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Moving Water: Managed Retreat of Western Agricultural Water Rights for Instream Flows
Get PDFClimate change-induced megadrought and rapid urbanization are forcing western agriculture into retreat as water supplies diminish and heat and drought ravage crops and livestock. At the same time, the megadrought is imposing deep ecological harm on riparian areas, fish species, and soil and increasing the concentration of pollutants in dwindling waterways. These developments raise the question of how to use the water rights left behind as western irrigated agriculture in-evitably shrinks. We argue that federal purchase of some of these rights could create a pool of water available for instream flows (also termed environmental flows) to preserve waterways and aquatic eco-systems. We propose that the federal government acquire some west-ern water rights from agricultural holders, just as it has acquired homes in residential “managed retreat” programs, and dedicate those rights to instream flows. This proposal is novel in agricultural policy, which has stubbornly subsidized agriculture in place, and in the schol-arship on government managed retreat from climate change, which has focused on retreating people and land, not rights in natural re-sources. Federal government managed retreat of western water rights reasserts a federal role in western water allocation, a feature we con-tend accords with current needs as well as history. The allocation of western water and the system of state and private water ownership are largely the result of the post-Civil War response to illegal gold and silver mining thought necessary to encourage western settlement. These policies no longer respond to the modern urbanized West and its present environmental challenges. Drought retreat presents an oppor-tunity for the federal government to move toward a more balanced al-location of western water and create durable environmental benefits
Corporate Sustainability Due Diligence: Combining Human Rights and the Environment
Get PDFEver since the concept of Corporate Social Responsibility (CSR) be-gan to take off in the 1970s, multinational corporations (MNCs) and international organizations have attempted to implement a variety of voluntary initiatives to detect and prevent human rights and environ-mental abuses within corporate supply chains. Despite these voluntary initiatives, however, human rights violations and environmental dam-age have continued to occur frequently within the supply chains of MNCs, leading to increased calls for binding, “hard law” remedies. The adoption of the United Nations’ Guiding Principles on Business and Human Rights (UNGPs) in 2011 catalyzed efforts to adopt domestic mandatory human rights due diligence (mHRDD) laws, and since 2017, a growing number of nations have passed more comprehensive human rights and environmental due diligence (HREDD) laws that recognize the connection between human rights and the environment. The most ambitious HREDD proposal thus far is the European Union’s proposed Corporate Sustainability Due Diligence Directive (CS3D), which, when enacted, will impose mandatory human rights and environmental due diligence requirements on corporations that conduct business in the European Union.
This Note assesses the feasibility and desirability of adopting domes-tic HREDD legislation in the United States based on the framework provided by the EU’s proposed CS3D. The predominant reliance in the U.S. on voluntary CSR initiatives and limited disclosure regulations is insufficient to prevent human rights and environmental abuses in the supply chains of US-based MNCs. This Note argues that the proposed CS3D provides a promising model for how Congress could take strong-er action in this area. Although it would not completely prevent adverse impacts and could be initially challenging to implement because of the ambiguity surrounding its scope, comprehensive federal HREDD legislation based on the CS3D framework would be a significant step towards filling in the gaps in U.S. corporate accountability
Facing Reality: Litigating the Fix When Pre-Merger Negotiations Fail: Sara Y. Razi
Get PDF“Litigating the fix” refers to the practice of defendants litigating divestitures or behavioral commitments (“the fix”) designed to resolve anti-competitive concerns, following rejection by the reviewing antitrust agency during the pre-complaint merger investigation. There have been relatively few cases with this posture, until recently. The vast majority of HSR-reportable mergers that were subject to remediation formerly were “fixed” via a settlement with the DOJ Antitrust Division or FTC, avoiding the need for litigation. But the antitrust agencies’ recent enforcement posture has caused them to be more circumspect about divestitures or other conditions, opting more often to challenge deals outright in litigation. This article examines the litigated decisions addressing this issue, the legal principles they rely on, and the legislative history behind the HSR Act and identifies the proper legal standards by which courts should resolve a government merger challenge in which the defendants have proposed a fix to address any identified competitive problems. The author concludes that the relevant inquiry for a reviewing court is whether the “fixed” transaction may substantially lessen competition, not (as the government argues) whether the proffered divestiture fully restores competition that may be—but for the fix—lost from the originally filed transaction
The COVID-19 Pandemic and the Health of Incarcerated People
No full textCOVID-19 has upended the daily operations of the criminal justice system. Correctional COVID-19 policies have altered how incarcerated people navigate legal proceedings, receive visitors, procure healthcare services, and maintain mental well-being and physical health. Although some of these changes have been positive (e.g., increased access to tablets, and de-incarceration policies), other strategies have exposed societal inequities that fail to meet the needs of people who are incarcerated. Lockdown orders may have unintended consequences for incarcerated people, particularly among those with mental disorders. This commentary examines the barriers and facilitators of healthcare access in our correctional system that has been made more acute due to COVID-19
Preliminary analysis of the disability landscape on Roatán, Honduras
No full textUnderstanding the needs of persons with disabilities (PWDs) is vital to improving targeted healthcare and resources. The project seeks to assess the prevalence of disabilities, resources used, and care and treatment needs for PWDs on Roatán, Honduras. There is little to no prior research about disabilities on the island of Roatán, and few disability studies available in the country of Honduras. We surveyed 581 community members on the island of Roatán over a period of 6 weeks, on questions surrounding the disability status of themselves and their family members, and resources used by PWDs. Interviews were conducted with physicians, promotoras (community health promoters), and staff at the local Rehabilitation Clinic to assess the social experiences and resource needs of PWDs on the island. Of the 613 subjects obtained from our surveys, 258 (42%) had one or more disabilities. The most common disabilities were vision impairment, mobility impairment, and diabetes. 44.98% reported that the PWD did not visit any medical care facility to receive treatment. We found that there was a lack of disability-specific resources on Roatán, and no consistent definition of disability among community members and healthcare providers. Barriers to care include discrimination; caretaker burden; lack of medications, assistive devices, and specialists; and transportation. Our research highlights the need for more education on disabilities within communities, as well as increasing the amount and depth of disability-specific resources accessible on the island. This study was conducted at the request of Clinica Esperanza to determine how it could better support PWDs on Roatán, and the potential benefit of developing a day home for PWDs
Attitudes and Behaviors Around Preventative Measures Against Malaria During Pregnancy in The Luwero District of Uganda
No full textBackground: In Uganda, the rate of malaria in pregnancy ranges from 8.9-50% depending on the level of transmission within the region. It is estimated that malaria may contribute to 8-14% of low birth weight, 3-8% of infant mortality, and 3-15% of maternal anemia. There is limited information on the attitudes and behaviors of pregnant women related to malaria prevention-health impacts for the child, including infant and maternal death.
Methods: A cross-sectional study was conducted in June of 2023. A structured interview was used to collect data on demographics, attitudes, and preventative behaviors related to malaria during pregnancy. Interviews conducted in participants’ homes took approximately 50 minutes. Descriptive statistics were run for demographic data. Chi-squared test and Pearson Product Moment Correlation with a significance level set at p < 0.05 were conducted to test relationships between variables of interest.
Results: Data were collected from 63 women with a mean age of 37. All women had at least one pregnancy resulting in a live birth. Almost one-third of women (31.7%, n = 20) reported getting malaria during their most recent pregnancy. Most respondents (82%, n = 52) received prenatal care and 87.3% (n = 55) used at least one prevention measure against malaria during their last pregnancy. For the participants that reported not protecting themselves (12.7%, n = 8) it was found to be statistically significant in preventing malaria (χ2 = 9.744, p = .008). Bed net use was found significant in preventing malaria during pregnancy (χ2 = 7.113, p = .029) and SP/Fansidar (χ2 = 46.534, p = < .001) during their most recent pregnancy. Receiving prenatal care was found to be significant (χ2 = 24.186, p = <.001). Education level was also found to be significant in to whether women received prenatal care (χ2 = 14.634, p = .023) and in the attitudes that pregnant women should receive malaria treatment during pregnancy (χ2 = 17.084, p = .009).
Conclusion: This study sheds light on the attitudes and behaviors surrounding preventative measures against malaria during pregnancy among a sample of women in rural Uganda. The study emphasizes the need for targeted health campaigns to promote bed net use, addressing barriers to IPTp implementation, and advocacy for improved policy change and antenatal care attendance. Improving access to prenatal care services, particularly in rural communities, is needed to keep women and children healthy.
Implications for Practice: Recognizing the challenges related to policy implementation, there is a pressing need to advocate for policies that support effective prevention strategies during pregnancy. Advocacy efforts should be directed towards improved policy implementation and encouraging regular antenatal care visits.  
Letter from the Editor
No full textDear Reader,
We are excited to share The Columbia University Journal of Global Health Fall 2023 Issue with you. As a journal we strive to uplift diverse perspectives that address the most pressing challenges to health equity faced by communities across the globe. This issue highlights the work of four academics, whose research explores themes of silence and confinement within healthcare systems. Ranging from the impacts of COVID-19 on incarcerated people to the overlooked struggles of obstetric fistulas among Ethiopian women, the articles critically examine the health environments of different marginalized groups. We hope you find their manuscripts to be insightful and thought-provoking.
We have continued to host events that promote health and wellbeing in our community, including a food and nutrition event that brought together the expertise of Dr. Jessica Bihuniak, Assistant Professor of Clinical Nutrition in the Department of Nutrition and Food Studies at New York University, and the cooking skills of Columbia Gormand to discuss affordable, nutritious meals for college students.
In our journal’s aim of highlighting student voices, we have been increasing our efforts in staff writing and publication. Our staff members have shared their perspectives on public health through our “What is Global Health?” blog and podcast, discussing important topics ranging from community health workers to asbestos in homes. Our most recent podcast features a discussion of careers in scientific research with Dr. Rachel Narehood Austin, Diana T. and P. Roy Vagelos Professor of Chemistry at Barnard College. On our blog, we were able to publish our first bilingual staff article “Obesity in Latine Communities in the U.S: What is at play? / Obesidad en Comunidades Latinas en Estados Unidos: ¿Qué está en juego?”. As we consider how to make our journal more accessible, we hope to continue to share staff perspectives across multiple subject areas and in multiple languages, furthering our journal’s mission of diversity and inclusivity.
The past year has been an exciting one for our journal: we published ten new articles that accumulated almost 22,000 downloads and were accessed by over 10,000 site users from 143 countries. We are honored to publish work that has reached such a wide, diverse community, and we hope to continue to expand this impact with the publication of our Fall 2023 Issue. We also recently welcomed two new faculty advisors, Dr. Julianna A. Bol, PhD and Dr. Ana Navas-Acien, MD, PhD, MPH, who will assist our journal in this growth while maintaining the academic rigor that we have always been proud of.
Our journal would not be possible without the dedication of our incredible team, which has grown in the past year. We are truly grateful for the support of our faculty advisor Esther Jackson, the resilience of our journal team, the insight of our peer reviewers, and the submissions from our authors. As always, thank you to our readers and listeners for engaging with our work and forming a vital part of The Columbia University Journal of Global Health community.
Sincerely,
Kairaluchi Oraedu & Ann Phan
Co-Editors-in-Chief, The Columbia University Journal of Global Healt
Consciously Choosing Unconsciousness: Clinical Decision-Making with Palliative Sedation
Get PDFPhoto by Olga Kononenko on Unsplash
INTRODUCTION
“Because there are no laws barring palliative sedation, the dilemma facing doctors who use it is moral rather than legal.” Dr. Timothy Quill, a professor of psychiatry, bioethics, and palliative care concisely articulates an ethical intricacy in end-of-life care. In a Washington Post article titled, “Assisted suicide is controversial, but palliative sedation is legal and offers peace,” the discussion revolves around the ethical challenges encountered by physicians when deciding to employ palliative sedation, particularly when faced with terminal illnesses causing unbearable physical and existential suffering. Palliative sedation is defined as the intentional lowering of awareness towards, and including, unconsciousness for patients with severe and refractory symptoms.[1] While assisted suicide remains embroiled in legal debates, palliative sedation emerges as a legally sanctioned alternative, thereby burdening medical practitioners with a moral quandary; while the boundary between assisted suicide and palliative sedation is arguably blurred, intent seems to distinguish the two choices– both aim to reduce suffering, but palliative sedation does not have death as the goal. This leads to the ethical question on the permissibility of hastening or causing unconsciousness in dying patients, rather than the issue of whether causing death is ethically justifiable. The absence of explicit laws governing palliative sedation places the ethical dilemma squarely on the shoulders of healthcare professionals, who must grapple with the responsibility of determining if palliative sedation is in the best interest of the patient. Evidently, the choice the clinician makes crucially impacts the patient’s quality of life moving forward, demonstrating the far-reaching consequences of palliative sedation in not just individual experiences in healthcare, but in shaping the future of how palliative care is handled. By integrating clinical and neuroscience knowledge, an argument can be made that the optimal clinical decision is reached by considering the subjective value of consciousness for each individual patient, with candor and transparency being the basis of all counseling approaches to prioritize patient advocacy.
ANALYSIS
Drawing on the precedent of assisted suicide, a major concern physicians have when debating the use of palliative sedation is the clause to “do no harm”, a principle fundamental to their profession in healthcare. A paradoxical dilemma arises when reducing the pain of a patient may come at the cost of their consciousness– which is more harmful? Having strict guidelines on when palliative seduction is even an option alleviates some responsibility on the physician to make this choice; the choice of the patient, or informed consent, is preliminary for this therapy.[2] By having the patient aware of the risks, and having that patient decide what state they value more, a physician can base their decision on what “harm” means in relation to the patient’s definition. Of course, there are additional considerations that must be contended with before this assumption can be reliably used, such as the state of mind of the patient when this decision is made, as well as the general consensus that exists among the patient, family, and staff about the therapy’s appropriateness. Another concern then seems to be the actual practice of palliative sedation– what are the side effects and unintended consequences of this therapy? So far, the academic literature seems promising in the accuracy of the therapy; according to a review of 1,807 patients, there is no direct evidence from randomized clinical trials that palliative sedation, when appropriately indicated and correctly used to relieve unbearable suffering, has detrimental effect on the survival of patients with terminal cancer, and can be considered as part of a continuum of palliative care.[3] A more cynical viewpoint should also be considered, however, for the integration of different perspectives, possibilities, and predictions that allow for a comprehensive overview of palliative sedation. One possibility, a prospect unfortunately commonly considered in healthcare, is that palliative sedation can lead to death prematurely. This is where the clinician’s knowledge comes into play, particularly their expertise in the field of neuroscience and the operational definitions of consciousness. Various medications used in palliative care may influence the brain's neurochemistry, impacting consciousness and contributing to the relief of suffering. For instance, benzodiazepines such as midazolam and lorazepam, commonly employed in palliative sedation, act as central nervous system depressants. They enhance the inhibitory effects of the neurotransmitter gamma-aminobutyric acid (GABA), leading to sedation, anxiolysis, and amnesia.[4] The neurological effects of these medications involve modulation of neurotransmitter activity, resulting in a calming effect on the brain. Midazolam, in particular, has a rapid onset of action and a short duration, making it suitable for managing acute distress in terminally ill patients.[5] As these medications induce sedation, they may contribute to the lowering of consciousness levels, while also relieving chronic suffering. Ultimately, it is up to the clinician to use their expertise to not only weigh the possible outcomes of the medications, but to also clearly communicate the potential consequences to the patients in a thoughtful manner.
The doctrine of double effect (DDE) may also help to ameliorate the ethical conundrum of whether practicing palliative sedation is ethically justifiable. In the context of palliative sedation, the application of the doctrine of double effect becomes particularly salient. According to the criteria set by the DDE, the action of administering sedative medications, such as morphine, is deemed morally permissible if certain conditions are met.[6] Firstly, the action itself, providing relief from severe and refractory symptoms through sedation, is not inherently bad—it is morally neutral or, in some cases, considered good due to its intent to alleviate suffering. The primary intention must be the relief of suffering, with the secondary and potentially adverse effect of unconsciousness or hastening death not being the desired outcome but rather an unintended consequence. The DDE thus allows healthcare professionals to navigate the ethical intricacies of palliative sedation by placing a strong emphasis on the intention behind the action. In cases where consciousness is significantly diminished, as is often the case with palliative sedation, the doctrine provides a framework for evaluating the ethical justifiability of the intervention. The principle that the good effect (relief from suffering) must outweigh the potentially adverse effect (unconsciousness or hastening death) ensures a careful and considered approach to decision-making.
The deliberation to use palliative sedation can be framed in the area of the ethics of neuroscience, as the choice to go through with palliative sedation involves the use of clinical decision-making, neuroscience, and ethical considerations related to consciousness.[7] The scientific diagnoses and definitions on how consciousness is perceived and how medications affect consciousness highlights a neuroscientific aspect; the optimal clinical decision-making process involves contemplating this variable value of consciousness. This brings in the ethical dimension, as clinicians must navigate the complexities of respecting individual perspectives and values related to consciousness, which can be influenced by neuroscientific factors such as cognitive functioning, brain health, and subjective experiences.
CONCLUSION
In summary, the ethical considerations surrounding palliative sedation compel clinicians to navigate the nuances of moral responsibility, patient advocacy, and clinical judgment. In the absence of clear legal guidelines, clinicians bear the weight of deciding the appropriateness of palliative sedation, influencing both individual patient experiences and broader palliative care practices. The doctrine of double effect provides a valuable ethical framework, emphasizing intentionality and the delicate balance between relieving suffering and unintended consequences. Ultimately, a patient-centered approach is essential to make the best decisions possible while upholding the principles of beneficence and non-maleficence, ensuring that end-of-life care aligns with the values of each individual patient.
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[1] American Academy of Hospice and Palliative Medicine. 2014. “Palliative Sedation | AAHPM.” Directed by AAHPM. 2023. https://aahpm.org/positions/palliative-sedation.
[2] Young et al. 2021. “The Neuroethics of Disorders of Consciousness: A Brief History of Evolving Ideas.” Brain 144 (11): 3291–3310. https://doi.org/10.1093/brain/awab290.
[3] Maltoni et al. 2012. “Palliative Sedation in End-of-Life Care and Survival: A Systematic Review.” Journal of Clinical Oncology 30 (12): 1378–83. https://doi.org/10.1200/jco.2011.37.3795.
[4] Griffin, CE, 3rd et al. 2013. “Benzodiazepine Pharmacology and Central Nervous System-Mediated Effects.” PubMed. https://pubmed.ncbi.nlm.nih.gov/23789008.
[5] Prommer, Eric. 2020. “Midazolam: An Essential Palliative Care Drug.” Palliative Care and Social Practice 14 (January): 263235241989552. https://doi.org/10.1177/2632352419895527.
[6] Takla et al. 2020. “A Conscious Choice: Is It Ethical to Aim for Unconsciousness at the End of Life?” Bioethics 35 (3): 284–91. https://doi.org/10.1111/bioe.12838.
[7] Roskies, Adina. 2002. “Neuroethics for the New Millenium.” Neuron 35 (1): 21–23. https://doi.org/10.1016/s0896-6273(02)00763-8
Decolonial Language Education and Identity Realization in Africa
No full textThis paper explores the relationship between language education and identity realization and the consequences of choosing either an Indigenous or a colonial language education approach. The focus is on the African postcolonial context; however, the arguments are also substantiated by examples from other parts of the world. I argue for a decolonial-multilingual approach to language education, where our conceptualizations of language must be decolonized (freed from colonial rhetoric) so that language use can be explored for its utility. The paper juxtaposes two lines of arguments: the first is an insistence on a return to Indigenous language education as a form of decolonial resistance and warnings against intellectual control through colonial language education. The second line of argument explores the possibilities of compartmentalizing and interrogating language use as an alternative decolonial-multilingual reality, thereby redefining an individual’s relationship with language and its influence on identity realization. As the paper highlights the extent to which language and identity are correlated, I conclude by stressing the need to decolonize language if identity realization is to be decolonized
Comparing Medical and Mass Media Discourse on Male Prostitutes in Occupied Japan, 1945-1952
No full textWhat can media representations of male prostitutes in Japan during the Allied Occupation (1945-1952) tell historians about the postwar period? This paper explores male sex workers in the wake of Japan’s World War II defeat to revise male-female centered historiographies of this seven-year period. While the population of male prostitutes remained stable—if not decreased—from before to after 1945, they became subjects of psychiatric case studies and popular magazine articles as unique symbols of postwar societal chaos. 1 Though Japanese lives changed dramatically after August 15, 1945, journalists and psychiatrists projected society’s “emasculation” and collapsing social norms onto male sex workers who had been part of society long before World War II began. This paper argues that postwar Japan lingered between tensions of real and perceived social instability, where psychiatrists and journalists alike wrote disorder, emasculation, and chaos into their depictions of male sex workers’ bodies