The article discusses the ethics of disability, dependency, and practices like eugenics and selective reproduction from multiple perspectives. It references views that see disability as a burden and analyze defenses of eugenics. The author argues these views are problematic as they essentialize health and see disability as uniquely difficult. While individuals may feel this way, expressing such views can be unethical by reinforcing harmful norms. The author draws on works by Dembroff and Kittay to argue we should have normative commitments to all people, not just those deemed healthy or independent. Overall, the article makes the case that disability and dependency are morally important aspects of human diversity that society should support rather than try to eliminate.

1. PASSIVE AND
ACTIVE
EUTHANASIA
The Medical
Trolley Problem
MANY ANIMALS ARE
EQUAL
A Consequentialist
Cognitive Basis for
Moral Considerability
WHICH IS WHICH
An Analysis of
Ambiguous Genitalia
and Cross Cultural
Bioethics
AND MUCH MORE
SPRING 2019 | ISSUE 1 | VOLUME 3
GROUNDSTHE VIRGINIA JOURNAL OF BIOETHICS

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Limericks as playful simulacrums of
time, imaginations of the polity, and
other (bio)ethical adventures
2
IN THIS EDITION
3
11
20
24
31
32
35
41
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Ethical Dilemmas in the Terminal Con-
dition Requirement for Living Will and
Physician Aid-in-Dying Policies in the
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Passive and Active Euthanasia: The
Medical Trolley Problem
The Role of States such as Virginia’s
Consent and Confidentiality Laws in
Limiting African American Female
Adolescents’ Access to Reproductive
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Which is Which and Why This: An
Analysis of Ambiguous Genitalia and
Cross Cultural Bioethics
Centered
Many Animals Are Equal: A Conse-
quentialist, Cognitive Basis for Moral
Considerability
Real Talk on Disability, Dependen-
cy, and Ethics
“Ain’t I Human?”: The Role of Bias
and Erasure in the Medical Subjuga-
tion of African/Black American Pa-
tients, A Personal Narrative

3. REAL TALK ON
DISABILITY,
DEPENDENCY,
AND ETHICS
ADAM BEDDAWI
University of Virginia Alumnus
3

4. Abstract
Notions of disability and dependence have been
at the center of moral and political development
in the United States dating back to the colonial
period, constituting immigration law as well as
policy on accessibility, accommodations and
education. In this paper, I consider the justifica-
tions for practices such as gene editing, liberal
eugenics apologia, and ableist discourse as par-
ticular instantiations of this moral and political
development. I do this in order to illustrate how
contemporary notions of disability and depen-
dency give rise to neo-eugenic practices, and
to offer a criticism of this process. To that end,
I will consult Robin Dembroff’s paper entitled
“Real Talk on the Metaphysics of Gender” and
Eva Kittay’s “Dependency.” The sum total of this
work will be a positive argument for the norma-
tive importance of disability and dependence
which serves as a sufficient rebuttal to contem-
porary practices of eugenics and the speech
acts used to justify them.
In August of 2017, CBS News published a
report on data compiled since the early 2000s
revealing that, in Iceland, 100 percent of moth-
ers who opt for prenatal screenings and receive
a positive test that their child has Down syn-
drome go on to terminate their pregnancies.
These marks are mirrored by a 67 percent rate
in the United States, a 77 percent rate in France,
and a 98 percent rate in Denmark. In Iceland,
there were only three babies born with Down
Syndrome in 2009.1
Practices such as the one
in Iceland leave many feeling ambivalent,2
torn
between the intuition that the practice and its
justifications are morally problematic, and the
recognition that there are limits on the ability
to impose on any one person or family’s choice
to either engage in that practice or subscribe
to its justifications. In achieving its conclusion,
this paper prescribes a suitable response to this
ambivalence.
In order to do this, I’ll consider the way in
which disabled individuals are broadly regarded
as being a burden on society and families, or as
1. Lajka, Julian Quinones Arijeta. “‘What Kind of Society Do You Want to Live in?”: Inside the Country Where Down
Syndrome Is Disappearing.” CBS News, CBS Interactive, 14 Aug. 2017, www.cbsnews.com/news/down-syndrome-ice-
land/.
2. Take the ongoing debates held over these very practices in the Washington Post’s op-ed section. On March
9 of last year, Ruth Marcus took a pro-choice stance in arguing for a woman’s right to abort a fetus with Down
Syndrome. 5 days later, conservative commentator George F. Will argued in the Washington Post that the practice in
Iceland amounted to a genocide. Will also pointed to a French court’s decision to bar French television from running
a video devoted to how children with Down syndrome may lead happy lives as an example of “today’s moral con-
fusions.” On March 30, Tim J. McGuire wrote glowingly of the value which his son Jason, who has Down syndrome,
provides his life. McGuire also makes a case for the necessity of building “a basic respect for all lives” which focuses
on the notion that “something about every human being gives life meaning.”
being unhealthy or dependent in an exceptional
way. This way of considering disabled individu-
als is certainly expressed in the statements of
someone like Kari Steffanson, an Icelandic ge-
neticist and founder of deCODE Genetics, who
attributed the staggering termination numbers
in Iceland to “heavy-handed genetic counseling.”
Steffanson contends that there is not “anything
wrong with aspiring to have healthy children,”
and that the challenging questions regard
“how far we should go in seeking those goals.”
Steffanson notably makes explicit mention
of “healthy children,” but particularly of note
here is the normative function of ‘health.’ For
Steffanson, not wanting to bring disabled indi-
viduals to term is understandable given their
essential unhealthiness; the relevant question
regards the extent to which this understand-
able preference for healthy people should be
realized.
This way of considering disabled individ-
uals is also commonly expressed outside of this
more provocative context. Last year, the philos-
opher Jonathan Anomaly published a defense
of eugenics in the Monash Bioethics Review.3
In his paper, Anomaly attempted to repackage
eugenics within a liberal paradigm through ap-
peals to “heritable traits that we value”4
and the
supposed moral virtues of early 20th-century
sterilization laws.5
For Anomaly, eugenicist pub-
lic policy stands to benefit society in ways which
are worth the potential harms to those individu-
als who would directly suffer — those who don’t
have “heritable traits that we value.” He closes
his paper with particular public policy sugges-
tions which follow from this eugenics apologia.
Consider, additionally, the following concessions
any well-meaning parent or caretaker might
make about the prospect of raising a child with
disability.6
They may say they would rather not
bear the burden of the personal, financial and
economic costs associated with paying for care
and equipment, of foregoing some of their own
personal projects, and of significantly adjusting
their plans and expectations for their child upon
receiving a diagnosis of disability. They might
also say that doing so will be very difficult, and a
3. Anomaly, J. Monash Bioeth. Rev. (2018) 35: 24.
4. Anomaly, J. Monash Bioeth. Rev. (2018) 35: 25.
5. Anomaly explicitly makes reference to Buck v. Bell, which upheld the state of Virginia’s right to sterilize the “feeble
minded,” and its compatibility with the moral principle that “a citizen can be required to undergo a procedure if the
cost to him is trivial compared to the social benefits.”
6. I don’t mean for this list to be necessarily exhaustive. In fact, it was constructed only after long, mostly very
difficult, conversations with my parents — both of whom are caregivers for a child with significant cognitive and
physical disabilities — two summers ago. As such, it’s merely representative of a slice of the experience of families
who care for a severely disabled member, though presumably one that is relatable for many.
4

5. pendency” paper, which, I will argue, provides a
sufficient response through Kittay’s care-based
ethics to the moral problematics alluded to
earlier. I will ultimately argue for a view that
centers the normative importance of disability
and dependency and admits about the beliefs
of individuals like Steffanson, Anomaly and the
hypothetical well-meaning parent that (a) they
may be justified and motivating, and yet still
(b) in certain contexts, expressing those beliefs
is morally wrong — even if, in doing so, we are
being accurately descriptive of some state of
affairs. I will close my paper with a discussion of
some of the implications of these practices and
justificatory beliefs with respect to society’s
current political and ethical behavior.
In “Real Talk,” Dembroff is writing in
response to the North Carolina GOP’s 2016
“bathroom bill” which bans transgender peo-
ple from using the bathroom concordant with
their gender identity. Dembroff uses the bill,
and the discourse surrounding its passage, as a
way to analyze our practice of ascribing gender.
Their arguments are extensible to categorical
ascriptions more broadly. Dembroff limits their
consideration of ascriptions to only those prop-
ositions which express metaphysical truths that
describe or imply a constitutively socially con-
structed state of affairs. Let me unpack those
terms: a metaphysical truth is a truth about the
necessary and sufficient conditions of mem-
bership in a given category. Something is con-
stitutively socially constructed if and only if its
definition necessarily makes reference to social
factors. The claim “trans women are women,”
for example, would be metaphysically true pro-
vided that ‘trans women’ satisfy the member-
ship conditions required of ‘women.’ It describes
or implies a constitutively socially constructed
state of affairs because the category ‘women’
is really only definable if reference is made to
the concept’s socio-historical construction. So a
proposition like “trans women are not women,”
which is more or less the expression of the bath-
room bill, would express the proposition that
trans women are not, and in fact should not be,
treated as women qua the consensus under-
standing of what womanhood entails. Insofar as
these states of affairs are socially constructed,
then the responsibility to deconstruct them
falls within society’s purview.
caregiving relationship may not bear fruit be-
fore many hard years of caregiving, years which
may be hard to commit to, or to use as a silver
lining, until the experience of those fruits in the
first place. If they had other kids, those parents
may justifiably worry that the increased focus
on caring for their disabled child — coupled in
some cases with economic constraints on their
ability to outsource that care ― will have nega-
tive effects on the long-term outcomes for all of
their children.
Steffanson, Anomaly and this hypothet-
ical, well-meaning parent make appeals and
advocate for particular actions which are pre-
mised on the notion that disabled individuals
are uniquely difficult or undesirable ― a bur-
den on society rather than the proper subject
of emotional and economic investment. Their
appeals are undergirded by problematic as-
sumptions. For instance, all suggest either that
there is something genetically essential about
health and wellness outcomes, that the result-
ing disparities ought to be resolved through
individual reproductive choice rather than
collective political and social action, or both. In
the Iceland case, ascribing healthiness or bur-
den-ness to non-disabled or disabled individuals
has a moral valence in the context wherein such
an expression serves as justification for the
practice of abortion. This moral status may vary
in other contexts, whether as debate behind
the implementation of certain public policy, or
as dialogue which, in part, develops a society’s
normative attitudes to practices such as gene
selection, genetic engineering, family planning,
and community building. In order to determine
what we ought to do in those contexts, I will ar-
ticulate a view on the expression of such beliefs
which renders their moral status in those con-
texts.
In order to do this, I’ll use Robin Dem-
broff’s paper, “Real Talk on the Metaphysics of
Gender,” to sketch a framework through which
one could respond to any of these practices and
their respective justifications. I will demonstrate
that, while there are some inadequacies with
Dembroff’s view which leave it insufficient to
apply in the case of disability on its own, Dem-
broff’s work nevertheless provides valuable
insights. I will then consult Eva Kittay’s “De-
5

6. and medical resource apportionment, among
other things, which are themselves historically
contingent and which make the particular con-
ditions of life for disabled children unhealthy or
burdensome.8
By basing the “moral communi-
ty” on this essentialization, a metaphysics-first
thinking allows for the administering of harms
to those who would otherwise have a plausible
claim to moral consideration.
Furthermore, all of the previously dis-
cussed beliefs and attitudes partly consist in
speech acts, the utterance of which reinforces
those beliefs and attitudes. For example, the
aforementioned benevolent family or caretaker
may harbor certain beliefs or perform certain
actions in light of their view that “person X is,
or will be, Y,” where person X is some disabled
individual and Y is some ascription which follows
tautologically as a result of a society’s views on
disability and dependency — say, that person
X is, or will be, overly dependent on others for
their entire life. These societal views themselves
are established through a plexus of cultural
representations, discourses and policies. The
question, then, is how societal actors ought to
respond to an unethical state of affairs wherein
notions of disability and dependency are de-
scribed or implied through statements in con-
texts which themselves reinforce those notions
and the practices to which they give rise.
Some may seek to answer this question
by addressing the philosophical consensus
which holds that qualification of personhood
precedes the possibility of inclusive member-
ship in the moral community of persons, where
membership entitles one to certain moral con-
siderations and demands of them certain moral
responsibilities. In order to change the state of
affairs which permits these moral traumas to
those who do not satisfy the membership condi-
tions of personhood, so the logic might go, the
moral prescription would be to advocate for a
metaphysics of personhood which includes dis-
abled individuals in ethical consideration. How-
ever, if the goal is to alter a given state of affairs,
Dembroff argues that metaphysics is the wrong
place to look; an adjusted metaphysics is neither
necessary nor sufficient for the right sort of an
adjusted ethics. After all, Dembroff reasons that
8. This is merely an acknowledgement of some social factors which play into disability, but is not intended to be an
endorsement of a social constructivist model of disability.7. “Taking Life: Humans.” Practical Ethics, by Peter Singer, 2nd ed., Cambridge Univ. Press, 1993, pp. 175–217.7. “Taking Life: Humans.” Practical Ethics, by Peter Singer, 2nd ed., Cambridge Univ. Press, 1993, pp. 175–217.
6

7. such disagreement over what we ought to do
in a particular instant might well persist even if
there were a consensus position on who belongs
to the categories in question. Dembroff’s “ar-
gument from unethical truths”9
is employed in
service of an ethical basis for ascriptive practic-
es, importantly distinguished from an alethic,
or truth-normed basis. Rather than striving for
metaphysical accuracy, Dembroff demonstrates
that our categorical ascriptions should be con-
strained by our normative commitments to
others.
Regarding these normative commit-
ments, Dembroff says that there are certain
contexts in which the expression of these
constitutively socially constructed states of
affairs may be unethical. In these contexts, a
moral duty not to express a categorical ascrip-
tion arises out of (a) its unethical description
or implication and (b) its unethical effects.
Dembroff considers unethicality in a myriad of
ways. Per their analysis, it may be unethical to
express a categorical ascription if it describes
or implies an unethical state of affairs, or if its
expression leads to, or reinforces,10
such a state
of affairs.11
They also mention how a categorical
ascription, and its concomitant associations and
implications, may be unethical if conferred unto
someone without consent.12
Another feature
of unethical constitutively socially constructed
states of affairs is that the unethical meanings
of their referents may persist beyond changes
in usage patterns.13
Despite the laundry list of
conditions for unethicality, Dembroff says that
the duty-generating reasons need not be lim-
ited to an expression’s “reinforcing effect on
an unjust social structure,” but may extend to
“other, more direct harms.”14
Essentially, any or
all of these conditions may factor into a consid-
eration over our normative responsibilities to
other people in those reinforcing contexts.
In these contexts where expressing
9. Dembroff, R. (2016). Real Talk on the Metaphysics of Gender. pp 19.
10. In the case of a categorical ascription like “disabled individuals are a burden,” a reinforcing context might be in
consultation with a family deciding whether or not to terminate their pregnancy.
11. Those statements which ascribe disability clearly have their reinforcing contexts. In the Iceland example, the
reinforcing context may be in consultation with an expectant mother who has received a diagnosis of their child’s
disability, or even in being quoted for the article cited in the first place. Anomaly’s eugenics defense concludes
with a series of public policy recommendations, meaning that any engagement with his work is over its practical
applicability.
12. This conception of unethicality is problematic in the case of cognitive disability, as there are cognitively disabled
individuals who require moral consideration, but nevertheless will, in virtue of their disability, be unable to consent
to any practice.
13. Dembroff thinks gender terms share this feature of meaning persistence. We may, for instance, change the
whom to which we ascribe woman,’ without changing that which the term connotes. As such, our categorical
ascriptions may be immoral to the extent that the metaphysical assumptions constitutive of gender category
constructions are unethical in their own right. Attempts of the disability pride movement to reclaim terms like ‘crip,’
are instructive in showing how disability might function similarly.
14. Dembroff, R. (2016). Real Talk on the Metaphysics of Gender. pp 22.
a proposition would be unethical, Dembroff
would say we have a duty to not express the
proposition. Additionally, insofar as the effects
of our categorical ascriptions are themselves
socially constructed, then it is society’s duty
to deconstruct the resultant unethical state of
affairs. In other words, Dembroff contends that
were it unethical to ascribe, say, burdenhood, to
disabled individuals, then the best practice in
any context would be to express the proposition
“disabled individuals are independent,” even if
that claim were not true. Expressing the false
correlate of a true, but unethical, statement
may, over time, shift the reference of key terms
and thereby alter the unethical constitutively
socially constructed state of affairs. On their
analysis, this moral reason to express the false
correlate of some true ascription is over and
above any obligation one might have to speak
the truth.
Still, a stronger argument could be made
for their thesis if Dembroff said more about why
the class of propositional statements they take
up are unethical, as well as how this unethicality
determines the moral prescription to express
an ethical falsehood. The following is one appli-
cative concern and one fundamental one with
Dembroff’s view. Applicatively, there may be
constitutively socially constructed states of
affairs whose expressions are classified errone-
ously by Dembroff’s accounting. Consider the
case of a caregiver expressing the proposition
that “X is dependent,” where X is a severely
cognitively disabled individual. Dembroff’s view
may classify the ascription as unethical insofar
as it (a) describes the individual as undeserving
of certain rights and responsibilities, or deserv-
ing of certain paranoias and stigmatizations,
and (b) may lead to harmful effects for that
person. But the expression still performs a use-
ful and accurate ascription by selecting out the
individual as the type of person to whom the
term “dependent” is meant to select out, and
to whom beneficial considerations, resources,
and moral appeals are warranted. Expressing its
false correlate would only be more pragmatical-
ly and morally problematic. Without more from
Dembroff, it is unclear why the speech act in
question ought to generate the moral respon-
sibility to express its false correlate despite it
satisfying their criteria. This problem also casts
7

8. into relief the worry that Dembroff’s project
doesn’t go far enough; speech acts are, perhaps,
a necessary but insufficient step toward the
types of change demanded by unethical consti-
tutively socially constructed states of affairs.
One might also offer a more fundamental
rebuttal to Dembroff’s account. Since Dem-
broff says that metaphysics is the wrong place
to resolve disagreement, one might say that
their argument might just as well be wielded in
service of an attempt to bring public consen-
sus regarding normative commitments, as well
as the whom to which those commitments are
properly directed, in lockstep with those meta-
physical facts. Dembroff’s view leaves us in a
good place by grounding the statements which
constitute our beliefs and practices regarding
disability and dependency in our moral consid-
eration. Without a more substantive ethics to
support Dembroff’s view, however, our correct
ascriptions are subject to the whims of a partic-
ular society, or the contingencies of any moral
or political movement. This is particularly true
in the case of cognitive disability, where the
consent of those severely cognitively disabled
ought not be a determinant factor in our moral
consideration, thereby leaving us with one less
desideratum of determining unethicality. What
is required, then, is an ethics to move toward,
and in the service of which action is required.
In “Dependency,” the philosopher Eva
Kittay offers just that. She centers our norma-
tive commitments around the nexus of interde-
pendency, which she envisages as the source of
“needed care, knowledge, culture, technology,
and political, social and economic goods.”15
She also implicates society in ameliorating the
negative circumstances facing those living
with disability by saying that any decent soci-
ety must accept the responsibility to meet the
needs of those who find themselves inevitably
dependent. Kittay tracks a societal preference
for independent living as partially the cause of
these negative circumstances.
This preference even permeated the
desired aims of the early wave of the disability
rights movement, which Kittay criticizes for at-
tempting to shift the understanding of indepen
15. Kittay, E.F. (2015). Dependency. Keywords for Disability Studies, pp 1.
dence as self-sufficiency to one of independence
as self-determination. Those scholars and ac-
tivists of the movement “rejected the notion of
dependence as inherent in disability,” preferring
instead to redefine independence as including
“the vast networks of assistance and provision
that make modern life possible.”16
Kittay right-
ly points out that, by centering independent
living as an aspiration and tying productivity to
any argument for the worth of disabled lives,
the early disability movement perpetuated the
damaging societal preference for independence
and independent living. Consequently, the
movement reinterpreted the established meta-
physical truth that “persons are independent”
to include certain disabled people, thereby
maintaining and reinforcing that same societal
preference for independent living. As a result of
the movement and the reinforced normativity
of independence, so many within decent soci-
eties continue to refuse to acknowledge their
inevitable dependency, instead considering
independence as a sufficient condition to proper
personhood. People who are not independent,
or whose capacities exclude them from ever
reaching independent status in a given soci-
ety, are therefore “thought to have a moral or
psychological flaw.”17
Similarly, those who have
the relevant moral or psychological flaws might
be considered dependent, or not capable of
independence. Kittay sources this refusal to
recognize inevitable human dependency in her
diagnosis of how the experience of disability “as
a particular kind of social problem”18
has shaped
the lived conditions of disabled individuals. In
this way, attempts to deconstruct dependen-
cy by reducing it to a social construction are
oppressive. They disadvantage and culturally
ostracize those disabled people “who do indeed
require looking after”19
and “whose ability to
be self-determining requires increased, not
reduced expenditures,”20
such as the severely
cognitively or physically disabled. In this way,
the more able still gain a material advantage.
Kittay’s insights force us to think about
dependency in a different, more universalistic,
way. She wants to consider how the benefits
procured by those scholars and activists of the
early disability rights movement — namely, that
17. Kittay, E.F. (2015). Dependency. Keywords for Disability Studies, pp 5.
17. Kittay, E.F. (2015). Dependency. Keywords for Disability Studies, pp 2.
18. Kittay, E.F. (2015). Dependency. Keywords for Disability Studies, pp 1.
19. Kittay, E.F. (2015). Dependency. Keywords for Disability Studies, pp 6.
20. Kittay, E.F. (2015). Dependency. Keywords for Disability Studies, pp 7.
8

9. 7
some of the harms resulting from a lack of ma-
terial resources and care can be deconstructed
by way of appropriate accommodations, person-
al assistants, and other such material changes
— might be protected without reinforcing the
stigmatization of those excluded by the focus
on independent living. She inquires as to how
society might accept the inevitability of depen-
dence while also regarding the negative effects
of socially constructed dependency as the prop-
er object of concern, accountability and change.
Kittay’s first step is to punt on the “quix-
otic quest”21
for independence in order that we
may recognize and embrace our own inevitable
dependency on others. All types of dependency,
while not always palatable for some, are “part
of a normal human life lived intertwined with
others.”22
Even relative independence occurs at
the expense of someone — such is the perva-
siveness of our dependency. The paradigm case
of this is that of the caregiver who, in meeting
the needs of the proper object of their care,
becomes derivatively dependent. Rather than
being considered an agent engaging in a re-
lationship of reciprocity, they are considered
merely a proxy for the recipient of their care;
they become responsible for the subject of
their care to the extent that their own agency is
rendered invisible. This helps make sense of why
Kittay conditions the recognition of our funda-
mental interdependency, which determines the
social lives of all individuals in society, save for
those unable to meet the needs of others, on
the recognition and embracement of our depen-
dency. For Kittay, the inevitable need which all
humans experience in their lives “becomes the
site of cultural identity, family warmth, artis-
tic creation and sociality.”23
By embracing our
dependency, and reveling in our concomitant
interdependency, we may “demand a reordering
of priorities and an assertion of entitlements
that are our due, not because we can be inde-
pendent and productive, but because our value
derives from the chain of dependent relations
that make all our lives possible.”24
The logic of
care ethics grounds both our individual value
and collective normative commitments in our
essential dependency on others. It therefore
rejects outright the appeal to health from Stef-
21. Kittay, E.F. (2015). Dependency. Keywords for Disability Studies, pp 8.
22. Kittay, E.F. (2015). Dependency. Keywords for Disability Studies, pp 4.
23. Kittay, E.F. (2015). Dependency. Keywords for Disability Studies, pp 2.
24. Kittay, E.F. (2015). Dependency. Keywords for Disability Studies, pp 9.
fanson, to valuable human traits from Anomaly,
and to opportunity cost from the well-meaning
parent. Statements such as theirs, as well as the
beliefs and practices they are intended to sup-
port, fall within the purview of societal respon-
sibility implicated by both Dembroff and Kittay.
However, Kittay takes us farther than
Dembroff. Dembroff offers insightful analysis
into how our beliefs and practices consist in our
speech acts and categorical ascriptions. They
also establish that it is our collective societal
responsibility to change the justificatory ascrip-
tions which reinforce a constitutively socially
constructed unethical state of affairs. Never-
theless, Dembroff offers a problematic solution
to the problem. In addition to the previously
discussed problems with Dembroff’s view, Kit-
tay helps us see how merely uttering the false
correlate of the unethical statement “disabled
people are dependent,” might reinforce a still
problematic societal preference for indepen-
Illustration by Nandita Venkataraman
9

10. dence. Kittay offers us a better prescription
to the moral landscape which Dembroff helps
us see clearer. For Kittay, the affairs which
we’ve constructed, and which the content of
our statements threaten to reinforce, actually
conceal the social benefits that lead from rec-
ognizing our inevitable dependency. On her
analysis, the lives of disabled individuals serve
as a paradigmatic example of the inevitability of
human dependency, as well as the robust and
normative relationship between caregiver and
recipient. As such, disabled lives aren’t merely
valuable because they belong to the community
of persons, but because their existence as such
elucidates important normative standards for
ethical consideration. The statements which ex-
press or describe a state of affairs that demeans
or disregards the existence of disabled individu-
als therefore conceals this good-making feature
of the lives of disabled individuals.
Statements such as those of Steffanson,
Anomaly, and Olafsdottir reify the view that dis-
abled individuals’ lives are relevantly different
from those of non-disabled individuals, while
preventing people from recognizing their capac-
ity, and even their responsibility, to change the
social structures and belief systems which fail
to properly regard disability in the first place.
We have a moral duty not to express such state-
ments, or, where appropriate, to express their
false correlates. Still, there’s a clear sense in
which this moral demand doesn’t go far enough,
for doing so might only recapitulate the errors
of the early disability rights movement. What’s
required, instead, is the reification in policy, law
and culture of an ethics which centers depen-
dency over independency. This broad-based rei-
ficiation would be instrumental toward decon-
structing the unethical state of affairs faced by
individuals with disabilities and those who care
for them. It also does not impose on any right
held by individuals or families, the most notable
of which would be the right for those parties to
conclude that it is in their best interest to abort
a disabled fetus, or to genetically engineer indi-
viduals able to accomplish independent living.
Instead, it offers a robust reason to subvert the
systems and beliefs which would inform the
decision to do so in the first place, and to create
a better world for all regardless of capacity.
References
Anomaly, Jonathan. 2018. “Defending Eugen-
ics.”Monash Bioethics Review 35, no.1-4 (July):
24-35.
Barnes, Elizabeth. 2016. The Minority Body. Ox-
ford University Press.
Dembroff, Robin. 2019. Real Talk on the Meta-
physics of Gender. Philosophical Topics. Forth-
coming.
Kittay, Eva F. 2015. “Dependency.” Keywords for
Disability Studies. Forthcoming.
Lajka, Julian Quinones Arijeta. “”What Kind of
Society Do You Want to Live in?”: Inside the
Country Where Down Syndrome Is Disappear-
ing.” CBS News, CBS Interactive, 14 Aug. 2017.
www.cbsnews.com/news/down-syndrome-ice-
land/.
Singer, Peter. 1993. “Taking Life: Humans.” Prac-
tical Ethics. Cambridge University Press. 2nd
ed: 175–217.
10

11. Introduction
The Role of States such as Virginia’s
Consent and Confidentiality Laws in
Limiting African American Female
Adolescents’ Access to Reproductive
Health Care
By: Christina Ross
Odela D.Cascells Fellow at the Maxine Platzer Lynn Women’s Center
Sexually transmitted diseases (STDs) are affecting youth at an
alarming rate, especially youth of color. In 2014, youth aged 13-24
with new HIV diagnoses included(777) Black females, (218) White
females, and (203) Hispanic females (CDC, 2016). Additionally,
despite the downward trend in teenage pregnancies, Black and
Hispanic teens make up 57% of teen birth rates in America, the
highest among all ethnicities (CDC, 2016).
In an attempt to address the sexual health disparities that are
prevalent among African American adolescents, many federally
funded interventions have been recently established. Interventions
often focus on promoting the use of contraceptive methods
such as long-acting reversible contraceptives (LARC), furthering
community involvement (leaders and families), and improving
health clinics (Wiltz, 2015; CDC, 2016). In addition to federally
mandated changes, African American adolescents’parents and
caregivers are effectively communicating with their children
about safe sexual practices and methods for the reduction of risky
behaviors that lead to teenage pregnancy and STDs(Aronowitz,
Todd, Agbeshie, Rennells, 2007). Conversely, parents and
caregivers often lack adequate resources to communicate
effectively with their adolescents; therefore, parents and caregivers
turn to health care providers for educational assistance (Aronowitz,
Rennells, & Todd, 2006; Aronowitz,Todd, Agbeshie, & Rennells,
2007; Aronowitz & Agbeshie, 2012).
Introduction
11

12. 12
Some parental strategies, myths or religious,
cultural, and ethnic beliefs can leave adolescents
uncomfortable talking to their parents and
caregivers, and in need of more information
regarding sexual education. As a result,
adolescents will seek the professional advice
of health care providers to provide additional
sexual health education and care. Despite
numerous federally funded interventions, as
well as community and family involvement, a
gap in knowledge remains regarding potential
factors that contribute to African American
adolescents being markedly affected by STDs
and teenage pregnancies in comparison to other
ethnicities. As a result, the objective of this paper
is to analyze the potential factors that limit
adolescents’ access to sexual and reproductive
health care.
In states such as Virginia, minority youth are
disproportionately impacted by consent and
confidentiality laws, which have the potential
to deter adolescents from seeking professional
advice and can leave some adolescents at a
disadvantage or at greater risk for being victims
of STDs and teenage pregnancies. Therefore,
this paper illustrates the need for health care
providers to provide supplemental care and
education to African American adolescents, and
will also demonstrate how minor consent and
confidentiality laws in states such as Virginia
can serve as a hindrance, preventing adolescents
from accessing care due to the risk of potential
parental involvement, notification, and conflict.
Parents/Caregivers Role in Adolescents
Sexual Health Education
Strategies/Methods:
African American parents and caregivers
implemented various strategies to communicate
with their adolescents about sexual health
practices. Strategies that were effective included
the following:
Limit Setting. Parents often inform adolescents
of various limits or expectations that are
expected of them. Parents reported setting
limits regarding when their children can start
dating and engaging in social activities with
the opposite sex (Aronowitz, & Eche, 2013).
Adolescents agreed that limit setting was an
effective parenting strategy that influenced their
behavior regarding sex.
Instilling Values. Parents instilled values in their
children by showing them love and support,
which fostered positive open communication and
enabled them to help their children set goals
regarding finishing school and avoid making the
same mistakes they had made during their own
youth (Aronowitz, & Eche (2013). Adolescents were
favorable of this strategy as it helped them to
focus on having a better future in comparison to
what their caregiver had experienced, and were
deterred from being involved in negative sexual
health behaviors (Aronowitz, & Eche 2013).
Authoritative Parenting Style. African American
parents often implemented authoritative
parenting styles to encourage their children’s
compliance. Authoritative parenting was suitable
for their children because it helped to meet
the needs of the child based on the location or
context they resided in, and served as protective
measures when dealing with authority or factors
such as negative racial experiences (Lecuyer,
Swanson, Cole & Kitzman, 2011).
While the previously mentioned strategies were

13. Illustration by Nandita Venkataraman
13
effective, adolescents reported a number of
strategies that were ineffective, including the
following:
Monitoring. Some parents implemented
the strategy of monitoring their children’s
actions at home and in the community, often
having other community members monitoring
their children to ensure adolescents were
not engaging in risky behaviors (Aronowitz,
Rennells, & Todd, 2006). While monitoring
served as a method for deterring adolescent
participation in risky behaviors, adolescents
were disappointed with this parental strategy
and preferred to have a strong bonding
relationship with their caregivers, which would
make it easy to communicate directly to their
caregivers about sex (Aronowitz, Rennells, &
Todd, 2006).
Scare Tactics. Some parents implemented
more intense strategies such as scare tactics
to influence their children’s behavior, such
as telling them they will die if they do not
wear condoms/engaged in certain activities
(Aronowitz, & Eche, 2013). Adolescents did not
favor the “scared straight” method, reporting
that it hindered their ability to effectively
communicate with their parents; they labeled
the strategy as the worst method a parent can
use (Aronowitz, & Eche, 2013).
Myths Regarding Communication About
Sexual Education. Parents are often afraid
and hesitant in talking to their children about
sexual health due to the possibility that it
will lead to increased curiosity, increasing the
potential for adolescents to initiate sexual
encounters (Aronowitz, Rennells, & Todd,
2006; Aronowitz,Todd, Agbeshie, & Rennells,
2007). While some myths can prove true, it
is important that health professionals help
address many fears and concerns parents have.
It is possible for some adolescents to engage
in sexual activity after talking to their parents
about sex and receiving their mothers’ approval
of birth control (Jaccard & Dittus, 2000).
However, choosing not to educate adolescents
about sex and contraceptives does not
guarantee abstinence or extended delay in the
initiation of sexual activity. Notably, regardless
of the parents’ decision to talk to adolescents
regarding sex and contraceptives, adolescents
will obtain the desired information from other
sources (Jaccard & Dittus, 2000). Additionally,
information from other sources might be
inaccurate and pose more harm to adolescents.
Therefore, it is more beneficial for parents and
health care providers to communicate with
their adolescents regarding safe sexual health
practice, as they will be equipped with the
adequate information when they are ready to
explore sexual activities. However, adolecents
and mothers are often uncomfortable talking
talking about sex because of its “taboo” nature,
resulting in adolescents being told not to engage
in sex, and parents lacking sufficient knowledge
to engage in the conversation (Aronowitz,
Rennells, & Todd, 2006; Aronowitz,Todd, Agbeshie,
& Rennells, 2007; Aronowitz & Agbeshie, 2012).
Therefore, adolescents often turn to health care
providers for additional information and care
regarding sexual health.
Virginia Minor Laws and its Effects on
African American Adolescents
In the United States, adolescents reach the age
of majority at 18 years and have adult rights and
status, which means parents and legal guardians
are no longer legally responsible and in control of
the adolescent (“Teens Learn & Live the Law

14. 14
| Virginia RULES”, n.d.). In terms of sexual and
reproductive health, minors are considered adults
and can fully consent for medical or health
services such as birth control, pregnancy, and
family planning (with the exception of sexual
sterilization) (The Center For Ethical Practice,
2010). Adolescents 14 and older who consented
to their care can access their medical records,
and unless there is a risk of harm to the minor,
parents and legal caregivers can access their
minor’s health records (The Center For Ethical
Practice, 2010).
The University of Virginia Teen Health Center
provides sexual and reproductive health care
to adolescents around the Charlottesville
area. In terms of minor consent, privacy and
confidentiality laws, the center has seen the
effects of the laws on its adolescent population.
In an interview with the Director of the University
of Virginia Teen Health Center, it was mentioned
that confidentiality regarding care obtained from
the teen center served as a barrier and a concern
for many adolescents. Under Virginia law, an
adolescent under the age of 18 can give consent
for family planning, venereal disease diagnosis
and treatment, pregnancy care, outpatient mental
health, and substance abuse care (Aretakis, 2015).
However, the law does not allow the information
allow the information to be confidential, meaning
that parents can request and access the health
records. Parents who contact the teen center
for their child’s records will be forwarded to
the Medical Records Department, who will
charge $2.50 per page (Aretakis, 2015). The cost
associated with obtaining the patient’s record
sometimes serves as a deterrent; however, it
does not prevent parents from accessing the
records if they wanted to. The teen center offers
counseling sessions to help adolescents discuss
important issues with their parents or caregivers,
especially when they find it difficult to engage
in a dialogue with their parents (Aretakis, 2015).
Counseling sessions can help the teen center
to retain its patients; adolescents learn how
to communicate with their parents about their
sexual health education choices, instead of the
teens leaving due to confidentiality concerns.
Minor laws can limit adolescents’ access to care
because confidentiality, privacy, and anonymity
are very important factors that influence
adolescents’ information seeking behaviors
(Smith & Stepanov, 2014). In a study of
adolescents, it was found that confidentiality was
the “most important quality of a sexual health
service, evaluated higher than friendliness of
staff” (Smith & Stepanov, pp. 44, 2014). Therefore,
confidentiality is one of adolescents’ highest
priorities and will ultimately determine if they
will seek health care or delay it due to fears
of their parents finding out. Another potential
impact of adolescent consent and confidentiality
laws is the risk for parental conflict. Some
African American parents do not want to talk
to their children about sex because it is seen
as “taboo” in nature or off limits, fearing that
conversations about sex will result in sexual
activity initiation (Aronowitz, Rennells, & Todd,
2006; Aronowitz,Todd, Agbeshie, & Rennells,
2007; Aronowitz & Agbeshie, 2012). Additionally,
some parents may have strong abstinence and
religious beliefs, which can potentially lead
them to condemn their adolescents’ need for
sexual and reproductive health education,
disapproving of the use of health care providers
to get such information. As a result, adolescents
who exercise their right to access care can place
themselves at risk for parental/caregiver conflict
if their parents were to find out by opening
the adolescent’s mail or calling the health care
facilities to check if their adolescent has any
medical records.
Current consent laws do make provisions for
minor confidentiality if it was determined
that the patient would be at risk for harm if
medical information was shared (The Center For
Ethical Practice, 2010). However, harm could be
subjective, where the adolescent may view their
parents disapproval and reaction as harmful
psychologically/emotionally even though it may
not be considered harmful legally. As a result,
there are limited grounds by which adolescents’
medical records could not be shared with their
parents. Additionally, it could be a psychological
stressor to know that at any point a parent or
caregiver can obtain information regarding their
sexual and reproductive health care. Therefore,
it is beneficial for adolescents to legally be
able to obtain sexual health care and education
independently, meaning that the law needs to
be revised and updated to protect adolescents’
health records from being shared without their
consent.

15. 15
African American Parents Lack of
Trust in Health Care Providers
Updated adolescents’ confidentiality laws
and policies regarding sexual health care can
potentially leave parents feeling disappointed
and disconnected from being involved in their
adolescents’ health and life. Parents may also
feel unable to support their adolescents if they
are unaware of what is going on. Also, historical
trauma faced by African Americans led many
of them to lose trust in White providers, and
this lack of trust persists today (Andrulis, 2003;
Clark, 2009). Historical trauma such as eugenics,
coercive family planning, and non-consensual
sterilization practices on mentally ill, poor,
minority or immigrant women continues to
shape African American women’s views on
contraception and family planning services
today (Dehlendorf, Rodriguez, Levy, Borrero, &
Steinauer, 2010). Some African American women
are skeptical about sexual and reproductive
health care, andbelieve that services such as
contraceptive are the government’s initiative
to promote sexual sterilization and control
the ethnic minority population (Dehlendorf,
Rodriguez, Levy, Borrero, & Steinauer, 2010;
Rocca & Harper, 2012).
As a result of historical trauma African
Americans experienced with health care
providers in the past, female African American
patients lack trust in the healthcare system
when it comes to contraceptive methods,
primarily due to myths and factual information
passed on from prior generations (Dehlendorf,
Rodriguez, Levy, Borrero, & Steinauer, 2010). This
mistrust in health care providers can, therefore,
be passed on to adolescents as parents try to
deter adolescents from seeking sexual health
care due to the risk of harm based on historical
unethical healthcare practices. Parents, as a
result, can have a difficult time allowing their
adolescent to seek completely confidential
care from health care providers. Therefore, it is
important for parents and healthcare providers
to have trusting relationships and know that
both parents and the health care provider are
working to promote the optimal health of the
adolescent.
Additionally, adolescents should be allowed to
exercise their autonomous rights, and seek sexual
health care services, as they deem necessary
Health care providers are obligated to provide the
best care to their patients; therefore, adolescents
are in “good hands” and will be guided
accordingly to make informed sexual health
choices. Also, there are no critical implications or
justifications as to why parents should be able
to access their adolescents’ health care records,
when adolescents have been deemed competent
to consent to sexual health care without their
parents’ approval. Lack of total confidentiality
creates dissonance and mistrust between
adolescents and their health care providers,
placing adolescents at greater risk for adverse
sexual health behaviors.
The Role of Health Care Providers
In addition to parents who are legally obligated
to provide the best level of care to their
adolescents, health care providers are experts in
their fields and can be trusted to provide honest,
informative advice to adolescents (Gormley-
Fleming & Campbell , 2011). Health care providers
are educated and obligated to follow evidenced-
based care when working with their patients, in
addition to offering referrals to other available
services and resources. As a result, adolescents
often implore the use of health care providers in
hospitals, schools, and other facilities for sexual
and reproductive health services. Adolescents
have keen interest in their sexual health,
and will seek information regarding fertility,
contraceptives, and sexually transmitted diseases
from health care providers, whom they can trust
and confide in to provide them with the best
level of care and service (Smith & Stepanov, 2014).
Adolescents often turn to health care providers
due to difficulties interacting with their parents
or being unable to get the information they seek.
Some adolescents reported being unable to talk
to their parents about sex-related issues due to
their parents’ cultural, ethical and ethnic values/
beliefs (Smith & Stepanov, 2014).
Health care providers work under various laws
and policies to guide their practice, however, laws
and policies related to adolescents can serve as
barriers to access for care due to confidentiality,
consent, and privacy issues adolescents have to
deal with. Additionally, adolescents reported that

16. 16
they will stop visiting their provider if their
information was shared with their parents, and
they would continue to engage in risky behaviors
(Smith & Stepanov, 2014).
Therefore, adolescents value being in control
of their sexual health, however, lack of
confidentiality can lead adolescents to lose that
value. It is also counterintuitive for adolescents
who are uncomfortable talking to their parents
about sexual health to talk to their health care
providers, especially if the information in the
patient’s medical records can be shared with
the adolescents’ parents or caregivers, which
is what the adolescent is trying to avoid. As
a result adolescents can have no motivation
to share confidential information with health
care providers because they are at risk for
their parents finding out. , In order for health
care providers to hold on to the important role
of caring for adolescents, the provider should
always be honest and open with the patient to
build a long-lasting relationship.
The provider should let the adolescent know that
they are aware of potential worries and concerns
regarding adolescent confidentiality laws, that
they are always there to provide support, and
will advocate for them. Additionally, health
care providers can provide interventions to help
adolescents talk to their parents or caregivers
about their sexual health, which would serve as a
tool for adolescents when they are ready to have
the discussion with their parents.
In addition to the interventions described above,
health care providers can help protect the rights
of the patient and make them feel comfortable in
their care by being careful with sending/mailing
correspondences to the adolescents’ home,
which could potentially be seen by their parents
and create conflict between the adolescent
and their parent or caregiver (Maradiegue,
2003). Also, health care providers can inform
adolescents that while the law enables their
parents and caregivers to have access to their
medical records, confidentiality is otherwise
strictly maintained by them (“Tips for Health Care
Providers: Helping Teens and Parents with Sexual
Health Needs”, n.d.). Health care providers should
also talk to parents who visit them about the
importance of confidentiality to adolescents, and

17. 17
how parents and caregivers can work on
having open discussions with their adolescents
regarding sexual health, their rights to seek
care, and the importance of adolescents’
rights to confidentiality (“Tips for Health Care
Providers: Helping Teens and Parents with
Sexual Health Needs”, n.d.). It is possible for
adolescents to continue visiting their health
care provider despite the risk of their parents
or caregivers obtaining their medical records;
health care providers need to build a long-
lasting and trusting relationship with the
adolescent who can, in turn, view them as aas a
valuable support system.
Proposed Amendment to Virginia’s
Current Minor Laws
Adolescents should continue to get consented
sexual and reproductive health care, but in
addition, adolescents should be able to have full
access to their health records, while parents
and caregivers can gain access with prior
proven authorization from the adolescent.
Legal parents/caregivers/guardians can have
the option to petition the court for such access
if the health records are deemed absolutely
essential and lack of access serves as a
hindrance to the legal obligatory care the parent
must provide to the adolescent. If a parent or
caregiver should petition the court for access,
the adolescent’s health care provider should
be in agreement with the parent and provide
justifications as to why it is vital for the parent/
caregiver to have such information before the
court can grant access to the parent/caregiver/
guardian. Also, the adolescent should have the
option to respond to the petition and give their
opinion if they so desire.
Conclusion
African American adolescents are markedly
affected by STDs and teenage pregnancies in
comparison to their White counterparts.
Numerous barriers limit African American
adolescents from accessing the sexual and
reproductive health care they need. African
American adolescents’ parents and caregivers
serve as effective educators for sexual health
education and promotion of safe sexual health
practices among their children. However, some
parents are limited in the amount of education
they can provide due to limited available
resources to facilitate teaching. Also, many
parents and caregivers are uncomfortable talking
to adolescents about sexual education due to
fear regarding early sex initiation, in addition to
religious, cultural, and ethnic reasons. As a result,
many adolescents seek information from health
care providers to avoid potential conflict with
their parents and caregivers.
Adolescents are faced with barriers such as
Virginia’s minor confidentiality laws that enable
parents and caregivers to gain access to their
child’s medical records. The ability for adolescents
to consent to sexual and reproductive health care
in Virginia is a benefit, as adolescents can get
honest, informative care that can guide them in
making positive sexual health choices. Lack of
confidentiality by allowing parents to access their
medical records could deter adolescents from
seeking health care and as a result, potentially
lead them to engage in risky sexual behaviors
that place them at risk of developing STDs
and unplanned pregnancies. It is important for
adolescents to be able to receive confidential care
in order to promote preventative gynecological
care and patient retention for future sexual and
reproductive health care (Valvano, 2009).
Since health care providers can be trusted to
provide the best care, support and guidance for
adolescents regarding sexual and reproductive
health, adolescents should be able to be in control
of whether or not their parents or caregivers can
access their health records. Laws have authorized
adolescents to consent to sexual and reproductive
healthcare; confidentiality cannot be divorced
from this care because it’s part of the whole
healthcare scheme. Confidentiality and consent go
together for healthcare to be effective.
Parents should ultimately allow their children to
have their rights and confidentiality respected in
order for them to continue receiving the health
care they need. Additionally, parents should seek
the help of health care providers in learning
how to facilitate a conversation about sexual
health education with their adolescents. By
having the necessary tools to have an effective
communication, adolescents can feel more
comfortable sharing confidential information with
the parent or caregiver. Additionally, adolescents

18. Illustration by Nandita Venkataraman
18
should be a part of a support system at home, in
the community, and with health care providers to
enable them to feel empowered and educated to
make positive sexual health choices. Therefore,
it is important for parents/caregivers, educators,
community leaders, and health care providers
to meet and come up with interventions to
help African American adolescents combat the
elevated STD and teenage pregnancy rates.
Emphasis should be placed on identifying and
addressing various racial and structural barriers
that are in place, especially those that markedly
affect African American adolescents.
Finally, Virginia’s minor confidentiality laws need
to be changed. Adolescents are able to consent
to various sexual health care, therefore they
should be able to control whether or not their
parent’s or caregiver can access their records. As
mentioned in this paper, adolescents would stop
visiting the healthcare provider or delay initiation
of their visit due to current confidentiality laws.
Adolescent avoidance of seeking sexual and
reproductive health care due to confidentiality
laws can lead to continued increased rates of
STDs and teenage pregnancies among African
American adolescents, primarily because they
can engage in high-risk behaviors without
adequate health care and guidan safe, effective,
and confidential care where they control their
parent’s access to their records in order for them
to continue seeing their health care providers
and receiving the necessary care and education.
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20. My nine month ordeal with multiple
primary care physicians leading up to my
Hypomelanosis of Ito diagnosis exemplifies
the legal perpetuation of implicit bias,
unregulated exploitation, and experimentation
on people of color within our medical system,
particularly Black Americans. By extrapolating
key experiences from my illness narrative,
I hope to form direct correlations between
medical implicit bias (specifically the idea of
“othering”), ethnic erasure, and human-based
experimentation on those with rare conditions
that are fairly unknown to “western medicine”
I also argue that the underlying force within
the medical system allowing such structural
“Ain’t I
Human?”
The Role of Bias and Erasure in the
Medical Subjugation of African/Black
American Patients, A Personal Narrative
By Mya Singleton
University of Virginia
violence to continue draws. from how
medicine has historically determined what
constitutes a “human” and the degree to
which “non-humans” (the “other” group)
can be exploited in the name of progressive
medicine.
The use of African/Black Americans for
medical experimentation reached its peak
during the colonial slave era in the United
States and has continued to proliferate
throughout our modern medical and
healthcare system. According to Harriet A.
Washington, the “racial health gulf” that
exists between the medical treatment
20

21. slew of medicinal creams and powders to
strengthen my epithelial cells and immune
system. I had doctor appointments every
week, and, because I was not allowed to
go outside uncovered, getting ready for
appointments was nothing short of a time
consuming nightmare. All my doctors
wanted to start me on a special diet and
discussed with my mother the possibility
of placing me in a special education
program (as they believed my mysterious
condition along with the fact that I was
born premature was affecting my nerve
and brain development). In retrospect,
there was nothing medically
life-threatening about my skin
condition nor did my condition delay my
development in any way, shape, or form.
Therefore, my skin was not a source of
concern but a source of wonder. My skin
condition resided beyond the span of
medical knowledge of the three primary
care physicians I was exposed to in my first
nine months of life. Hypomelanosis, though
“rare,” is not unknown to the medical
community; it was, however, highly studied
within eastern (particularly Japanese)
medicine. The overwhelming response
of the three primary care physicians
to my skin is an example of “othering”
exemplified in Van Loon’s 1928 medical
report of the “amuk” (or insanity)
“I had doctor appointments
every week, and, because
I was not allowed to go
outside uncovered, getting
ready for appointments
was nothing short of a time
consuming nightmare.”
of Black Americans and other racial
populations not only insinuates that
the knowledge concerning the health of
Blacks is based on biological dimorphisms
(the perception that external and
internal differences are caused by
genetic inheritance) but also neglects
the “history of ethically flawed medical
experimentation” on African Americans.
[1] The social condition that colored slaves
were, in one way or another, inferior (and
therefore subhuman) has lead to a series
of experiments designed to support a
biological basis for the structural violence
that socially undermined the Black
American community.
Medical physicians experimented on
blacks in an effort to understand the
human body and how it functioned. I was
born with a rare skin condition called
Hypomelanosis of Ito. My skin was covered
from head-to-toe with various swirls and
stripes of various shades of brown. Some
portions of my skin were completely white
while others were near-black. No one in the
hospital unit had ever seen skin like mine.
The doctors and nurses on call immediately
placed me in the Intensive Care Unit as
my skin was thought to be a result of me
being born premature. I was placed in
an incubation unit and given purified air
through a breathing tube. I remained in
the Intensive Care Unit for approximately
a week as the doctors continued to both
run tests on my skin and monitor my lung
capacity due to my asthma. This week
quickly progressed into a nine month long
“quest” to determine what was wrong
with my skin. I was assigned to at least
three primary (pediatric) care physicians
who were concerned about my skin. I was
subjected to even more tests to rule out
common skin conditions seen amongst the
American population (most particularly
the African American population) such as
eczema and vitiligo. I was prescribed a
21

22. that manifests amongst the Malay
population and other “primitive” races
(including Blacks). According to Van Loon,
medicine should “seek [evidence] not in
normal but in abnormal behaviours” and
conditions.[2] This notion continues in our
modern medical system in that the need to
pathologize (group and categorize) bodies
in such a way is another part of medical
implicit bias. The primary care physicians
that were “treating” my skin were only
considering the skin conditions that were
considered to be common for people of
color (particularly African Americans/
Blacks) without considering the possibility
that my skin condition existed beyond
their medical expertise. The physicians
conducted a multitude of unnecessary
tests before my final physician diagnosed
me with Hypomelanosis of Ito by a simple
visual examination.
One major portion of my illness narrative
that I believe most embodies the idea
of “othering” and ethnic erasure is the
perception of pain in my nine months of
intensive medical care as told from the
perspective of my mother. My mother
remembers being restless for hours in the
hospital, watching every single needle
get inserted beneath my skin and wincing
every time a skin scrape test gave me any
type of discomfort. After my release from
the hospital, I had a Personal Care Nurse
for three to four months who came and
monitored my “progress” every week. She
would bring with her any new cream or
medicine the doctors wanted me to try
as well as track any changes in my skin
or breathing. The application of some of
these medications resulted in additional
tests in order to monitor how they affected
me. To my knowledge, no pain-relieving
medication was administered during this
process as the addition of such medication
may lead to “inaccurate readings” of my
“medical progress”.
Unregulated experimentation on
young adults/children and experiments
“measuring” Black people’s pain tolerance
is not a new concept to western medicine.1
Measuring pain tolerance amongst Black
Americans is an example of reporting
the “ethnographically visible” (an
objective observation) that obscures the
ethnographically invisible (the social
underpinnings of the ethnographically
visible, typically the result of structural
violence), which is the assumption that
Black Americans experience pain differently
than their counterparts.[3] In the case of
my illness, prescribing me the multitude of
unnecessary medication while repeating to
my mother that every action was necessary
in order to make me better (no matter how
obviously painful) concealed the historical
notion that Black individuals (primitive
non-humans) experience pain to a lesser
degree than humans (Eurocentric Whites).
[1] By equating their experimentation on
my skin to proper health care procedures,
the physicians systematically erase their
perpetuation of the ethnically invisible.
This means of erasure takes the form
of “mute suffering” (a social coping
mechanism through which one forgets
what is not wanted).[3] No matter how
these physicians decided to reconcile their
actions amongst themselves, I became
a mere test subject on which they could
actively test their various hypotheses
in the name of medicine. The refusal to
prescribe pain relief medication and/
or anesthetics while performing certain
tests only further attests to their clinical
subjectivity of not needing to prescribe
patients of color with pain medication. This
is possibly due to the socially ingrained
notion that Black Americans experience
pain differently being rendered invisible by
our modern medical system.[4] From the
perspective of medical professionals, they
were not consciously trying to exploit my
skin as a cell culture but rather working to
find a definitive answer as to what
22

23. esentially went wrong with my cells and
genetic makeup. Unfortunately, the results
of their experiments justified their means
of testing no matter the toll this may
take on me in months and years to
come.
If there is nothing else to be taken from
this personal narrative, I hope I have
efficiently conveyed the importance of
considering the continuous exploitation
of Black Americans within our medical
system. The majority of procedures,
medical operations, and understandings of
the human body we know of today are the
result of the relentless medical subjugation
of people of color, particularly those within
the African American/Black population.
Overlooking the unethical use of Black
patients as test subjects perpetuates
the systematic erasure of the structural
violence experienced by Black Americans in
the medical system, which perpetuates the
cycle of abuse towards patients of color in
the name of progressing medicine. It is my
hope that bringing the underlying medical
abuse of people of color to the forefront of
discussion will lead us all to reevaluate on
what grounds and at what cost we exploit
the underprivileged and disadvantaged in
the name of “western medicine”.
Works Cited
[1] Washington, H. A. (2010). Medical Apartheid
The Dark History of Medical Experimentation
on Black Americans from Colonial Times to the
Present. Paw Prints.
[2] Van Loon, F.H.G. (1928). Protopathic–Instinc-
tive Phenomena in Normal and Pathological
Malay Life .British Journal of Psychology 8:
264–276
[3] Farmer, Paul (2004). An Anthropology of
Structural Violence.Current Anthropology 45(3):
305–25
[4] Crowley–Matoka, Megan and Gala True
(2012). Nobody Wants to Be the Candy Man:
Ambivalent Medicalization and Clinician Sub-
jectivity in Pain Management. Cultural Anthro-
pology 27(4): 689–712.
23

24. -01
Magazine Title
PASSIVE
AND ACTIVE
EUTHANASIA:
THE MEDICAL
TROLLEY
PROBLEM
BY THEODORE
MARGHITU
24

25. 
Ever since the second half of the twentieth century,
the medical field has been experiencing ongoing
advancements but these advances have been more
technological than humane, while policy and ethics
often lacked behind technology and science. Due to
the advancement of technology, people can now live
for a long period of time in a vegetative state, as long
as they are connected to a machine; however, we still
do not know in which cases we should keep them
alive, and in which cases it would be more “moral” to
just pull the plug. An even more complex concern is
related to patients who are terminally ill and make
demands to end their suffering, accepting that death
is the only bearable option. Assuming these patients
have a complete understanding of the consequences
of their decisions and are free from any outside
influence, would it be more morally-acceptable to let
a patient die through the cessation of life-sustaining
treatment (passive euthanasia) rather than actively
provoke his/her death through medical interventions
such as lethal injections (active euthanasia)? This
paper will explore the varied views on the difference
in the morality of passive and active euthanasia by
focusing on three points of view that dominate the
discussions surrounding this issue: that passive
euthanasia is more moral than active euthanasia, that
the two types of euthanasia are morally equivalent,
and paradoxically, that active euthanasia is morally
preferable to passive euthanasia. The focus of this
paper won’t be determining the morality of passive
and active euthanasia, but rather analyzing their
differences.
1) Passive euthanasia is morally preferable to
active euthanasia
The official medical position, as dictated by the
American Medical Association (AMA) is that killing
is different from letting die and that the former is
wrong while the latter can sometimes be morally
acceptable. Although it has withheld its approval of
“mercy killing” (which really means active euthanasia),
it acknowledges the principle of “letting die” through
“the cessation of the employment of extraordinary
means to prolong life”. The term “extraordinary
means”, in this case, has been defined as “any
procedure or medication whose origin is not the
human in question (a.k.a. the patient)”.
Doctors have embraced this position, as its absence
would have plunged them into an ethical paradox that
is similar to the infamous trolley problem: suppose
five people are tied to a railway, and there’s a trolley
coming towards them. Would it be more ethical to
let the trolley kill the five people, or pull a lever in
order to make the trolley change its path and kill
only one person tied to another set of tracks (Fig. 1)?
Were this policy not to exist, the only solution given
to the physician is the Hippocratic Oath. Using the
Hippocratic Oath may seem strangely archaic and of
no contemporary help, since the oath states that it is
imperative to relieve suffering, and that is sometimes
at odds with its other imperative, that of prolonging
and protecting life. However, it is debatable whether
a policy is considered moral just because a better
alternative does not exist.
The “Do no harm” imperative is used by Dr. John
Fletcher, physician and professor of biomedical
ethics at the University of Virginia, in his essay
titled “Abortion, Euthanasia, and Care of Defective
Newborns” (Fletcher 1975) . He uses this concept to
show that passive euthanasia is morally preferable
to active euthanasia by arguing that during active
euthanasia, harm was done to the life of the patient,
whilst for passive euthanasia it was not. However,
Fletcher considers the ending of life as harm to life,
and this consideration is debatable. In the cases of
incurable diseases, which inflict serious suffering
and impairments upon the patient, is the termination
of life worse for the patient than its painful
continuation?
25

26. -03
Magazine Title
A reaction to this question could be that, along with
improvements in the science of medicine came the
creation of palliative care, which is meant to improve
the quality of life of patients and their families facing
the problem associated with life-threatening illness.
This is done through prevention and relief of
suffering by means of early identification, impeccable
assessment, and the treatment of pain, along with
other physical, psychosocial, and spiritual problems.
Palliative care uses mostly analgesics and sedatives
in order to relieve the suffering of patients, but
these analgesics have also been regulated to
prevent any possible misuse of these potentially
addictive substances. The World Health Organization
proposed an ‘analgesic ladder’ in the treatment of
pain, beginning with a non-narcotic and progressing
through weaker and stronger opioids, depending on
the type and intensity of the pain felt.
Moreover, as medicine is not a perfect science , there
remains a chance that the prognosis or the diagnosis
made by the physician is wrong, and that the severity
of the disease is actually exaggerated by the current
diagnosis. Such an argument shows that active
euthanasia is immoral by proving that a patient who
is left to die might still survive if he/she proves to
be resistant enough to the disease, or if the disease
proves to be poorly identified. On the opposite side,
by killing, all possibilities are closed, and the physician
might kill a patient whose illness is not terminal. If
the physician considers the disease to be incurable,
that still does not mean that actively killing him is
moral, since there may be other physicians who think
that they can cure the patient. Even if, after all these
attempts fail and the patient is not cured, it is still
in the physician’s duty to research the disease in an
attempt to find a cure (this argument brings forth
the other duty of the physician, which is to help
improve medicine through any means possible, such
as research).
Therefore killing a patient does not only forbid other
physicians from trying to save the patient, but also
slows medicine down by eliminating a potential
resource for medical research. This point, however,
considers the patient as a research subject rather
than a human being, and fails to take into account
the economic consequences of the numerous medical
procedures made by different physicians who try to
save the patient (the cost of a major surgery revolves
around tens of thousands of dollars, on average). This
view also fails to take into account the physical and
mental state of the patient during the course of his/
her illness: the prognosis might be getting worse, or
the surgeries might have been unsuccessful
We can also consider passive and active euthanasia
from the point of view of the person performing
treatment (a.k.a. the physician or the nurse) rather
than the person receiving it. Douglas Neil Walton,
researcher in reasoning, argumentation, and rhetoric
at the University of Windsor, emphasizes the fact
that in the case of letting one die, the actor (in
this case, the medical professional) can fight any
act of interference against his own act, but won’t
necessarily do it (Walton 1981). For instance, if I let a
plate fall, I won’t necessarily attack a person trying
26

27. to catch it. Similarly, if a patient is left to die,
the doctor won’t actively intervene if the patient
somehow gets better, so this view takes into account
the possibility of a miraculous recovery of patients.
However, if the actor kills a person, he/she will forcibly
fight any attempt of interference that might occur
during the process4. Using the previous example, if
I throw a plate down and acknowledge the possible
outcomes of me throwing the plate, then I will oppose
anybody that tries to catch the plate, as that person
interferes with my plan. Similarly, if a physician kills
the patient and acknowledges the fact that he/she
is killing the patient, then he/she will try again if the
patient happens to survive.
Probably the largest argument that favors passive
euthanasia over active euthanasia is the acts and
omissions doctrine, which states that there is a moral
difference between performing an act and failing to
do the opposite. In the case of euthanasia, this point
of view argues that it is morally preferable to fail to
provide treatment than to actively end a person’s
life, just because in the former case the physician
is technically not doing anything, meaning that he/
she is not purposely killing the patient. This point of
view is reinforced by the difference in guilt that the
physician or the nurses feel when they administer a
lethal injection rather than let the patient die (Dines
1995). On the other hand, an obvious critique of this
argument is that the feeling of guilt is personal, and
is influenced by a large number of factors, Therefore,
it is impossible to affirm with certainty that the
difference between active and passive euthanasia
is the origin of the difference in the guilt felt by the
physicians. It can also be said that a feeling of guilt is,
by philosophical and scientific points of view (which
are relevant for this paper), not sufficient for an
argument and can only serve as an example.
Passive euthanasia seems to be accepted as a more
moral end for the patient than active euthanasia,
although it entails a longer and usually more painful
death. However, it apparently allows the physician to
feel less guilty about the status of the patient than if
he/she actively ended the patient’s life. However, isn’t
the intent the same in the case of passive euthanasia
and of active euthanasia, since euthanasia in general
is defined as the act of “intentionally ending a life in
order to relieve pain and suffering”?
2) Passive and active euthanasia are morally
equivalent
James Rachels, American philosopher, is known to
be one of the most fervent attackers of the view
that passive euthanasia is morally preferable to
active euthanasia, and he focuses on the intent of
the physician in order to make his argument. Rachels
affirms that moral accountability can accrue from
inaction just as well as from action, and he uses the
famous examples of Smith and Jones to prove his
point (Rachels 1975).
In his argument, both Smith and Jones stand to gain a
large inheritance if anything were to happen to their
six-year-old cousin. One night, while the cousin is
taking a bath, Smith sneaks in and drowns the child,
making the murder look like an accident. In another
case, Jones also sneaks in planning to drown the
child, but just as he enters the bathroom, the child
slips and hits his head, falling face down in the water.
Jones stands by, ready to push the child’s head back
under the water, but such a measure proves to be
unnecessary since the child drowns all by himself,
“accidentally”. In this case, it is safe to assume that
Smith killed the child, while Jones let him die, but it
is still very difficult to say that Jones’ fault is smaller
than Smith’s. The reason for that, Rachels argues, is
that they both kill the child. By not doing anything,
Jones participates in his death, since if he did
something, the child would have survived. Similarly,
if Smith had not drowned the child, he would have
survived. Both men had the same motive, personal

27

28. -05
Magazine Title
gain, and both had the same end goal in mind when
they acted, and that is sufficient to justify the moral
equivalence between passive and active euthanasia.
This argument, however, has been criticized for only
being related to the issue surrounding passive and
active euthanasia analogically, and an argument from
analogy is only as strong as the resemblance between
the analogies. Since here they are substantially
different, there are no grounds in Rachels’ argument
for concluding that the passive/active distinction is
always morally irrelevant (Beauchamp 1978, 248).
Moreover, Rachels’ view seems to be in direct contrast
with the acts and omissions doctrine, which is favored
by the American Medical Association. From a legal
point of view, Rachels’ arguments are invalid, but that
does not necessarily mean that they are invalid from a
philosophical or bioethical point of view.
The probability of outcome has previously been
discussed, and we managed to say that in all cases,
the patient entered the process of dying. Therefore,
it can be said that, although the doctor kills the
patient by actively injecting him, the patient was
already dying, and the physician shortened this
process, which is similar to what happens in the case
of passive euthanasia. In both cases, the physician
does something (either a positive or negative act);
whereas “positive” means “actively doing (an act)”
while “negative” means “refraining from doing (an
act)”. Refraining from doing is still doing, since
refraining is, in itself, a lack of action. What does this
argument entail for the physician? For one, any guilt
felt should not be felt more strongly in the cases of
active euthanasia than in cases of passive euthanasia,
and the excuses made by physicians who “go along
with nature” when they let their patients die are not
valid. How can the difference in guilt be explained
then? Rachels argues that the reason why people
usually think that killing is worse than letting die is
directly linked to past experiences, mainly related
to media. Indeed, murders are often televised partly
because they provide a safe source of income for
the media companies, whilst occasions of letting die
rarely do (since they are “less entertaining”). Murders
are presented as the worst thing that a person can
do, and people apply this notion to their lives without
putting more thought into how similar killing and
letting die actually are.
3) Active euthanasia is morally preferable to
passive euthanasia
Some people think that, in a medical context, killing
a terminally-ill person is better than letting him/her
die of “natural causes”, and the reasons that they
bring up are related to the wellbeing of the patient.
Rachels, for instance, describes the suffering of
patients who do not undergo treatment and are left to
die of their specific diseases in the hospital. What that
implies for the patient is a long period of suffering
without any form of relief, and it does not seem
justifiable to let a patient suffer when the physician
can eliminate his/her pain (which is one of the main
aims of the physician, considering Hippocrates’ Oath).
For the patient, therefore, a lethal injection would be
beneficial, since it would eliminate the patient’s pain
and would stop his/her struggle with the disease.
Since Rachels wrote his article, numerous medical
advances have contributed to the creation of better
sedatives, which can be used to alleviate the pain of
the patients. Therefore, these drugs can be used to
manage the patient’s pain during the last moments
of his/her life, which would devalue the argument and
make active euthanasia pointless. There is, of course
a certain morbidity to letting a patient die from a
disease that is slowly consuming him/her, and there
are also problems related to the drugs themselves.
These drugs are assessed depending on the pain of
the patient, and as the patient gets used to the drugs,
these become less effective and need to be upgraded.
28

29. 
The more “efficient” drugs are, however, the more
addictive they are (such as morphine and other
opioids like methadone). For terminally ill patients,
addictive drugs can push them even more towards
analgesic drug abuse, as they want to feel as
comfortable as possible during the last period of their
lives. On the other hand, such an addiction would
pose a problem to the economy as a whole, since such
drugs are very expensive.
An even newer problem is related to the abuse of
these drugs by the physicians themselves, who start
administering addictive drugs to dying patients very
early although they are not necessary. With efficient
administration of drugs and non-pharmaceutical
alleviation of pain (through physical therapy, for
example), these problems are very unlikely to appear,
and so there would be no need for active euthanasia.
The autonomy of the patient would be respected, and
the physician would feel less “guilty” because of the
decision.
One of dying patients’ last requests is usually for
a dignified death, where dignity is considered as
a state free from suffering or disabilities. Patients
who go through passive euthanasia are slowly
dying, and although their pain can betaken care
of with medication, it is needless to say that their
bodies are deteriorating. In time, the patient might
need assistance with basic needs such as going
to the bathroom or eating, and such needs tie the
patient to other people such as nurses, and reduce
their autonomy. In the case of some diseases such
as Alzheimer’s, the patient’s mind might also be
disturbed by the illness. Therefore, wouldn’t a patient
prefer to die when he/she is autonomous and logical
enough to take decisions for himself/herself, rather
than wait in a continually worsening state for natural
death to occur?
Such an argument is faced with the opposition
that, after the moment the patient realizes that he/
she is dying, he/she can no longer be considered an
autonomous decision-maker because of the shock
created by the imminent death. The patient goes
through the “five stages of dying” (namely, Denial,
Anger, Bargaining, Depression, and Acceptance), and
depending on the stage at which the patient is at,
his/her decision may vary considerably (Kubler-Ross
1969). Moreover, it is difficult to quantify the dignity
of a patient, although it is difficult to argue that a
patient who is tied to his/her bed during the whole
day, who requires assistance from a nurse for every
physiological need, and can’t communicate anymore,
has dignity. Such cases are, of course, very rare, but
they exist.
Overall, three views dominate the discussion revolving
around the differences in morality between passive
and active euthanasia. The first view (respected by
the law) proclaims that passive euthanasia is morally
preferable to active euthanasia by arguing that
active euthanasia represents harm to the patient
while passive euthanasia does not, and that passive
euthanasia allows for unpredictable improvements in
the health of the patient, while active euthanasia is
sure to stop any possibility for recovery. The second
view argues that passive and active euthanasia are
morally equivalent, since the motive is the same,
and since the act of not doing anything is still an act
that harms the patient. Along with these two views
comes a third which is not defended by many, but
which argues that the comfort and the dignity of the
patient are more important than the “Do no harm”
principle present in the Hippocratic Oath. However,
this last point of view presents risks such as potential
cases of abuse and/or malpractice, as well as outside
influences coming from the patient’s environment
affecting the patient’s decision-making. Ultimately,
physicians may or may not adhere to any of these
views, therefore possibly biasing their decision-
making. A recommendation for physicians would be
29

30. -07
Magazine Title
to isolate their point of view and attempt to remove it
from their decision-making. A suggestion for patients
would be to, if possible, question the physician on
these views in order to uncover his/her hidden biases
and in order to truly make an arbitrary, informed
decision.
References
Burton’s Legal Thesaurus, 4E. S.v. “Euthanasia,
passive.” Retrieved February 9 2019 from
https://legal-dictionary.thefreedictionary.com/
Euthanasia%2c+passive
Burton’s Legal Thesaurus, 4E. S.v. “Euthanasia,
active.” Retrieved February 9 2019 from
https://legal-dictionary.thefreedictionary.com/
Euthanasia%2c+active
Fletcher, John. 1975. “Abortion, Euthanasia, and Care
of Defective Newborns.” New England Journal of
Medicine 292, no. 2: 77-78.
Walton, Douglas. 1981. “Splitting the Difference:
Killing and Letting Die.” Dialogue 20, no. 1: 68-78.
Dines, Alison. 1995. “Does the distinction between
killing and letting die justify some forms of
euthanasia?” Journal of Advanced Nursing, 21: 911-
916.
Medicine.net. “Medical def. of euthanasia.” Retrieved
February 9 2019 from https://www.medicinenet.com/
script/main/art.asp?articlekey=7365
Rachels, James. 1975. “Active and Passive Euthanasia.”
New England Journal of Medicine 292, no. 2: 78-80
Beauchamp, Tom. 1978. ‘A Reply to Rachels on Active
and Passive Euthanasia,’ Beauchamp, Tom and Perlin,
Seymour, eds. Ethical Issues in Death and Dying,
Englewood Cliffs, Prentice-Hall, Inc.
Kubler-Ross Elisabeth. 1969. On Death and Dying.
New York: Macmillan.
30

31. C e n t e r e d
Hannelore Tahmassebi
University of Virginia
You have cancer
You will die
If you do not listen
You must eat
You must run
Come on now
Be healthy
He does not listen
He does not try
I give him lists
So he will not die
I go round and round
But never to the source
The patient is the center
The patient is the subject matter
He must decide
He must direct
He must want to change
He must want to live
I give my job to you
Direct me to your will
And I will stand my ground
For you
I wrote this poem in the fall of 2018 when my father and I had a disagreement
on his lifestyle choices with his diagnosis of Leukemia. During this time, as
a nursing student, I was taking a Care class where we were learning about
patient centered care. Therefore, when I wrote this poem it was a way for me
to express my fears for my father and learn that he needs to decide how he
wants to live and take care of his health. I also realized I needed to support his
choices and understand that I do not know the extent of what he is truly going
through.
31
Illustration by Nandita Venkataraman

32. Limericks as playful simulacrums of
time, imaginations of the polity,
and other
(bio)ethical
adventures.
EDWARD STRICKLER
University of Virginia School of Medicine, Institute
of Law, Psychiatry and Public Policy
32

33. For your consideration:
Guns kill many and mainly by suicide
although NRA guns up fears of homicide.
This appears to be contrarian
‘cause many suicides are young folks, rural guys, and veterans.
When we make this partisan politics are we proud?
33

34. Our polity is awash in a red tide (or is it a
blue wave, or a purple tsunami, or some other
drowning metaphor) of righteousness about
rights. Righteous, self-righteous, and un-righ-
teous claims about rights -- abuse of rights, de-
nial of rights, neglect of rights, abandonment of
rights, assertion of rights, oppression of rights,
the right to have rights -- are on the verge of
drowning us with the proliferating toxic bloom.
Some years ago I attended a talk about Second
Amendment rights by the leader of a statewide
2A rights organization. The toxic bloom of my
self-righteousness showed in my red face. I du-
eled with the speaker about the public health
epidemic of suicide, epidemiologically the
most common gun violence, and the complicity
of the 2A rights organization in that carnage.
The speaker was calm – as a former detec-
tive should be, shouldn’t he? – and said that
the Second Amendment includes the person’s
liberty to kill herself. How furious should I be
with such a claim? A claim so extremely vio-
lative of human dignity? Or was he making a
claim - as he seemed blithely to believe - about
the dignity of a person’s choice? About who
can decide the person’s end: the nursing home
administrator moving the patient out to a less-
er quality facility, the hospital’s ethics consul-
tation team who knows the patient only as an
interesting case (who may or may not be able
to pay the bill, even in a hundred lifetimes), the
insurance claims department or small print
of the insurance plan denying coverage, or the
person with her gun?
(Bio)ethical inquiry rides these waves.
The speaker responded to my further probing:
Q. Does the easy access to a firearm drive a
decision for suicide?
A. The community should have more resources
or mental health interventions.
Q. Will your organization endorse or discuss
policy or law to provide more mental
health interventions?
A. We may as individuals but that is not the
mission of our organization.
Q. What is the mission?
A. To protect Constitutional rights.
...My red tide ebbed with the speaker’s simple
honesty. Richard Rorty, a philosopher who
taught at the University of Virginia throughout
the 1980s and 1990s, said that we live in this
sort of pragmatic age: “the traditional Western
metaphysico-epistemological way of firming
up our habits simply isn’t working anymore …
So the pragmatist suggestion … that we think of
our sense of community as having no founda-
tion except shared hope and the trust created
by such sharing – is put forward on practical
grounds” (Rorty, 1985, p. 15). Of course, what is
pragmatic support for individual autonomy to
one group is violative of the polity to another
group. The gun rights group claims that the
Second Amendment is primary to the First
since it may fall to individuals and local com-
munities to defend their 1A rights (of religion,
speech, and assembly). In Rorty’s language,
they are founding their community in a ‘shared
hope and trust’ that each will help protect each
other’s rights, by arms. Another side calls such
a foundation something other than ‘hope and
trust’. Is our polity struggling in a cataclysm of
conflicting pragmatisms? We are blistered by
the red tide(s) of one partisan ideal crashing
against a different partisan ideal.
Ouch, it hurts.
NOTE:
Several other limericks were submitted for
publication but space did not allow
publication of all. The body of work represent-
ed how something as playful as the limerick
form could introduce or catalyze discourse on
complex topics of interest to (bio)ethical inqui-
ry. If you are interested in reading the body of
work please contact the author.
REFERENCES:
Rorty, Richard. “Solidarity or objectivity.”
Post-analytic philosophy 3 (1985): 5-6.
34

35. Many Animals Are
Equal:
A Consequentialist,
Cognitive
Basis for Moral
Considerability
Many consequentialist arguments in favor of the
equal treatment of animals are based on their
sentience-based interests, the most basic of
which are to avoid pain and maximize pleasure. I
believe that the criterion for having equal moral
considerability should be higher. This criterion
ought to be based on having consciousness as
that is the basis for real, self-aware thoughts
and actions that can engage with moral
problems. In this essay, I first argue that the
pain-and-pleasure principle for assessing
moral considerability is based on problematic
assumptions of animal interests and their moral
valuations. I then argue why the threshold for
actual interests, and thus moral considerability,
should be based on consciousness, which is
accessible only to a smaller group of cognitively-
developed beings. I then respond to potential
critiques, ending with suggestions on how we
humans ought to engage with other animals and
the environment under this ethical framework.
By John Han
University of Virginia
Abstract
35