Guest editor alert!!

Celebrating Change

KIPPA MATTHEWS - COPYRIGHT NOTICE

Hello folks, please join me in welcoming the first of three guest editors for this blog!

Jessie Joe Jacobs is an amazing women – activist, campaigner, charity leader, writer and passionate Teessider! Please visit her website to find out more about the amazing things she’s been involved with, including founding A Way Outcharity, and co-founding We Are Our Mediaproject to produce and distribute positive news and fight tabloid hate-mongering.

She is interested in receiving poetry, flash fiction and short film submissions that speak to issues of power, patriarchy and abuse – heaven knows, there’s plenty to be said! So get sending in your work to celebratingchange2017@gmail.com – you have until 31st January!!

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In US, Illness is Financial Anxiety

In August 2016, I moved from Texas to the northwest of England. Last summer, I while walking in the local park I slipped on a stepping stone and sprained my ankle. As the pain pulsed through my body and my ankle began to swell, I began to wonder whether I needed an ambulance, an x-ray, or possibly even surgery.

I did not think about the cost of an ambulance or whether my insurance might refuse to pay for it, the cost of an x-ray if needed, the price of surgery, or even co-pays for medication or any possible treatments. I was worried only about my condition and getting better.

I enjoy hiking, cycling, dirt bike riding and other sports with risk of injury, so I’m not unaccustomed to dealing with the occasional injury. With similar injuries in the United States, though, I always thought immediately of the cost. Mind you, I was never uninsured, but even with insurance proved by the college where I taught, a shattered tibial plateau in 2001 that required two surgeries and months of physical therapy left me with surmountable but daunting bills long after I had recovered. Since 2001, prices have risen dramatically along with higher deductibles, narrower networks, and higher copays for treatment.

In the United States, illness or injury means an immediate calculation of costs and threats to financial security even for working people securely in the middle class. For others, the situation is much worse. Of course, long-term illness or injury can throw middle-class workers out of work, which means they will lose their insurance, unless they can afford COBRA payments to maintain their insurance for a limited time after employment. In my experience, COBRA payments are much higher than people expect or are able to pay.

As a student in medical humanities, I read many narratives of illness. They all focused on suffering from the condition, facing mortality, finding or making meaning in the face of prolonged pain, but not so much about what truly horrifies Americans when they fall ill. Illness or injury should be a time to focus on healing, if possible, or confronting or preparing for prolonged pain in the case of a chronic condition, or to prepare for death in the case of terminal illnesses. It should not be a time to worry about financial ruin for oneself and one’s family.

The study of medical ethics offers many opportunities to contemplate challenging philosophical problems with rich and varied intellectual interest. However, access to healthcare is by far the most pressing problem in the United States. Anyone concerned about illness, suffering, and medicine must assume the obligation to relieve the suffering created by unaffordable healthcare.

 

 

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Payment as Coercion: Researchers Versus Research Participants

In the world of medical research, ethicists say it is unethical to pay a substantial amount of money to research participants. If you give a hefty sum for participation, people might sign up for risky research that they would otherwise avoid, so they can only receive minimal compensation for their time. Large payments exploit them and violate their autonomy by removing their ability to refuse participation. Of course, people with little money and few resources will sign up for risky experiments, anyway, because they need the money, even if the sum is paltry. Poverty reduces one’s autonomy and makes one ripe for exploitation, unfortunately.

The other way to look at it, of course, is that individuals are participating in research that may yield lucrative products, may cause unpleasant or harmful side effects, and may be quite inconvenient, indeed. For loaning their bodies to this unpredictable, but likely profitable, enterprise, it might make sense to compensate them more generously for their time and willingness to risk their own health. After all, it is common for workers who engage in other types of risky work to be compensated above normal pay scale. So, I say the industries should compensate their research participants in ways that are commensurate with the risk and inconvenience they are accepting.

Finally, if payment is coercive for research participants, surely it is coercive for researchers as well. Even workers with six-figure salaries can be exploited and manipulated with large sums of money and other favors. Without large payments, doctors and researchers might well be doing the work they are doing, but surely large payments (much larger than any research participant ever gets) must compel them to conduct their research in ways they would not in the absence of such large payments. We might say they have, in effect, had their autonomy stripped from them through coercive payments.

And so it goes.

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How the Affordable Care Act has Affected Lives

The following was written in response to a Republican politician’s request for stories about how the Affordable Care Act has affected constituents. He was hoping for horror stories, but many people are depending on the ACA for life-prolonging treatment. Her story is here:

In December 2015, our adult daughter began to have debilitating headaches. Then one morning she woke up and couldn’t focus her eyes. She saw her optometrist who sent her to an ophthalmologist who sent her to a neurological ophthalmologist. But it was the end of the year, and her insurance plan was discontinued, and she had to switch plans and start over with all new doctors. I’ll make a long story short. It took 10 months and too many tests and doctors to count for her to be diagnosed with pseudo tumor cerebri, a neurological condition that is characterized by increased intracranial pressure. The pressure was so great that it increased the pressure on her optic nerves and optic disks causing her eyes to cross. She was forced to wear prism lenses over her glasses to avoid seeing double.

After a while, even those weren’t sufficient for her to see well. With treatment, the pressure was reduced, but her eye muscles were damaged, and last December she had extensive eye surgery to straighten her eyes. They are still well aligned (thank God), but the pressure in her optic nerves and her right optic disk have begun to rise again. She is scheduled to have more tests to try to determine if she can have some stents placed to keep the pressure down. She is on some very strong drugs that have significant side effects, but she is managing. She also is facing having regular lumbar punctures or having a permanent shunt placed to keep the volume of cerebrospinal fluid down.

Our daughter works in a skilled professional position but is hired on a contract basis and has no benefits. She was only able to get health insurance through the ACA marketplace. If she hadn’t had that insurance, she would probably either be blind or dead by now. Even if we had sold our home and cashed out our retirement, we probably could not have paid for more than 1 to 2 years of her medical expenses. Is the system perfect? No! But it saved my child’s life. I’m sure that there are many similar stories. So, obviously, I am a supporter of the ACA. Its repeal would have devastating results for so many people.

Personally, I believe that the problem lies with giving too much power to the private insurance companies. Maybe that’s a political judgement; I’m not sure. What I know is that the CEO of our insurance company, Aetna, makes over $40,000,000 each year. I cannot begin to image how that is merited.

I suspect that you are a supporter of the state high risk insurance pool. Here is a link to an article that reviews those pools, and the results are disturbing.

I ask that you read it with an open mind. I know that there are problems with the ACA, but I also know that the ACA has ensured coverage for millions of people who would otherwise have NO care at all. PLEASE, do not repeal this life-giving law.

 

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Ask an Ethicist: Expanding Fast-Food Outlets

Just to be clear, I wrote both the question and answer for this.

Question: I’m a CEO of a large fast-food chain. Obamacare (or the Affordable Care Act) requires me to provide health insurance to employees working more than 30 hours each week. Providing insurance is expensive and I would rather not have to hire so many part-time workers to avoid providing benefits. If Obamacare is not repealed, I won’t be able to expand and create more jobs. How can I ethically expand my business without incurring more expenses?

Answer: Any law that prevents you from opening more outlets should be expanded, but that’s just my opinion. Limiting the number of restaurants you open will encourage locally-owned businesses and aspiring entrepreneurs to open their own establishments serving their friends and neighbors. Chains such as yours destroy local economies and limit workers to minimum-wage jobs with no benefits.

What happens as a result of your not offering health insurance and other benefits? The most obvious consequence is that your employees are likely to not be able to go to the doctor, so they will be sicker, and they will come to work sick because you also do not offer them sick time. Having employees work while they are sick might help explain why noroviruses spread so quickly, but I don’t guess you are concerned with that.

Keeping employees part-time to avoid giving them benefits also means that they must work more than one job in order to survive. This in turn means they are not available to their families and cannot pursue further education. The system you want to maintain keeps workers sick, uneducated, tired, and disconnected. While having a constant pool of desperate job applicants probably sounds like a business bonanza to you, it has consequences. If you haven’t noticed, societies filled with people unable to develop personally and professionally, care for themselves, or seek leisure activities are unhappy societies, and that affects everyone.

What would happen if you provided health insurance? Your employees could afford to work only one job. You could have a more stable workforce, meaning your employees would be more reliable, better trained, and more prepared for advancement. It would mean your employees could get treatment for illnesses and come to work in better health. If you and other businesses provided health insurance, it would mean workers would have more income. More money for workers means expanding markets. And that means you may be able to open a few more outlets after all.

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Seeking Truth through Social Media

Not too many years ago, serious people were holding workshops and seminars touting the transformative power of social media. Twitter and Facebook were new tools that could expose more people to critical information about politics and social justice, raise awareness of suffering and human rights abuses, and organize activists to check and even overthrow tyrannical governments. Now, those same serious people mock online “slacktivists” who think for a moment that Tweeting or sharing on Facebook does anything to make the world a better place.truth

So much difference a few years can make. It didn’t take long for government and corporations to seize control (or tighten control, as they already controlled the entire system) of the information flow on the Internet. Worse, government agencies, police forces, and corporate legal departments used information from social media to track and punish activists.

Worse still, various groups for diverse reasons poisoned the supply of information on the Internet till it was next to impossible to separate factual information, propaganda, satire, and hoaxes. Enough professional journalists from respected news outlets have been exposed for plagiarism and fabrication to make readers and viewers suspicious of all news outlets, and some people now actually believe that propaganda mills are more reliable than once-trusted journalistic outlets.

Further, accusations of plagiarism, ghostwriting, and fraud have even plagued scientific and medical journals, raising legitimate suspicions about the reliability of scientific literature. With major papers being retracted in large numbers in pharmaceutical and medical journals, it becomes more believable for some that climate scientists may be perpetuating some kind of elaborate hoax. While experts are clearly more qualified to evaluate the quality of scientific data than untrained observers, sadly, most people feel they are quite competent to pass judgment on scientific work. “Everyone has a right to an opinion” has become, “All opinions should be taken equally seriously.”

In spite of constant assaults on truth, we still share information, because that is part of what humans do. The human appetite for information has resulted in some positive developments. Scientists are demanding more transparency and data sharing. Independent groups are publicizing retractions, publishing data that contradicts earlier published reports, and demanding that funding sources be revealed. Journalists are holding each other and public officials to greater scrutiny, and many are realizing the importance of good investigative journalism. And members of the “general public” are taking greater care to check sources and look at new information skeptically.

Still, misleading information such as propaganda often comes from powerful sources, and it will not go away. Perhaps, though, we will see a revival of skeptical inquiry and analysis. Perhaps more people will begin to follow the advice to hold beliefs only in proportion to the available evidence.

In the meantime, I see no reason to mock those who find information and post it on social media, even if that is all they do for the cause. Social media “slactivism” may seem like the least one can possibly do, but for some it is also the most they can do. If someone doesn’t have the time, energy, or skills to do more, then so be it.

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April is the Cruelest Month: Help Prevent Suicides

I’m a depressive. It has been some time since suicidal ideation, depersonalisation, and derealisation enveloped my pshche and smothered me in a warm fog. Still, being a depressive is like being an alcoholic. It never really goes away. “My name is Randall, and I’m . . . .”

When my depression comes, it usually greets me in early spring along with the new blooms of fresh gardens and reinvigorated old trees. I have no idea why spring is such a difficult time for those of us who struggle with depression, but I do know I am not alone. When most non-depressives think of depression and seasonal sadness, they think of winter when the skies are dark and the holidays strain the resilience of family ties and over-burdened budgets. But it is spring that brings the spike in suicides.

I don’t think anyone can say for sure why suicides peak in the spring. Some say it is due to allergic responses to pollen. Some say people tend to take action in the spring after a relatively dormant winter. You can click hereIMG_3180 for a brief overview of theories.

Whatever the reason, please be aware of the increased risk of suicide as spring rolls on. Many of the warning signs are straightforward: talking about suicide, buying weapons or poison, becoming withdrawn, expressing feeling of hopelessness, or mood swings. A less obvious symptom, though, is an increase in energy and mood after a period of depression. Sometimes people may feel happier or energised after deciding on what they see as their only way out. You can click here for a list of suicide warning signs.

Women report suicidal thoughts more often than men, but the majority of completed suicides are men. That doesn’t mean you shouldn’t take women seriously if they are having suicidal thoughts, of course, but it may be that men are less likely to seek help or admit to feelings of weakness, so it would behoove us all to make support available to men and to help men feel more comfortable seeking help.

Finally, some people may threaten suicide in a bid to get attention, or they may be judged that way, anyway. I can only say that if someone will go to those lengths to get attention, they desperately need attention. Please try to give them some. Attention in the form of care is a human need as real as the need for water or air.

Posted in ethics, Gender, Grief, Psychotherapy | Tagged , , , | 2 Comments