Why Do the Mentally Ill Die Younger?

Posted on: December 7, 2008  |   Author: Gina
Filed Under: Access to Care, Center for Health Law Studies Symposia, Disability, Other   |   Leave a Comment

Two years ago, the National Association of State Mental Health Program Directors (NASMPHD) published “Morbidity and Mortality in People with Serious Mental Illness,” a study that analyzed data from 16 states and found that on average people with severe mental illness die 25 years earlier than the general population. After the study was released, many mental health agencies in the U.S. made it a priority to determine why their patients died earlier and how to improve longevity in their patient population.

The causes of physical illness and death among psychiatric patients were similar to the general population – cigarette smoking, obesity, diabetes – all of which are treatable. The challenge with seriously mentally ill individuals is that they tend to belong to the lower socioeconomic population and often do not receive the best available health care, with their doctors paying little mind to their physical health.

NASMPHD’s next step may be to educate the doctors who care for the mentally ill. The agency plans to release guidelines for standardizing the medical tests, assessments and care given to mental health patients in the public system. The recommendations include taking regular measurements of patients’ height and weight, checking their glucose levels and carefully evaluating their medication history. Psychiatrists, likewise, are not exempt. Additionally, the Mental Health American organization is now working on an initiative, with the American Psychological Association, to better educate mental health specialists about the physical concerns facing patients with serious mental illness.

To read more, visit http://www.time.com/time/printout/0,8816,1863220,00.html.

Response to Janet Malek: Disability and the Duties of Parents

Posted on: May 9, 2008  |   Author: Garrett
Filed Under: Bioethics, Center for Health Law Studies Symposia, Disability   |   Comments Off

Let me begin by saying that I do not have a history of disability, I have no children who are disabled, and I myself am not disabled in any way, so perhaps my perspective is simply not as attuned to the implications of the strong position that Malek defended in her presentation (for a full discussion of Malek’s arguments see http://lawblogs.slu.edu/healthlaw?p=156). The “strong position” argues that in some situations where potential parents have the opportunity to choose between an embryo without a disability and an embryo with a disability, then the parents have the moral obligation to choose the embryo without a disability. She admitted that her interest in this topic was generated by the much publicized cases of parents who are deaf taking steps to ensure that their child is also deaf, and whether it could be argued that the parents had any moral obligation to have a child without disability. It was my opinion that Malek rather objectively defended her thesis with full understanding of the implications and arguments against her position, while her dissenters seemed to react with vehement and emotional opposition.

The most contentious issue that arose during the presentation, and during the question period that followed, was whether adopting the strong position necessarily results in a devaluation of those currently living with disability. An additional aspect of this critique was that the strong position defines all people living with disability solely by their disability, without taking into account the entirety of the person. At the heart of this question is really how we should define the obligations of a parent. If we accept that a parent has the moral obligation to provide their children with the most possible opportunities, then the strong position seems to be a logical corollary to this stance. Few would argue that parents do indeed have the obligation to provide their already born children with the most possible opportunities, yet when this stance is rephrased in the form of the strong position it suddenly becomes an extremely contentious issue. I cannot disagree that if the strong position does indeed devalue those currently living with disability, then this is a quite offensive stance. So perhaps we simply have to accept that different duties are owed to potential children than to children who have already been born.

However, I would have to agree with Ms. Malek that the strong position does not necessarily devalue those currently living with disability. The strong position does not even take a position regarding the future value of children living with disability, but instead is only a statement regarding the moral obligations of parents. It states that parents simply have the same obligation when choosing a particular embryo from a group that could be implanted, that they do when rearing their children who have already been born – to provide those children with the most opportunities possible. This does not necessarily imply that those with disability have less value than those without, but instead is merely the recognition that disability is a sort of limitation on opportunities. This is not a Gattaca reality where only those who have been genetically altered are normal, but is instead a rejection of the ultra politically correct stance that disability itself does not exist but instead there are only those who are differently abled.

Eugenics History and the Culture Wars (Lombardo)

Posted on: April 28, 2008  |   Author: Garrett
Filed Under: Bioethics, Center for Health Law Studies Symposia, Disability   |   Leave a Comment

As the summary of Paul Lombardo’s presentation, Eugenics History and the Culture Wars: Sterilization and Reproductive Rights, states, 2007 marked the 100th Anniversary of eugenic sterilization in the United States. This commemoration provides the rare motivation to look back at the history of sterilization legislation in the United States and abroad, and to examine the societal context in which it evolved. Eugenics development in history was largely based on the cultural idea of eliminating feeble mindedness based on the now defunct theory that preventing the criminal and disabled from reproducing could eventually rid society of crime and poverty. The basic predecessor for the development of the eugenics movement was the work of Francis Galton and Gregor Mendel, which led to the “Mendelian” theory of inheritance. Ultimately the eugenics movement peaked in the early part of the 20th century with eugenics inspections at Ellis Island, laws against certain classes of people reproducing, and books analyzing the family history of the characteristic of “feeble mindedness.”

However, this less than noteworthy history of eugenic sterilization was not the take-away point of Lombardo’s presentation. Professor Lombardo was careful to explicate that while the popularization of evolutionary theory, courtesy of Darwin and others, was a necessary cog in the development of the eugenics movement, this association should not be used as a “political epithet in the ongoing culture wars.” This association has been further illuminated, rather extensively, in the recent documentary by Ben Stein, Expelled: No Intelligence Allowed. It is precisely the stance taken by Stein that so disturbs Lombardo. There is a scene in Stein’s documentary – and if Michael Moore’s works can be qualified as documentaries, I suppose that rather broad category with all its connotations of simply reporting the facts can apply here as well – where he states that evil can sometimes be rationalized by science, while standing in the Dachau concentration camp. This is a perfect example of the implication argued against by Lombardo, that acceptance of evolutionary theory somehow necessarily results in an acceptance of genocide and ethnic cleansing. It cannot be argued that the association exists, however, the reliance on evolutionary theory, actually social Darwinism, by groups that performed horrible acts does not by implication make evolutionary theory equally as contemptible. The Nazis relied perhaps as extensively on the anti-Semitic writings of Martin Luther, yet no one is rushing to condemn the entire protestant movement because of this association. As Lombardo stated, “We must be careful not to try to shape history to tell the story that we want to tell, and by doing this tie Darwin to all the evils of modern culture.”

Finally, Lombardo ended by discussing the current challenges to the principle of reproductive liberty in the context of the history of American eugenics. However, here it could be argued that Lombardo was making a similar logical error to those that wish to associate Darwinism with ethnic cleansing. It is true that current issues regarding abortion practices that are making their way to the Supreme Court fall under the general category of “reproductive rights.” These rights at issue, however, are very different from the rights that were restricted by eugenic sterilization legislation. The right to be free of any inhibitions that would prevent a person from reproducing is simply not analogous to a right to be free to control all aspects of the reproductive process.

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