Thursday, May 7, 2015
Senate passes human trafficking bill
Excerpted from "Senate Passes Human Trafficking Bill With Abortion Restrictions On
Victims," Huffington Post. April 22, 2015 — The Senate
passed a sex trafficking bill on Wednesday after a bitter, weeks-long fight over
an anti-abortion provision tucked into it. The Justice for Victims of
Trafficking Act passed 99-0.
At its core, the bill has had broad support. It provides resources to law enforcement officials and collects fees from sex traffickers that go into a new fund for victims. But Republicans included language subjecting the victim fund to the Hyde Amendment, the federal provision that bars the use of taxpayer funds for abortions except in cases of rape and incest. Democrats refused to let the bill advance over the Hyde language, particularly because, for the first time, it would have applied to non-taxpayer funds.
It took a month of back-and-forth between Sen. John Cornyn (R-Texas), the bill's author, and Sen. Patty Murray (D-Wash.) to find a compromise. They settled on creating two funding streams in the bill. One collects fines from traffickers and uses them for survivor services, excluding health care. That stream doesn't include Hyde restrictions. The second one comes from community health center funds already subject to the abortion limits.
The deal lets both parties walk away with a solid talking point: Democrats can say they prevented an expansion of Hyde, and Republicans can say they prevented victims of sex trafficking from using federal funds for abortions.
CMDA Health Consultant on Human Trafficking Jeffrey J.
Barrows, DO, MA (Bioethics): “This legislation passed unanimously by
the Senate focuses on the trafficking of children under age 18 and will provide
many resources should it become law. There are provisions that apply to the
healthcare profession, especially those who are “first responders” and
healthcare officials. The bill provides grants to train professionals who
commonly encounter victims of trafficking on how to identify victims of human
trafficking, address their unique needs and facilitate their rescue. Emergency
department personnel are a prime example.
“One study has shown that almost 88 percent of victims of domestic sex trafficking regularly encounter healthcare professionals while being trafficked, especially those working within emergency departments.1 Unfortunately, fewer than three percent of emergency department personnel have been trained on human trafficking and so these victims are rarely identified.2
“CMDA’s Commission on Human Trafficking has addressed the issue of training by developing a series of online educational modules on human trafficking specifically designed for the healthcare profession which can be found at www.cmda.org/tip. In addition, the commission is planning an in-depth training seminar later this year in Atlanta on November 13-14. More information will be forthcoming and registration will be open to anyone who desires to learn more about the interface between healthcare and human trafficking. Any questions about CMDA’s work against human trafficking can be addressed to humantrafficking@cmda.org.
1Lederer L, Wetzel, CA. The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities. The Annals of Health Law 2014; 23:61-91.
2Chisholm-Straker M, Richardson LD, Cossio T. Combating Slavery in the 21st century: The role of emergency medicine. J Healthcare for Poor and Underserved 2012; 23:980-987.
Resources
CMDA’s Human Trafficking Ethics Statement
Commission on Human Trafficking
Human Trafficking Continuing Education
At its core, the bill has had broad support. It provides resources to law enforcement officials and collects fees from sex traffickers that go into a new fund for victims. But Republicans included language subjecting the victim fund to the Hyde Amendment, the federal provision that bars the use of taxpayer funds for abortions except in cases of rape and incest. Democrats refused to let the bill advance over the Hyde language, particularly because, for the first time, it would have applied to non-taxpayer funds.
It took a month of back-and-forth between Sen. John Cornyn (R-Texas), the bill's author, and Sen. Patty Murray (D-Wash.) to find a compromise. They settled on creating two funding streams in the bill. One collects fines from traffickers and uses them for survivor services, excluding health care. That stream doesn't include Hyde restrictions. The second one comes from community health center funds already subject to the abortion limits.
The deal lets both parties walk away with a solid talking point: Democrats can say they prevented an expansion of Hyde, and Republicans can say they prevented victims of sex trafficking from using federal funds for abortions.
| Commentary |
CMDA Health Consultant on Human Trafficking Jeffrey J.
Barrows, DO, MA (Bioethics): “This legislation passed unanimously by
the Senate focuses on the trafficking of children under age 18 and will provide
many resources should it become law. There are provisions that apply to the
healthcare profession, especially those who are “first responders” and
healthcare officials. The bill provides grants to train professionals who
commonly encounter victims of trafficking on how to identify victims of human
trafficking, address their unique needs and facilitate their rescue. Emergency
department personnel are a prime example.“One study has shown that almost 88 percent of victims of domestic sex trafficking regularly encounter healthcare professionals while being trafficked, especially those working within emergency departments.1 Unfortunately, fewer than three percent of emergency department personnel have been trained on human trafficking and so these victims are rarely identified.2
“CMDA’s Commission on Human Trafficking has addressed the issue of training by developing a series of online educational modules on human trafficking specifically designed for the healthcare profession which can be found at www.cmda.org/tip. In addition, the commission is planning an in-depth training seminar later this year in Atlanta on November 13-14. More information will be forthcoming and registration will be open to anyone who desires to learn more about the interface between healthcare and human trafficking. Any questions about CMDA’s work against human trafficking can be addressed to humantrafficking@cmda.org.
1Lederer L, Wetzel, CA. The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities. The Annals of Health Law 2014; 23:61-91.
2Chisholm-Straker M, Richardson LD, Cossio T. Combating Slavery in the 21st century: The role of emergency medicine. J Healthcare for Poor and Underserved 2012; 23:980-987.
Resources
CMDA’s Human Trafficking Ethics Statement
Commission on Human Trafficking
Human Trafficking Continuing Education
The key to a thriving practice
Excerpted from “Majority of ETSU’s Quillen graduates heading into primary
care,” Johnson City Press. April 25, 2015 — As the world
of health care dramatically changes around East Tennessee State University’s
Quillen College of Medicine, Dr. Kenneth Olive, a professor and associate dean
for academic and faculty affairs, is still seeing medical students follow
specialties about which they’re most passionate. The majority of the time,
ETSU’s statistics show that this passion is involved with primary care, which
includes family medicine, internal medicine, pediatrics and general obstetrics
and gynecology. For the May 8 graduating class, 52 percent of the students are
going into the primary care field.
Olive meets with each and every one of the 59 graduates, getting a sense of their time at the Quillen College of Medicine and what path they’re currently on. They discuss job options and how to be competitive as well, citing the changes in health care. Changing reimbursement models, electronic health records, the effects of the Affordable Care Act and the use of team collaboration among health care professionals are some of the topic issues in the field.
Dr. Brian Cross, an associate professor and vice-chair of the Department of Pharmacy at ETSU’s Bill Gatton College of Pharmacy, and Dr. Reid Blackwelder, a medical professor in the Quillen College of Medicine, recently delivered the keynote address at the American Pharmacists Association annual conference in San Diego in late March, centering their talk on the ongoing transformation of the health care system and the need for collaboration to meet the needs of a community and the outcomes a patient meets.
Citing egos and the established hierarchy among health care providers, the pair have made it their mission to start a collaborative mentality early on in a student’s education. “That’s something that we’ve been doing at ETSU,” Blackwelder said. “There’s no question that this is a very powerful and readily available way to improve outcomes.”
Through team collaboration, ETSU’s involvement is leading the charge in the way a patient receives health care in this area, which is getting noticed across the country. In his opinion, the use of team collaboration is huge for community-based medical schools and health care systems.
Family Practice Physician Peter Anderson,
MD: “As a family physician of 30 years, I was negatively impacted by
the changes that came from an aging population, health information technology
and declining reimbursement. But teamwork became my practice’s salvation. As
much as ‘collaboration’ is needed between the larger entities of healthcare like
pharmacy, nursing, behavioral medicine and community resources, it would not
have fixed the difficulties I faced daily in the exam room.
“Two main responsibilities are associated with the primary care exam room. The first is the compilation of a complete medical picture and decisions for the patient’s care. The second is the documentation of data and explanation of decisions to the patient with the necessary education and implementation of actionable steps. The first part is physician work; the second is non-physician work. The first part is effective today because it evolved as medicine advanced. The second is broken and archaic because the process has not changed for the last century.
“We have accepted the notion that only the physician belongs in the primary care exam room. This belief has led to a delivery process that absolutely fails to make primary care physicians accessible. And this failure of the delivery process is the only reason primary care practices are not thriving.
“The problem is the delivery process, not primary care itself. Primary care is incredibly valuable and desperately needed. But the lack of teamwork in the exam room has kept our product from our culture.
“Build a team inside your exam room and your practice will thrive.”
Resources
June 2015 Christian Doctor's Digest Interview with Peter Anderson, MD - Joyful and Efficient Patient Care (CMDA member only content)
The summer edition of Today’s Christian Doctor includes an article by Dr. Anderson with more information about team care medicine. Visit www.cmda.org/tcd for more information when this article becomes available.
Olive meets with each and every one of the 59 graduates, getting a sense of their time at the Quillen College of Medicine and what path they’re currently on. They discuss job options and how to be competitive as well, citing the changes in health care. Changing reimbursement models, electronic health records, the effects of the Affordable Care Act and the use of team collaboration among health care professionals are some of the topic issues in the field.
Dr. Brian Cross, an associate professor and vice-chair of the Department of Pharmacy at ETSU’s Bill Gatton College of Pharmacy, and Dr. Reid Blackwelder, a medical professor in the Quillen College of Medicine, recently delivered the keynote address at the American Pharmacists Association annual conference in San Diego in late March, centering their talk on the ongoing transformation of the health care system and the need for collaboration to meet the needs of a community and the outcomes a patient meets.
Citing egos and the established hierarchy among health care providers, the pair have made it their mission to start a collaborative mentality early on in a student’s education. “That’s something that we’ve been doing at ETSU,” Blackwelder said. “There’s no question that this is a very powerful and readily available way to improve outcomes.”
Through team collaboration, ETSU’s involvement is leading the charge in the way a patient receives health care in this area, which is getting noticed across the country. In his opinion, the use of team collaboration is huge for community-based medical schools and health care systems.
| Commentary |
Family Practice Physician Peter Anderson,
MD: “As a family physician of 30 years, I was negatively impacted by
the changes that came from an aging population, health information technology
and declining reimbursement. But teamwork became my practice’s salvation. As
much as ‘collaboration’ is needed between the larger entities of healthcare like
pharmacy, nursing, behavioral medicine and community resources, it would not
have fixed the difficulties I faced daily in the exam room.“Two main responsibilities are associated with the primary care exam room. The first is the compilation of a complete medical picture and decisions for the patient’s care. The second is the documentation of data and explanation of decisions to the patient with the necessary education and implementation of actionable steps. The first part is physician work; the second is non-physician work. The first part is effective today because it evolved as medicine advanced. The second is broken and archaic because the process has not changed for the last century.
“We have accepted the notion that only the physician belongs in the primary care exam room. This belief has led to a delivery process that absolutely fails to make primary care physicians accessible. And this failure of the delivery process is the only reason primary care practices are not thriving.
“The problem is the delivery process, not primary care itself. Primary care is incredibly valuable and desperately needed. But the lack of teamwork in the exam room has kept our product from our culture.
“Build a team inside your exam room and your practice will thrive.”
Resources
June 2015 Christian Doctor's Digest Interview with Peter Anderson, MD - Joyful and Efficient Patient Care (CMDA member only content)
The summer edition of Today’s Christian Doctor includes an article by Dr. Anderson with more information about team care medicine. Visit www.cmda.org/tcd for more information when this article becomes available.
German mom expecting quadruplets at 65
Excerpted from “German Mom Expecting Quads at 65 Is 'Irresponsible':
Bioethicist,” NBC News. April 14, 2015 — Berlin school
teacher Annegret Raunigk is proudly prolific and, at age 65, not done making
babies — pregnant with quadruplets that would enlarge her family from 13 to 17
children. Raunigk said she became pregnant again because her 9-year-old daughter
asked for a younger sibling. (Her first 12 children — by five men — are ages 22
to 44). She told German tabloid Bild that donated eggs were fertilized
and implanted at a clinic in Ukraine. Multiple attempts were required to get the
eggs to fertilize. She did not say whose sperm was used or if the egg donor was
paid.
What she is doing is unethical. She doesn't think so. But she left her country to receive an infertility treatment that's illegal in Germany due to her age. And she sought that help on the sole grounds that her youngest daughter wants a sibling. Of course, given that logic, future requests by any of her newest kids apparently guarantee no end to her pregnancies.
The number of reasons why this very-late-in-life pregnancy is morally wrong nearly equates to the number of children Raunigk has conceived. But let's stick to the main issues. First, she likely will not live long enough to raise her current children, much less any new kids. It is not fair to children, as adoption agencies know when they limit adoption to those under 55, to intentionally create a family where mom and dad will enter a nursing home as the kids enter junior high.
Making four kids in a 65-year-old body also is irresponsible. The quadruplets are likely to be premature and, if they survive, may pay a steep price for this decision in terms of their health. Her older body makes the pregnancy extremely high risk all the way around. There will be a C-section, which is dangerous for her. And there certainly will be no breast-feeding by mom.
And what clinic would agree to accept as a patient a woman with 13 children — simply because her daughter wants a sibling? What clinic would not insist on a surrogate mom? What clinic would not demand she stay nearby during the pregnancy? What clinic would even let her try to deliver four fetuses?
The answer: One looking to gain fame and clients by engaging in a publicity stunt with nascent lives. Then again, this theoretically could have happened as well in the U.S. where there are no restrictions about who can use technology to have a baby — grandparents, mentally ill, very old single parents, even child molesters. Despite the headlines babbling about "miracles" and "gifts," and despite Annegret Raunigk's insistence that she should be free to reproduce however and whenever she wants, what's needed is a far more thoughtful, moral stance to govern reproductive technology.
CMDA Member John Pierce, MD: “The case of Annegret
Raunigk is another clear example of doing what is ‘…wise in your own eyes’
(Proverbs 3:7a, NIV 2011). In the world, there are arguments for age limits on
IVF including the multiple health risks for the older mother and her infant, as
well as arguments against age limits purporting reproductive freedom, equality
for women (as older men can father a child) and social factors ‘to help fulfill
lifelong dreams.’ Moral arguments might ask questions such as, ‘Is it right to
have a child when the average life expectancy (about 80 years old for women in
the developed world) means the child would be without a mother before driving a
car?’ or ‘On what grounds do you deny the patient her rights?’
“Clear thinking using the principles of autonomy, beneficence, non-maleficence and justice has been supplanted with situational ethics incorporating intense emotions and cultural relativism. Why would we not have these struggles when there is no standard and a crumbling foundation? The law is silent on age in reproductive rights and most medical organizations provide weak recommendations,i leaving the decision up to individual clinics,ii or refute the need for practitioners to use their conscience.iii
“Solomon sincerely asked the Lord, ‘So give your servant a discerning heart to govern your people and to distinguish between right and wrong...’ (1 Kings 3:9, NIV 2011). While we may argue vehemently, the loudest voice will be undeniable examples of healthy relationships, thriving marriages, happy families and renewed minds.”
iEthics Committee of the ASRM. Oocyte or Embryo Donation to Women of Advanced Age: A Committee Opinion. Fertil Steril, 2013;100:337-40.
ii Fisseha S and NA Clark. Assisted Reproduction for Postmenopausal Women, AMA Journal of Ethics, Jan 2014, Vol 16, No 1:5-9.
iiiCommittee on Ethics. ACOG Committee Opinion: The Limits of Conscientious Refusal in Reproductive Medicine. Obstet Gynecol, 2007 (reaffirmed 2013);110:1203-8.
Resources
CMDA’s Assisted Reproductive Technology Ethics Statement
Standards4Life – Infertility and Reproductive Technology
What she is doing is unethical. She doesn't think so. But she left her country to receive an infertility treatment that's illegal in Germany due to her age. And she sought that help on the sole grounds that her youngest daughter wants a sibling. Of course, given that logic, future requests by any of her newest kids apparently guarantee no end to her pregnancies.
The number of reasons why this very-late-in-life pregnancy is morally wrong nearly equates to the number of children Raunigk has conceived. But let's stick to the main issues. First, she likely will not live long enough to raise her current children, much less any new kids. It is not fair to children, as adoption agencies know when they limit adoption to those under 55, to intentionally create a family where mom and dad will enter a nursing home as the kids enter junior high.
Making four kids in a 65-year-old body also is irresponsible. The quadruplets are likely to be premature and, if they survive, may pay a steep price for this decision in terms of their health. Her older body makes the pregnancy extremely high risk all the way around. There will be a C-section, which is dangerous for her. And there certainly will be no breast-feeding by mom.
And what clinic would agree to accept as a patient a woman with 13 children — simply because her daughter wants a sibling? What clinic would not insist on a surrogate mom? What clinic would not demand she stay nearby during the pregnancy? What clinic would even let her try to deliver four fetuses?
The answer: One looking to gain fame and clients by engaging in a publicity stunt with nascent lives. Then again, this theoretically could have happened as well in the U.S. where there are no restrictions about who can use technology to have a baby — grandparents, mentally ill, very old single parents, even child molesters. Despite the headlines babbling about "miracles" and "gifts," and despite Annegret Raunigk's insistence that she should be free to reproduce however and whenever she wants, what's needed is a far more thoughtful, moral stance to govern reproductive technology.
| Commentary |
CMDA Member John Pierce, MD: “The case of Annegret
Raunigk is another clear example of doing what is ‘…wise in your own eyes’
(Proverbs 3:7a, NIV 2011). In the world, there are arguments for age limits on
IVF including the multiple health risks for the older mother and her infant, as
well as arguments against age limits purporting reproductive freedom, equality
for women (as older men can father a child) and social factors ‘to help fulfill
lifelong dreams.’ Moral arguments might ask questions such as, ‘Is it right to
have a child when the average life expectancy (about 80 years old for women in
the developed world) means the child would be without a mother before driving a
car?’ or ‘On what grounds do you deny the patient her rights?’“Clear thinking using the principles of autonomy, beneficence, non-maleficence and justice has been supplanted with situational ethics incorporating intense emotions and cultural relativism. Why would we not have these struggles when there is no standard and a crumbling foundation? The law is silent on age in reproductive rights and most medical organizations provide weak recommendations,i leaving the decision up to individual clinics,ii or refute the need for practitioners to use their conscience.iii
“Solomon sincerely asked the Lord, ‘So give your servant a discerning heart to govern your people and to distinguish between right and wrong...’ (1 Kings 3:9, NIV 2011). While we may argue vehemently, the loudest voice will be undeniable examples of healthy relationships, thriving marriages, happy families and renewed minds.”
iEthics Committee of the ASRM. Oocyte or Embryo Donation to Women of Advanced Age: A Committee Opinion. Fertil Steril, 2013;100:337-40.
ii Fisseha S and NA Clark. Assisted Reproduction for Postmenopausal Women, AMA Journal of Ethics, Jan 2014, Vol 16, No 1:5-9.
iiiCommittee on Ethics. ACOG Committee Opinion: The Limits of Conscientious Refusal in Reproductive Medicine. Obstet Gynecol, 2007 (reaffirmed 2013);110:1203-8.
Resources
CMDA’s Assisted Reproductive Technology Ethics Statement
Standards4Life – Infertility and Reproductive Technology
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