Curious Bioethics: April 17-22, 2023

Supreme Court keeps mifepristone available, Montana legislature hates trans people, communication skills

Hey there, Curious Human!

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

• Bioethics in the News: mifepristone remains available, Montana attacks trans citizens and representative, new round of Covid boosters approved

• What I’m Reading: on surfing, W.E.B. Dubois’ letter to his daughter

• Educational Opportunities: Vital Talk

Bioethics in the News

Mifepristone Remains Available

We don’t often get good news about abortion access, but this week mifepristone remains available! The Supreme Court issued a full stay of Kacsamaryk’s order to remove FDA’s 23-year-old approval of mifepristone. Access to medication abortion protects millions of people annually from the harms of unwanted pregnancy. It can be safely taken at home and should be widely, easily available.

You can read more details from

Law Dork with Chris Geidner

(below). Both Thomas and Alito voted against the stay.

Supreme Court keeps medication abortion drug available, with eased access, during appeals

Montana Attacks Trans People and Trans Representative

The Montana legislature really hates trans people.

They want to prevent transgender kids from accessing medical care. SB99 lays out the following:

• Prohibiting certain medical and surgical treatments to treat minors with gender dysphoria

• Prohibiting public funds, programs, property, and employees from being used for these treatments

• Providing that a healthcare professional who violates this law commits professional misconduct

• Providing a private cause of action

• Prohibiting discharge of professional liability via insurance

Another bill that just passed, SB458, will erase trans people from the state’s legal codes. Not only will these erase trans people, they erase the existence of intersex people. The bill is clearly not written by anyone with a complex understanding of human sexuality or gender. But we knew that already…

As with many laws attacking the rights of transgender people, they also attack healthcare workers - knowing we are the access points for evidence-based care.

Representative Zooey Zephyr, the first transgender woman elected to the Montana legislature, has spoken out strongly against the bill:

“If you are forcing a trans child to go through puberty when they are trans, that is tantamount to torture, and this body should be ashamed… The only thing I will say is if you vote yes on this bill and yes on these amendments, I hope the next time there’s an invocation when you bow your heads in prayer, you see the blood on your hands.” - Zooey Zephyr

For speaking out for the health of trans kids in Montana, Rep. Zephyr has been censured. Read more below from

Erin In The Morning

.

Let Her Speak - Representative Zephyr's Support Grows As GOP Refuses To Let Trans Elected Speak On Any Bill

New Covid boosters approved

Older people and people with weakened immune systems can get another Covid bivalent booster. The originally approved versions of the vaccine are being phased out.

Dr. Jeremy Faust’s Four Key Takeaways

1. An additional bivalent booster (2nd doses) is now authorized for people ages ≥65 who are at least 4 months out from their first bivalent dose.

2. People with immune compromise may now be boosted as frequently as every 2 months. This is a major change which I’ll discuss in depth below. (There are some caveats for children under age 5, depending on individual vaccine history.)

3. The primary series (for the unvaccinated) will now be the bivalent vaccine. A single dose of the bivalent vaccine will now suffice for most people, though for children under age 6, the old multi-dose primary series strategy will remain in place (i.e., two doses for Moderna or three doses of Pfizer-BioNTech).

4. No change regarding pregnancy and additional boosters. This was not mentioned in the FDA announcement. However, I learned today that the FDA will consider authorizing additional booster doses during pregnancy and that’s news I wanted to share and highlight with you right away.

Read more analysis on each of these points at

Inside Medicine

:

FDA authorizes frequent Covid-19 boosters for the immunocompromised, Spring boosters for ages ≥65, moves to bivalent-only regimens.

What I’m Reading This Week

The Buddy System

“There is nothing quite like it. Surfing is a way of being connected to a deeper deep, an older old.”

I love surfing. I’m not good at it, but I love it. Being in any body of water is healing for me, and the best is being surrounded by the salty, wild ocean. The Buddy System gets to magical solitude you can experience when it’s just you and mother ocean.

W.E.B. Dubois’s Magnificent Letter of Advice to His Teenage Daughter

As I raise and tween-soon-to-be-teen, I gravitate to any words of wisdom from the generations of parents and teens who tread this path before me. Plenty to learn from the timeless advice W.E.B Dubois delivers to his daughter - no matter your age.

“Be honest, frank and fearless and get some grasp of the real values of life… Read some good, heavy, serious books just for discipline: Take yourself in hand and master yourself.”

- W.E.B Dubois

Educational Opportunities

Communication Resources for Clinicians

Communication is the most used clinical intervention in every medical encounter, yet few physicians have had intensive training in how to do it well. Communication is something I’ve invested in for a long time, and it has been worth it. If you really want to improve your communication, it takes active participation, vulnerability, and lots of feedback.

Vital Talk is one of my go-to organizations for both quick communication advice and longer communication training programs.

While these resources are generally designed for physicians, I find many of these skills are universal. As a patient, I find myself reverse-Vital Talking to the clinician. 🤫

When I’m on my way to a difficult conversation, I like to pre-game: think through how to serve the patient, family, and health staff well. What energy am I bringing to the conversation? What are likely pitfalls?

I’ve been using the Vital Talk Tips app for many years. The free app helps clinicians looking for quick, clear communication advice and provides the source of the recommendation.

The fact that it’s right in my pocket makes a big difference. Reviewing the resources gives me a moment to collect myself before walking (or logging) in to a meeting with a family.

Screenshots of the Vital Talk Tips app. First screen with ombre blue tabs with titles including “Improve,” “Advance Directive,” “Dying,” and “Conflict.” The second screenshot expands on the concept. The third screenshot shows how each piece of advice also comes with a reference.

That’s it!

As always, thanks for being curious!

Hit reply and let me know what ethics issues you are most curious about this week—I’d love to hear from you!

See you next week!

Be Well & Be Curious,

Alyssa