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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Madison, Wisconsin / USA - April 24th, 2020: Nurses at Reopen Wisconsin Protesting against the protesters protesting safer at home order rally holding signs telling people to go home.

Safer at Home? Yes, but Not According to the Wisconsin Supreme Court

By Beatrice Brown, Jane Cooper, and Danielle Pacia

Due to the Bill of Health production schedule, this piece is being published two weeks after it was written, on May 20th, 2020. The authors would like to affirm the importance of protests against anti-Black racism in America.

Stay-at-home orders—the primary means of managing the COVID-19 pandemic in the U.S.—face increasing opposition as protestors against these public health measures clamor for a “return to normal.” In Wisconsin, pushback against stay-at-home orders culminated in the state Supreme Court’s decision on May 13 to reverse the state’s “Safer at Home” policy.

Republican leaders of the state legislature filed suit against state Department of Health Services Secretary-designee Andrea Palm and other health officials, resulting in the case Wisconsin Legislature v. Palm. In a 4-3 ruling, the Wisconsin Supreme Court held that the “Safer at Home” order was “unlawful” and “unenforceable.”  Read More

Madison, Wisconsin / USA - April 24, 2020: Demonstrators hold flags and signs at an anti lockdown rally on the steps of the Wisconsin State capitol. State Street is in the background.

COVID-19 Policies and Constitutional Violations

By Daniel Aaron

The past few weeks have seen protests against stay-at-home orders across the country. As protesters clamor for their freedom to leave home and conduct business, a constitutional battleground emerges over the novel coronavirus.

There is a strong argument that the Constitution has been infringed during the COVID-19 pandemic. But these infringements, I will argue, have more to do with the (lack of) federal response to the pandemic than curtailed rights to move, travel, and do business.

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WASHINGTON MAY 21: Pro-choice activists rally to stop states’ abortion bans in front of the Supreme Court in Washington, DC on May 21, 2019.

The Harms of Abortion Restrictions During the COVID-19 Pandemic

By Beatrice Brown

Several states, including Texas, Ohio, and Alabama, have dangerously and incorrectly deemed abortions a non-essential or elective procedure during the COVID-19 pandemic. The stated reason for these orders is to conserve personal protective equipment (PPE), a scarce, important resource for protecting health care workers treating COVID-19 patients.

However, these policies restricting abortion are unlikely to conserve PPE, and more importantly, they mischaracterize the nature and importance of abortions.

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Health care workers in personal protective equipment attend to a patient.

Preparing to Go Back to the Bedside During COVID-19: A Nurse-Turned-Bioethicist Reflects

By Emily Largent

Alarms are going off. They are loud and insistent, demanding the attention of doctors and nurses. I hear them, too.

Roughly a decade ago, I was a cardiothoracic ICU nurse in Los Angeles, California. Working with patients was deeply satisfying, but I regularly encountered ethical challenges that I wanted to address. Therefore, I stepped away from the bedside to go to law school and pursue my PhD in health policy. Now, I live in Philadelphia and work on ethical issues in medical policy and practice.

Recently, though, I renewed my California nursing license and began the process of pursuing a Temporary Practice Permit in Pennsylvania. The COVID-19 pandemic requires us all to sacrifice, to serve in ways that advance the greater good. So, I located the clogs I had pushed to the back of the closet and (literally) dusted them off. My parents sorted through the boxes I’d left in their garage when I moved east for grad school; they found my stethoscope and a few pairs of scrubs and shipped them to me. The box arrived this weekend.

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Box of Hydroxychloroquine Tablets

Human Subjects Research in Emergencies: The Texas Nursing Home “Study” (Part II)

By Jennifer S. Bard

This post is the second in a series about conducting human subjects research in emergencies. These posts are being written in response to a rapidly evolving situation and will reflect the state of knowledge at the time of writing.

In April 2020, Dr. Robin Armstrong, medical director of the Resort, a nursing home in Texas City, Texas, reported “signs of improvement” after he gave hydroxychloroquine, a drug approved by the FDA to treat malaria, to 39 of his nursing home patients who were diagnosed with COVID-19.

At about the same time, information was emerging that now represents the current understanding that hydoxychloroquine isn’t only ineffective in treating COVID-19, but also may cause serious harm to patients. Tensions were raised even higher by the seemingly inexplicable enthusiasm for this treatment by the President and some media outlets.

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baby feet

News on the Fertility Fraud Front: Mortimer v. Rowlette Raises Possibility of Punitive Damages

By Jody Lyneé Madeira

Since families and doctor-conceived children first began to file lawsuits against physicians and clinics alleging “fertility fraud,” a term for illicit physician insemination, each subsequent court order has presented much-needed information about how courts could address these allegations. Mortimer v. Rowlette, pending in the U.S. District Court for the District of Idaho, was one of the first filed, and has provided considerable insight into how these novel claims could be resolved.

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mask

The Disparate Impact of COVID-19 on Individuals with Intellectual and Developmental Disabilities

By James W. Lytle

Katrina Jirik’s compelling post on the dangers posed to people with disabilities if care is rationed during the COVID-19 pandemic powerfully characterizes discriminatory allocation criteria as a form of “updated eugenic thought” that cannot be reconciled with the Americans with Disabilities Act and other anti-discrimination statutes.

I worry, however, that persons with disabilities and other vulnerable populations face an even graver threat:  policymakers may unintentionally adopt policies that neglect to consider the unique needs of persons with disabilities and inadvertently place them at much greater risk.

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covid-19 virus.

New COVID-19 Resources from the Petrie-Flom Center

The COVID-19 pandemic has raised many health law, policy, and bioethical questions. The Petrie-Flom Center is working hard to address many of the issues raised by the pandemic through our scholarship, events, and commentary in the news.

In the interest of sharing this knowledge, the Petrie-Flom Center has collected these resources on a new page on our website. In addition to a list of featured resources is a broader collection of our work on COVID-19. The page is dynamic and frequently updated. Check it out here.

mask, gloves, goggles.

Are Clinicians Without PPE Morally Obligated to Care for COVID-19 Patients?

By Beatrice Brown

There is currently a dire shortage of personal protective equipment (PPE) at hospitals across the United States, especially in areas that have been hit the hardest by COVID-19.

PPE is essential to protecting those on the front lines of the pandemic – the President of the American Medical Association (AMA) has said that without adequate PPE, we may face a shortage of clinicians to treat COVID-19 patients, in addition to other shortages of critical resources.

Without adequate PPE, are clinicians morally obligated to provide care to patients who are either presumed positive for COVID-19 or who definitely have the virus?

Here, I argue that to treat patients without adequate PPE is supererogatory but not obligatory. In other words, this is a noble and praiseworthy act, but clinicians should not be obligated to perform these heroic acts, nor should we blame them, morally, for their decision to refuse to provide care.

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