In today’s curated collection, you’ll find:

• 🗞️Bioethics News: SCOTUS abandons students, LGBTQ+ people, and kills affirmative action
• 📚Recommended Reading: Bootstrapped book, vaccines and disability cultural competence
• 🦉Educational Opportunities: Sawbones teaches about Xylazine

Hey there, Curious Human!

Happy July… I’m in absolute denial that the year is more than half over. 

Thank you for reading Curious Bioethics: Curated Bioethics for Curious Humans! I hope you’ll share it with your curious friends.

🗞️ Bioethics in the News

SCOTUS Decisions regarding Student Debt, Affirmative Action, and LGBTQ+ access to business

Three major decisions announced on Friday mean a lot for bioethics:

1. Debt Forgiveness in Biden v. Nebraska

“In every respect, the Court today exceeds its proper, limited role in our Nation’s governance.”

Justice Elena Kagan’s dissent, joined by Justices Sonia Sotomayor and Ketanji Brown Jackson

Biden v Nebraska: SCOTUS voted along partisan lines 6 – 3 to stop more than 40 million borrowers from receiving loan forgiveness. This attacked the Post-9/11 Heroes Act which gives the secretary of the Department of Education authority to “waive or modify any statutory or regulatory provision applicable to the student financial assistance programs … as the Secretary deems necessary in connection with a war or other military operation or national emergency.” 

Why it matters: Student debt is a major source of ongoing inequality in America. Excessive student debt holds students back from accruing wealth and stifles social mobility. Who will suffer most? The people who already have the least wealth and influence. 

Four years after graduation, the average Black college graduate owes $52,726, compared to $28,006 for the average white college graduate. With federal interest rates between 2.75% and 5.3%, the average white household will be able to deduct their complete interest payment each year while the average Black household will not. The tax system prevents low-wealth, high-income households from ever catching up with high-wealth households. – Brookings

This decision will reinforce wealth and racial divides in student debt, including medical student debt.

2. SCOTUS ends Affirmative Action in Higher Ed

“The Court has come to rest on the bottom-line conclusion that racial diversity in higher education is only worth potentially preserving insofar as it might be needed to prepare Black Americans and other underrepresented minorities for success in the bunker, not the boardroom.”

Justice Ketanji Brown Jackson’s dissent

Affirmative Action was a tool to combat long standing race-based inequality. Because the playing filed has been excruciating unfair to some populations, affirming action provided a mechanism to right these historical (and ongoing) wrongs. SCOTUS chose to overturn affirmative action (in most of higher ed spaces). However, they left a major form of affirmative action intact: legacy admissions (I’ll call it fancy affirmative action) – which overtly favors those who already have power and status. 

We already know what will happen at universities without affirmative action in place – diversity will plummet. California’s 1996 Proposition 209, banned affirmative action at public universities in the state. Educators say “they haven’t been able to meet their diversity and equity goals — despite more than a half billion dollars spent on outreach and alternative admissions standards.”

Conspicuously, U.S. military academies have permission to continue to utilize affirmative action practices. The government specifically lobbied to have an exception so the military could continue to recruit and prioritize diverse soldiers. (see Justice Jackson’s quote above)

3. 303 Creative v. Elenis

SCOTUS closes PRIDE month by promoting LGBTQ+ discrimination

“Today is a sad day in American constitutional law and in the lives of LGBT people. … the immediate, symbolic effect of the decision is to mark gays and lesbians for second-class status.”

Justice Sotomayor’s dissent

The court ruled 6-3 for the owner of 303 Creative (designer Lorie Smith), saying she can refuse to design websites for same-sex weddings despite a Colorado law that bars discrimination based on sexual orientation, race, gender and other characteristics. 

The court said forcing her to create the websites would violate her free speech rights under the Constitution’s First Amendment.

Beyond its terrible implications for the LGBTQ community, this is a case that the Court should never have agreed to hear. The case is not grounded in any actual events – Smith didn’t have standing. Lorie Smith has not been asked to make a site for any same sex couples. (The story behind a falsified request are quite bizarre.)

Pride month ended with the Supreme Court writing a blank check to discriminate against LGBTQ folks, even though the case was garbage. 

📚 Recommended Reading

Bootstrapped

Liberating Ourselves from the American Dream

“It’s all right to tell a man to lift himself by his own bootstraps, but it is cruel jest to say to a bootless man that he ought to lift himself by his own bootstraps.”

Dr. Martin Luther King, Jr.

Alissa Quart is the executive director of the Economic Hardship Reporting Project and author of the book Bootstrapped: Liberating Ourselves from the American Dream. 

Quart uses the pandemic to invite re-examination of our national mythology around going it alone and being “self-made.” Quart examines the role of popular fiction and commentary on American go-it-alone ideology through the work of popular writers like Emerson and Thoreau, Ayn Rand, and Laura Ingalls Wilder. 

I had not thought of Little House on the Prairie as novels that shaped American politics. However, in the chapter “Little House of Propaganda” I can see the connection. I wasn’t familiar with the author’s daughter Rose Wilder Lane, and her daughter’s role in rewriting the books (Ingalls Wilder’s first draft was called Pioneer Girl). Nor did I realize that Wilder Lane is one of the most influential advocates of the American libertarian movement. She was a crusader for a particular brand of individualism that’s been sold to Americans again and again. 

Throughout the book, Quart shows how dependency on others isn’t a bad thing, and that mutualism and interdependence are necessary for surviving and thriving.

In an interview, Quart says “And I think we need to remember it’s still an absurdity. Nobody is able to do this alone. You need infrastructure. You need a tax base. You need parents. You need schools. And this is the message that I’m hoping will get through from this book. And it’s also a message that has to do with the pandemic. It’s things we learned during the pandemic about relying on each other and surviving with the help of others.”

Vaccines and Disability Narratives

Finding more constructive ways forward in the debate over vaccines with increased disability cultural competence by Dr Carolin Ahlvik-Harju

“[—] that’s really what all of this is about: we’re facing a massive public health crisis because a disturbing number of people believe that autism is worse than illness or death. My neurology is the boogieman behind a completely preventable plague in the making.”

Sarah Kurchak in I’m Autistic, And Believe Me, It’s A Lot Better Than Measles

“What if parents to young children would be allowed to circulate their worries at the doctor’s office and have someone say that autism might be a challenge, but also a gift? What if more research funding could go into creating the necessary support for autistic families, instead of merely to finding out why they have autism in the first place? What if representants for the media would highlight a more complex and optimistic view of (people with) autism when reporting on the safety of vaccines? What if the presence of the 1 in 68 people (or more) that are diagnosed with autism would be a reminder of life’s giftedness, rather than a sign of catastrophe? What if research about vaccine attitudes, public health and bioethics would extend its basic premises, principles and views on human being so that they would actively work against polarisation and discrimination of people with disabilities?…

“Because when both research and the wider discourse are limited to whether there is a link between the MMR vaccine and autism, there is an implicit ableist message there that autism is not wanted. People with autism are not wanted.”

Today, this essay is available for free (no paywall) in BMJ Medical Humanities.

🦉Educational Opportunities

No registration required! Just go straight to your favorite podcast app for this on-demand bioethics education. 

Sawbones: Xylazine Poisoning

Sawbones: A Marital Tour of Misguided Medicine is one of my favorite medical history podcasts. While it usually covers medical history, this recent episode covers Xylazine, an animal tranquilizer, and the specific dangers is causes to human beings. 

Have you heard of Xylazine (AKA “tranq”) contaminating the opioid supply? 

I hadn’t. 

Xylazine is an alpha-2 adrenergic receptor agonist that was trialed in humans, but found to cause serious undesirable side effects. Because it is mixed into opioids like fentanyl, the drugs work together to cause more severe symptoms. Symptoms can include: 

• sedation
• difficulty breathing
• dangerously low blood pressure
• slowed heart rate
• wounds that can become infected (xylazine causes skin ulcers at injection sites)
• severe withdrawal symptoms
• death

However, because xylazine is not an opioid, naloxone (Narcan) can’t reverse the effects.

Since Dr. Sydnee McElroy practices in West Virginia, we get to learn a little more about the clinic where she works and how they respond to patients they suspect of Xylazine poisoning. I appreciate how Dr. McElroy highlights the primacy of treating patients who use opioids as human beings, worthy of care and attention. Their lives are not worth less because of using substances. 

According the Drug Enforcement Agency (DEA), xylazine and fentanyl mixtures have been seized in 48 of 50 States. In 2022, approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.

That’s it!

Thanks for being curious!

Please email me at the blog and let me know what ethics issues you are most curious about this week—I’d love to hear from you! If you have an upcoming or past webinar available to the public, please send it my way to be featured. 

Alyssa Burgart, MD, MA is co-editor of BioethicsToday and a clinical associate professor at Stanford University. She also writes at Poppies & Propofol.