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The Internationalist Vision of Black Theology and Black Power : Toward a Theology of Solidarity with Palestinians
No full textExploring the Role of Generative AI in Second Language Education: Insights for Instruction, Learning, and Assessment: Introduction to the Forum
No full textArtificial Intelligence (AI), broadly speaking, refers to the efforts to program computers in order to mimic human understandings and problem-solving abilities (Voss, 2024). Recent developments in Generative AI utilize large volumes of available training data that allow users to prompt AI-powered tools to automatically produce specific content (e.g., text or images) (Vajjala, 2024). As an innovative technology, Generative AI is reshaping many fields, including second language education (Ji et al., 2023; Zou et al., 2023). At the same time, it has sparked discussions about its seemingly obvious advantages and potential pitfalls (Voss et al., 2023). Many students, educators, and researchers have embraced Generative AI in their everyday practices. There are numerous Generative AI-powered language learning chatbots, tutors, programs, and tools freely available and widely used in language learning contexts around the world. 
Gazeta Matematică: A Historical Perspective on Its Role in Romanian Mathematics Education
Get PDFThis study examines Gazeta Matematică's (GM) influence on mathematics education in Romania from 1895-1945. Analyzing 13 articles from GM's archives, this research explores discussions on mathematics methodology and didactic issues and highlights Ion Ionescu’s contributions. Findings reveal tensions between idealized rigorous pedagogy and practical classroom challenges. The study highlights GM’s dual role as a mirror reflecting the complexities of mathematics education in a modernizing Romania and as a catalyst for educational reform. It demonstrates GM's significance in fostering mathematical discourse and provides insights into evolving priorities and attitudes toward mathematics instruction during a period of significant social and political transformation
Learning and Inspiring Outside the Classroom: Museums of STEM in NYC
Get PDFLearning and Inspiring Outside the Classroom: Museums of STEM in NY
Fostering Growth Mindset and Grit within Students in the Mathematics Classroom
Get PDFFostering Growth Mindset and Grit within Students in the Mathematics Classroo
"We're Not Giving This Child Back To Lesbians": An Examination of LGBTQ+ Parents' Loss of Children to the Family Regulation System
Get PDF"We're Not Giving This Child Back To Lesbians": An Examination of LGBTQ+ Parents' Loss of Children to the Family Regulation Syste
Unavoidability in U.S. Privacy Law
Get PDFWhy is U.S. privacy law structured the way it is, with a series of sectoral laws rather than a cross-sectoral law or laws? Why does U.S. privacy law protect information shared in certain contexts—such as information shared with an attorney, a healthcare provider, or a financial provider—rather than particular types of information? One possibility is that sectoral laws apply to contexts in which people typically share highly “sensitive” information containing intimate secrets or with the potential to harm them financially or psychologically.
But this Article argues that there is something else at play—that in fact, an under-discussed and underappreciated factor has been a key consideration throughout the history of U.S. privacy law: the unavoidability of information sharing. Tracing the development of several areas of sectoral U.S. privacy law over time, this Article shows that as society changed and contexts emerged in which individuals increasingly found they could not avoid sharing information about themselves with other parties, policymakers repeatedly responded by ratcheting up the privacy protections for information shared in those specific contexts.
Taking the discussion of unavoidability into the modern era, this Article ties the tradition of unavoidability consideration in U.S. privacy law to lawmakers’ current struggle to craft comprehensive privacy legislation. Recent years have seen widespread recognition that the sectoral approach is no longer adequate in the modern information economy. But legislators struggle to decide whether it is sufficient to focus on facilitating individuals’ control over their data—as U.S. privacy law historically has strived to do—or whether the law should more directly restrict the use of data in certain ways or for certain purposes. This Article argues that the current privacy legislation struggle, and the types of innovative legislative provisions being proposed, can be better explained with the aid of unavoidability analysi
End-of-Life Decisions for Isolated Patients Under New York's Family Health Care Decisions Act
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ABSTRACT
The most challenging end-of-life cases involve patients who lack capacity and have no surrogate decision-makers. New York's Family Health Care Decisions Act provides alternative criteria for withdrawing or withholding treatment in such cases, including the requirement that the patient "will die imminently, even if the treatment is provided." This article clarifies the interpretation of "imminent" and offers recommendations to improve end-of-life policies, including greater reliance on Ethics Review Committees (ERCs).
INTRODUCTION
Probably the most distressing end-of-life cases involve patients who lack capacity and who are socially isolated – that is, who do not have a health care agent, family member, or friend who knows them, cares about them, and will make decisions for them.[1] Health care professionals caring for these socially isolated patients struggle with exceedingly difficult professional, ethical, and legal issues.[2] Several states have enacted laws with standards and procedures for such decisions.[3] In New York, the Family Health Care Decisions Act (FHCDA) governs end-of-life decisions for most socially isolated patients.[4] This article examines the provisions for socially isolated patients in the FHCDA. While the FHCDA is just one state’s statute, the clinical, ethical, policy, and even interpretive issues addressed here will be instructive to health care professionals and policymakers in other states as well.
Special attention is given to the FHCDA provision that requires, as a basis for withdrawing or withholding treatment from socially isolated patients, a finding that the patient “will die imminently, even if the treatment is provided.”[5] That critical phrase is a source of uncertainty, both with respect to time period that qualifies as “imminently” and to the application of the phrase to DNR orders.[6] A clear, uniform understanding of the “will die imminently clause” will reduce both undertreatment and overtreatment of socially isolated patients at the end of life.
But an additional policy change is needed. This article recommends that, once standards for ethics review committees are strengthened, the FHCDA should be amended to allow the attending physician to decide to withhold or withdraw life-sustaining treatment for a socially isolated patient based on the standards that now apply to surrogate decisions, subject to approval by an ethics review committee. The FHCDA already allows decisions on this basis for socially isolated patients in hospice;[7] the approach should be broadened.
I. The Family Health Care Decisions Act
The FHCDA governs decisions for patients in hospitals, nursing homes, and hospices who lack capacity and who did not, prior to losing capacity, make the decision personally or appoint a health care agent.[8] The statute governs consent to treatment and decisions to withdraw or withhold life-sustaining treatment.
In general, the FHCDA provides for the designation of a surrogate decisionmaker from a priority list. The highest priority category on that list is a court-appointed guardian when there is one. After that, the list proceeds through levels of close relatives and ends with the category “close friend.”[9]
a. A Surrogate Decision to Withdraw or Withhold Life-Sustaining Treatment
Under the FHCDA, a surrogate may decide to withhold or withdraw life-sustaining treatment from the adult patient who lacks decision-making capacity based on the patient’s wishes, if known or ascertainable through reasonable efforts or when the patient’s wishes are unknown and not reasonably ascertainable, on best interests. Whether the patient’s wishes or the best interest standard is applied, certain clinical ethical standards must be met. For example, either:
(i) treatment would be an extraordinary burden to the patient and the patient has an illness or injury which can be expected to cause death within six months, whether or not treatment is provided; or the patient is permanently unconscious; or
(ii) the provision of treatment would involve such pain, suffering, or other burden that it would reasonably be deemed inhumane or extraordinarily burdensome under the circumstances, and the patient has an irreversible or incurable condition.[10]
This standard, referred to in this article as the “surrogate decision-making standard,” does not require a finding that the patient is imminently dying.
b. FHCDA Provisions Regarding Socially Isolated Patients
FHCDA section 2994-g governs decisions for most incapable adult patients without surrogates. Subsections 5 and 5-a establish the three alternative bases for ordering the withdrawal or withholding of life-sustaining treatment for socially isolated adult patients. As explained further below, life-sustaining treatment can be withdrawn or withheld from a socially isolated patient based on:
1) judicial approval;
2) the "will die imminently" test; or
3) decisions regarding hospice care
c. Judicial Approval
First, the FHCDA allows treatment to be withdrawn or withheld from a socially isolated patient if a court finds that the decision meets the surrogate decision-making standard (terminally ill, permanently unconscious, or extraordinary burden).[11] Prior to the FHCDA, a court had no such authority; it could approve the decision only if it found “clear and convincing evidence” of the patient’s “firm and settled commitment” to forgo treatment under the circumstances.[12]
d. The “Will Die Imminently” Test
Second, treatment can be withdrawn or withheld from the socially isolated patient where:
The attending practitioner, with independent concurrence of a second practitioner, determines to a reasonable degree of medical certainty that:
(i) life-sustaining treatment offers the patient no medical benefit because the patient will die imminently, even if the treatment is provided; and
(ii) the provision of life-sustaining treatment would violate accepted medical standards.[13]
As noted previously, there is uncertainty among clinicians and others regarding the meaning of “will die imminently”[14] — what does it mean and how long a time period is “imminently”? Or to use a legal lens: how would the phrase “will die imminently” be construed in an administrative or judicial legal proceeding?
As explained below, the phrase “imminently” clearly includes a period of hours or a few days, probably includes a week and perhaps two weeks, but probably does not include a month or more.
Administrative and judicial definition. There is no NYS Department of Health regulation or guidance that further defines the phrase “will die imminently.”[15] Such state agency regulation or guidance would have been entitled to considerable deference if a court found that the interpretation required specialized knowledge or expertise.[16]
Moreover, no published judicial opinion interprets the meaning of “will die imminently” in the FHCDA, so there is no binding precedent.
The words “imminent” and “imminently” appear in several other New York state statutes. For example, under New York Mental Hygiene Law, confidential mental health information can be disclosed to an endangered individual based on the practitioner’s determination that the patient presents “a serious and imminent danger” to the endangered individual.[17] The Family Court Act defines “neglected child” to mean a child “in imminent danger of becoming impaired....”[18] Several courts have interpreted those words for the purpose of those other statutes. In a child neglect case, the NYS Court of Appeals explained that “’ imminent danger’” must be “near or impending, not merely possible.”[19] However, the interpretation of “imminent” for the purpose of statutes other than the FHCDA is not dispositive of its meaning in the FHCDA.
The phrase "imminent death" is also used in Georgia and Vermont laws as a basis for a DNR order.[20] But the phrase is not defined in those statutes either.
Principles of statutory construction. In the absence of administrative guidance or judicial precedent, a court would define “will die imminently” by using familiar principles of statutory construction.[21] Initially it would look to the plain, customary meaning of the words as well as the statutory context. If the court needed further guidance, it would consider the legislative history and then possibly professional or scholarly interpretations. A court would be mindful of policy implications, but it could not twist the plain meaning of the words to achieve policy ends.
Plain meaning. Courts typically start with dictionary definitions “as guideposts to determine a word’s ordinary and commonly understood meaning.”[22] Webster’s International Dictionary, Third Edition (1993) defines “imminent” to mean “Ready to take place; near at hand; impending; hanging threateningly over one’s head; menacingly near.”[23] The Oxford English Dictionary defines “imminent” to mean “Of an event (almost always of evil or danger): Impending threateningly, hanging over one's head ready to befall or overtake one close at hand in its incidence coming on shortly.”[24] Merriam-Webster, a commonly used online reference, defines “imminent” as “ready to take place: happening soon.”[25]
Not surprisingly, none of these definitions specify a time period; the term is intentionally imprecise. It is a qualitative, not quantitative, concept. But it unmistakably means “soon.”
Statutory context. Courts will also construe a statute as a whole and consider sections together with reference to each other.[26] In this instance, the statutory context is revealing: one of the other bases in the FHCDA for a surrogate decision to forgo life-sustaining treatment is that “the patient has an illness or injury which can be expected to cause death within six months....”[27] Accordingly, “imminently” must mean something sooner than “within six months.” The Legislature would not have used different phrases for the same time period. Put differently, if the Legislature meant “within six months,” it knew how to say it. It used “imminently” to mean something sooner.[28]
Legislative history. The legislative history of the phrase “will die imminently” is the most revealing guide to its meaning. The FHCDA was based on the 1992 report and recommendations of the New York State Task Force on Life and the Law, When Others Must Choose – Deciding for Patients Who Lack Capacity.[29] The Task Force recommended two bases for a decision to forgo treatment for socially isolated patient:
1.) A decision by the attending physician to withhold or withdraw life-sustaining treatment, based on the standard that would apply to a surrogate, subject to ethics review committee approval; or
2. ) “health care without benefit” defined as follows:
a.) An attending physician determines, in accordance with accepted medical standards and to a reasonable degree of medical certainty, that the patient will die within a short time period despite the provision of treatment and that treatment should be withdrawn or withheld; and
b.) one other physician selected by the hospital concurs in this determination.[30]
The Task Force’s proposed clause in paragraph (2), “will die within a short time period,” is the direct forerunner to PHL 2994-g’s “will die imminently” clause. Moreover, as discussed below, the Task Force regarded “a short time period” and “imminently” as having the same meaning.
The Task Force report devotes a full chapter to “Deciding for Adults Without Surrogates,” with a section on “Treatment Without Medical Benefit.” Its discussion in that chapter in support of the “will die within a short period” standard uses all of these phrases for the same concept:
“during the final days and hours of the dying process”
“the final days of their dying process”
“at the end stage of their dying process”
“will die within a short period even if treatment is provided”
“patients who are imminently dying”
Ultimately, the NYS Legislature deleted the first option of allowing a decision for a socially isolated patient based on the surrogate decision-making standard subject to ethics review committee review proposed by the Task Force. Further below, this article recommends revisiting that option.
More to the point for present purposes, the Legislature modified the Task Force proposed phrase “will die within a short time period” to “will die imminently.” But neither phrase is quantifiable and, as noted above, the Task Force used them interchangeably.
This article cannot provide an authoritative definition of the precise time period conveyed by the phrase “will die imminently.” That would need to come from a court, the legislature or a state agency. But in the absence of such definition, principles of statutory construction indicate that “imminently” clearly includes a time period of hours or a few days, probably includes a week and perhaps two weeks, but probably does not include a month or more.
This conclusion may seem unremarkable. But it may help counter interpretations at opposite ends of the spectrum. If “imminently” is read to mean that the patient must be expected to die within minutes or hours for treatment to be withheld or withdrawn, clinicians may feel compelled to provide highly aggressive treatment to the dying socially isolated patient that most would regard as extraordinarily burdensome in light of minimal benefit. On the other hand, if “imminently” is read to mean that the patient will probably die sometime in the next few months but not the next few weeks, a decision to withhold or withdraw treatment from the socially isolated seems to involve more of a value judgment than a medical judgment.
e. DNR Orders
Applying the term “will die imminently” to DNR orders raises special issues. As explained below, the phrase, as applied to a DNR order means that a DNR order can be written based on a finding that in the event of cardiac arrest, the patient will die imminently even if the treatment is provided. The phrase does not require a finding that the patient is imminently dying at the time the DNR order is written.
A do-not-resuscitate (DNR) order directs the medical staff not to attempt cardiopulmonary resuscitation if and when, at some point in the future, the patient goes into cardiac arrest. New York’s former DNR law, in effect from 1988 to 2010, created a process and standards for securing surrogate consent to a DNR order.[31] For socially isolated patients, it provided that a DNR order could be entered based on an attending physician and concurring physician determination that resuscitation would be “medically futile.” Per the former statute, “medically futile” means that “cardiopulmonary resuscitation will be unsuccessful in restoring cardiac and respiratory function or that the patient will experience repeated arrest in a short time period before death occurs.”[32]
Significantly, the standard to enter a DNR order for socially isolated patient did not require a finding about the patient’s condition or life-expectancy at the time of writing the order; it just required a finding about whether, in the event of a future cardiac arrest, resuscitation would work.
The FHCDA was developed to extend the DNR Law to a broader range of life-sustaining treatments.[33] The Task Force and legislature, in proposing the FHCDA, adopted or adapted DNR Law provisions on, among other topics, determining incapacity, a surrogate priority list, clinical predicates to support a surrogate decision to forgo life-sustaining treatment, the patient‘s wishes or best interest standard, and the use of an ethics committee.
With respect to socially isolated patients, the FHCDA could not simply reproduce the DNR Law’s provision on medical futility because the DNR Law provision was treatment-specific: it referred only to the effectiveness of cardiopulmonary resuscitation. The FHCDA needed to extend the DNR concept of medical futility to encompass decisions about ventilators, feeding tubes, dialysis, antibiotics, and more. Accordingly, the DNR provision on the futility of resuscitation, extended to other treatments, became in the Task Force’s proposal a finding “that the patient will die within a short time period despite the provision of treatment.” In the final FHCDA, that phrase was changed to a finding that “the patient will die imminently, even if the treatment is provided.”
That background illuminates the meaning of the FHCDA term “will die imminently” as applied to a DNR order: It means that a DNR order can be written for a socially isolated patient based on a finding that in the event of cardiac arrest, the patient will die imminently, even if the treatment is provided.
The language of the provision supports the above conclusion. “Will die imminently even if the treatment is provided” ties the phrase “will die imminently” to the time the treatment, resuscitation (when the patient has a cardiac arrest), is provided.
Consider a socially isolated patient dying from cancer that has metastasized. The attending practitioner considering a DNR order may not be able to state with certainty that the patient “will die imminently.” But the physician may well be able to say with certainty that when the disease finally causes the patient’s heart to stop, the patient “will die imminently, even if the treatment is provided.”
This is the standard that was in effect under the DNR Law from 1988 to 2010. Neither the Task Force nor the NYS Legislature intended to disturb that standard in proposing and enacting the FHCDA. As others have noted, “Although the law now uses different words, there are few, if any, cases in this ... category where a DNR order legally could have been issued before FHCDA but could not be issued under FHCDA.”[34]
A NYS Bar Association website, “The Family Health Care Decisions Act Resource Center,” endorses this view.[35] It includes an FAQ that states as follows:
Health Care Decisions for Adult Patients Without Surrogates. N.Y. PHL § 2994-g
Q – Under the former DNR law, a DNR order could be entered for an incapable patient who did not have a surrogate if the physician and a concurring physician determined that resuscitation would be “medically futile” (if CPR would “be unsuccessful in restoring cardiac and respiratory function or that the patient will experience repeated arrest in a short time period before death occurs”). Can a practitioner still do that?
A – The language of the standard has changed, but it still ordinarily supports the entry of a DNR order if resuscitation would be “medically futile” as defined above. Under the FHCDA, the practitioner and a concurring practitioner would need to determine that (i) attempted resuscitation (in the event of arrest) would offer the patient no medical benefit because the patient will die imminently, even if the treatment is provided; and (ii) the attempt would violate accepted medical standards.
This NYS Bar Association FAQ, while not an authoritative source of law, was written, reviewed and approved by a broad range of experienced health lawyers and provides strong support for a facility or practitioner that follows this approach.
Moreover, an article by clinicians and bioethicists at the New York City Health + Hospitals, including bioethicist Nancy Dubler, adopted this position as well:
"Life-sustaining treatment decisions should be seen as situation-specific, as they depend on the treatment in question and on the medical condition and prognosis of the individual at the time the adverse event occurs, such as cardiopulmonary arrest. Based upon the dismal CPR survival data for nursing home residents with dementia, in the event of cardiac arrest, CPR likely will result in imminent death."[36]
The DNR laws in other states specify this temporal concept. For instance, a provision in Vermont’s DNR law allows a physician to write a DNR order for any patient (not just isolated patients) upon a certification “that resuscitation would not prevent the imminent death of the patient, should the patient experience cardiopulmonary arrest. . . .”[37]
It would seem that the same conclusion can be reached for a do-not-intubate (DNI) order, a nursing home do-not-hospitalize order, or any other order that directs the withholding or withdrawal or life-sustaining treatment in the event of a future clinical contingency. Such orders are distinguishable from noncontingent orders meant to be carried out immediately, such as discontinuing a ventilator or feeding tube. But these treatments may raise different clinical and ethical issues. In any case, the clearest case, based on words and history, relates to DNR orders.
To be sure, it would have been preferable if the drafters of the FHCDA specified, as Vermont did, that for the purpose of a DNR order, the test is whether, in the event of cardiac arrest, the patient will die imminently, even if the treatment is provided. And it would be helpful if policymakers clarified this point now.[38] Legislative bills to accomplish this have been introduced repeatedly.[39] The state Department of Health could also accomplish such clarification by a “Dear CEO/Administrator Letter,” [40] or by revising the MOLST checklist for adults without surrogates.[41] Such clarification would help decrease uncertainty and misunderstanding among health care professionals and their advisers and allow DNR decisions for socially isolated patients based on longstanding, ethically sound principles.
But even without an official pronouncement, the words and history of the “will die im
Is it Time to Recognize Political Anxiety as a Social Determinant of Health?
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Introduction
Physicians are on the lookout for social determinants of health, which are those economic, social, and environmental factors that shape a person’s well-being (or lack of it). Physicians often ask patients what their sleep schedule is like or if they have secure access to food and housing, to construct an accurate picture of the patient’s quality of life. Questions that once might have felt invasive (“Does anyone in your household regularly scream at you?”) now feature regularly in clinical encounters. Given the volatile state of US politics, it might not be unreasonable for physicians to try and determine whether and to what extent political rhetoric takes a negative toll on patients’ health. There is potential for the DSM-5 to include political anxiety as a new disorder. Physicians should begin to take political stress seriously as a social determinant of health.
Political Stress and Anxiety
A 2020 article investigated the role that partisan politics plays in health outcomes.[1] The title blasted the results: “Partisan Politics may be Literally Killing Us.” According to the authors, “mortality rates increase by 0.7% for every 10% of the population that votes for the losing candidate.” This turns out to be a more than 3 percent increase in mortality rates “for extremely partisan counties.” In other words, the study suggests that Party Loss (PL) has deadly consequences. Although questions of cause versus correlation are beyond the scope of the paper, the authors suggest the answer for the uptick in death might have to do with an increase in anxiety and social isolation. Chronic stress kills — and many voters, it seems, are chronically stressed.
In 2019, a psychiatrist at the University of Michigan gave an interview discussing how to avoid “political fatigue.”[2] Signs that political discussions are stressing you out might include high blood pressure, weight fluctuation, and sleep struggles. Her first recommendation: be aware of how much time you spend consuming political media.
Easier said than done. Social and mainstream media are an inescapable feature of life in 2024. The media are paid for by advertisements and during campaign season, these advertisements are often political. So, even though you might be sitting down with your family to watch an anodyne program like Jeopardy, you’ll likely see some sort of “attack ad” — the very name of which tells you that it’s been created to foster hostility.
It's not only political ads, though. Even mainstream news feels as if it is engineered to elicit the strongest possible response from readers. This has to do with the financial stakes of the news game: with less (or sometimes no) revenue from subscriptions, media are forced to compete for digital audiences. They do so by goading you into clicking on their headlines. The first newsroom I was part of was progressive by most political standards. On one of my first days on the job, I asked a colleague why the televisions in the main office were set to FOX News. “I guess so that when they say something stupid, we can be the first outlet to write an article about it.” I learned that day that this news organization’s mission included not only reporting the news but also making people angry. To some reporters, these were two sides of the same coin.
Even when news is not written to elicit anger, it seems constructed to make readers feel emotionally involved with the story. In the past month alone, there have been countless reported variations on a single theme: “Early polling shows the presidential race to be neck and neck, but here’s an alternative data point that might make you feel very strong.”
A 2023 poll found that 90 percent of Americans always, often, or sometimes feel “angry” when they think about politics, with about the same number reporting they always, often, or sometimes feel “exhausted.”[3] The same survey asked Americans to sum up their feelings about American politics in a word — four in five respondents used negative words, like “divisive,” “dysfunctional,” and “sad.”
Politics in the Doctor’s Office
The question healthcare providers need to answer is whether this data ought to make its way into exam rooms. For example, if a patient who complains of sleeplessness comes in for an examination the week before an election wearing a t-shirt advertising a political candidate, a physician might find this clinically relevant. Perhaps the physician might consider asking the patient if the upcoming election is affecting their emotional or mental health. Or if in the days following an election, a patient, similarly dressed, presents to the ED complaining of chest pains, the physician might try to determine whether political disappointment — “Party Loss,” as the above-mentioned study calls it — might be contributing to the patient’s increased anxiety levels.
Of course, mentioning politics in clinical settings, especially to patients who seem all too eager to discuss them, carries a certain risk. It is possible that asking about the patient’s level of political involvement might trigger them to launch into a rant, experience a spike in blood pressure, and yell. Or worse, the patient could become hostile towards the provider and ask about the provider’s own political leanings. This, however, need not end in a negative clinical outcome. The physician could calmly explain that she likes to limit discussing politics to certain times and with certain people. By doing this, she is modeling for the patient a different way of engaging politics: with respect, with restraint, and with people of her own choosing (i.e., not strangers on the internet or passing acquaintances).
Recommendations
Physicians are beginning to take the role that social determinants play in the health of their patients seriously. Given the ubiquity of political rhetoric in the US, physicians have good reason to see “political sentiment” as one such determinant of health. Hostile political rhetoric risks tearing apart friends, families, and neighborhoods. As physicians now understand, a person’s health is inextricably tied up with the health of the communities to which she belongs. Social isolation, for instance, is a good predictor of negative health consequences. If a patient reports that she is not visiting her parents for the holidays because of their political differences, a physician could consider including this information in the patient’s clinical chart.
Some might argue that discussing “political anxiety” in healthcare settings is an example of medicalization: political anxiety, they might reason, is a social issue that ought not be brought under the purview of medicine. But social issues have health consequences, both at an individual and population level. While stress might be triggered by, for instance, social phenomena, its physiological effects are profound. It is not always possible to treat the latter without addressing the former. Treatment, however, does not necessarily need to be pharmaceutical: sometimes simply recommending breathing exercises or nature walks might do the trick. In a similar way, physicians discussing political anxiety with their patients will likely not prescribe medications at first. Simply suggesting the patient be mindful about their political content could be a good first step.
People experience anxiety for a variety of reasons. The DSM-5 includes Illness Anxiety Disorder (IAD). The next version could even include preliminary recommendations for studying “Political Anxiety Disorder” (PAD) or Obsession With Respect to Controlling Political Outcomes. Just as patients who suffer from IAD obsessively check their online portals for the latest lab results, some patients obsessively check political polls. There should be a point where the physician suspects this patient’s behavior is negatively affecting her health. It is conceivable that a physician ought to recommend a patient take a break from cable news. It might be appropriate for medical organizations to release policy statements urging the general public to be on the lookout for signs of political anxiety in themselves and in their families. While for now other types of anxiety may include political anxiety, noting the importance of politics as a social determinant of health may highlight the need for physicians to develop best practices and recommendations, like limiting political news, taking breaks from social media, and finding common ground with those with opposing views.
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[1] Maas A, Lu L. “Elections have Consequences: Partisan Politics may be Literally Killing Us.” Applied Health Economic Health Policy. Jan 2021: 19(1): 45-56.
[2] Health Lab. “5 ways to manage political induced stress,” Republication November 4, 2024.
[3] Pew Poll Center, September 2023, “Americans’ Dismal Views of the Nation’s Politics