The Daily – Toward Insuring Immigrants

Toward insuring immigrants
2006-05-01

The older Asian woman tugs insistently at the young blonde doctor’s coat, pulling her out into the pouring rain, talking in a foreign tongue.

The doctor, a new intern, is confused but following. What she finds shocks her: a young woman by the dumpster, face lacerated and in need of stitches.

The intern tries to convince the young woman to come inside, but in broken English she refuses. She’s afraid. She’s an illegal, as is her mother. There was an accident in the factory, could she please be stitched up?

Time slows and the intern faces her options. Just as fast, time snaps back into place and the intern slowly moves around the hospital, gathering the supplies she’ll need to stitch the laceration in the parking lot.

She gets the young woman, now her patient, to promise she’ll come back to have the stitches removed. The woman promises and disappears. She never comes back.

Chances are good that if you’re a fan of the television show Grey’s Anatomy, this scene is familiar to you. After all, it played out during a first-season episode, with Dr. Izzy Stevens as the young intern treating the illegal Asian immigrant.

Chances are also good that you’re aware that there is a large immigration rally this Monday afternoon.

Smell a coincidence? I didn’t think so.

Immigration — legal and illegal — is a contentious issue in our country. So it only made sense to talk about the issue of illegal immigrants and the strain placed on our medical system.

To be very clear on my position, I support immigration.

I think it should be easier to immigrate to this country. I think that if people honestly believe that if those farm and sweatshop workers just weren’t there Americans would step up and harvest those berries in the burning sun or spend hours a day over a sewing machine for low, low wages, they are, in a word, delusional.

No offense.

Illegal immigration does more than impact the theoretical jobs available for Americans (legal immigrants or those born here).

It seriously impacts our hospitals, in two ways.

First, I suspect we have all been in the situation where we’re in the ER because we’ve been sick, or injured; perhaps you were kicked across the room during a slightly rowdy party, breaking your wrist.

But I digress. You sit in that waiting room, and you wait. Depending on what’s wrong, you wait.

Depending on the time of the day, and where you’re located, if you’re a non-emergency case, you can wait for quite a long time.

As many before me have pointed out, waiting often happens because people who don’t have insurance are using the ER as a place to receive basic medical care.

Any hospital in the United States that receives funding from Medicaid is required to treat any patient who appears in the ER.

What this means, practically speaking, is that anyone without insurance tends to end up in the ER to have non-emergency issues treated.

That person’s lack of payment is ultimately passed on to those who can pay. This is the second significant impact illegal immigrants have on our hospitals.

I don’t think this translates into throwing all the illegal immigrants out, locking down the country and building giant walls, and not just because it’s not terribly practical.

What I think this means, at least from a big and cuddly humanist point of view, is that we need to fix the system so illegal immigrants can pay into insurance policies and, even more importantly, not be afraid of accurately reporting address and other information to the hospital itself.

It might be woefully idealistic, but I believe that if we remove the fear of deportation, illegal immigrants will be more inclined toward providing accurate information and working with the hospital to cover medical costs.

The Daily – Pharmacists’ moral acumen

Pharmacists’ moral acumen
2006-04-24

One of the more interesting and underrepresented facts about many women’s health providers — places that are routinely targeted because they provide low- or no-cost birth control for women, as well as access to abortions — is that they often offer other health services, such as flu shots and general health exams.

Sometimes, antibiotics are prescribed.

Most of these clinics don’t have on-site pharmacies, so it is up to the patient to go elsewhere to have the prescription filled.

Or, as was the case with a patient from the Cedar Rivers Clinic, which has facilities in Renton, Tacoma and Yakima, Wash., the prescription is called into a pharmacy for pickup.

Unfortunately, in May 2005, a pharmacist at the Swedish Medical Center outpatient pharmacy took it upon him or herself to decide it was morally unacceptable to receive antibiotics from a clinic that provides access to birth control and abortion, and refused to fill the prescription.

That’s right. A pharmacy refused to fill a prescription based on who prescribed it.

“Well maybe,” you try to rationalize to yourself, “the pharmacist believed that it was an abortion-related complication and they felt complicit?” Ignoring the logic behind that, which basically says that someone deserves an infection, let’s move to another example.

At a Safeway in Yakima, Wash., a pharmacist refused to fill pregnancy-related vitamins for a pregnant woman who was receiving healthcare from Cedar River Clinic. This is a woman who was making an active effort to have a healthy pregnancy.

The Safeway pharmacist reportedly repeatedly quizzed the woman why she needed the pills (seems obvious to you and me, eh?), and then launched into why she was going there.

There.

As if the woman should be castigated for receiving healthcare for her pregnancy.

My friends know that I often play devil’s advocate for pharmacists who decline filling Plan B or chemical abortificant prescriptions on moral grounds.

My reasoning for this is that in some ways you can argue that the filling of these prescriptions does directly force the pharmacist to participate in the providing of a service they morally oppose — what they view, rightly or otherwise, to be abortions.

We do not force doctors to perform abortions on women who want them, and I think it’s reasonable to extend this logic to pharmacists.

But these pharmacy moral-police are overstepping their boundaries when they begin denying prescriptions based on who writes them.

If a pharmacist decides he or she has the moral acumen to decide if someone should or should not have access to antibiotics, what’s next?

Denying someone their AIDS cocktail?

Refusing to fill someone’s prescription for methadone, since maybe they’re lying about having chronic pain and they’re really a heroin user in recovery?

Maybe these morally righteous pharmacists will determine that you shouldn’t have access to any “Class II drugs,” or that you’ll need to provide documentation of your illness before they release the prescription to you.

The potential nightmares can be spun out for a while.

Thankfully, the Washington State Pharmacy Board realizes the potential for abuse, while also recognizing the right of the pharmacist to conscientiously object to some prescriptions, such as Plan B.

Late last week, the board released its first draft of a new rule outlining a pharmacist’s right to refuse prescriptions.

While the exact wording of the rule remains uncertain as it undergoes further revision, so far the indications have been pretty clear: Pharmacists have the right to a conscientious clause only so long as there is another pharmacist on site or closely nearby who can fill the contested prescription.

Which is how it should be. Pharmacists dispense medicine, they don’t practice it.

The Daily: Finding Saviour in a Sibling

Finding a savior in a sibling
Publish Date: 2006-04-17

This at last is bone of my bone and flesh of my flesh.

The paper reads, “‘Designer Baby’ clinic to charge ?6,000 a child.”

That’s a lot of money, even for an in-vitro fertilization (IVF) kid. The second sentence in the article explains, in a simple phrase, why: Savior siblings.

Savior siblings are not a new concept, and parents have been creating them for years.

Parents of sick children will, after all, go to great lengths to help their child, and savior siblings are children born in the hope that they will be genetic matches for a sick relative.

This option took on new life in 2000, when Adam Nash was born.

The Nash’s had a little girl with a disease that causes leukemia, and often death at a young age. Doctors theorized that cord blood from a donor would extend Molly’s life and prevent leukemia.

(Cord blood contains adult stem cells. The recipient is irradiated, killing his or her original bone marrow, and then infused with the blood. The stem cells migrate to the bone and begin creating new marrow.)

Molly’s parents underwent 4 rounds of IVF therapy combined with pre-implantation genetic diagnosis (PGD), ultimately creating 24 healthy embryos. Of those embryos, five were a match for Molly, and one implanted and was brought to term.

At Adam’s birth, the cord blood was collected; a short time later it was infused into Molly.

Today, Molly is an active sixth grader, thinks her younger brother is a pest, and adores her baby sister, Delaine.

Until now, Adam and the handful of other savior siblings have been a relative rarity. Most insurance companies will not cover IVF, let alone an IVF/PGD combination, and the out-of-pocket cost is staggering.

If the prospective parents can get around the cost hurdle, they still have to find a doctor, or a willing team of specialist doctors, to assist them. While many doctors have the expertise, the controversy around the practice has limited its availability.

This controversy is what brings designer-baby clinics to the news this week.

What, exactly, is that controversy?

First, people criticize the idea of savior siblings by saying that instead of each individual being an end unto themselves, savior siblings are used as a means to an end and that children should be wanted solely for being that child, not for being spare parts for another.

But the argument almost never stops at this admittedly valid concern.

Instead, it deviates.

It ceases to be about savior siblings, or even about a baser debate around IVF/PGD and whether it is an active form of eugenics.

The argument goes from what is possible to potential, from medicine and eliminating disease to a blonde-haired, blue-eyed, post-Nazi era, speculative fiction-fueled, designer-baby slippery slope.

This, inevitably, is where the debate circles and stops, going no further. That’s the shame in this whole mess.

Saying that creating babies that are free of a genetic disease, or are tissue matches for siblings, will lead to a genetically designed race of tall, blonde, buxom and blue-eyed babes who can all play the piano like Beethoven while writing like Austen is a non causa pro causa fallacy.

This sort of causal fallacy says that if A happens, then by a small series of indeterminable steps, Z will eventually happen and since they are tiny steps, we won’t be able to draw a line that should not be crossed.

And if Z shouldn’t happen, then neither should A.

The problem with this argument should be very clear: Anything has the potential to be used for ill.

What we should focus on is not the technology, but the people using it.

What we should focus on is not trying to stop medicine from preventing illness and curing disease, but making sure people are educated about the possibilities inherent in technology.

We should be discussing the idea of savior children and whether it’s okay for a human being to be created as a means to an end, or if those who’re so intentionally created have more thought gone into them than most.

Shay Saves the Day

I took Shay’s advice, after pounding my head against my thesis so long I swear I’ve a large purple bruise on my forhead. I collected together all my writing in one document, in roughly the order I thought it should all go in. I then expanded around each section, explaining what else I thought needed to go in around these fuller paragraphs.

Suddenly, I have 20 pages of thesis. Which is between 1/3-1/5th of the way done with the project, and 20 pages more than I had yesterday.

More importantly, by far more importantly, I actually feel, now, like this is something I can do.

Autopoiesis in Action

I had one of the most amazing experiences in class today. It was the first truly “Thurtle” lecture, and towards the end of the class we started talking about what happens to our body when we go on the internet, where do “we” exist, and so forth. If you’re not taking the class or part of the Thurtle ducklings, it’s understandable if you just scratch your head and say “bwuh?”

Anyhow, I offered to the class that the internet itself is a body that we inscribe meaning upon, just as meaning it inscribed upon us – by other people, and by the internet. That it is an organized body as much as we are. And as I started saying this (admittedly more elegantly than this), Phillip’s lips twitched up and he got this most amazingly satisfied smile – you see, this was one of the first arguments he and I had, only I was very firmly arguing against the idea of the internet as a body. Lo, what difference two years makes.

About 10 minutes later, the discussion about the body has continued…and Phillip mentions a beautiful passage from Shantideva, asking where “I” resides – does “I” reside in the fingers, the hand, the arm?

It was my turn to light up, smiling and containing my glee just barely. You see, I gave Phillip that article on Shantideva over a year ago.