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Medieval Georgian Coinage: A Cross-Cultural Introduction
No full textThis article surveys the medieval coinage minted on Georgian lands to the Mongol age. Aimed at college-level pedagogy, it underscores the benefits of contextualizing this rich numismatic record regionally, ecumenically, and cross-culturally. The Christianization of the region named for the Caucasus Mountains, which accelerated after the royal conversions of the fourth century, heightened the isthmus’ long-standing cross-cultural condition. Meanwhile, Caucasia’s traditional socio-cultural orientation southwards, especially towards Iran, did not come to an end with the entrenchment of Christianity. Since the Iron Age, Caucasia has been an active component of the Iranic (Persianate) world. The formation of the dār al-Islām and its extension across Caucasia did not thwart the southwards orientation. In Georgian lands, Islamic types and Arabic inscriptions were commonplace on the local coinage produced by Muslims and Christians alike. The Georgian Bagratids, identifying themselves as a Christian Byzantine-like dynasty, continued to deploy Islamic types on their coinage even during its “Golden Age” in the eleventh to early thirteenth century. At the same time, the nexus of the Iranian and Persianate world, on the one hand, and Caucasia, on the other, endured and evolved. The chronological span investigated here is appropriately bookended by coins embodying imperial hegemonies whose epicenters were located in Iran (i.e., the Sasanians and the Ilkhans)
Remarks by the Recipient of the 2023 MEM Lifetime Achievement Award
No full textRemarks by the Recipient of the 2023 MEM Lifetime Achievement Awar
Defending Race-Conscious Policy: New York State’s Criteria for Identifying Disadvantaged Communities
Get PDFBeginning in the 1980s, a coalition of community groups, activists, and non-profits loosely referred to as the “environmental justice movement” campaigned to draw awareness to the disproportionate distribution of environmental burdens to low-income communities of color. These burdens cause severely negative health impacts, reduce property values (which in turn reduce generational wealth), and im-pact quality of life. Low-income communities of color also receive few-er environmental benefits, including parks and green space (which re-duces heat in urban areas) and access to healthy food. Climate change further threatens vulnerable communities by causing increased heat in already-overheated neighborhoods, more frequent and severe storms, and rising sea levels in coastal areas.
In 2019, New York State enacted the Climate Leadership and Com-munity Protection Act (CLCPA), an ambitious piece of legislation that creates a framework to reduce statewide greenhouse gas emissions and to invest in “disadvantaged communities” (DACs). The latter goal reflects the environmental justice movement’s success. The current set of criteria developed under the CLCPA to identify U.S. census tracts within New York as DACs considers, among a large set of factors, the racial and ethnic demographics of the tracts. While this approach re-flects the environmental justice movement’s values, it also makes the CLCPA vulnerable to a potential constitutional challenge. Drawing on decades of precedent from the U.S. Supreme Court in cases regarding affirmative action programs, a plaintiff might bring a case arguing that the New York State government is distributing benefits based onindividuals’ race or ethnicity, in violation of the Equal Protection Clause.
This Note examines the degree to which the CLCPA’s current DAC criteria are vulnerable to such a challenge, and sets forth how the state might argue that the DAC criteria do not violate the Equal Protection Clause. Specifically, this Note argues that the state could mount a strong argument at the outset that such a plaintiff cannot satisfy the requirements for standing. In the alternative, the state could argue that the criteria should not draw strict scrutiny because race and eth-nicity are relatively insignificant factors in a complex and context-sensitive process. If the criteria do draw strict scrutiny, the govern-ment could argue that it has a compelling interest in remedying the ef-fects of its past acts of racial discrimination, and that the criteria are narrowly tailored to this interest. And finally, the government could argue that even if the criteria are unconstitutional for considering race, the issue is severable, and the criteria can be easily amended to remove race and ethnicity
What COVID-19 Vaccine Distribution Disparity Reveals About Solidarity: Solidarity and COVID-19 Pandemic
No full textPhoto by Spencer Davis on Unsplash
ABSTRACT
Current conceptions of solidarity impose a morality and sacrifice that did not prevail in the case of COVID-19 vaccine distribution. Notably, the vaccine distribution disparity revealed that when push came to shove, in the case of global distribution, self-interested persons reached inward rather than reaching out, prioritized their needs, and acted to realize their self-interest. Self-interest and loyalty to one’s own group are natural moral tendencies. For solidarity to be normatively relevant in difficult and emergency circumstances, solidarity scholars ought to leverage the knowledge of the human natural tendency to prioritize one’s own group. This paper recommends a nonexclusive approach to solidarity that reflects an understanding of rational self-interest but highlights commonalities among all people. A recommended task for future studies is to articulate what the account of solidarity informed by loyalty to the group would look like.
INTRODUCTION
The distribution of COVID-19 vaccines raises concerns about the normative relevance of the current conceptions of solidarity. Current conceptions of solidarity require individuals to make sacrifices they will reject in difficult and extreme situations. To make it more relevant in difficult situations, there is a need to rethink solidarity in ways that align with natural human dispositions. The natural human disposition or tendency is to have loyalty to those to whom one relates, to those in one’s own group (by race, ethnicity, neighborhood, socioeconomic status, etc.), or to those in one’s location or country. While some may contend that such natural dispositions should be overcome through moral enhancement,[1] knowledge about self-interest ought to be leveraged to reconceptualize solidarity. Notably, for solidarity to be more relevant in emergencies characterized by shortages, solidarity ought to take natural human behaviors seriously. This paper argues that rather than seeing solidarity as a collective agreement to help others out of a common interest or purpose, solidarity literature must capitalize on human nature’s tendency toward loyalty to the group. One way to do this is by expanding the group to the global community and redefining solidarity to include helping the human race when emergencies or disasters are global.
The first section describes the current conception of solidarity, altruism, and rational self-interest. The second section discusses how the moral imperative to cooperate by reaching out to others did not lead to equitable COVID-19 vaccine distribution. The third section argues that solidarity should be rethought to align with natural human dispositions toward loyalty to groups and rational self-interest. The final section briefly suggests the global community be the group for nonexclusive solidarity.
I. Solidarity: Understanding Its Normative Imperatives
Solidarity literature is vast and complex, attracting contributions from authors from countries of all income levels.[2] Notably, the literature addresses how solidarity develops from interpersonal, then group to institutional, and how it is motivated and maintained at different levels.[3] Solidarity is unity among people with a shared interest or goal.[4] The term was popularized during an anti-communist labor movement in Poland.[5] While a show of solidarity traditionally meant solidarity within a group, for example, workers agreeing with and supporting union objectives and leaders,[6] it has come to include sympathy/empathy and action by those outside the group who stand with those in need. In bioethics, the Nuffield Council defines solidarity as “shared practices reflecting a collective commitment to carry financial, social, emotional, and or other ‘costs’ to assist others.”[7] As conceptualized currently, solidarity prescribes a morality of cooperation and may incorporate altruism.
Solidaristic actions like aiding others or acting to enhance the quality of others’ lives are often motivated by emotive connections/relations. For this reason, Barbara Prainsack and Alena Buyx define solidarity as “a practice by which people accept some form of financial, practical, or emotional cost to support others to whom they consider themselves connected in some relevant respect.”[8] Although this description has been critiqued, the critics[9] do not deny that sympathy and understanding are the bases for “standing up beside” or relating to others. Political solidarity is a “response to injustice, oppression, or social vulnerability”[10] and it entails a commitment to the betterment of the group.
“Rational self-interest” describes when parties behave in ways that make both parties better off.[11] They may be partly motivated by their own economic outcome. It may be that when some regions or groups act solidaristically, they are also motivated by shared economic goals.[12] Rational self-interest is not always opposed to the commitment to collectively work for the group’s good. Rational self-interest can intersect with collective action when parties behave in ways that make both parties better off. For example, one study found that individuals are willing to bear the burden of higher taxes in favor of good education policies that significantly increase their opportunities to have a good life.[13] Rationally self-interested persons may be partly motivated by their own economic outcome. It may be that when some regions or groups act solidaristically, they are also motivated by shared economic goals.[14] Specifically, individuals, organizations, and governments are driven to positively identify with or aid others because they feel connected to them, share the same interest, or would benefit from the same action. Cooperating with others on this basis guarantees their interests. Individuals will be less likely to help those with whom they do not feel connected. Respect, loyalty, and trust among solidary partners are equally grounded in this belief. “[S]olidarity involves commitment, and work as well as the recognition that even if we do not have the same feeling, or the same lives, or the same bodies, we do live on common grounds.”[15] Although individuals are more likely to exhibit solidarity with those to whom they feel connected, their lives and interests are still different.
Some African philosophers describe solidarity as entailing reciprocal relations and collective responsibility.[16] The bases for positively acting to benefit others are communal relations and individual flourishing, similar to solidarity as it is described in the global literature. Common motifs and maxims typify this belief: the West African motifs like the Siamese Crocodile and the African maxims like “the right arm washes the left hand and the left arm washes the right arm”, and the Shona phrases “Kukura Kurerwa” and “Chirere chichazo kurerawo” – both meaning the group’s development is vital for the individual’s development.[17] As a reciprocal relation, solidaristic actions are instrumentalized for one’s self-affirmation or self-emergence. This view underlies practices in Africa like letsema, which is an agricultural practice where individuals assist each other in harvesting their farm produce. It is also the animating force underlying a favorable disposition towards joint ventures like the ajo (an African contributing saving scheme whereby savings are shared among contributors by rotation).[18] Furthermore, as entailing collective ownership, solidaristic actions become ways of affirming each other’s destiny because it is in one’s best interest to cooperate with them this way or help others realize their life goals given the interconnectedness of lives. One advantage of forming solidary union that reaches out to others is that they possess qualities and skills that one lacks. This application of solidarity is more localized than solidarity among countries or global institutions.
Furthermore, solidarity also entails altruism, an idea that is particularly common in the philosophical literature of low-income countries. On this account, solidarity implies a voluntary decision to behave in ways that make individuals better off for their own sake. Here, it matters only that some have thought about solidarity this way. Moreover, this belief informs pro-social behaviors – altruism is acting solely for the good of others.[19] Altruistic behaviors are motivated by empathy, which is an acknowledgement of individuals who require aid, and sensitivity, which is a thoughtful response to individuals in need of help. Solidarity can seem to be a call to help strangers rather than a genuine feeling of uniting with people for a common cause. Altruism and solidarity appear similar although they are distinct in that solidarity is not merely helping others. It is helping others out of a feeling of unity. In some cultures in Africa, an indifference to the needs of others or a failure to act solely in ways that benefit others or society are often considered an exhibition of ill will.[20] Precisely, the phrases “Kukura Kurerwa” and “Chirere chichazo kurerawo” among the Shona people in Southern Africa morally compel one to play an active role in the growth and improvement of others. “The core of improving others’ well-being,” as explained, “is a matter of meeting their needs, not merely basic ones but also those relevant to higher levels of flourishing, e.g. being creative, athletic, theoretical.”[21] On this basis, self-withdrawal, self-isolation, and unilateralism, would be failures to be solidaristic.
II. COVID-19 Vaccine Distribution Disparity And The Imperative To Reach Out
The strength and benefits of cooperation are well documented. COVID-19 vaccine distribution did not reflect solidarity despite the use of rhetoric suggesting it. COVID-19 vaccine distribution disparity exemplifies how solidarity requires individuals to make sacrifices that they will refuse under challenging circumstances.
Solidaristic rhetoric was not uncommon during the COVID-19 pandemic. This was expressed through maxims like “Stronger together”, “No one is safe until everyone is safe”, “We are all in this together”, and “Flatten the curve”, as well as cemented through actions like physical distancing, mask-wearing, travel restrictions, and limits on social gatherings. Before the pandemic, solidarity rhetoric informed alliances like the Black Health Alliance that was created to enable Black people in Canada to access health resources.
This rhetoric and the global recognition of the vital importance of exhibiting solidarity had little if any impact on preventing vaccine distribution disparity. Notably, the World Health Organization set a goal of global vaccination coverage of 70 percent. The 70 percent figure was recognized as key for ending the pandemic, preventing the emergence of new variants, and facilitating global economic recovery.[22] The solidaristic rhetoric that no country was safe until all countries were safe did not result in enough vaccine distribution. Nor did the rational self-interest of common economic goals. The economic impact of the pandemic has been huge for most nations, costing the global community more than 2 trillion.[23] Vaccine distribution disparity across countries and regions undermined international efforts to end the COVID-19 pandemic.
The disparity revealed that self-interested persons, organizations, and countries reached inward, prioritized their needs, and acted to realize their own self-interest. Empirical studies confirmed the disparity at the macro and micro levels. Some of the findings are worth highlighting. The number of vaccine doses injected in high-income countries was 69 times higher than that in low-income countries.[24] In fact, the UK had doubly vaccinated about 75 percent of its adult population by February 2022, while more than 80 percent of African nations had not received a single dose of the vaccine.[25] Precisely, the national uptake of vaccines in Uganda (which is a low-income economy without COVID-19 production capacity) was “6 percent by September 2021 and 63 percent by June 2022. The vaccination coverage in the country was 2 percent by September 2021 and 42 percent by June 2022. Yet both the national COVID-19 vaccination uptake and coverage were far below WHO targets for these dates.[26] Although a report which assessed the impact of COVID-19 vaccines in the first of year of vaccination showed that about 19 million COVID-19-related deaths were averted, they were mainly in the high-income countries rather than in countries that failed to reach the vaccine coverage threshold for preventing the emergence of new variants.[27] There were more than 250,000 COVID-related deaths in African countries.[28] Though this figure is significantly lower than reported COVID-19 deaths in North America (1.6 million), the report and other studies confirm that many of the deaths in Africa could have been prevented if the vaccines had been widely distributed in the region. [29]
Still at the macro level, whereas 78 percent of individuals in high-income countries were vaccinated by February 15, 2022, only 11 percent of persons in low-income countries were vaccinated by the same date.[30] By February 15, 2022, high-income countries like Lithuania and Gibraltar (a UK territory) had more than 300 percent of doses required for vaccinating their population, while low-income countries in Africa had only managed to secure about 10 percent of the necessary vaccine doses for their people. Burundi had vaccinated less than 1 percent of its population by December 2022.
The disparity between countries of similar income levels was also evident. For example, among 75 low- and middle-income countries, only about 14 countries reported vaccinating at least 50 percent of their population. And, while high-income countries like Qatar had secured more than 105 percent of doses for their people, other high-income countries like Liechtenstein had only managed about 67 percent vaccination coverage by December 2022.[31] Within countries, vaccination coverage gaps were also evident between urban and rural areas, with the former having higher vaccination coverage than the latter.[32]
There were many tangible solidaristic efforts to cooperate or reach out through schemes like the COVID-19 Vaccines Global Access (COVAX), African Vaccine Acquisition Trust (AVAT) and Technology Access Pool (C-TAP). Notably, the schemes were testaments of the global recognition to lift others as we rise and not leave anyone behind. Both high-income and low- and middle-income countries supported the programs as an expression of solidarity. Indeed, many low- and middle-income countries secured about 800 million doses through these schemes by the end of December 2021. Nonetheless, this was still far below these countries’ two-billion-dose target by the same date. The wealthier countries’ rhetoric of support did not lead to delivery of enough vaccines. The support by high-income countries seems disingenuous. While high-income countries at first allocated vaccines carefully and faced shortages, they had plentiful supplies before many countries had enough for their most vulnerable people. Thus, these schemes did very little to ensure the well-being of people in low- and middle-income countries that relied on them.
These schemes had many shortcomings. For example, COVAX relied on donations and philanthropy to meet its delivery targets. In addition, despite their support for these schemes, many high-income countries hardly relied on them for their COVID-19 vaccine procurement. Instead, these high-income countries made their own private arrangements. In fact, high-income countries relied on multilateral agreements and direct purchases to secure about 91 percent of their vaccines.[33] These solidaristic underfunded schemes had to compete to procure vaccines with the more highly resourced countries.
Arguably, many factors were responsible for the uneven distribution of COVID-19 vaccines. For example, vaccine production sites facilitated vaccine nationalism whereby countries prioritized their needs and enabled host states like the UK to stockpile vaccines quickly. Regions without production hubs, like many places in Africa, experienced supply insecurity.[34] The J & J-Aspen Pharmacare deal under which a South African facility would produce the J&J COVID vaccine did not improve the local supply.[35] Companies sold vaccines at higher than the cost of production despite pledges by many companies to sell COVID-19 vaccines at production cost. AstraZeneca was the only company reported to have initially sold vaccines at cost until it replaced this with tiered pricing in late 2021.[36] Moderna estimated a 19 billion net profit from COVID-19 vaccine sales by the end of 2021. Pricing practices undermined solidaristic schemes designed to help low-income countries access the doses required for their populations.[37]
The unwillingness of Western pharmaceutical companies like Johnson and Johnson, Pfizer-BioNTech, and Moderna to temporarily relinquish intellectual property rights or transfer technology that would have eased vaccine production in low-income countries that lacked production capabilities even when taxpayers’ money or public funding accelerated about 97 percent of vaccine discovery is another example of acting without solidarity. South Africa and India proposed the transfer of essential technological information about COVID-19 vaccines to them to increase local production.[38] The EU, UK, and Germany, which host many of these pharmaceutical companies, opposed the technology transfers.[39] Corporations protected their intellectual property and technology for profits.
There were many other factors, like vaccine hoarding. Although the solidaristic rhetoric suggested a global community united to help distribute the vaccine, COVID-19 vaccine distribution demonstrates that individuals, institutions, regions, or states will prioritize their needs and interests. This leads to the question, “What sort of behaviors can reasonably be expected of individuals in difficult situations? In what ways can solidarity be re-imagined to accommodate such behaviors? Ought solidarity be re-imagined to accommodate such actions?
III. COVID-19 Vaccine Disparity: Lessons For Solidarity Literature
COVID-19 vaccine distribution disparity has been described as inequitable and immoral.[40] One justification for the negative depiction is that it is irresponsible of individual states or nations to prioritize their own needs over the global good, especially when realizing the global interest is necessary for ensuring individual good. Although such contributions to the ethical discourse on COVID-19 vaccine disparity are essential, they could also distract attention from vital conversations concerning how and why current solidarity conceptions can better reflect core human dispositions.
To clarify, the contestation is not that solidaristic acts of reaching out to others are morally unrealistic or non-realizable. There are historical examples of solidarity, particularly to end a common affliction or marginalization. An example is the LGBT support of HIV/AIDS-infected persons based on their shared identities to confront and end the stigma, apathy, and homophobia that accompanied the early years of the crisis.[41] Equally, during the apartheid years in South Africa, Black students formed solidarity groups as a crucial racial response to racism and oppression by the predominantly White government.[42] Additionally, the World Health Organization’s (WHO) director, Tedros Ghebreyesus cited solidarity and its rhetoric as the reason for the resilience of societies that safely and efficiently implemented restrictive policies that limited COVID-19 transmission.
To improve its relevance to emergencies, solidarity ought to be reconceptualized considering COVID-19 vaccine distribution. As demonstrated by the COVID-19 vaccine distribution disparity, individuals find it difficult to help others in emergencies and share resources given their internal pressing needs. Moreover, humans have a natural tendency to take care of those with whom they identify. That may be by country or region, race, ethnicity, socioeconomic status, type of employment, or other grouping. By extension, the morality that arises from the tendency towards “the tribe” is sometimes loyalty to one’s broader group. Evidence from human evolutionary history, political science, and psychology yields the claim that “tribal [morality] is a natural and nearly ineradicable feature of human cognition, and that no group—not even one’s own—is immune.”[43] Tribal morality influences mantras like America First, South Africans Above Others, or (arguably) Brexit. These conflict with solidarity.
As another global example, climate change concerns are not a priority of carbon’s worst emitters like the US, China, and Russia. In fact, in 2017, the US pulled out of the Paris Agreement, a tangible effort to rectify the climate crisis.[44] Droughts experienced by indigenous people in Turkana, the melting ice experienced by the Inuit, the burning bush experienced by the aboriginal Australians, and the rise in ocean levels that remain a constant threat to the Guna are examples of the harm of the changing climate. In the case of climate action, it appears that governments prioritize their self-interests or the interests of their people, over cooperation with governments of places negatively impacted. In the instance of COVID-19 vaccine distribution disparity, loyalty to the group was evident as states and countries kept vaccines for their own residents.
Solidarity has a focus on shared interests and purpose, but in its current conceptions it ignores huma
Alcohol Exclusion Laws and Its Drawbacks
Get PDFPhoto ID 143764115 © Chris Dorney | Dreamstime.com
INTRODUCTION
Since the repeal of the 18th Amendment in 1933, alcohol consumption has become prevalent among many Americans. Alcohol intoxication is an increasing contributor to emergency room visits wherein individuals present to the emergency department (ED) in an inebriated state, often with secondary injuries or severe medical co-morbidities related to alcohol poisoning. The ED is a stressful environment with providers working under taxing conditions while triaging difficult cases. Alcohol related visits contribute to this added stress for staff given that intoxicated individuals increase wait times for the ED, use up valuable resources, and have the capacity to act violently towards providers. As one nurse puts it, some intoxicated individuals present with “an aggressive state, perhaps have been in a fight, blood everywhere, careening around the place – it can make things very difficult.”[1] To combat these circumstances, thirty-four States including the District of Columbia have implemented a countermeasure recognized as Alcohol Exclusion Laws (AELs).
AELs reduce or cut insurance coverage of certain visits to the ED if the cause of the visit is due to alcohol intoxication.[2] The vast implementation of this law is derived from the idea of individual decision making, that it is an individual’s choice to consume alcohol, and therefore they hold a personal responsibility for their intoxication. By using insurance coverage as a leverage, the law aims at reducing the number of ED visits relating to alcohol intoxication, saving resources, and deterring irresponsible drinking. While the intention behind AELs aims for positive change, it is unethical to use AELs, a form of financial leverage, to address certain problems within emergency medicine.
ANALYSIS
Stigma is prominent in almost all substance abuse cases including those seen with alcohol intoxication. Many patients feel embarrassment or shame when seeking medical attention for a condition that was brought on by alcohol misuse. A personal account by Jonathan Hunt Glassman, a former alcoholic and NBC contributor, emphasizes on this negative bias. He knows firsthand how unsettling an ED visit can be. He felt demoralized from a superficial prognosis made by a nurse on his complex alcohol abuse condition, in which the nurse said, “You need to stop drinking.”[3]
Whether it be from shame or insecurities about an individual’s condition, the stigma behind substance abuse cases in the emergency department and the daunting task of asking for help can turn a lot of patients away from seeking and receiving medical treatment. The implementation of Alcohol Exclusion Laws can amplify this already present stigma. A study conducted by the National Institute of Health (NIH) analyzed States that implemented and continued to enforce Alcohol Exclusion Laws and the stigma in those states surrounding alcohol-related ED visits. The result from the study showed that AELs correlated with an increase in stigmatization regarding medical attention for alcohol-related incidents, and that AELs “negatively impact people’s willingness to seek medical care after alcohol-related injuries or illnesses.”[4] Both the NIH study and the personal account by Hunt-Glassman go on to show that AELs have the adverse effect of reinforcing the stigma surrounding alcohol cases in the ED. While the idea behind AELs is in good faith, it contributes to the stigma. This contribution ethically challenges the idea that the emergency room is a space where the treatment of injuries is carried out without biases infringing on such medical care. The mission of EDs is to provide medical care to anyone in need. AELs have the effect of discouraging these patients from seeking help with the unintended consequence of doing them harm.
A point of argument for the implementation of AELs is that it is the individual’s choice to be intoxicated and therefore justifiable that an individual receives less insurance coverage for medical expenses from a preventable intoxication. The idea of it being an individual choice to become intoxicated is one of the strongest supports for these exclusion laws. However, it is unjust to assume that all alcohol intoxications come by choice. Instances that disprove this assumption include both the college party scene and bar scene. Spiked drinks significantly increase alcohol concentration and can cause any responsible drinker to become intoxicated without intention or against their will. Additionally, alcoholic beverages served in various social gatherings like those in or around college campuses may not have a clear percentage of alcohol determination. Liquor containing high percentages of alcohol, such as Everclear which contains up to 190 proofs, are often masked by sweeteners and flavorings. Cocktails like these can cause a person to become dangerously intoxicated without their realization or intention. Some may argue that consuming an alcoholic beverage still holds accountability, that the person should be aware of the potential for a tampered drink, and therefore AELs should remain in use to deter this. However, like any law, AELs needs to have defined restrictions and/or exemptions. If the individual choice argument is used in favor for AELs, then how far reaching can the laws be applied? An attorney who specializes in these exclusion laws believes that AELs often offer more ambiguity than clarification when it comes to insurance policy, which leads to further ways insurance claims can be denied.[5]
CONCLUSION
In summary, the idea behind the use of Alcohol Exclusion Laws aims to reduce intoxication cases in the ED, however, there are drawbacks and aspects of this law that challenge the ethics of seeking medical care from the emergency department. The present stigma surrounding going to the ED for alcohol-related emergencies is already prevalent in hospitals across the country. When applying AELs, the present stigma may be magnified and further push the idea that seeking help for alcohol-related emergencies is shameful and embarrassing for patients, and therefore should be punished via financial means. Secondly, one of the main justifications for AELs is the idea that it is a deliberate intention to become intoxicated. It isn’t always the intention of individuals to get drunk when they choose to consume alcohol. There are additional factors that may play a part to exonerate a person’s accountability. It is difficult for people to recall the specifics of a situation when they become intoxicated; in some cases, accountability cannot be determined and the used of AELs can become unjustified. Overall, Alcohol Exclusion Laws try to solve the issue of alcohol incidents in a way that produces more detriment than progress. A method to combat the issue of irresponsible drinking and intoxication in the emergency room within the US should not use AELs and financial leverage as one of its forefronts. In fact, a study that based its findings obtained from the Behavioral Risk Factor Surveillance System nationwide survey that spanned twenty-four years from 1993-2017, showed no real impact on binge drinking or increased alcohol consumption.[6] Given the downsides to AELs and its proven non-significant effects, several States have already repealed their AELs. For all these reasons, it would be beneficial to find an alternate method to address alcohol related issues within healthcare.
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[1] Gregory, A. (16 Jun 2014). Nurses say drunk patients should be banned from A&E as ‘waste of resources’ UK: Mirror. https://www.mirror.co.uk/news/uk-news/nurses-say-drunk-patients-should-3706280 2(Jan 2008).
[2] Alcohol Exclusion Laws. National Highway Traffic Safety Administration. https://www.nhtsa.gov/sites/nhtsa.gov/files/810885.pdf.
[3] Glassman, J.H. (28 Apr 2022). Why don’t alcoholics get prescribed the medication they need?. NBC. https://www.nbcnews.com/think/opinion/alcohol-related-deaths-er-visits-rose-covid-solution-use- rcna26425.
[4] Azagba, S., Ebling, T., Hall, M., (2023). Health claims denial for alcohol intoxication: State laws and structural stigma. Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/acer.15153.
[5] (7 Sep 2021). The Alcohol Exclusion Chart Denied Life Insurance Claim. https://www.lifeinsuranceattorney.com/blog/2021/september/the-alcohol-exclusion-state-chart-denied-life-in/.
[6] Azagba, S., Shan, L., Ebling, T., Wolfson, M., Hall, M., Chaloupka, F., (26 Nov 2022). Does state repeal of alcohol exclusion laws increase problem drinking? National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10099925/
Changes in Undergraduate Students’ Self-Efficacy and Outcome Expectancy in an Introductory Statistics Course
Get PDFThe exploration of psychological variables that potentially impact college student performance in challenging academic courses can be useful for understanding success in introductory statistics. Although previous research has examined specific beliefs that students hold about their abilities and future outcomes, the current study is novel in its examination of changes in both self-efficacy (SE) and outcome expectancy (OE) in relation to performance over the course of an undergraduate introductory psychology statistics course. These psychological variables—relating to one’s belief about one’s ability to accomplish a task and the anticipated outcomes—may impact student motivation and performance. Students’ SE, OE, and other variables related to statistics performance were measured through a survey administered at the beginning and end of the course. Multivariate logistic regression and McNemar tests were conducted to examine factors that affected changes in SE and OE as the semester progressed. Students with lower scores on the final exam demonstrated a decrease in both high SE and positive OE. However, higher scores on exams earlier in the course were associated with increased odds for high SE but not for positive OE, suggesting that SE is less resilient to course performance. Based on these findings, the authors recommend that statistics instructors identify students at risk for decreasing SE. Instructors can help foster high SE in students struggling academically by connecting the course content to their everyday lives and suggesting strategies to enhance their confidence in their content knowledge and increase their comfort in navigating such a challenging course
Sexual and Intimate Partner Violence Against Women with Schizophrenia: A Scoping Review
Get PDFBackground: Globally, 641 million women are touched by intimate partner violence (IPV), establishing it as the most prevalent form of violence affecting women. Women, who are already disproportionately affected by sexual and IPV, face an elevated risk when dealing with severe mental illnesses (SMI) compared to the general population. Schizophrenia, classified as an SMI, poses numerous obstacles that impact women’s ability to maintain employment, good health, and sustain stable relationships. Nevertheless, limited data exists on IPV against women with schizophrenia and its impact. Aims: The objective of this scoping review was to summarize the available literature on sexual and IPV against women with schizophrenia and underlie future avenues of research. Methods: We conducted an electronic search using keywords in the following databases: APA PsychInfo, PubMed, Scopus, Google Scholar and Psychology and Behavioral Sciences Collection. The search yielded a total of 6,099 articles. Upon title and abstract review, 97 articles were retained for full-text reading, after which 7 articles were included in this review. Results: The available articles reveal an association between sexual and IPV against women with schizophrenia. Younger women diagnosed with schizophrenia, especially those with low income or unemployed, are at a higher risk of experiencing sexual and IPV. This victimization increases the likelihood of suicide and exacerbates psychopathology. Conclusion: Research should examine care-setting interventions for women with schizophrenia, who are at increased risk of sexual and IPV, aiming to prevent severe harm. Implementation of preventive measures is essential for enhancing healthcare and societal transformation
Exploring the Relationship Between Attentional Bias and Symptoms of Adult Separation Anxiety Disorder
No full textPurpose: Research has identified attentional bias towards threatening stimuli as a contributing factor to anxiety disorders, and treatment targeting this bias has been shown to reduce symptoms of anxiety (Azriel & Bar-Haim, 2020). Studies have found attentional bias to threats among children with separation anxiety disorder (SAD) when tested with dot-probe tasks, with a stronger bias seen when threats are disorder-congruent (Pergamin-Hight et al., 2015). No study has yet investigated this relationship among adults, despite growing recognition that separation anxiety is frequent in this population. Therefore, we investigated the relationship between SAD symptoms and attentional bias toward threatening stimuli (general and separation-specific) on a dot-probe task in a sample of adults, with the goal of informing targeted treatment for adult separation anxiety disorder (ASAD). Methods: Undergraduate participants (n = 57) completed a measure of ASAD symptom severity (ASA-27) and two versions of the dot-probe task, one with separation-specific threatening words and one with generally threatening words. Attentional bias was tested using detection latency. Results: Spearman’s rho correlations between ASA-27 and separation-specific threat trials (rs = -.07; p = .62) and general threat trials (rs = .07; p = .60) were not significant. However, ASAD symptoms were correlated with reduced accuracy on trials following ASAD-specific threat words (rs = -.38, p = .004), but not general threat words (rs = -.16, p = .22). Conclusions: We did not find that ASAD symptoms related to attentional bias. However, individuals with more ASAD symptoms were less accurate on trials that involved ASAD-threat words, suggesting an emotional interference effect of disorder-specific threats on task performance
State Actions to Ban Gender-Affirming Care for Minors and the Ways Forward
Get PDFAs of October 2023, twenty-one states have passed laws that ban medically necessary gender-affirming care to minors. This Note will discuss the actions of three such states—Texas, Florida, and Arkansas—in 2022.2 These state actions demonstrate three different ways in which states have restricted access to medically necessary gender-affirming care. To move forward, lawyers and advocates must continue to litigate against these bans, state legislatures should enact sanctuary statutes protecting trans youths’ access to gender-affirming care, and the U.S. Food & Drug Administration (FDA) should make medications—including puberty blockers and hormones—available on-label and across state lines through Telehealth. It is important to recognize that disapproving parents pose insurmountable barrier to minors’ self-realization, exploration of their genders, and access to care. There is abundant legal scholarship on parental consent in this context and analogous ones, such as the mature minor doctrine that concerns minors accessing abortion and reproductive care like birth control. However, this Note focuses solely on situations in which transgender youths’ parents support their children’s identities and allow them to receive gender-affirming care. When a state has a ban on gender-affirming care, parents’ consent would not matter in the face of such a ban, unless the family is financially able and willing to move to a state allowing access to such care