Breaking the Barrier Between Us and Others

By Chelsea A. Jack

Disability scholars aim to socially deconstruct naturalized, or seemingly inevitable and fundamental, understandings of what it means to be able-bodied or disabled.  As is the case with much postmodern writing, disability scholars forward their ideas with a general suspicion toward claims of knowledge fortified by dichotomous relationships, e.g. male/female, nature/culture, disabled/abled. However, this is not to say that actual differences do not exist among different groups of people. It is only to say that the barriers between “us” and “them” are never quite as solid as they appear, and that questioning those barriers allows for reimagined relations among community members.

Here, with disability scholarship as my primary example, I draw on the writings of three feminist scholars across different academic disciplines to show how a self-reflexive style can show the vulnerable relationship between the self and other. Such stylistic choices in favor of self-reflexivity betray the academic mantle of omniscience, or objectivity, that characterize arguments removed from the first person. Further, these choices can encourage reimagined relations with those we might understand as other.

When philosopher Eva Kittay has written against ideal theory in bioethics, she has made a strategically feminist move in her criticism of such theory and its proponents, specifically philosophers Peter Singer and Jeff McMahan: she self-reveals. For example, when she criticized Singer’s and McMahan’s theories concerning necessary cognitive and psychological criteria for the status of moral personhood, Kittay reveals that her own daughter, Sesha, was diagnosed as severely to profoundly retarded. Kittay shares that her own daughter might be counted among those whom McMahan has stipulated as undeserving of justice or life. Kittay purposes the developmental experiences of her own daughter as counterpoints to Singer and McMahan’s arguments that deny severely disabled and congenitally severely mentally retarded (CSMR) persons the status of moral personhood.    

In her own reflections on feminist ethnography, anthropologist Ruth Behar has contemplated the implications of acknowledging the place of “I” in the representations of others. In The Vulnerable Observer, Behar suggests that it makes scholars nervous to “forsake the mantle of omniscience” in favor of revealing personal stories into what we have been taught to think of as the analysis of impersonal social facts (1996:12). Both Behar and Kittay approach their own feminist scholarship with an appreciation for humility. Humility, for Kittay, requires both resisting the impulse to impose your own values on others and acknowledging what you do not know (2009:229). As Kittay writes about her own daughter Sesha, she admits, “What cognitive capacities Sesha possesses I simply do not know, nor do others. And it is hubris to presume” (2009:229). By utilizing a narrative from her own life, Kittay not only values humility as a maxim of ethical theorizing but her argument here is feminist for its ability to respond to the theme of vulnerability and marginality underlying subject-object formation.

When Kittay revealed her own relationship to disability, she created a space for conversation about “the tenuous nature of selfhood,” to borrow phrasing from feminist scholar Karen O’Connell (2005:219). In O’Connell’s analysis of the Romany term for the Holocaust – a term that translates to “the devouring” – she argues that attempts to expel unwanted people (i.e. the disabled, women, Jews) are never successful, since total expulsion is a myth. The existence of the self requires attempts to expel unclean and improper elements (218). In this sense, the constitution of threats to the self represents an exigency for the latter. The self, then, is a very fragile thing. This realization then becomes critical in the analysis of violence toward otherness, whether manifested against disabled people, people of color, or women.

How might self-revealing break down entrenched notions of “we” versus “them”? In what way do hypothetical analogies in ideal theory – such as Singer’s between cognitively impaired people and chimpanzees – reinforce epistemic structures of hierarchy and domination, where moral knowledge rests on obscuring the situated-ness of the author herself – situation meaning the circumstances that formulate our identity, i.e. race, class, gender – and the disturbing absence of disabled people in this theorizing? I personally admire those, such as Behar and Kittay, who betray the academic mantle of omniscience in order to advocate humility and recognize the vulnerability of the self.

Works Cited

Behar, Ruth. 1996. The Vulnerable Observer: Anthropology That Breaks Your Heart. Boston: Beacon Press.

Kittay, Eva. 2009. “Ideal theory bioethics and the exclusion of people with severe cognitive disabilities.” In Naturalized Bioethics: Toward Responsible Knowing and Practice, edited by H. Lindemann, 218 – 37. Cambridge.

O’Connell, Karen. 2005. “The devouring: Genetics, abjection, and the limits of Law.” In Ethics of the Body: Postconventional Challenges, edited by Margrit Shildrick and Roxanne Mykitiuk, 217 – 34. MIT. 

Chelsea is a Research Assistant at The Hastings Center. She graduated with highest distinction from the University of Virginia, where she received a B.A. in political and social thought and anthropology with a minor in bioethics. Her research interests include medical and legal anthropology, political and social theory, bioethics, and contemporary feminist thought. 

The Daniel Callahan Young Writer's Prize

Prize Summary 
This post is pleased to announce a new award, The Daniel Callahan Young Writer's Prize, sponsored by Daniel Callahan. Submissions will take the form of essays on a bioethics topic that are written as blog posts, designed for this blog, Bioethx Under 25. From all submissions, a group of finalists will be chosen and then an expert panel of bioethicists, including Daniel Callahan, will read the finalists' essays and award one prize amounting to $500. 

All submissions will be considered for publication on the blog and eligibility to be a finalist or receive the prize is dependent on willingness to edit and revise the essay for publication. Submissions will be judged anonymously. Please see guidelines below for further information. 

Prize Submission Guidelines

- Essays must be 500-1000 words and original submissions to Bioethx Under 25 i.e. never posted before on the blog. 

- Essays must conform to all other submission guidelines for the Bioethx Under 25 blog and thus, be clearly related to bioethics and be written in an accessible manner. Please refer to the blog's About Page for more information. 

- Essays will be accepted from September 10th, 2014 to November 15th, 2014. 

- Any writer who is also a student in high school, college, or a graduate program is eligible to submit. Any writer who is not a student is eligible so long as he/she has not completed a PhD and/or worked more than 5 years in the bioethics field with a terminal degree (e.g. JD or MD). So long as the other guidelines have been met there is no age limitation or requirement for submission. 

- Writers are not eligible if they currently or have previously worked full time for The Hastings Center or Daniel Callahan. Anyone affiliated with Bioethx Under 25 in an editing capacity is also ineligible. 

- To submit, please email bioethicsunder25@gmail.com with your essay attached in word format. In the body of the email please indicate that you are submitting for The Daniel Callahan Young Writers Prize and include your name, phone number, email address, current occupation and place of occupation (if a student, then your school, potential degree, and expected graduation year), and your highest degree attained with the school and year. 

- For any questions please email bioethicsunder25@gmail.com or comment below. 

About Daniel Callahan

Daniel Callahan is Senior Research Scholar and President Emeritus of The Hastings Center. He was its cofounder in 1969 and served as Director and President between 1969 and 1996.  Over the years his research and writing have covered a wide range of issues, from the beginning until the end of life. In recent years, he has focused his attention on ethics and health policy.

He has served as a Senior Lecturer at the Harvard Medical School and is now a Senior Scholar at Yale. He received his B.A. from Yale and a PhD in philosophy from Harvard. He has honorary degrees from the Charles University, Prague, the Czech Republic, the University of Colorado, Williams College, Oregon State University, the State University of New York and the University of Medicine and Dentistry of New Jersey.

Callahan is an elected member of the Institute of Medicine, National Academy of Sciences; a former member of the Director’s Advisory Committee, the Center for Disease Control and Prevention, and of the Advisory Council, Office of Scientific Responsibility, Department of Health and Human Services. He won the 1996 Freedom and Scientific Responsibility Award of the American Association for the Advancement of Science. He is the editor or author of 47 books. 

Summer Hiatus

Bioethx Under 25 is on a summer break and will be back in September with bioethics commentary by young scholars and writers. Please check out our archive for some great reads!

Please email bioethicsunder25@gmail.com if you would like to submit a blog post or topic.

Follow on twitter @BioethxUnder25 for up to date news stories and commentary on medical and environmental ethics.

Hobby Lobby and Freedom from Religious Employers

By Naomi Scheinerman

The decision in Burwell v. Hobby Lobby Stores has been severely scrutinized, from rebukes against corporate personhood to feminists decrying that the Court’s majority, five conservative male judges, devalue and deny women’s personhood. Justice Ginsburg’s scathing dissent and Justices Sotomayor and Kagan’s equally passionate disapproval offer a gendered lens that is impossible to ignore. And further, the Hobby Lobby decision actually does far more harm than good in protecting religious freedoms.

First, Hobby Lobby’s anti-contraception argument relies on fallacious scientific claims that will facilitate further violations of the corporation’s religious beliefs. Hobby Lobby objects to the two IUD’s and Plan B and Ella (emergency contraception) by claiming that using them is akin to having an abortion. This is false. Plan B and Ella prevent ovulation which prevents pregnancy after sex. The International Federation of Gynecology & Obstetrics published a study concluding that because Plan B does not inhibit implantation, it is therefore not an “abortifacient,” a substance that induces abortion. Because Hobby Lobby argued that emergency contraception equals abortions, when in fact emergency contraception does NOT equal abortions, the Court should have thrown out Hobby Lobby’s arguments. As a result of this decision, women who work for Hobby Lobby and are now denied emergency contraception coverage will be much more likely to seek an abortion in their future. Half of women who purchase Plan B do so because of unplanned pregnancy (which includes both consensual and non-consensual sex). Hobby Lobby is paving the way for more abortions, not fewer.

Second, Hobby Lobby’s small closely held corporation’s religious freedoms are being protected at the expense of the freedom from religious imposition on its employees who rely on health insurance to access reproductive freedoms. A closely held company is one in which five or fewer people own the majority of the company. Not only is it strange to treat a corporation as a person with its own convictions, but this decision shows that the Court prefers the religious arguments of a few people in charge over the views of many more who actually work for the corporation. The Religious Freedom Restoration Act of 1993 (RFRA) – the legislation that Hobby Lobby claimed the contraception mandate violated - was originally enacted to protect Native Americans from laws that burdened their exercise of religion. As such, the RFRA was originally constructed to protect employees from theburdensome religious standards of employers and laws. In fact, Catholic and other Christian denominations were even opposed to the RFRA initially because they thought it would protect the “right to a religiously-motivated abortion.” Even if an employee of Hobby Lobby does not have a religious conviction to use contraception, the employers of Hobby Lobby are imposing their religious views by forcing the employees’ actions to align with their own religious practices that forbid abortions. An individual at Hobby Lobby, who is not one of the five people in the entire corporation who wants to prevent contraceptive access, is burdened, something the RFRA was meant to prevent, not allow.

Third, there is real danger in granting religious freedom to corporations that claim exemptions to laws. In Callahan v. Woods, for example, taxpayers used the RFRA to object to the use of social security numbers, arguing that they related to the “mark of the beast.” The Court dismissed this argument. Since the release of the Hobby Lobby decision, many companies have come out of the woodwork, claiming religious exemption to other laws that ban discrimination in hiring or protect women’s reproductive freedoms. The Court ruled that the religious freedom is protected when the law imposes a “substantial burden” on the corporation. This should be interpreted to what the corporation does (its business and goals) rather than how the five or fewer owners feel about the actions of their employees. Is it a substantial burdensome to the selling of paint and brushes to allow female employees to obtain emergency contraption or an IUD?

My last fear is that real and compelling claims of religious exemption, wherein an employer or employee has a true and ethical, religious  belief that a law severely infringes, will become watered down by the numerous unethical claims. About 90% of all American businesses fit the category of closelyheld.  Corporations should not be in the business of determining the appropriate health care package for employees based on religious convictions when it overrides the individual employees’ values. This places an inordinate amount of control on employees’ actions outside the office, such as their reproductive decisions, something the Supreme Court declared was protected by the right to privacy. Employers should not define employee competency by her personal life decisions, but rather based on qualifications and aptitude for the job. This is why employers should not discriminate against gay applicants and should not dictate the sexual freedom of its female employees. Justice Ginsburg accurate identified the dangers of the Hobby Lobby decision: it validates inordinately unethical claims of religious exemption that employers have no right to make.

Naomi Scheinerman is a Research Assistant at The Hastings Center. She graduated Phi Beta Kappa, with high honors and in distinction from the University of Michigan in Ann Arbor, where she received bachelor’s degrees in philosophy, political science, and Hebrew and Jewish Cultural Studies. She contributes a bi-weekly column on reproductive health.

On the Matter of Life and Death

By Michael DiBello

The Death of Ivan Ilyich by Leo Tolstoy provides a chilling and sobering tale of death. Ivan Ilyich is caught up in the everyday routine of what most would consider a patently ordinary life. His main concerns are everyday problems and affairs. He holds an unreflective stance towards death, perceiving it as a simplistic event experienced by the other, not himself. Yet, that all changes when he begins to die. He grapples deeply with the meaning of life, suffering, and death. Questioning the core of his being, he starts to doubt how well he had actually lived his life and experiences an agonizing death.¹

For me, the novel raised several important questions, including: Can we truly live well and meaningfully without thoroughly reflecting on our own mortality? What, if anything, can be done to prevent deaths like Ivan Ilych's and other so called “bad deaths”?

People can live similar lives and die similar deaths. Nonetheless, just as every individual lives in a way fundamentally his own, everyone has a unique encounter with the specter of death. We can die quickly or slowly, painfully or painlessly, in denial or with acceptance, of old age or by accident, bitter or satisfied; the list of descriptions can go on and on.  Most people, when asked, could probably come up with an ideal conception of how they would like to go. While some undoubtedly experience a serene and graceful passing, surgeon Sherwin Nuland explains in How We Die that this is rare. Sadly, a norm for the end of life has become futile life support and unfamiliar doctors and nurses.² Perhaps educating ourselves on what we can more realistically expect to happen to us in the dying process can not only minimize physical suffering but also allow us to appreciate and reflect more deeply on what we distinguish as valuable and important in being a person. Indeed, what tortured Ivan Ilyich was that it was too late for he, himself, to think about what death really meant and hence, what life really meant.

How often do we really think of death in terms of ourselves? The philosopher Martin Heidegger was concerned that conceptualizations of death separate it from the self and are inauthentically placed in the public domain. He argued this was evident through linguistic expression that reduced death to an event that happened to “one” or “they”. As he says, “dying is not an event, it is a phenomenon that should be understood existentially… by its very essence, death is in every case mine, insofar that it ‘is’ at all.”³ Heidegger asks the question: Why is the concept of “dying” only utilized in the context of imminent death? In Being and Time he introduced “being towards death” as a philosophical idea.³ This means that dying is something happening all of the time to everybody, most importantly to oneself, not just to specific people at specific times.

Popular media and culture surrounding medicine play powerful roles in attitudes about death and dying. The latest reports about miracle drugs, while in some ways encouraging, may unconsciously cultivate unrealistic expectations about sustaining life when death is inevitable. These and other technological advances can give the illusion that dying is something we can control and have a choice in, or that the process can micromanaged. It is hard to deny that choice has become an integral part of the dying process in modern medical culture. A plethora of choice can foster hope for people in many medical situations. While hope can bring deliverance, false hope can bring suffering. Nuland explains that doctors (and the patients they influence) may tend to see death as something that must be conquered at all costs, as something for science to overcome. Unfortunately, he says the process devolves into a “puzzle” that must solved, far removed from real human emotions and needs.²

Ars moriendi, or the art of dying,² perhaps is the type of paradigm shift that is needed regarding mortality. Death should not be avoided at all costs, yet it should not always be readily accepted without medical intervention. It is an ambiguous, complex phenomenon that is not conducive to pure ideologies. Just as the artist does not look to science when he paints a canvas, one need not look to science to engage in an intensely personal experience. Doctors and other healthcare workers need not be the only “experts” on dying. Perhaps, ironically, grappling with the nature of mortality and what it entails can be healthy for an individual's sense of personhood. For example, upon learning he was terminally ill, Australian philosopher Julian Young was so inspired that he wrote three books in four years. A terminal patient describes a new-found vividness: “To live in the bright light of death is to live a life in which colors and sounds and smells are all more intense, in which smiles and laughs are irresistibly infectious, in which touches and hugs are warm and tender beyond belief…”.³

Henry David Thoreau may teach a further lesson on death and dying. A great thinker, social activist, and naturalist, he was clearly full of passion for the extraordinary life he lived. However, if we are to trust his comments in midst of a terminal disease, it is clear he gave quite a bit of consideration to his own mortality: “When I was a little boy I learned that I must die, and I set that down, so, of course, I am not disappointed now. Death is as near to me as it is to you”.³ 

1. Tolstoy, Leo, and Richard Pevear. The death of Ivan Ilyich and other stories. New York: Alfred A. Knopf, 2009. Print.

2. Nuland, Sherwin B.. How we die: reflections on life's final chapter. New York: A.A. Knopf :, 1994. Print.

3. Barry, Vincent E.. Philosophical thinking about death and dying. Belmont, CA: Thomson/Wadsworth, 2007. Print.

Mike graduated from Northeastern University in January 2014 with a major in biology and a minor in ethics. He is interested in a wide range of issues in bioethics and how they are applied in today's world.  

Medical Doctors Should Remain "Medical" Doctors

By Naomi Scheinerman

Earlier this year, Britain’s Faculty of Sexual and Reproductive Health, a faculty of the Royal College of Obstetricians and Gynaecologists (RCOG), issued guidelines establishing that the faculty’s Diploma qualifications include a “willingness to prescribe all forms of hormonal contraception, including emergency contraception, regardless of personal beliefs.” Though welcome to undergo the training, those who “hold moral or religious reservations about any contraceptive method,” will not be able to “complete the syllabus [rendering] candidates ineligible for the award of FSRH Diploma” - a legal requirement to practice obstetrics and gynecology in England. Though clinicians may abstain from both performing and counseling regarding abortions, they are required to provide full information on options for unplanned pregnancy and make “timely arrangements” for the patient to see a doctor who is comfortable counseling on abortions.

In this post, I will address three questions: Does the Faculty have the authority to issue guidelines on this matter? If so, are these the correct guidelines to issue? And should we make exemptions to those who hold conscientious objections for religious reasons?

Does the Faculty have the authority to issue guidelines on this matter?

The medical world offers numerous examples of authoritative bodies passing rules of ethical and appropriate treatment. For example, guidelines have codified that informed consent must be acquired from a patient undergoing a medical procedure or participating in a clinical drug trial. Another example: U.S. federal law (HIPPA) protects a patient’s privacy of personal health information such that doctors may not share information with others without the patient’s permission. The authority of the Faculty to issue program guidelines regarding its training is perfectly consistent with our expectations that the medical community governs practitioners’ medicine to ensure ethical and safe care. Medical care cannot be divorced from value judgments, and thus medical training must be considered alongside medical decision making.

Is requiring willingness to prescribe contraception an acceptable use of the Faculty’s power to dictate appropriate medical practice?

I argue that the job of prescribing birth control has become a central part of the job of a gynecologist, and it should be for a number of reasons. Birth control is an ethical and safe option. Women have the right to control their reproduction, and doctors therefore have an obligation to provide access to the means to do so. Patients do not have unlimited rights to services from their doctor - a doctor could and should refuse to operate on an individual who does not need to be operated on. Contraceptive access, in contrast, is not an extravagance, but rather is an important tenant of women’s health. More than just allowing her to regulate her period and perhaps mitigate the negative and uncomfortable experiences of her “natural” cycle, contraception allows women to practice family planning, which has far reaching implications for her overall wellbeing by affecting her job, income, relationships, social network, and status. These results may also be beneficial for her family relations and friendships, as well as, of course, the wellbeing of a child from a pregnancy she neither planned nor wanted. Furthermore, denying a woman access to birth control denies her valid medical desires. Granted, what constitutes a medical necessity is illusive: ultimately numerous medical and nonmedical treatments lead to better welfare and happiness, but it seems strange to classify them all as necessary. However, because birth control affects the body chemically and hormonally, it should be classified under the purview of medicine, and therefore falls within the medical profession.

Should we make exceptions for conscientious objectors, particularly religious conscience objectors?

Just as a conscientious objector to informed consent should be barred from conducting clinical trials, so too should a gynecologist who refuses birth control to women. First, the merits of an argument for conscientious objections must be evaluated, regardless of whether it is religious or nonreligious. One of the primary arguments against contraception is that they are akin to abortions and therefore immoral. This argument is invalid because it relies on a false claim: contraception prevents pregnancy, it does not terminate it. Take for example the anti-vaccine movement: when deciding whether to allow doctors to refuse to vaccinate children, we should only give weight to arguments that are based on scientific claims regarding the safety of vaccines.

Another argument given against contraception is that it increases the rate of casual sex, in particular sex out of wedlock. First, this is a faulty understanding of statistics: access to birth control neither increases nor decreases rates of sexual intercourse, but instead makes it safer. A similar argument was made in the case against the HPV vaccine trials: developing a vaccine that protects against certain kinds of cervical cancers would make girls more promiscuous. This value-loaded claim attempted to maliciously bar an important way to increase sex safety for women and was then proved to be factually incorrect. Even if contraception did increase the rates of sex, either before or after marriage, the argument must prove why this is negative.

Religious reasoning should be scrutinized as vigorously as nonreligious reasoning. For example, the value of having a family is often cited in opposition to contraceptive use by referring to religious texts. However, one could just as easily interpret the value of family in another way: birth control allows women (and their partners) to choose when to have a family, thereby making a more secure, safe, and well-off household. Religious preferences in the medical world should be tolerated only if they do not harm the patient’s welfare. Denial of birth control can and does cause such harm. Religious objectors claim that a patient could see a different doctor, but there are many examples in which this is unfeasible. For instance, a young teenager who wants to become sexually active and is hiding her doctor’s visit from her parents may not simply be able to switch physicians or may be too intimidated to try after being driven off the first time.

The Faculty’s rules are not only permissible, they are imperative for women’s health. They do not suggest that all women should seek birth control or will, nor do they demand that all gynecologists prescribe birth control to all women. Ultimately, the Faculty’s rules are valid because they demand that doctors provide ethically valid and vital medical options to their patients.

Naomi Scheinerman is a Research Assistant at The Hastings Center. She graduated Phi Beta Kappa, with high honors and in distinction from the University of Michigan in Ann Arbor, where she received bachelor’s degrees in philosophy, political science, and Hebrew and Jewish Cultural Studies. She contributes a bi-weekly column on reproductive health.

Reevaluating Mandated Reporting: A Case Study in Sexual Assault

By Douglas Meyer

In light of recent personal events, I have been forced to reevaluate my views on mandated reporting. By mandated reporting, I am referring to the collection of laws and professional codes of conduct that force people to file a variety of reports for situations including, but not limited to, child and elder abuse, sexual assault and self-harm. While the specifics of the situations that must be reported vary widely, a general theme is that an adult must report any risky situation they observe in a professional capacity so that those involved can get necessary help. What follows should not be taken as a comprehensive argument against mandated reporting, but rather as a suggestion for why “getting someone the help they need” is not strong enough to warrant mandated reporting.

Imagine a sixteen year old, we’ll call him Sam, who was recently sexually assaulted. Sam is showing mild signs of depression and has night terrors almost every night as a result of the assault. He knows that some psychological help may prove beneficial, but is unwilling to forfeit his privacy, even if necessary to get the help he needs. I’m going to make a few assumptions for the purposes of analyzing Sam’s case:

1.     Sam’s peers would be supportive, but lack sufficient training to help him.

2.     Sam’s high school has guidance counselors who are well trained in helping sexual assault survivors.

3.     Sam would not be able to afford a psychiatrist without financial assistance.

One of Sam’s options would be to seek the help of a Mental Health Professional (MHP). For the purposes of this discussion, I will define an MHP as a person who has received extensive training in offering psychological assistance and who maintains patient confidentiality. This would be Sam’s best chance of getting the help he would need for his depression and night terrors because the mental health professional would be able to help Sam work through his traumatic experience. In addition, this option would let Sam maintain his privacy, since the only person who would find out about his experiences would be the MHP. Unfortunately, Sam would likely need to explain why he was in need of an MHP to his parents in order to receive their financial assistance. Sam’s unwillingness to forfeit his privacy coupled with his inability to afford an MHP on his own means that this option is unavailable to him.

There are likely only two free options available to Sam. First, are anonymous helplines (AHs) which include services such as online support groups and hotlines Sam could use. AHs would be helpful to Sam, but they would only be beneficial as supplements to other forms of help. Most support groups are comprised of well-meaning peers who bond over shared tragedies, but without sufficiently trained professionals included, they just do not have the capacity to provide all the help Sam needs. Hotlines are very often staffed by volunteers who have minimal training to provide basic guidance and support to callers, but these volunteers would only be able to guide Sam in finding MHPs and another type of assistance, which will be discussed momentarily. As a result, AHs could provide Sam with a lot of support, but only supplementally.

The other possibility would be a cluster of psychological services, which I’ll call Nonconfidential Psychological Agents (NPAs.) As the name suggests, NPAs are services and people, including school guidance counselors and teachers, who cannot offer their clients confidentiality because of their mandated reporting obligations. NPAs can be assumed to have sufficient training to provide Sam with the help he is seeking, and I’ll assume that there are sufficient NPAs available at little to no cost such that cost would not be a barrier to Sam.

Unfortunately for Sam, these three options are insufficient to deal with his case. Option 2 (AHs) would only be able to provide supplementary assistance, but on its own, couldn’t provide Sam with the necessary assistance. Options 1 and 3 (MHPs and NPAs, respectively) would be able to provide the necessary assistance to Sam. However, option 1 would be inaccessible to Sam due to financial barriers.

Earlier, I mentioned that my interpretation of the purpose of mandated reporting was to get someone the help they need. However, this would seem to fall apart when applied to Sam’s case. Mandated reporting does nothing to alleviate the financial burden associated with psychological counseling, and so it would not make MHPs a valid option to Sam. Mandated reporting does have a very strong effect on Sam’s access to NPAs. By preventing NPAs from protecting client confidentiality, mandated reporting actually acts as a barrier to these services. Ironically, the program that was implemented to get people help actually prevents many people seeking counseling from accessing those services. Moving forward, programs that promote access to counseling, like financial assistance programs, should be considered as replacements for mandated reporting strategies.

Douglas Meyer recently completed his first year at UCLA studying microbiology and the intersection between advancements in biology and society. Next fall, he will serve as Co-president of UCLA's Undergraduate Bioethics Club.