Making a Murderer: Empty threats in Trump’s misdirected opioid war

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For more than a year, Donald Trump paid lip service to victims of the opioid crisis. As he grandstanded to his base about the problem, more than 100,000 people died of drug overdoses in what he labeled a “public health emergency” even while he chose not to release any additional funds for this emergency. And even though Congress finally included in its late-February budget deal $6 billion to address the epidemic, the President has adopted a Philippines-style law-and-order approach that he says now includes seeking the death penalty for drug dealers.

Let’s forget for a moment the plainly racist legacy of the failed War on Drugs. Let’s also ignore how costly and ineffective the death penalty is, with 88 percent of criminologists agreeing it does not act as a deterrent. There are a number of other ethical problems with Trump’s opioid approach. His fixation on the supply-side source of the epidemic has routinely included scapegoating Mexico, an obvious target that fits seamlessly with his “build The Wall” movement that’s rallied on all varieties of xenophobia since his early campaign days.

But building a wall or otherwise tightening security between the U.S. and Mexico is likely to have little effect on the continuing trend of overdoses. For one, according to the Center for Disease Control and Prevention, nearly half of opioid deaths in 2016 were the result of prescribed opioids not including those categorized as illicit such as fentanyl or heroin. If Trump wants a scapegoat for these deaths, he’s going to have to target the doctors who are likely practicing patient-centered care to those in pain. That’s not to say prescribing doctors are blameless in this epidemic, but it does highlight the quandary of confounding substances when speaking of opioid deaths using blanket terminology.

Secondly, as a foreign source, Mexico is often just an intermediary, with China producing the majority of fentanyl coming into the U.S. Far from the image of contraband smuggled into the U.S. through a loose Mexican border, the internet and dark web provide easy access to fentanyl that can be shipped directly to U.S. consumers and forego the type of drug dealer Trump has made a target of his opioid war.

Another ethical problem with Trump’s supply-side preoccupation is that it diverts funding that could be better spent on the root of the problem: the biochemical processes that cause dependence, overdose, and death from consumption. Naloxone, a medication that blocks the effects of opioids, was developed over 50 years ago and according to the CDC, tens of thousands of overdoses have been reversed using it. The fact that we are relying on science from 1961 should be evidence enough that developing more advanced pharmacokinetic solutions to opioids should be a priority. From 2014 to 2016, the price for a package of Naloxone increased from $690 to $4,500. If Trump is serious about preventing opioid deaths, addressing access to lifesaving treatments should be his most immediate concern.

Demonizing drug dealers is easy, plays well with the public, and draws a clear “us versus them” dichotomy. But the more nuanced reality is that many street dealers are addicts themselves and dealing is often a last resort to fund unsustainable chemical dependence. By the time many addicts have resorted to selling, it’s because they’ve been unable to maintain jobs, have lost control of their lives, and have reached the near-end of an unmanageable cycle. Threatening them with the death penalty is not a tenable solution and only increases stigma that might prevent them from seeking help. Further, it’s a vacuous warning when so many of the actual “dealers” are just dark-web commerce sites that deliver directly to consumers’ doors through the postal service.

With $6 billion to spend on the opioid problem, the repetitive Band-Aid of law enforcement and execution of drug dealers shouldn’t be the articulated priority of the Trump administration. Only funding science to develop interventions and medications to treat addiction and prevent overdose deaths can stop the opioid epidemic at its root.

– Tyler

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Fight For Your Right to Die

With Donald Trump’s nomination of Neil Gorsuch to fill the open seat on the Supreme Court vacated by Antonin Scalia’s death, questions of the judge’s position on a number of issues from gay rights to healthcare to abortion have been mostly left to speculation.
But one position Gorsuch has been consistently candid in addressing is his opposition to physician-assisted death and euthanasia. His vehement disapproval of the practice (legal in 6 U.S. states and the District of Columbia) manifested in the 2016 book he authored entitled The Future of Assisted Suicide and Euthanasia. In short synopsis: Gorsuch equates physician-assisted death and euthanasia with “taking of human life” and opposes it on the grounds that all human life is fundamentally valuable and it’s always wrong to intentionally kill.
This type of paternalistic imposition of religious values is oppressive of human choice and autonomy and has no place being legislated in a society that otherwise appears to value individual liberty above all else. Federal opposition to euthanasia violates the bioethical principles of respect for autonomy, justice, and beneficence—the duty to do good.
It is wrong to deny a mentally competent person the right to safely end their life should they choose to do so. By outlawing physician-assisted death, suicide often becomes physically dangerous and puts the wellbeing of others at risk, such as suicide by cop, automobile, firearm, or jumping. Not to mention, those exposed to non-physician suicides are likely to suffer significant psychological trauma as well.
When might a mentally competent person seek euthanasia? Take the case of Dax Cowart, a former Air Force pilot who was severely burned and lost sight in both his eyes following a natural gas explosion in 1973. While his father died in the blast, Cowart survived the ambulance ride to the hospital despite his attempts at refusing treatment knowing the debilitating extent of his injuries. While being held in the hospital, Cowart continued to plead with doctors to let him die even as they “forcibly” administered treatments that he likened to “being skinned alive” for ten months. This is a clear violation of the principle of beneficence, the duty to do good and perhaps the principle of nonmaleficence, the duty to do no harm.
During the course of these ten months, he repeatedly attempted to commit suicide on his own, including trying to jump out of the hospital window to end his suffering. Following his eventual release from the hospital, he chronicled his story in a video entitled “Please Let Me Die” and went on to earn a law degree, which he uses to advocate for the patient rights he was denied.
A ban on euthanasia also violates the bioethical principles of justice, the fair distribution of resources and treatment. When patients have clearly expressed preferences via advance directives that they don’t wish to be artificially sustained in life while incapacitated, providers who continue treatment despite these wishes divert precious financial and medical resources that could be used to treat those who actually do want to be treated and kept alive.
Judge Gorsuch may passionately believe that life is always worth sustaining, but for patients who are forced to maintain an existence of suffering and pain, his stonewall opposition is an obstruction to relief and a violation of autonomy, liberty, and patient rights.

– Tyler