hospital equipment

Taking Control During COVID-19 Through Advance Care Planning

By Stephanie Anderson and Carole Montgomery

A deep divide exists in the American health care system between patients’ values and the care they receive.

Let’s start with a story – Marcus was in his mid-40’s when he underwent high-risk heart surgery during which he suffered a brain injury. Afterward, the surgeons at first reassured his family that the surgery itself was successful (his heart was working fine) in spite of his brain injury.

Unfortunately, after many days in the ICU he remained unconscious and was not able to get off the ventilator. Specialists told the family that his brain injury was severe, and he would likely not be able to carry on a meaningful conversation or live independently ever again.

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Young male doctor in telehealth concept

Call for Abstracts: Looking Forward to a Post-Pandemic Landscape

By Carmel Shachar and Katie Kraschel

The COVID-19 pandemic has disrupted virtually every facet of day-to-day life.

This disruption has forced us to examine baseline choices and assumptions about how to deliver health care, participate in public discourse, provide access to education, and support the workforce. This “great revision” will continue in several iterative stages: an immediate response to the crisis, a modulation as the pandemic continues, and a resolution into a “new normal.”

The Petrie-Flom Center and the Solomon Center for Health Law Policy are interested in tracking when crisis settles into the new normal and articulating how public policy and law should respond to that evolution.

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a crowd of people shuffling through a sidewalk

The SSTAR Initiative: A Policy Proposal for a Full, Equitable Recovery from COVID-19

By Sara E. Abiola and Zohn Rosen

Full recovery from the COVID-19 pandemic in the U.S. will require new policy that promotes equity and streamlines access to social services while supporting small businesses

Unprecedented job loss due to COVID-19 has led to an economic crisis for families of all backgrounds and income levels.

Current health and social services programs are ill-equipped to handle this need. Moreover, long-standing racial health inequities and the stigma associated with using social services will persist in the absence of significant systems-level change.

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Task force on coronavirus and equity report card.

The Health Equity Failures of Massachusetts’ COVID-19 Reopening Plan

By Charlene Galarneau

Massachusetts began Phase III of its reopening plan this week. Reopening unquestionably involves disproportionate risks to the health of some residents relative to others, and the State’s push forward fails to adequately address these risks.

Phase III of Governor Baker’s Reopening Massachusetts Plan began on July 6, with the exception of Boston, which will begin Phase III on July 13. The first step of Phase III focuses on the reopening of recreational activities: gyms, movie theaters, museums, casinos, and professional sports teams, with specific rules for each type of operation.

In its May 2020 report, “Reopening Massachusetts,” the State’s Reopening Advisory Board asserts that “key public health metrics will determine if and when it is appropriate to proceed through reopening phases.” It references six indicators, including the COVID-19 positive test rate, deaths, hospitalizations, health care system readiness, testing capacity, and contact tracing capabilities.

But these state-wide metrics are inadequate, in both public health and ethics terms. Missing from these metrics in particular, and this Reopening Plan in general, is recognition of, not to mention accountability for, the predictably disproportionate negative impacts that reopening has on the lives of Black and Latinx residents, low-wage workers, and other groups already disparately harmed by COVID-19.

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Return to work graphic.

A Conversation on Safeguarding Employee Health During COVID-19

By Sarah Rispin Sedlak

On July 9th, as part of an ongoing “Coronavirus Conversations” series hosted by the Duke University Initiative for Science and Society, three experts will gather to discuss how the novel coronavirus spreads in the workplace, the steps employers can and should be taking to provide for employee safety in light of that, and how to do so while respecting employee concerns about personal safety, privacy and autonomy.

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Busy Nurse's Station In Modern Hospital

A Physician Reflects on COVID-19 and Advance Care Planning

By Shoshana Ungerleider

It was the end of a 24 hour shift in the ICU when the 85-year-old woman I had just admitted with end stage heart failure began having trouble breathing. While I knew she did not desire “aggressive measures” taken to prolong her life, I wondered what that meant in the context of this moment. Even though I was a young medical resident, I knew without swift intervention, she would not be able to survive the night. I ran into the waiting room to search for her son, her medical decision maker, but he had gone home for the night.

I returned to the bedside to see that my patient was tiring as her breathing was becoming shallow and fast. She was awake and I sat down to explain why she was feeling breathless. I explained that her condition had rapidly worsened and asked if she had ever considered a scenario where she may need a breathing tube. She had not. As her oxygen levels dropped, it quickly became clear that we had to act. What wasn’t clear to me was whether this frail woman would actually survive this hospital stay, and if she truly understood what intubation and mechanical ventilation were and whether this would cause her to suffer.

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empty hospital bed

The COVID-19 Pandemic Highlights the Necessity of Advance Care Planning

By Marian Grant

The COVID-19 pandemic has laid bare the importance of clearly expressing personal wishes for medical care in emergency situations.

Health systems and providers across the country are seeing how important it is that all of us discuss our medical goals in advance. Not having one’s medical goals known in advance puts a burden on frontline clinicians and loved ones, because it leaves important medical decisions up to them.

You can and should speak up about the kind of medical care you would want, and tell doctors what matters to you. You also should tell those who matter most to you what you’d want if you couldn’t make decisions for yourself.

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Introducing New Contributor Jorge Contreras

Jorge Contreras.Jorge Contreras is joining Bill of Health as a regular contributor.

Jorge L. Contreras is a Presidential Scholar and Professor of Law at the University of Utah with an adjunct appointment in the Department of Human Genetics. His research focuses on intellectual property, technical standards and science policy, and he is one of the co-founders of the Open COVID Pledge, a framework for contributing intellectual property to the COVID-19 response. Professor Contreras is the editor of six books and the author of more than 100 scholarly articles and chapters appearing in scientific, legal and policy journals including Science, Nature, Georgetown Law Journal, NYU Law Review, Iowa Law Review, Harvard Journal of Law and Technology and Antitrust Law Journal.  He has served as a member of the National Institutes of Health (NIH) Council of Councils, the Advisory Councils of the National Human Genome Research Institute (NHGRI) and the National Center for Advancing Translational Sciences (NCATS), and as the Co-Chair of the National Conference of Lawyers and Scientists. He is a graduate of Harvard Law School (JD) and Rice University (BSEE, BA).

an ambulance parked at the entrance of an emergency department

Racial Disparities Persist in Human Subjects Research

By Beatrice Brown

Human subjects research has long been plagued by racial inequality. While flagrant abuses have been curtailed, disparities have, unfortunately, persisted.

One area ripe for scrutiny is clinical trial enrollment. A 2018 study by William Feldman, Spencer Hey, and Aaron Kesselheim in Health Affairs documents racial disparities in trials that are exempt from typical requirements for informed consent from study participants.

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stethoscope on computer keyboard

How Traditional Health Records Bolster Structural Racism

By Adrian Gropper, MD

As the U.S. reckons with centuries of structural racism, an important step toward making health care more equitable will require transferring control of health records to patients and patient groups.

The Black Lives Matter movement calls upon us to review racism in all aspects of social policy, from law enforcement to health. Statistics show that Black Americans are at higher risk of dying from COVID-19. The reasons for these disparities are not entirely clear. Every obstacle to data collection makes it that much harder to find a rational solution, thereby increasing the death toll.

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