Playing God: The Legality of Plans Denying Scarce Resources to People with Disabilities in Public Health Emergencies

Public health emergencies can arise in a number of different ways. They can follow a natural disaster, such as Hurricane Katrina, the 2004 tsunami, and the recent earthquakes in Haiti and Chile. They may be man-made, such as the September 11 attacks and the anthrax scare. They may also be infectious. While no pandemic flu has yet reached the severity of the 1918 flu, there have been several scares, including avian flu and most recently H1N1. Few questions are more ethically or legally loaded than determining who will receive scarce medical resources in the event of a widespread public health emergency. The answer will often mean the difference between life and death for affected Americans. Despite this reality, or perhaps because of it, there has been little guidance from the federal and state governments on how to prioritize distribution of those resources among individuals. To fill this gap, some public health and medical organizations promulgated protocols that set forth a hierarchy of resource allocation in response to the predicted H1N1 pandemic. Although these efforts at advance planning are to be lauded, they raise a number of troubling civil rights issues. Several of the protocols exclude some people with disabilities from receiving care even when their disabilities do not affect the likely success of the medical interventions at issue. Both the legality of such plans and the ethical implications of promoting the health of the community at the expense of people with disabilities are highly problematic. This Article explores the legality of the proposed allocation protocols under the Americans with Disabilities Act (ADA) and the Rehabilitation Act. It also evaluates their compatibility with the ethical principles that guide public health decisions and discusses their implications for people with disabilities in the preplanning for public health emergencies

The Impact of Disability: A Comparative Approach to Medical Resource Allocation in Public Health Emergencies

It is a matter of time before the next widespread pandemic or natural disaster hits the United States (U.S.). The international response to the 2009 H1N1 influenza stands as a cautionary tale about how prepared the world is for such an emergency. Although the pandemic fortunately proved to be less severe than initially anticipated, it nevertheless resulted in shortages of medical equipment, overburdened hospitals, and preventable patient deaths, particularly among young people. A pandemic will inevitably lead to difficult decisions about the allocation of medical resources, such as who will have priority access to ventilators and critical care beds when demand exceeds supply. We previously evaluated the protocols public health and medical organizations have promulgated to guide allocation decisions in a public health emergency. We concluded that many of these protocols violate U.S. law and ethics with respect to people with disabilities, because they exclude some people with disabilities from receiving care altogether or because of a need for prolonged use of resources, poor “quality of life,” or limited long-term prognosis. Because the legal and social status of people with disabilities is tied to underlying societal attitudes toward impairments, cultural differences between populations may lead to significantly different distributive outcomes. In this paper, we examine other countries’ approaches to the allocation problem in public health emergencies, both to identify other approaches to these challenging problems and to provide insight into how to develop more equitable policies to guide allocation decisions during a public health emergency in the U.S

Territorial Integrity Treaties, Uti Possidetis, and Armed Conflict over Territory

Paper presented at the 2006 Shambaugh Conference Building Synergies: Institutions and Cooperation in World Politics, University of Iowa, 13 October 2006. Earlier versions of this paper were presented at the 37th Annual Meeting of the Peace Science Society (International), Ann Arbor, November 2003, and the 45th Annual Meeting of the International Studies Association, Montreal, March 2004. The authors wish to thank Ashley Leeds, Bumba Mukherjee, Chris Reenock, and Jeff Staton for their valuable comments and suggestions, while taking full blame for all errors and interpretations herein. Abstract A recent article suggests that a norm of territorial integrity spread rapidly across the globe during the twentieth century. While the successful acquisition of territory by force has become much less frequent, though, there have been numerous attempts to acquire territory by force during this time, and there appear to be several different types of obligations in territorial integrity treaties. Drawing from the content of treaties with territorial integrity provisions, we reconceptualize the norm to distinguish between treaties guaranteeing territorial integrity in a general sense and those that only proscribe the acquisition of territory by force, and we examine an important precursor in the nineteenth-century Latin American norm of uti possidetis juris. We find that both norms seem to have been associated with generally increased low-level conflict over territory but (at least for general territorial integrity obligations and for the Latin American states that developed uti possidetis) less of the more intense forms of conflict

Excitonic condensate and quasiparticle transport in electron-hole bilayer systems

Bilayer electron-hole systems undergo excitonic condensation when the distance d between the layers is smaller than the typical distance between particles within a layer. All excitons in this condensate have a fixed dipole moment which points perpendicular to the layers, and therefore this condensate of dipoles couples to external electromagnetic fields. We study the transport properties of this dipolar condensate system based on a phenomenological model which takes into account contributions from the condensate and quasiparticles. We discuss, in particular, the drag and counterflow transport, in-plane Josephson effect, and noise in the in-plane currents in the condensate state which provides a direct measure of the superfluid collective-mode velocity.Comment: 7 pages, 3 figure

A Daily Diary Analysis of Condom Breakage and Slippage during Vaginal Sex or Anal Sex among Adolescent Women

Background Adolescent women Adolescent women are disproportionately impacted by the adverse outcomes associated with sexual activity, including sexually transmitted infections (STI). Condoms as a means of prevention relies upon use that is free of usage failure, including breakage and/or slippage. This study examined the daily prevalence of and predictors of condom breakage and/or slippage during vaginal sex and during anal sex among adolescent women. Methods Adolescent women (N=387; 14 to 17 years) were recruited from primary care clinics for a longitudinal cohort study of STIs and sexual behavior. Data were daily partner-specific sexual diaries. Random intercept mixed effects logistic regression was used to estimate the fixed effect of each predictor on condom breakage/slippage during vaginal or during anal sex (Stata, 13.0), adjusting model coefficients for the correlation between repeated within-participant diary entries. Results Condom slippage and/or breakage varied across sexual behaviors and was associated with individual-specific (e.g., age and sexual interest) and partner-specific factors (e.g., negativity). Recent behavioral factors (e.g., experiencing slippage and/or breakage in the past week) were the strongest predictors of current condom slippage and/or breakage during vaginal or anal sex Conclusion Factors associated with young women’s condom breakage/slippage during vaginal or during anal sex should be integrated as part of STI prevention efforts, and should be assessed as part of ongoing routine clinical care

Std fimbriae-fucose interaction increases Salmonella-induced intestinal inflammation and prolongs colonization

Author summary The intestinal epithelium is a crucial biological interface, interacting with both commensal and pathogenic microorganisms. It’s lined with heavily glycosylated proteins and glycolipids which can act as both attachment sites and energy sources for intestinal bacteria. Fut2, the enzyme governing epithelial α1,2-fucosylation, has been implicated in the interaction between microbes and intestinal epithelial cells. Salmonella is one of the most important bacterial gastrointestinal pathogens affecting millions of people worldwide. Salmonella possesses fimbrial and non-fimbrial adhesins which can be used to adhere to host cells. Here we show that Salmonella expresses Std fimbriae in the gastrointestinal tract in vivo and exploit Std fimbriae to bind fucosylated structures in the mucus and on the intestinal epithelium. Furthermore, we demonstrate that the Std fimbriae-fucose interaction is necessary for bacterial colonization of the intestine and for triggering intestinal inflammation. These data lend new insights into bacterial adhesion-epithelial interactions which are essential for bacterial pathogenesis and key factors in determining tissue tropism and host susceptibility to infectious disease

Dipolar superfluidity in electron-hole bilayer systems

Bilayer electron-hole systems, where the electrons and holes are created via doping and confined to separate layers, undergo excitonic condensation when the distance between the layers is smaller than typical distance between particles within a layer. We argue that the excitonic condensate is a novel dipolar superfluid in which the phase of the condensate couples to the {\it gradient} of the vector potential. We predict the existence of dipolar supercurrent which can be tuned by an in-plane magnetic field and detected by independent contacts to the layers. Thus the dipolar superfluid offers an example of excitonic condensate in which the {\it composite} nature of its constituent excitons is manifest in the macroscopic superfluid state. We also discuss various properties of this superfluid including the role of vortices.Comment: 5 pages, 1 figure, minor changes and added few references; final published versio