Playing God: Making the Impossible Choices

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. 

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Strange Friend

Madison Boyer, Wake Forest University School of Law J.D. Candidate ’23

Department of Health and Human Services – Project Proposal & Request for Funding

Working Name: Project Talos

I. Proposal Summary

The Project Talos team has collaborated for six years to develop an artificially intelligent physician, or “AIP”. The AIP has the capacity to diagnose and treat all medical conditions complained of by adults. The AIP is a cost-conscious and effective way to ensure access to healthcare for all Americans, who otherwise may be unable to afford the services of a physician. Project Talos is requesting $15,000,000 to complete the necessary coding work, to install Project Talos “Dr. Touring”® AIP stations in pharmacies and primary care offices, and to offset the initial costs of providing healthcare. 

II. Project Description

Project Talos will revolutionize the American healthcare system. Currently, approximately one in four Americans (22%) are not receiving necessary medical care due to cost. Over thirty-one million Americans under the age of 65 do not have health insurance. Project Talos will allow those Americans to access excellent medical care at little to no out-of-pocket cost, whether or not they are insured. 

III. Goals and Objectives

The Project Talos AIP was built with three goals: (1) to promote health on an individual level (“individual health goal”); (2) to promote the overall health of the American population (“public health goal”); and (3) to promote health across generations (“future health goal”). All three goals are constantly monitored by the AIP. If the AIP detects health issues arising, it is independently capable of correcting for error. The AIP was trained on high-quality medical data that was graciously donated by Harvard Medical School. The data was stripped of all identifying information so that the AIP cannot reflect any possible bias concerning age, race, sex, or gender identification. The primary objective of Project Talos is to provide the highest possible quality of healthcare to all Americans at affordable prices. This will encourage patients to seek preventative healthcare services before their condition leads to a medical emergency. The AIP will help millions achieve better health outcomes and lead longer, happier lives.

IV. Conclusion

With the support of the Department of Health and Human Services, and with the eventual approval of the FDA, Project Talos is hopeful that millions of lives will be improved at an extremely reasonable cost to the United States taxpayer.

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North Carolina’s Extended Limits of Confinement: Woefully Underutilized in the Face of COVID-19

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[1], contracting the virus at a rate five times higher than the national average.[2] 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.[3] 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.[4] 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.[5]

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.[6] 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.”[7] 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.[8] Meanwhile, 3,000 inmates, or close to 10% of the prison population, have tested positive.[9] 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.

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The Disproportionate Impact of the COVID-19 Pandemic on Black Americans

by Madison Woschkolup, WFU JD Candidate ’21

The impact of the COVID-19 pandemic on the United States is immense, but this impact has been disproportionately felt by Black communities. In thirty-three states and the District of Columbia, Black people comprise a higher proportion of COVID-19 cases relative to the percentage of the state’s population they make up.[1] In Maine, for example, Black people account for 21% of the state’s total COVID cases, even though only 1% of the state’s total population is Black.[2] In comparison, in all fifty states and the District of Columbia, the percentage of each state’s total COVID cases attributable to white people remains well below the relative percentage of white people in the state. This state-by-state trend extends nationally as well. As of June 2020, the Centers for Disease Control and Prevention (CDC) reported that 21.8% of COVID-19 cases in the United States were Black individuals, despite the fact that this group only represents 13% of the total population.

It is widely recognized that health outcomes of communities of color are objectively worse than those of white communities.[3] In addition to experiencing an increased risk of contracting the virus, Black Americans are also experiencing the highest actual COVID-19 mortality rates nationwide, more than double the mortality rate of their white counterparts.[4] As of August, 1 in 1,125 Black Americans has died from COVID-19, or 88.4 deaths per 100,000.[5] For perspective, the mortality rate for white Americans was 40.4 deaths per 100,000.[6] This gap only increases when the data are adjusted for age differences within the race groups.[7]

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What Do You See?

What Do You See?

By: Emily Burke, JD ’18, Wake Forest University

The cold surface pricked my fingers as I stretched my palms flat against the motorized table beneath me. The coolness sent a chill up my spine, stretching up from the very tips of my toes. It was when the chill spread a dull numbness in my ears that I realized how naked, how vulnerable, and how exposed I was.

I was wearing a hospital gown, laying inside a tunnel beneath a thin, white bedsheet. Away from his gaze. And yet, just as I felt the narrow x-ray beams dance across the sheet, I felt his eyes on me. As the beams skipped across my skin, my heart began to race. I closed my eyes. My brow furrowed as my fingertips pushed    into the table. I was trying to escape the whiteness, the brightness of the tunnel. Just as I lifted my fingers, the blood rushed and pulsed its way back into my fingertips. I swallowed and realized my jaw was clenched. I knew I couldn’t move my hands, or any part of my body, for that matter. I desperately wanted to massage my jaw, my furrowed brow, my pulsing fingers. Instead, all I could do was lay there. Silently.

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What Blinds One Might Blind Another

By: Mary Kate Gladstone, JD Candidate at Wake Forest University School of Law

The Researcher

I still remember the very first day I walked through the doors here.  It was much like the first time you do anything, really. There were nerves and excitement and the ever-sobering realization that I would never be able to do that very thing for the very first time ever again. The research center was situated on the outskirts of the city, lifted up on a small hill where it bounced the early morning sunbeams off of its metallic surface and into the eyes of passersby like myself. The first day I drove up to the center, I had to throw my hand up to my eyes to protect from the building’s blinding reflection. Continue reading “What Blinds One Might Blind Another”

Treating Gun Violence as a Public Health Problem: Exploring Intersecting Root Causes

By: Professor Christine Coughlin, Wake Forest University School of Law

Photo by Fabrice Florin

Run, hide in the closet.”  Little eyes fill with tears and arms stretch out. The teacher gives the children tootsie roll candies and whispers for them to be quiet.  A fifth-grade boy starts to pray.  The children all hold hands as the teacher hugs them.  They huddle in the closet in the music room and wait. . .  

That day, these children were all safe, thanks to the brave teachers and administrators who quickly instituted a lock down, the resilient children who stayed calm, and the fast-acting police force.  For this, I will always be grateful, as this was the scene described to me by daughter, now fourteen, about events that happened to her when she was ten.

I write, in part, because it helps me make sense of a world where alternative facts have become our reality.  However, there are no alternative facts for the events that took place this week in Parkland, Florida:  an 18-year-old with an assault rifle and 17 innocent lives lost.

Continue reading “Treating Gun Violence as a Public Health Problem: Exploring Intersecting Root Causes”