you cherry-picked to tell the story you wanted.

I’m not a half bad storyteller myself, and I’d tell quite a different story if a son were born to me. I always said if I had a son I’d name him Charles James, after my grandfather and father (ironically also now after two heroes of my own writing). So, if he were born, I’d say this: Continue reading →

Monday Morning Ethics Warm-Up, 4/27/2020: It’s Come To This…

/ Jack Marshall / 12 Comments

…I have to rely on cute Jack Russell Terrier videos to keep me from heading to the bridge…

1.  No, guys, it’s not unethical to retract a bad law. SCOTUS Justices Samuel A. Alito Jr, Thomas and Gorsuch were annoyed that the Supreme Court refused to consider the Constitutionality of a New York anti-gun law after the state not only repealed the law, but passed a law preventing a similar law from being passed again. The Supreme Court today dismissed a major gun rights case that Second Amendment activists had hoped would clarify the right to bear arms. The decision dismissing the case was unsigned, but the dissent was signed, so we also know who made up the majority.   “By incorrectly dismissing this case as moot, the court permits our docket to be manipulated in a way that should not be countenanced,” Alito et al. hurrumphed. The law’s removal rendered the case moot and denied the Court an opportunity to explore whether there is a right to carry a gun outside the home.

I’d say that when the prospect of being slammed by the Court makes a state back down from an overreaching law, that’s a win. Stop complaining. Continue reading →

Sunday Ethics Warm-Up, 4/26/2020: Face Masks, Face-Saving, Faceplants, And Truths Too Awful To Face

/ Jack Marshall / 28 Comments

1. Mask ethics:

See, when someone complains, she tells them they must be too close to her. Heck, why not decorate a mask with accident photos, abortion pics and fellatio snapshots?

  •  Michigan State Senator Dale Zorn, a Republican, was photographed wearing  a mask with a  Confederate flag design. I’d say the First Niggardly Principle applies: people are irrationally emotional about the flag, which is part of our history, still included in a couple of state flags, and a bold design, but there are less inflammatory design options. One has to wonder if someone deliberately displaying the flag is making a political statement, and since many of the possible statements are repulsive and divisive, it seems the ethical move is to choose another design. Like penises.

Zorn, however, not only wore the mask, he denied that it was  the Confederate flag, using a Clintonian argument ( it was more similar to the Kentucky or Tennessee flags, he said), then issued this apology:

So if he didn’t support what he knows the design represents to many people, why did he display it in a political forum?

  • I don’t know about you, but I’m thoroughly sick of conflicting information about the value of facemasks. This expert, for example, says they may make you sick.

Maybe that explains this confounding photo, from a recent flight into New York’s LaGuardia airport…

2. Trump’s face-saving tactic is a half-truth. In the wake of the latest fiasco, the President is going to limit the daily Wuhan virus press updates, and this is his explanation:

What is the purpose of having White House News Conferences when the Lamestream Media asks nothing but hostile questions, & then refuses to report the truth or facts accurately. They get record ratings, & the American people get nothing but Fake News. Not worth the time & effort!

He’s right about the media, which is why the White House briefings were suspended before the pandemic. But the President is leaving out half the reason: he is over-exposed, not playing on a field he’s qualified to play on, and stumbles like the “Are we exploring using disinfectant as medicine?” followed by “I was just kidding!” are reckless self-inflicted wounds in a Presidential campaign. Trump needs less exposure, not more, and apparently someone persuaded him to cut back. Good.

I will never get used to the President of the United States using juvenile, hackneyed insults like “lamestream media.” Continue reading →

Saturday Ethics Warm-Up, 4/25/2020: The Quiet Before The Storm

/ Jack Marshall / 38 Comments

Something’s coming.

(I’d have the West Side Story song up, but for some reason WordPress hasn’t been letting me embed videos lately.) Do you feel it? I sure do…

1. Our incompetent leaders, Part 645, 991. The proper anti-virus conduct as modeled by Nancy Pelosi on TV last week: take off your mask, wipe your nose with your hand,

…and touch the podium. Members of both parties demonstrated similar Wuhan virus safety awareness:

2.  Meme Wars…

[Pointer: Steve Witherspoon (not Other Bill, as I erroneously stated originally. Sorry, Steve)]

…and this (from the Babylon Bee):

3. You know, I really don’t care what someone like this thinks about illegal immigration. In a review of a pro-illegal immigration book by illegal immigrant (OK, she’s a “Dreamer”)

Quick diversion: Education Secretary Betsy DeVos announced that “Dreamers”—people brought to the U.S. illegally as children—cannot access emergency funding set aside for college students who are enduring disruptions in their education because of the pandemic, because grants may only be given to students who are eligible for federal aid under Title IV of the Higher Education Act,  meaning U.S. citizens. Naturally, she is being attacked as cruel and racist.

It is the correct, responsible, legal and ethical decision.

So she is laboring under emotional difficulties, a law-breaker herself, and a liar. That’s some expert you got there. She’s also not very bright, based on this statement from her book: Continue reading →

The Dumb Ad-lib/Malicious Reporting/Confirmation Bias/Big Lie Cycle, ‘Inject Disinfectant’ And ‘Shine Light In The Body’Chapter

/ Jack Marshall / 40 Comments

Boy, am I ever sick of these stories.

The pattern is so familiar its completely familiar and would be boring if it weren’t so annoying. President Trump ad-libs something that popped into his head, using his unique stream of consciousness/if James Joyce had a 1000 word vocabulary version of communication. The news media rushes to interpret it in the most negative way possible, and reports that as what he both said and meant. Democrats, “the resistance” and especially social media addicts who barely have vocabularies over 1000 words themselves rush to say and write that the President is a Nazi, or racist, or moron, based on the deliberately misleading reports by people starting from the assumption that he is all three….the essence of confirmation bias.

Then people like me, being  reasonable, public spirited and unbiased,  point out that this is not a fair interpretation of what he said, whereupon such people are attacked as enablers of Nazis, racists and fools. Even after the original report is shown to be malicious fake news or close to it (my position is that if it’s almost fake news, it’s fake news), politicians, and unscrupulous pundits like Joe Scarborough, and your Trump Deranged friends and mine continue to repeat them. The President said that the white supremacists were “good people.” He said that Mexicans were rapists.  He said the Wuhan virus was a hoax. Now, thanks to yesterday’s blather, they will be saying that he told people to “inject” or drink bleach and disinfectant as a cure for the virus. Continue reading →

No A Study Did Not Prove That Trump’s “Touted” Drug Didn’t Work. Not Exactly Fake News, But Close Enough.

/ Jack Marshall / 12 Comments

Salon: Trump-touted hydroxychloroquine may increase risk of death from COVID-19; “largest study yet finds no benefits but higher deaths,”

CNN: Study finds no benefit, higher death rate in patients taking hydroxychloroquine for Covid-19.

Fox News: COVID-19 treatment hydroxychloroquine showed no benefit, more deaths in VA virus study

The Washington Post wrote, “On Tuesday, a new government study was published suggesting the drug didn’t offer any benefit in fighting covid-19, the disease caused by the virus, and worse, that its use was correlated with more deaths.”

To be fair to the Post, at least it said that the study should be be viewed “with caution,” and provided a link to the study, not that most of its readers would actually read it. If they had, they would have realized that the study was wildly over-hyped in the media, and didn’t really “suggest” anything of the sort. Once again, this was another example of the news media playing to the confirmation bias of those who want to see the President be wrong. Are they cheering for the pandemic to do as much damage as possible? I refuse to believe that, but some of them sure manage to sound like they do.

I wasn’t going to discuss this tonight, but a smart, usually fair Facebook friend wrote a false description of the study calculated to appeal to the Trump Deranged. I don’t think he would have done that if he had read it, but he hates Trump too, and he doesn’t think the news media is biased—they agree with him, after all, so they must be fair– so he’ll trust the headlines, or the spin, every time. Continue reading →

Wuhan Virus Ethics Updates, Part 1

/ Jack Marshall / 41 Comments

1. Why keep calling it the Wuhan virus? Because the largely successful news media and political correctness assault on the completely legitimate (and non-racist) label continues to bolster Chinese Communist propaganda and blame-shifting, and because the effort emerged as yet another use of Big Lie #4: “Trump Is A Racist/White Supremacist.”

As for me personally, I will keep using the term because I resent being told that what cannot possibly be racist is racist, especially when my capitulation enables similar political correctness bullying. See the Third Niggardly Principle.

2. Because it’s so darn difficult to maintain social distancing while playing tennis... About  200 yards from my home in Alexandria, Virginia, the public tennis courts have their nets removed by another proto-fascist. Yesterday, I saw two people playing on one of the courts using a self-rigged net.  Good for them.

3. The problem is, you can’t force bank employees to come to work. Our bank, a large national chain, has all of its offices closed in this area, Banking is certainly an essential  service, but the fact is that you can’t do banking completely remotely, though the bank is pretending you can. Its website asks for a social security number at the same time as scammers are sending out fake emails that lead you to an authentic-looking clone of the bank’s site so they can steal your personal data. Try to call to clarify or address any problem, and you get a message about how wait times are longer than usual. I’ll say they are: to try to get a fraudulent $4000 charge to our account cancelled, I had to wait for an hour and 40 minutes, then be transferred to wait another 35 minutes, then be cut off when a transfer failed.

Meanwhile, the bank’s on-hold music is played at an unbearable volume, and is an endless loop of some hellish arrangement of a melody that would have been rejected for a theme park ride. I am certain that the recording is designed to make you hang up, or, in the alternative, go crazy and run into the street naked.  It is exactly like the deliberately uncomfortable seats and garish color schemes fast food outlets use to ensure you vacate the premises the second you finish eating. I swear that there cannot be a single person on the globe who would find this music anything but torture. The genre is “loud, abrasive, repetitious semi-music,” and there is no market for that. It makes hip-hop seem like Chopin.

Banks are essential, and rather than stopping stores from selling “non-essential” items, the government ought to require really essential services to have open outlets to serve depositors and bank customers experiencing their own emergencies. If a 7-11 clerk can come to work, so can a bank employee. Banks have my property within their control, and in exchange for the privilege, they are obligated to respond when I need service related to that money. Continue reading →

Morning Ethics Warm-Up, 4/22/2020: Krugman, Whitmer And Lemon

/ Jack Marshall / 8 Comments

Good morning, all!

1. Bad guys 1. Paul Krugman’s column yesterday had the despicable headline, “The Right Sends In The Quacks.” “The quacks” according to Krugman are the Americans who are protesting in public to send a vivid message to increasingly dictatorial mayors, governors and police departments that opening society and allowing people to live their lives like free citizens rather than inmates needs to be a priority, a concept many in office as well as much of the news media appear to have discarded.

Why are the protesters “quacks?” Well, for one thing, they don’t regard protesting government policy as a non-essential activity, as we were told last week by one of our courageous, first-responder police departments. Second, many of them wore MAGA hats, meaning they are per se racists and idiots. Worst of all, some of them carried guns, legally, but still. Guns bad.

Although if I were a protest consultant, I would advise against the guns, legal weapons symbolize the Second Amendments assertion that individual rights much not be squashed by government over-reach, and that citizens have a right to arm themselves as a matter of self-defense, against their own government if necessary. It may be a message that progressives and anti-Second Amendment fanatics are incapable of processing, but it is a crucial message nonetheless, particularly when Americans are witnessing things like this, or this.

2. Or this: Democratic Michigan Governor Gretchen Whitmer, currently the face of Wuhan virus crypto-totalitraianism, told  Rachel Maddow last week that she was considering extending social distancing guidelines in response to Michigan  protests against her stay-at-home restrictions. “We might have to actually think about extending stay-at-home orders, which is supposedly what they were protesting,” Whitmer said.

“Supposedly.” Nice. Continue reading →