Life as an Extreme Sport

Author: Kelly

Is Phoenix Taking Quarantine Too Far?

AJOB Editors Blog, Bioethics

In a modern day Typhoid Mary case, Arizona has opted to quarantine a man infected with extreme drug resistant tuberculosis (XDR-TB) — in the local county hospital’s Ward 41, the section set aside for sick criminals. Robert Daniels has been locked up there since last summer, and is going to be there…indefinitely. He says that he’s being denied showers, has to clean with wet wipes, and has had his television, radio, personal phone and computer, etc, removed. He is effectively in solitary confinement, visited only by the medical personal who make sure he takes his medication. And I have to wonder — this really the least restrictive method of protecting the public? While I can understand having to remove someone who’s a serious threat to the community during treatment, is (effectively) a jail cell the appropriate place? Why do the Phoenix hospitals not have isolation rooms outside their criminal ward? What are they planning on doing during a major outbreak of any massively contagious disease — toss out the inmates and take over the cells? And why is he being denied a television, radio, personal phone and computer, and etc? It’s not like XDR-TB is going to attach itself to an email and infect the world…

There is an interesting discussion of a ruling by the European Court on Human Rights in this article by Jerome Amir Singh that suggests how to determine if forced quarantine and isolation are reasonable and justified measures (a topic Matthew Wynia wrote on in the January issue of AJOB). The courts ruled with the applicant in a Swedish case where the public health officials wanted to lock up a man who’d spread HIV after being told (basically) to knock it off, saying that “any such detention must be in compliance with both the principle of proportionality and the requirement that there be an absence of arbitrariness such that other less severe measures have been considered and found to be insufficient to safeguard the individual and the public.”

The Arizona XDR-TB case is clearly flunking some of the most basic requirements of confinement for a public health matter. Singh (et al) say that

The use of legally sanctioned restrictive measures for the control of XDR-TB should not obscure the fact that being infected is not a crime. A strong reciprocal obligation is borne by authorities so wishing to invoke these measures. Those who are isolated require humane and decent living conditions. In fact the restriction of their liberties is more for a collective good than for their own. Thus every effort must be made to ensure conditions of living that preserve dignity.

I’m pretty sure being locked up in a cell, no human contact, no mirror, no shower, no forms of entertainment, etc, for an indefinite period of time, is about the furthest you can possibly get from preserving dignity.

-Kelly Hills

Originally posted on the American Journal of Bioethics Editors Blog.

Following Up, with Horns

...and everything else

I’ve written a follow-up to my original thoughts on the Edwardses continuing their campaign in light of Elizabeth’s metastatic cancer for the Medical Humanities blog. I typically don’t fill this blog with references to the other blog posts I make – this blog would become less content and more external linking that way, but I particularly liked this off-the-cuff essay, and suspect some of my more regular readers (especially those familiar with my writing at The Daily) will enjoy it, as well.

Hold Your Breath

AJOB Editors Blog, Bioethics

Not to be left out of the recent slew of video posts, I offer “Hold Your Breath”, a new film from the Program in Bioethics and Film at Stanford’s Center for Biomedical Ethics (whew, long title). A documentary by Maren Grainger-Monsen, Hold Your Breath looks at multi-cultural miscommunication in medicine. From the website,

After fleeing Afghanistan in 1979, Mohammad Kochi settled in Fremont, California and raised his family. Just when life seems to be getting easier for Kochi, he is diagnosed with an aggressive, life-threatening cancer. When Mr. Kochi rejects chemotherapy and instead embarks on a pilgrimage to Mecca, his doctor fears that family members acting as interpreters have misinformed Kochi about the gravity of his disease.Meanwhile, Kochis daughter, Noorzia, blames a culturally insensitive health care system for her fathers rapidly declining health.

This haunting documentary exposes the poignant clash between ancient Islamic traditions and contemporary medical technology through intimate moments of anguish, frustration and hope.

There are screenings across the country, and select PBS stations will also be airing the documentary this month. For those of us unlucky enough to live in markets without either, a short video clip can be seen here.

[With thanks to Rebecca Garden and Audrey Schafer!] — Kelly Hills
[and thanks for the heads up from Maren Grainger-Monsen! – Glenn]

Originally posted at the American Journal of Bioethics Editors Blog.

one common refrain

...and everything else, Academics

Aaah, Google. Every year, you remind me why, if I were to ever leave academia, I would run as fast as I could to your hallowed doors. This year’s 1 April joke is another example of the fabulously twisted humour running through the hacker-run domains of the computer industry. The San Jose Mercury News has a good roundup of recent jokes at Google, and they’re so familiar they ache.

I think the best joke I was ever involved in was probably pulled when I was at Microsoft, and we did similar to the Mercury News mentioned sand in an office. When I was at Microsoft, the Core Networking group was in a newer building with cubiffices – cubicle material, but the walls stretch to the ceiling, forming an office. The nice thing about these, at least from a practical joke point of view, is that they were very easy to break into – just get a ladder, punch your way up through the ceiling (typical office drop down ceiling tiles), and drop yourself gently onto the desk – you were good to go.

Of course, in our case, we didn’t actually want in. We just wanted to get the straw in. For long and ultimately irrelevant and long-gone reasons, we filled the assistant director’s office with straw. A lot of straw. So much straw, I’m not actually sure he could open his door. I’m pretty certain, in fact, we closed the blind to his hall window and then stood there in our own offices, discreetly laughing, as he tried to open his door, finally clued in that we’d had some fun while he was on vacation, and reluctantly went to get the ladder to see just what we’d done. Someone had rigged a webcam on the top of the straw, so when he lifted up the ceiling tile, we could all watch exactly what his expression was – and it was, indeed, priceless. And made the two days of work it took to get the straw out of his office more than worth it.

Of course, I can’t tell a Microsoft story without telling an Apple one (must balance out allegiances); many moons ago (very much dating my time at the company), a bunch of us snuck out from Building 2 and 3, over to Building 6, where we promptly stole every Newton we could get our hands on, replacing them all with etch’n’sketches and notes that “these might be less buggy.”

Aah, good times.

The…staidness of academia is probably one of the things that has been most difficult for me to adjust to. I have a rather well-defined sense of humour, and for years I worked in environments that looked more like overgrown toy stores than offices. I come from a long tradition of office nerf wars, water gun fights, and team built spud guns. The shift from that to the hallowed halls has been interesting, and I often have to reel in my impulse for mischief. And it really hasn’t helped that one of my immediate responses to encountering that sort of staidness is to do something, anything that would counter the mood.

Control wasn’t so hard at the University of Washington, in large part because CHID was a bit more software-industry than most departments, and I worked in the UW computer labs as a sysadmin, where many of the people I worked with shared the hacker humour vibe, and we could send each other stupid, geeky email and play pranks with ease. It was a good escape valve. Here, I’m noticing that sans that escape, I’m a touch pent up and a bit more mischievous than is perhaps wise. Hence my serious consideration of going back into improv comedy. I’ve not been able to join up with the class I’d like to take, due to my travel schedule, but when that calms down I’ll likely find myself on the stage again…for the release, if nothing else. If I’m going to open my mouth to find God speaking, I’d rather it be on a stage than in a classroom.

Still, if you occasionally see the corners of my mouth drift up at inappropriate moments, or catch a far-away gaze in my eyes when I should be focusing on whomever’s lecturing, chances are good I’m just containing impulse and dreaming of running away – not to the circus, but the computer.

collective souls

Bioethics, Politics

All the rest of us who are now collectively soldiers in the war on terror…

The words there are not as surprising, nor do they leap out of the page so much as when they are summarized by others. Over the course of my weekend academic readingsMy final paper for the public health ethics course I’m taking will be on bioterrorism, biodefense, and bioethics. Mmm, bioX., I several times caught the quote “we are all soldiers in the war on terror now”, and every time it was attributed to Art Caplan. It’s the sort of thing that jumps out at you, especially when it seems not quite right, but not for any particular reason you can articulate.

So today, taking a break from virtual work, I grabbed Smart Nice, Not-So-Smart People off my bookshelf, to see if the oft-cited article was in the compilation of essays. Indeed it was, and I could read the entire article. Having read it, I feel more comfortable with the statement Caplan was making, and am a bit amused at seeing it taken so dramatically out of context elsewhere, most likely because it’s imminently quotable taken ever-so-slightly out of context.

But reading the article as a whole, it was really the end of it that hit me. Not for its Caplan-esque quotability, but for the deep sadness knowledge brings about. Caplan says

After the World Wars, Korea, Vietnam and the Gulf War, those who served knew that they would get the medical care they needed. A grateful nation promised them what they had earned.

Medical care that includes falling down rooms, leaking ceilings, mold, unwashed linens. Discharing our veterans with medical injuries and then losing them to followup, or flat out deny their care – that is, if we’re not re-deploying the seriously injured.

If this is how we treat our actual veterans, why do we have any illusions that we will treat the people of our country any better, by granting universal access to health care? Caplan says in his article that “[i]n the new world where each of us is a target and every American is a veteran, we must make the same promise to one another.” I hate to be the bearer of bad news, but we have, and we do. We treat our veterans like we do the rest of the population: we offer a safety net that isn’t actually there, and hope no one actually falls and needs it.