Viewing entries by
Songhan Pang

TOXICITY: ETHICS OF THE BLACK PLUME AND CHEMICAL VIOLENCE ON COMMUNITIES

Comment

TOXICITY: ETHICS OF THE BLACK PLUME AND CHEMICAL VIOLENCE ON COMMUNITIES

Recently, a large black cloud hovered over the small town of East Palestine, Ohio — chemicals released from a massive train wreck were burning en masse. At face value, a “mushroom cloud” of chemicals cannot be good. This accident garnered national intervention; it demonstrated how a toxic plume is a sign that a community has been subjected to chemical violence. The derailment has since become one of the United States’ highest-profile chemical disasters in recent years [1]. While the East Palestine, Ohio incident should be addressed in its severity, it should not overshadow the communities who have, time and time again, silently suffered from chemical violence as a result of industrial pollution. Rather, widespread public attention offers a chance for state and national leaders to have high-level conversations about such communities and take action. 

Industrial pollution is not a new phenomenon in the United States. Communities near power plants, factories, or any other industrial area are disproportionately exposed to air-born toxins, and resultantly have high rates of cancer. Yet, these toxins are just that — airborne. Without bringing in the necessary equipment and personnel, the toxins are hard to determine as harmful. And, without a telltale sign of the toxic plume, citizens have little basis to prove on their own that they are victims of chemical violence. 

Air quality has improved over the past few decades in the United States through the persistent struggle of community advocates to garner votes and translate community voices into action [2]. Nevertheless, recent years have seen an uptick in petrochemical factory locations, especially in Louisiana, one of the most affected states. The “Cancer Alley” – a nickname for the stretch of the Mississippi River between New Orleans and Baton Rouge – has a high concentration of such factories and cancer diagnoses. With little intervention from state governments on everyday toxicity, it is evident that industrial companies continue to have leverage over the health and well-being of ordinary citizens. 

When citizens’ biological illnesses go unrecognized, a new battle ensues — what can one do to obtain state assistance for an ailment that is out of their control? Chloe Ahmann, an Assistant Professor at Cornell University, describes the concept and practice of toxic disavowal as a way for such citizens to gain support. Toxic disavowal is the state where citizens who have been subject to chemical or biological harm choose not to be a toxic subject to the state, in order to receive state assistance. How and why would a person willingly become a toxic subject? When a community of people are affected by a chemical disaster, there are often not enough resources in that community to bring it back to health on its own. Think of events such as Hiroshima and Chernobyl, to industrial neighborhoods constantly harmed by pollution — the consequences as deadly as they are invisible. The people affected then have an opportunity to appeal as toxic subjects to their government in hopes of obtaining the benefits and care they need [3]. Ideally, the state recognizes the toxicity and takes action to prevent its harm. However, less visible chemical attacks are more likely to be swept aside, or even ignored. 

According to Ahmann, the citizens of Wagner’s Point, an industrial and former residential area in Baltimore, Maryland, had grimly suffered years of biological symptoms without government intervention. Images of their everyday suffering are poignant and shocking: snow would turn rainbow like “asphalt tinged with gasoline,” and year by year, chemical plants advanced until the communities seemed engulfed in toxicity [3]. The citizens, having no way to prove that the industrial chemicals were the cause of their suffering, decided to engage in toxic disavowal when a series of petrochemical explosions happened nearby. In other words, they chose not to become toxic subjects and instead pushed their government to take down the residential area because frequent factory explosions put them at risk of chemical violence [3].

The idea worked to an extent. Residential living did end up being cleared at Wagner’s Point, and citizens moved out [3]. Yet, if there had not been physical proof — dangerous explosions — of life being untenable at Wagner’s Point, then perhaps even this attempt would have left governments unconvinced. For chemical violence awareness to truly change the lives of those affected, stakeholders must recognize the slow and invisible impact of toxicity on a daily basis. 

The East Palestine train derailment reveals the resources that governments have at their disposal to test for chemical risk. Within four days of the accident, the U.S. Environmental Protection Agency discovered multiple hazardous chemicals released into the environment, including vinyl chloride, a colorless gas that can cause dizziness and headaches in the short-term, and liver cancer in the long term [1]. Bringing these same detection tools to smaller communities at risk can give the citizens there the transparency they need, or at least baseline recognition of their dangerous daily living conditions. Just recently, EPA chief  Michael Regan traveled to Louisiana to announce a proposal to sharply reduce toxic emissions in the state and around the country [4]. Taking in the train derailment as not just a tragedy, but an area of growth is a step in the right direction for public health and environmental regulators. 

It goes without saying that healthy air is a basic need of human life. Governments, agencies, and companies alike have an opportunity to reverse their complacency and truly prove that they can make lives of everyday people safer. Above all, we should not wait for the black plume. 



References

  1. Fortin, J. (2023). Ohio train derailment: Separating fact from fiction. The New York Times. https://www.nytimes.com/2023/02/28/us/ohio-train-derailment-east-palestine.html.

  2. Baurick, T., Younes L., & Meiners, J. (2019). “Welcome to ‘Cancer Alley,’ where toxic air is about to get worse.” ProPublica. October 30, 2019. https://www.propublica.org/article/welcome-to-cancer-alley-where-toxic-air-is-about-to-get-worse.

  3. Ahman, C. “Toxic disavowal.” (2020). Somatosphere. http://somatosphere.net/2020/toxic-disavowal.html/.

  4. McFadden, C., Reimchen, K., & Schapiro, R. “EPA Chief Goes to ‘Cancer Alley’ to Announce Proposal to Cut Toxic Air Emissions.” (2023). NBC News. https://www.nbcnews.com/news/nightly-films/epa-chief-regan-cancer-alley-louisiana-proposal-toxic-air-emissiions-rcna78381.

Comment

Physician Assisted Suicide: A Good Death Should Not Eclipse a Good Life

Comment

Physician Assisted Suicide: A Good Death Should Not Eclipse a Good Life

What comes to your mind when you think of death? While death is an uncomfortable subject to ponder, it is one of our few unavoidable certainties. Due to modern technological advances, there has been an overall increase in the life expectancy of the general population. However, the incidence of terminal diseases such as cancer also increases with age. Patients and their loved ones, in turn, must face difficult but necessary conversations deciding how to cope with death. This process is often unpredictable, scary, and painful. Physician assisted suicide (PAS), also referred to as physician-assisted dying or euthanasia, has been fiercely debated in the U.S. over the past few decades as a way to control our deaths. PAS must have strict legal safeguards for the practice to be truly effective at putting patients’ well-being in life first.

Before examining the implications of PAS policy on human life and death, it is important to define its definition and history. According to professors at the University of Pennsylvania’s Department of Medical Ethics and Health Policy, PAS is defined as when physicians intentionally administer “medications or other interventions to cause the patient's death with the patient's informed consent” [1]. Medical professionals are in wide consensus that involuntary and nonvoluntary PAS are unethical as they end the life of the patient without their informed consent — a doctrine that protects patients’ right to their own body [2]. As such, they should not be the subject of this debate. Voluntary PAS on the other hand has been slowly gaining support from different countries around the world, from Switzerland’s legalization of the practice in 1942 to most recent approval in Canada, New Zealand, and Australia. In the United States, PAS is authorized in 10 states and 1 district, including but not limited to Oregon, Maine, and Washington D.C. Therefore, the growing legalization of PAS warrants serious discussion on how it should be applied in medical settings. 

Legalizing PAS helps some patients to regain autonomy and dignity in death. In deciding exactly how and when they will die, it creates a space for mourning that would not otherwise be there if the patient was either unconscious in critical life support, or suffered a sudden death. In one example, Avivah Wittenberg-Cox recalled that her mother used Canada’s Medical Assistance in Dying (MAID) program to end her life [3]. She believed this decision empowered her mother to live as an “essentially whole person, brave, realistic, [and] facing the truth of life and inevitable death.” Using MAID, her mother was able to pass away with family by her side in her own home instead of the hospital. For the mentally capable, terminally ill patients in particular, choosing PAS may relieve their suffering by owning autonomy and coming to terms with death. PAS holds the key to a meaningful death for some patients.

We must not, however, forget that the implication of PAS is death. Strict legal safeguards must be enforced to prevent the unethical use of this practice. Patients experiencing immense physical and mental suffering should not choose PAS as their only or first option of relief. Instead, after assessing the patients’ unique circumstances, physicians should consider PAS alongside other end-of-life care options that provide progress and hope towards a better life. For instance, palliative care, medical services geared at optimizing a patients’ quality of time regardless of if they have a terminal illness or not, can actually increase one’s lifespan despite physician prognoses [4]. Other options that should be considered are psychiatric evaluations or home healthcare services. Overall, physicians can continue to serve as stewards of autonomy and dignity in their own institutions to make a holistic assessment on their patients’ needs, instead of turning to death immediately.

Without strict legal safeguards on PAS, institutions put forth the idea of planned death as the first course of action, indirectly suggesting that there are no other means of salvation for those with intense suffering or terminal illness. The physician-patient relationship uniquely positions physicians to take initiative in introducing interventions for issues such as mental health, poverty, lack of housing, and extreme loneliness. Therefore, when there is a combination of vulnerability, trust, knowledge, and confidentiality, the physician-patient relationship creates a safe space for patients to disclose their concerns [5]. Such non-terminal reasons, nonetheless, have been cited in real life as reasons for PAS. If patients are turning to PAS because of unbearable mental and social burdens, then we as a society have failed to implement preventative care. Surgeon and writer Atul Gawande puts it best in his book, Being Moral: “Our ultimate goal, after all, is not a good death but a good life to the very end” [6]. Therefore, healthcare systems must focus more on improving inadequate treatment of symptoms to prevent the unnecessary end-of-life suffering that justifies PAS.

Death may seem far away enough to feel irrelevant for some of us. Yet, with more choices on how to spend our last moments, we should embrace the debate on which will be the most empowering and meaningful for ourselves. Every new end-of-life policy brings a way we could possibly close the chapters of our life. Healthcare providers, leaders, and policymakers should encourage patients to consider other treatment options to help promote a better life first rather than risk hurrying an avoidable death. Ultimately, when the inevitable comes, planned or not, we can face it as the whole person we know ourselves to be. 

References: 

  1. Emanuel, E. J., & Joffe, S. (2003). Assisted suicide and euthanasia, Holland-Frei cancer medicine (6th ed.), BC Decker. 

  2. Paterick, T. J., Carson, G. V., & Allen, M. C. (2008). Medical informed consent: General considerations for physicians. Mayo Clinic proceedings, 83(3), 313-319. https://doi.org/10.4065/83.3.313

  3. Wittenberg-Cox, A. (2022). A designed death – where & when the world allows it. Forbes

  4. Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., Dahlin, C. M., Blinderman, C. D., Jacobsen, J., Pirl, W. F., Billings, J. A., & Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England journal of medicine, 363(8), 733–742. https://doi.org/10.1056/NEJMoa1000678

  5. Chipidza, F. E., Wallwork, R. S., & Stern, T. A. (2015). Impact of the doctor-patient relationship. The primary care companion for CNS disorders, 17(5), https://doi.org/10.4088/PCC.15f01840

  6. Fink, S. (2014). Atul Gawande’s ‘Being Mortal.’ The New York Times




Comment

China's Zero-Covid Policy in Shanghai:  The Pandemic's Legacy

Comment

China's Zero-Covid Policy in Shanghai: The Pandemic's Legacy

On one side of the world, citizens peer outside strictly quarantined homes to find closed shops, empty streets, and healthcare workers armed to the teeth in personal protective equipment. On the other hand, it is almost business as usual. The way the United States has experienced and managed the COVID-19 pandemic vastly differs from China. In the U.S. today, vaccination clinics, hybrid classes, and non-mandatory masking have permanently altered the country’s landscape; many people are ready to move onto a new normal [1]. Yet, three years into the COVID pandemic, China’s dynamic zero-COVID policy still remains, defining the daily lives of an estimated 1.5 billion people. Mass public health responses should give more weight to bioethical, human impacts, and it is time to take a critical look at China’s policy from a non-western perspective to do just that. 

First, the motivations and implications of China’s dynamic zero-COVID policy must be established to understand its human impact. The policy was first created by the Chinese government to contain the initial outbreak of COVID in Wuhan during March of 2020. The policy decrees that the Chinese government will take “dynamic” action to eliminate cases that arise as necessary [2]. The implication of this statement has been two-pronged: prevention through frequent PCR testing, especially in cities, and lockdowns. Particularly in the latter, tactics can include neighborhoods to whole cities quarantining in their homes or government-controlled facilities, for weeks or even months. Now, Xi Jinping, the president of the People’s Republic of China and the general secretary of the Chinese Communist Party, stakes much of his political reputation on the policy in hopes that its success will carry him through his unprecedented third-term tenure for CCP’s general secretary position [2]. 

All this begs the question: has the policy truly been successful? From a purely statistical perspective, there is no denying that it has. According to Johns Hopkins University’s COVID mortality analyses, China has 1.12 deaths per 100,000 people [3]. On the other hand, the U.S. has the highest mortality rate in the world, with 326.74 deaths per 100,000 people [3]. Indeed, as The Atlantic science journalist Ed Yong states in his article The Pandemic’s Legacy Is Already Clear, negative responses to U.S. government-issued vaccine and mask mandates have led to less efficacy in containing it, making the country more vulnerable to new variants [4]. In comparison, China reflects its highly collectivist values in going to extreme measures to put the interest of the whole country or the “group” above the individual. 

However, from a bioethical perspective, the zero-COVID policy tells a different story. Shanghai’s lockdown this past spring demonstrates the need for public health responses to look beyond cultural values and prioritize bioethical concerns. In early April 2022, a large spike of COVID cases in Shanghai led to the entire city being shut down for two months, making this lockdown one of the most severe across the globe. Hundreds of thousands of Shanghai residents were forced to quarantine in their homes or designated facilities, relying on government-issued delivery services for medical supplies and food. People posted calls for medical help online when they could not get to the hospital they needed. In fact, facilities exacerbated the vulnerability of the elderly in this otherwise highly effective method [5]. In April, COVID spread widely among elderly Shanghai residents at the Donghai Hospital, many of whom were not vaccinated, and yet no extra protections were made for this already at-risk population. To make matters worse, families were not allowed to visit their elderly relatives in the hospital for a long time. Mr. Shen, a 45-year-old businessman, is just one example of the human cost of this policy. His father, who was already immunocompromised, died alone after running out of medication while waiting in a 400-person line [5]. 

Shanghai is not the only major Chinese city that has been in sudden mass lockdown like this. Beijing, Chengdu, and Shenzhen are just a few examples. Each lockdown equates to millions of changed lives. Even after lockdown, the daily impact of the zero-COVID policy is apparent; there is still mandatory PCR testing to get on public metro transport, and quarantines are still common even in neighborhoods that just have one or two cases. Public resistance towards the policy has been strong — with their lives clearly on the line, citizens posted their outrage, fear, and despair on social media platforms that contrasted with the cheery lockdown response that the government has tried to project in the media [6]. The usual government censorship struggled to contain public opinion that called for policymakers to rethink China’s COVID controls. 

In fact, just this past month on November 26th, 2022, protests in Shanghai in the wake of a deadly fire in a Urumqi quarantine facility added extra pressure to the Chinese government. In response, China has rapidly lifted the strictest parts of their zero-COVID policy, allowing citizens with symptoms to isolate at home instead of state-sponsored facilities and opening up free travel within the country without need for proof of negative tests [7] The immense rise in infections and sudden shift in the government’s language around COVID-19 has caused concern that the country’s healthcare system could be overwhelmed. However, from the relieved public’s response, one thing is certain: public health responses are malleable and should adjust based on the needs of a country. 

Shanghai’s reality is one that I, living on the other side of the world, could not ever imagine. I remember watching a Chinese New Years skit performed not too long before the lockdown started. In the skit, citizens young and old smiled wistfully and conversed, wearing KN95 masks, over food delivery and across apartment porches. No matter how these stringent policies have been quelling COVID mortalities, no one should have to live like this for months and years. Yet, the U.S. is a painful reminder that individualist policies downplay the truth that pandemics affect the collective, and individuals must do their part to keep everyone safe. No matter how different cultural values may be, the bottom line is that we all are humans, stumbling our way through a changed world with hope. While people across the world from each other may not live these stories, they must listen and learn from them. Inevitably, this will not be the world’s last pandemic; let these stories be what informs and strengthens public health responses to the next one.

References: 

1. John Gramlich, “Two Years Into the Pandemic, Americans Inch Closer to a New Normal,” Pew Research Center, March 3, 2022. 

2. Reuters, “Factbox: What is China's zero-COVID policy and how does it work?,” Reuters, November 3, 2022. 

3. Johns Hopkins University, “Mortality Analyses,” Johns Hopkins Coronavirus Resource Center

4. Ed Yong, “The Pandemic’s Legacy Is Already Clear.” The Atlantic, September 30, 2022. 

5. John Liu, Amy Chang Chien, & Paul Mozur, “Outbreak at Shanghai Hospital Exposes Covid’s Risks to China’s Seniors.” The New York Times, April 1, 2022.

6. Vivian Wang, Paul Mozur, & Isabelle Qian, “China’s Covid Lockdown Outrage Tests Limits of Triumphant Propaganda,” The New York Times, April 27, 2022.

7. Frances Mao, “China abandons key parts of zero-Covid strategy after protests,” British Broadcasting Corporation, December 7, 2022.

Comment