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


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


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

The gold standard of Olympic sex testing

It’s the first summer Olympics since trans and gender-neutrality issues have come to the forefront of national discussions about sex and gender identity, duality, and exclusivity in the United States on the heels of legislation passed in several states to assign bathroom usage restrictions. The debate about the fluidity of sex and gender is at a pivotal moment that has yet to find any consensus, and not the least of which is apparent in regard to organized athletics.

Up through early 2016, the official strategy of the International Olympic Committee has focused on testing levels of “natural testosterone” which can lend to a diagnosis of “intersex” individuals whose combination of XX and XY chromosome mutations can lead to deviations that often go unknown to the individuals until they are tested. Aside from the tests being incredibly invasive and stigmatizing and leading to disruptive surgeries undertaken to “prove” these athletes are of a certain sex, the justification of the IOC stands on shaky ground ethically.

There are a few problems with this kind of discriminatory testing. The IOC argued that it’s necessary for women to have an even playing field that is not skewed in favor of those born with a certain level of hormones that is higher than others. But why is it just natural hormones that give someone an “unfair”advantage? What about a hurdler born with naturally longer legs, a runner with a naturally high lactate threshold, an Olympic weightlifter with naturally high creatine levels?

The truth is for as much hard work and dedication as Olympic athletes put into their training, the benefits of winning the genetic lottery play a bigger role than most of society cares to admit. Shaquille O’Neal wasn’t a great basketball player because he honed his skills through practice and could shoot the ball through the hoop. Not at all. He was a terrible shooter and once missed all eleven of his free throw attempts in one game. He was a great basketball player because he was enormous, and was born with the genetic makeup that made him so. The same is true of female athletes who excel in fields where uniquely high levels of testosterone prove beneficial. They should be discriminated no more than someone who won a 1996 gold medal in the Olympics with the help of his God-given traits…Shaquille O’Neal.

– Tyler



Access and allies

The Food and Drug Administration has revised the guidelines for a pill that induces abortion. The changes allow women to take the pill further into their pregnancy and reduced the number of required visits to the doctor. The pill, mifepristone has increased in use in recent years, and the debate over their use from anti-abortion leaders has heightened in parallel.

The new guidelines reduce the number of required visits from 3 to 2 and allow the medication to be taken up to 10 weeks into pregnancy, up 7. This has in fact been standard practice in most states as doctors have been following the new research and prescribing in line with that evidence under the common practice of off label use. Many states have passed laws to restrict the use of the pill since it was approved by the FDA.

These laws include requiring the pill to be administered by physicians rather than nurses or physician assistants, or requiring the prescribing doctor be present with the patient while the pill is taken which abortion rights activists point out as a strategy to block many women living in rural areas to receive the medication at all. Some states required that physicians follow the label instructions strictly, so the new language from the FDA could have a real impact.

In 2014, a mother of three in rural town Pennsylvania went to jail for ordering mifepristone online to induce a miscarriage for her 16 year old daughter. The nearest clinic to their home was about 75 miles away and  Pennsylvania requires women seeking abortions to get counseling and wait 24 hours before they can return for the procedure. A first-trimester abortion is typically between $300 and $600 and that does not include the added costs of time off work and travel. To order this pill cost this family $45.  This mother was charged with a felony for offering medical consultation about abortion without license and three misdemeanors for endangering the welfare of a child, dispensing drugs without being a pharmacist and assault.

Bioethicists, when discussing abortion, can often get mired in questions on personhood and the moral status of a fetus. Legal questions usually cover the rights granted to a fetus. This post takes for granted that abortion is part of medical practice and care for women in the United States and asks us to weigh the risks of the use of this pill without direct presence of a physician versus the large need for resources related to abortion for those who are lower income, or living in rural areas far from available clinics. It also brings to light the systemic criminal treatment of those who seek this abortions.


A Brighter Futurism

I finally had a chance to listen to Neil Degrasse Tyson interview inventor/futurist/AI soothsayer Ray Kurzweil on the season premiere of Star Talk, and it turned out to be pretty much what I expected: Kurzweil rigidly answered the host’s hypothetical questions with robotic confidence, while guest neuroscientist Gary Marcus questioned the scientific validity of Kurzweil’s predictions and Pulitzer Prize-winning author and professor of cognitive science Douglas Hofstadter compared Kurzweil’s worldview with lunacy and dog excrement intermingled with a few scientifically-sound and reality-based predictions.

I’m not going to comment on the relative accuracy of Kurzweil’s science, but I do think the ethics of AI and nanotechnology are among the most pressing ethical issues of the next twenty years and thus worth exploring even in vague terms here.

Ethics have historically almost always lagged behind technology, so I was especially solaced to hear Dr. Marcus vow to meet these demands as the founder of While Kurzweil touts neurocognitive nanobots as a foregone conclusion and a positive step in evolution, he also seems optimistic about the nature of its use in discussing the moral imperative that accompanies it. Dr. Marcus is more measured in his predictions and the barriers that currently exist, taking a critical perspective of Moore’s law (or as Dr. Marcus calls it, Moore’s Trend) explaining the exponential acceleration of technological capability. The truth is that this acceleration has in fact slowed and so even with reference to the initial trend, future paces of advancement might not be easily determined. Dr. Marcus also acknowledges the negative side of this unharnessed technological advancement and stopping short of omens about grey goo, he notes the potential for terrorists, tyrannical governments, and other evildoers and stresses the need for early regulation and ethical codes since technology does often proceed quickly unrestrained.

Perhaps my biggest problem with Kurzweil’s predictions is not the scientific validity of the ideas he so adamantly proposes but his use of “we” to denote those who will be using/benefitting/engaging in “The Singularity” (the forthcoming date—he proposes the year 2045—in which machines will function, reproduce, and blend with human biology). Perhaps he mentions it in his books (which, full disclosure, I have not yet read), but I believe there will continue to be large swaths of the population who have no interest in merging with machine. From uncontacted tribes to the Amish to modern day hippies and naturalists, I don’t foresee the entire human race necessarily jumping aboard this invasive technology.

The other major flaw (albeit not related to ethics) in the predictions espoused in the interview was that of a variation of immortality achieved through creating digital copies of brain scans. Kurzweil describes it as “uploading to ‘the cloud’” but the idea is that the electrical impulses that travel the synapses of the brain can be technologically cloned to operate through computer systems. I don’t have a major problem with this idea except for the use of the word immortality or the notion that anything doesn’t reach a finite conclusion in this universe. Eventually the sun is going to become a white dwarf and engulf the Earth and even if that is somehow avoided, most competing theoretical physics models (including those proposed by host Neil Degrasse Tyson) conclude an eventual demise of the universe. In my view, it’s hard for immortality to endure the end of the universe.

But it does illuminate an interesting question to be explored in the future: if The Singularity does occur as Kurzweil describes, what will we ultimately fear? Death…or unrelenting existence past a natural lifecycle?

– Tyler