Hannah Norem, Wake Forest University, J.D./M.Div Dual Degree Candidate ’23
Preface: Chaplaincy and End-of-Life Decision-Making
As a hospital chaplain, you have the privilege of experiencing the best and worst parts of patients’ lives. You bear witness to the beginnings of life that take place in a hospital, like births and successful organ transplants. However, you also are in the room when people are experiencing the worst days of their lives. Unspeakable tragedies and accidents, patients coding, and other traumatic events dot a chaplain’s shifts. Hearing a pager go off in the middle of the night and having to rush down to the emergency department to comfort strangers is not uncommon. While this is a normal day in the life of a chaplain, it is not a normal day for the patients and families the chaplain encounters. The difficulty and the ritual found in a chaplain’s everyday life and work do not detract from the sadness of any particular patient encounter but rather attune you to the rhythms of beginning and ending that are integral to the human experience.
From my first days as a chaplain, I heard the same sorts of things again and again. Entering the patient rooms in the ICU, I often found an unresponsive patient teetering in the liminal space between life and death. However, the family that gathered around the bedside, as this was before COVID, painted a robust picture of who this patient was before they found themselves laying in a hospital room, hooked up to countless machines and monitors. So many times, the families that I spoke with said they would have never wanted to be this way. Speaking to families of veteran farmers, resilient teachers, and other pillars of their community, the spouses, siblings, and others portrayed how self-reliantly this person lived but how dependent the patient now was on machines and other people for every facet of their continued existence. How could someone who never needed anything in their life from others now be so helpless? Grieving families looked me in the eyes with their tear-soaked faces time and time again as they explored this painful juxtaposition taking place in front of them.
Continue reading “Living (and Dying) on Your Terms: End-of-Life Decision-Making Before and During COVID-19”
Charlotte Robinson, Wake Forest University School of Law JD ’22
The room feels darker than most. It is cold and uninviting. For someone who works in a hospital, you’d think I would be used to this environment. I should have adapted to it. After all, no one has ever described a hospital as sunny and welcoming. I look around the waiting room of the psychology wing, taking in all the textbooks and self-help books, stewing. As I wait, I can hear every beat of my heart. My ears feel muffled, like when you swim underwater. I finally understand how patients must feel waiting for their doctor to show. Why make an appointment if you can’t commit to the time you offered? The door to her office creaks open, and I hear the small click-click of the doctor’s heels as she walks out to grab me. We walk the three feet back into her office. It’s even darker than the waiting room. Dr. Markin sits down at her desk and opens a folder. It’s thick. I know it’s my patient master file – a simple manilla folder than contains all my patients and their stories. For such a simple folder, it’s mere presence makes me nauseous.
Continue reading “Playing God: Making the Impossible Choices”
by Kristen Kovach, WFU JD Candidate ’21
Michael opened his email on a dreary Tuesday morning. Casually scrolling through the spam messages between sips of coffee, his eyes paused on one message sent to him in the early hours of the morning. “I think your brother is dead,” the subject line read.
Michael froze. His heart pounded in his chest. Sweat beaded on his forehead and dampened his palms. His brother, Todd, had been in prison for drug possession since 2018. The brothers had not spoken in a while. But that’s because it’s just hard to get in contact with prisoners, Michael thought. There’s no way he’s dead.
The email came from his brother’s cellmate, Greg, who said that Michael’s brother had been sick for a while. Todd had been coughing terribly, complaining that his chest hurt, and suffering from a bad fever. Todd thought he had COVID. Two weeks ago, the medics came for Todd. Yesterday, the guards came for Todd’s belongings. Todd never came back.
Continue reading “COVID-19 Has Laid Bare Our Inhumane Treatment of Incarcerated People and Their Families”
By Oluwatemilorun Adenipekun, WFU S.J.D. Candidate ’21
COVID-19 is a serious global challenge, but it is also a wake-up call for the revitalization of universal human rights principles. Governments should ensure that response measures to this novel virus do not target or discriminate against any groups, and that responses are inclusive of and respect the rights of marginalized groups, including people with disabilities and the elderly. Also, governments should guarantee equal access to emergency services for these groups, while working on combating stigma and discrimination by using mass media and school networks to expand public awareness of human rights, recognizing that the virus knows no boundaries and recognizes no distinction.
Continue reading “Right to Treatment During the COVID-19 Pandemic”
by James Hughes, WFU JD Candidate ’22
Due to the infectious nature of COVID-19, our health care system has been forced to evolve in order to appropriately serve patients during this deadly pandemic. Before the public health emergency, roughly 13,000 Medicare beneficiaries received fee-for-service telehealth services per week, while almost 1.7 million Medicare beneficiaries utilized telehealth services in the last week of April, according to Centers for Medicare & Medicaid Services (“CMS”) data. Further, telehealth coverage should be a permanent fixture in our health care system, and the federal government should support telehealth coverage beyond the COVID-19 public health emergency.
Before the public health emergency, the U.S. Department of Health and Human Services (“HHS”) did not provide Medicare reimbursements for audio-visual telehealth visits unless the patient lived in a qualified rural area or was within the confines of certain medical facilities. Reimbursement has historically been the primary obstacle to telehealth services. The Telehealth Services During Certain Emergency Periods Act of 2020 allowed for HHS to modify or waive rules for telehealth under Medicare during the public health emergency, and recently, the American Medical Association asked President Trump, HHS, and Congress to extend some of the telehealth policies used during COVID-19 beyond this public health emergency.
Continue reading “Let’s Continue to Reap the Benefits of Telehealth After the COVID-19 Public Health Emergency”
by Remy Servis, WFU JD/MA in Bioethics Candidate ’22
Amidst the 2020 COVID-19 pandemic in the United States, incarcerated people have been one of the most at-risk subgroups, contracting the virus at a rate five times higher than the national average. Due to overcrowded conditions in prisons and jails, this population has limited opportunity to effectively socially distance, and infection rates are exacerbated by squalid conditions, limited testing, and violence within correctional facilities. Incarcerated persons represent a more vulnerable sector of the population, reflecting the disparities in social determinants of health that affect groups more likely to be incarcerated: racial minorities, those with unstable housing, and those with mental illness. In particular, prisoners over the age of fifty-five experience a uniquely threatening sum of risk due to the uncontroverted finding that COVID-19 has been particularly deadly to older adults, with 80% of deaths in US occurring in patients aged sixty-five and older.
Early in the pandemic, advocates across the country began to call for the early release of incarcerated people who pose a low risk to society, including the elderly and nonviolent. Scholars highlighted how this type of release would assist with “flattening the curve” by removing volume from correctional institutions which are “notorious incubators and amplifiers of infectious diseases.” Regarding the provision of early release, North Carolina has two laws on the books: “Medical Release of Inmates”, passed in 2008 and codified at N.C. Gen. Stat. § 15A-1369, and N.C. Gen. Stat. § 148-4, which provides for state discretion in granting “Extended Limits of Confinement” (ELC). Both of these statutory options have their strengths and weaknesses, but the state has chosen to utilize its more amorphous powers under ELC to mitigate the release of select inmates. However, due to disappointingly narrow release criteria, only about 300 inmates (out of 34,000 total in state facilities) have been granted this ELC privilege. Meanwhile, 3,000 inmates, or close to 10% of the prison population, have tested positive. The ELC law, as it is currently formulated, is a lackluster response from the state of North Carolina to the threat of coronavirus in the state prison population. These ELC policies and eligibility criteria should be appropriately modified given the deadly context of this pandemic and any future virulent public health emergencies.
Continue reading “North Carolina’s Extended Limits of Confinement: Woefully Underutilized in the Face of COVID-19”
by Carley Fisher, WFU JD Candidate ’21
COVID-19 reached U.S. shores sometime early this year; the first laboratory confirmed test was discovered on January 20, 2020 and reported to the CDC two days later. To date, the number of COVID-19 cases in the United States has risen to over 8 million, with over 200,000 lives tragically lost.
The end of the disease is not yet in sight, and while countries have remained innovative in their approach to caretaking, an early concern still exists: will patients be able to obtain hospital access? This question is as important to non-COVID-19 related patients as it is to COVID-19 patients, and the issue becomes especially acute in the face of a pandemic surge.
Continue reading “Convalescing in the Era of COVID-19”
By Nnaemeka Obiagwu, 2021 J.D. Candidate
With the advent of the coronavirus pandemic in the United States, telemedicine has been brought to the limelight because it provides an opportunity for patients to have access to quality care remotely, particularly patients that need to be quarantined as a result of the outbreak. Given that data breaches are a critical issue for the health care industry and with telemedicine being offered online, it is understandable why patients are uncomfortable with sharing personal information with their providers. Last year, the healthcare sector saw a whopping 41.4 million patient records breached fueled by a 49 percent increase in hacking, and in the first half of 2020, 41 healthcare providers reported falling victim to ransomware.
Continue reading “Cybersecurity Concerns Impacting Telemedicine During The COVID-19 Pandemic”