Lady Justice blindfolded with scales.

Achieving Economic Security for Disabled People During COVID-19 and Beyond

By Robyn Powell

The COVID-19 pandemic has highlighted the pervasive inequities experienced by historically marginalized communities, including people with disabilities.

Activists, legal professionals, scholars, and policymakers must critically examine the limitations of our current disability laws and policies, including the Americans with Disabilities Act (ADA), to elucidate why disabled people continue to endure these inequities, including those related to economic insecurity.

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WASHINGTON, DC - OCT. 8, 2019: Rally for LGBTQ rights outside Supreme Court as Justices hear oral arguments in three cases dealing with discrimination in the workplace because of sexual orientation.

Affirming Nondiscrimination Rights: HHS Needs to Acknowledge a Private Right of Action for Section 1557 Violations

By Cathy Zhang

Last week, on the heels of attacks on trans youth and their families in Texas, the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) issued a notice and guidance expressing support for transgender and gender nonconforming youth and highlighting the civil rights and privacy laws surrounding gender affirming care.

OCR all but names the Texas attacks as unlawful under Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability by federally funded health programs or activities. It notes that for federally funded entities, restricting medically necessary care on the basis of gender — such as doctors reporting parents of patients to state authorities — “likely violates Section 1557.”

The guidance directs those who have been discriminated against on the basis of gender identity or disability in seeking access to gender-affirming health care to file a complaint through OCR. HHS can go further, however, by formally acknowledging that individuals have a legal right to enforce Section 1557 when they have experienced prohibited health care discrimination.

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View over woman' shoulder seated at desk, videoconferencing on computer.

Our New Remote Workplace Culture Creates Opportunities for Disabled Employees

By Arlene S. Kanter

While the COVID-19 pandemic has taken an enormous toll on the nation, it has also opened an unprecedented opportunity to transform our workplaces and offer greater flexibility for employees with and without disabilities.

This shift in our workplace culture presents employment opportunities for disabled people that they may not have had in the past, even with the Americans with Disabilities Act (ADA).

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NEW YORK, NEW YORK: MAY 18, 2020: A jogger runs past a banner by the Battery Park City Authority reminding park visitors to please wear face masks.

Negotiating Masks in the Workplace: When the ADA Does and Does Not Apply

By Katherine Macfarlane

Workplaces are, by and large, no longer safe for employees who are high-risk for serious illness or death from COVID-19.

During the early months of the COVID-19 pandemic, it was common for workplaces to require masks, at least in shared spaces. Two years later, though the pandemic is still ongoing, mask requirements are now far less prevalent as a result of the politicization of masks, so-called mask fatigue, and new guidance from the U.S. Centers for Disease Control and Prevention (CDC).

This move to relax masking rules presents significant dangers to those most vulnerable to severe outcomes from COVID-19. High-risk employees still need their co-workers to wear masks. They must now negotiate for safe workplaces in a social and political climate that is increasingly indifferent (or actively hostile) to their needs.

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New York, USA, November 2021: Pfizer Covid-19 Paxlovid treatment box isolated on a white background.

How to Fairly Allocate Scarce COVID-19 Therapies

By Govind Persad, Monica Peek, and Seema Shah

Vaccines are no longer our only medical intervention for preventing severe COVID-19. Over the past few months, we have seen the arrival and wider availability of treatments such as monoclonal antibodies (mAbs), and more recently, of novel oral antiviral drugs like Paxlovid and molnupiravir.

The recent Delta and Omicron surges have made these therapies scarce. The Delta variant led the federal government to resume control over mAb supply and promulgate allocation guidelines. The Omicron variant exacerbated scarcity because only one of the currently available mAbs, sotrovimab, appears to be effective against it. While Paxlovid and molnupiravir are effective against Omicron, both will likely be in short supply for many months. Paxlovid is currently constrained by a lengthy manufacturing process. Molnupiravir — which is substantially less effective — is contraindicated for use in patients under 18 and not recommended for use during pregnancy.

To allocate COVID-19 vaccines, the CDC’s Advisory Committee on Immunization Practices, the National Academies of Sciences, Engineering and Medicine (NASEM), and the World Health Organization (WHO) identified ethical goals for prioritization, such as maximizing benefit and minimizing harm, mitigating health inequities, and reciprocity. These committees, particularly the NASEM and WHO committees, included ethics experts as well as experts in social science, biology, and medicine. Current federal guidelines for therapy allocation, in contrast, do not identify ethical objectives or involve ethics expertise.

In an open-access Viewpoint in Clinical Infectious Diseases, we identify ethical goals for the allocation of scarce therapies. We argue that the same ethical goals identified for vaccine allocation–in particular maximizing benefit, minimizing harm, and mitigating health inequities — are also relevant for therapy allocation. Because many people have now taken steps to mitigate pandemic scarcity, for instance by protecting themselves through vaccination, we argue that reciprocity is also relevant.

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Concept: An ounce of prevention is worth a pound of cure.

The Paradoxical Legal Treatment of Preventive Medicine

By Doron Dorfman

Preventive medicine is a tool used by individual patients, primary care physicians, and governmental agencies to preempt illnesses rather than to treat them after they have arisen. Despite this salubrious aim, stigma, shame, and fear often are attached to the use of preventative care.

The stigma around preventive medicine can arise from the tendency to view such measures as a proxy for risky or otherwise socially marginalized behavior or lifestyle. Why would someone use a preventative measure if they are not at high risk as a consequence of their own choices?

Consider, for example, what I call “sexually charged” preventative health measures like the human papillomavirus vaccine or Pre-Exposure Prophylaxis (PrEP). PrEP is a highly effective daily drug regimen that prevents HIV infection, which has become specifically popular with gay and bisexual men.

As I discuss in a forthcoming paper, PrEP has been viewed by policymakers and health care professionals as a “license for promiscuity” due to the fear of risk compensation, meaning the adjustment of risky behavior by those who take PrEP to potentially have sex with more partners and with no condoms. Such views are reflected in Kelley v. Becerra, a case pending before the U.S. District Court of the Northern District of Texas, where plaintiffs wish to purchase insurance that excludes coverage for PrEP and contraception, to which they object to on religious and moral grounds.

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Patient receives Covid-19 vaccine.

The Target of Health Justice

By Sridhar Venkatapuram 

As we amplify, further develop, and advise in the realizing of health justice, there would be much benefit in clarifying the basic units of moral concern.

This call for more specificity relates to both who is the primary unit of moral concern (individuals, communities, nation-states, etc.) as well as what it is that we care about in relation to them (i.e., liberties, resources including health care, basic needs, respect, opportunities, capabilities, relationships, etc.).

In the current context of the COVID-19 pandemic, where vaccines have become the preeminent goods of value worldwide, I focus my discussion here on how distributing vaccines equitably at the level of geographical units such as districts or nation-states may obfuscate or tolerate injustices, as well as provide suboptimal control of the pandemic.

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SANTA PAULA, CALIFORNIA - CIRCA 1980's: A small-town barbershop, Santa Paula, CA.

The Road to Systemic Change: Health Justice, Equity, and Anti-Racism

By Keon L. Gilbert and Jerrell DeCaille

The health justice movement helps to marry social justice models with equity frameworks.

This critical partnership advances health equity through community-based approaches to health care and social services, collaborations that minimize duplicative services, and the creation of sustainable relationships to advocate for systemic change.

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Photo of doctor's exam room.

Using Health Justice to Identify Inequities Experienced by Employees with Disabilities

By Katherine Macfarlane

Disability discrimination negatively impacts the health of people with disabilities, yet disability law often overlooks discrimination’s health consequences. A health justice framework does not. It recognizes that discrimination impacts health, and then goes a step further, highlighting how legal systems are complicit in perpetuating health injustice. That wider lens better captures the lived experiences of those who experience discrimination, including people with disabilities.

My own work explores disability law’s insistence that disability be confirmed through medical examination. Without confirmation from a health care provider, disability does not exist, and reasonable accommodations need not be provided. A health justice framework has deepened my understanding of the harm those encounters impose. Identifying the full scope of the harm people with disabilities endure is the first step toward dismantling the systems that cause it.

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Top view of white cubicles in modern office with white walls and carpeted floor. 3d rendering.

Challenges Faced by Employees with Disabilities amid the Return to In-Person Work

By Doron Dorfman

Over a year into the COVID-19 pandemic, many employers are calling workers who had been fulfilling their roles remotely back into the office.

In May 2021, for example, Jamie Dimon, the CEO of JPMorgan Chase told employees that by July, they were expected to come back into their offices for at least a few days a week, adding that remote work “just doesn’t work for those who want to hustle. It doesn’t work for spontaneous idea generation. It doesn’t work for culture.” In July 2021, Apple announced its plan to require employees to be in the office at least three days a week.

These calls for getting back to the office raise particular quandaries for employees with disabilities, many of whom have disproportionally borne the brunt of pandemic layoffs.

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