Will Transgender Identity Be Declassified as a Mental Illness?

According to the current Internal Classification of Diseases (ICD) set forth by the World Health Organization, being transgender is considered a mental illness.  There have been proposals, however, to declassify transgender identity as a mental illness in the new ICD-11, which is expected to be approved in 2018.

Instead of removing the diagnosis altogether, Geoffrey Reed, a Professor of Psychology and consultant on the ICD-11, proposes a new diagnosis called “gender incongruence” that would be found in a new medically and biologically oriented chapter called “Conditions Related to Sexual Health.” It is important that the transgender classification is not removed from the ICD entirely to ensure that transgender individuals have continued, and hopefully improved, access to health care.

Yet, many transgender activists see this change as only “a small battle won” in the “war being waged for trans rights”. One activist, Alok Vaid-Menon, explains that stressors related to being transgender come from the outside world and there are bigger issues than the ICD classification that must be addressed, including violence, poverty, homelessness, and housing discrimination. “The true victory,” according to Vaid-Menon, “would be to de-stigmatize diversity and difference itself.”

Sources: http://www.chicagotribune.com/news/nationworld/ct-transgender-mental-illness-classification-20160729-story.html

Tags: Transgender Rights, ICD-11, Declassify Mental Illness, De-stigmatize diversity, Transgender Health Care Access, Gender Identity

Field Trial Supports Removal of “Transgender” from Mental Health Classification

The first field study was recently conducted in Mexico City to assess the transgender diagnosis listed in the mental disorders chapter of the World Health Organization’s (“WHO”) International Classification of Diseases. Senior author of the study, Professor Geoffrey Reed from the National Autonomous University of Mexico, explained that such diagnosis stigmatizes transgender individuals which, in turn, impacts legalization, human rights, and appropriate access to healthcare. These misconceptions have negatively impacted transgender rights across the globe, with many countries denying transgender individuals autonomy, such as in their legal documents and child custody rights.

The study consisted of interviewing 250 transgender individuals, ranging from 18 to 65 years old. The participants answered a series of questions, such as, when they first became aware that they were transgender, their experiences of gender, social rejection, violence, etc. Participants disclosed that they were often victims of violence and family rejection. Majority of participants cited their adolescent years as the highest period of distress.

The researchers believe that eliminating the transgender diagnosis from the WHO classification would be the first step in diminishing the stigma and abuse of transgender individuals. Dr. De Cuypere, from University Hospital in Belgium, and Dr. Winter, from Curtin University in Australia, stated: “‘Transphobia is a health issue’. This study prompts primary caregivers and psychiatrists to be aware of a ‘slope leading from stigma to sickness’ for transgender individuals, and to contribute to their mental health by a gender-affirmative approach.”

The study was published in The Lancet Psychiatry on July 26, 2016 and is now being replicated in Brazil, France, India, Lebanon and South Africa. These subsequent studies are being performed as an effort to build enough clinical evidence to remove transgender from the list of mental health disorders.

Source: http://www.eurekalert.org/pub_releases/2016-07/tl-tlp072516.php, http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30165-1/abstract

 

Tags: Clinical Ethics, Mental Health, Bioethics, Access, News, Gender Orientation

CDC Needs to Speak Up on Gun Violence in the U.S.

Gun violence has become all too prevalent across the country, and many believe that it is time for the Centers for Disease Control (CDC) to speak up on the issue. Georges Benjamin, Director of the American Public Health Association, explains that gun violence has become the “second-biggest killer of young people in the United State.” He also points out that it has disproportionately affected African-American men. Activist groups believe that to effectively reduce gun violence, the issue needs to be framed as a public health concern. Yet, throughout the six years that Dr. Thomas Friedan has been the Director of CDC, he has failed to address it. Some believe that Dr. Friedan is worried about losing funding for other important health issues if he takes a stance on the politically driven gun control movement. Dr. Friedan’s silence is even being compared to Ronald Reagan’s silence on the AIDS epidemic in the 1980s.

“CDC is a trusted organization, and the white coat is a powerful tool,” stresses Benjamin.  Because of its large budget, CDC could be much more influential than other government organizations that have already showed support for gun control. Benjamin believes that CDC’s support could pave the way for state and federal legislation to effectively reduce gun violence nationwide.

Source: http://www.cnn.com/2016/07/13/health/cdc-gun-research-black-health-leaders/

Are Legal Limits for Marijuana Level Impairment Reliable?

The number of fatal car crashes involving marijuana use doubled in the state of Washington after the use of recreational marijuana was legalized.  One of the difficulties the state has encountered in preventing such crashes is determining per se limits for the amount of marijuana drivers can have in their systems.  Unlike alcohol impairment, which is defined by a blood alcohol content (BAC) level of .08 or higher, marijuana impairment is difficult to quantify. There is no reliable data showing that drivers become impaired at a specific level of marijuana content. Frequent users of marijuana, for example, may maintain higher levels of the drug for a longer period of time then occasional users. Thus, depending on the individual, drivers with relatively high levels of marijuana in their system might not be impaired, while others with low levels may be unsafe behind the wheel.  While there is no clear indication that a certain level of THC definitively increases the risk of car crashes, some states have implemented per se limits ranging from 1 ng/mL of THC to 5 ng/mL.

The AAA Foundation for Traffic Safety, however, is urging states to implement more comprehensive enforcement measures to improve road safety.  It suggests that, rather than relying on arbitrary legal limits, states should use a two-component system that requires (1) a positive test for recent marijuana use and, more importantly, (2) behavioral and physiological evidence of driving impairment. Marshall Doney, AAA’s President and CEO explained: “States need consistent, strong and fair enforcement measures to ensure that the increased use of marijuana does not impact road safety.”  But to maximize road safety, all motorists are advised to avoid driving while impaired regardless of whether the use of marijuana is legal in their state.

Source: https://www.sciencedaily.com/releases/2016/05/160510103131.htm

Legalization of Marijuana Reduces Teenage Use

According to the results of a biannual poll conducted by Colorado’s Department of Public Health and Environment, teenage marijuana use has not increased since the state legalized the use of recreational marijuana for adults over the age of 21. The poll surveyed about 17,000 high school students in Colorado, of which 21.2 percent responded that they used marijuana in the preceding thirty days. This is a slight decrease from the 2011 results of 22 percent. The 2015 survey also indicated that the nationwide average for teen marijuana use is slightly higher than Colorado’s at a rate of 21.7 percent. Yet, contrary to the results of Colorado’s survey, a survey by the U.S. Department of Health and Human Services placed Colorado at the top of the list of states which the highest rate of marijuana use in teenagers between the ages 12 to 17.

Advocates for legalization of marijuana believe that the results in Colorado’s survey prove that the “fears of widespread pot use by minors” in states with legalized cannabis are unwarranted. Yet, others are skeptical about the results. SMART Colorado, an organization that lobbies for stricter marijuana regulations, believes it is “‘deeply concerning” that according to the survey, only 48 percent of students in Colorado view regular marijuana use as a risky behavior.

Source: http://www.scientificamerican.com/article/colorado-s-teen-marijuana-usage-dips-after-legalization/

“Physician-Assisted Suicide is now legal in Canada”

With the passing of new legislation, Canada has become one of the few nations to legalize physician-assisted suicide.  The new law imposes strict requirements, however, by limiting the option to the incurably ill and requiring medical approval, a 15-day waiting period and two independent witnesses. Moreover, to obtain a request for physician-assisted suicide, a patient must: (1) be eligible for government-funded health care; (2) be a mentally competent adult over the age of 18; (3) have a serious and incurable disease, illness or disability; and (4) be in an “advanced state of irreversible decline” with enduring and intolerable suffering.

The legislation is more restrictive than some of the lawmakers had wanted.  Some argued that it should be broadened to include degenerative disease, whereby patients who are suffering from incurable degenerative diseases but are not necessarily close to death would also qualify for physician-assisted suicide. Yet, others believed that such a broad criteria would push the law too far. As Justice Minister Jody Wilson explained, the requirements in the final legislation “strike the right balance between personal autonomy for those seeking access to medically assisted dying and protecting the vulnerable.”

 Source: http://www.npr.org/sections/thetwo-way/2016/06/18/482599089/canada-legalizes-physician-assisted-dying

“Extreme Overvalued Belief” or Mental Illness?

Society and courts of law often find themselves struggling to understand what causes someone to commit a violent act. Mental illness is often cited as the motive for such crimes.  However, Dr. Tahir Rahman, an Assistant Professor of Psychiatry at the University of Missouri’s School of Medicine, has concluded that in some cases, violent crimes are not the result of mental illness but rather an “extreme overvalued belief,” a term Dr. Rahman uses to classify the cause of criminally violent behavior when psychosis can be ruled out.

Dr. Rahman conducted a case study on Andres Breivik, a Norwegian terrorist who claimed to be a “savior of Christianity” after detonating a car bomb that killed 77 people in 2011. A psychiatric team concluded that Breivik was not psychotic and instead diagnosed him with personality disorder. Dr. Rahman suggests, however, that Breivik’s criminal acts were a result of his extreme overvalued belief.  An extreme overvalued belief is “a belief that is shared by others and often relished, amplified and defended by the accused.”  This intense emotional commitment to a particular belief is what causes the accused to commit a violent act.  Dr. Rahman hopes that his study can help forensic psychiatrists properly identify the motive for a crime in courts of law when a defendant’s sanity is in question. Although more research must be done to fully understand the concept of extreme overvalued beliefs, Dr. Rahman also hopes that future research will enable mental health professionals to identify early signs of such extreme beliefs and intervene before violent behavior occurs.

 

Source: https://www.sciencedaily.com/releases/2016/05/160523130806.htm

Texas Abortion Law Struck Down by Supreme Court

On June 27, 2016, the Supreme Court invalidated a Texas law that limited women’s access to abortion. The law required physicians performing pre-viability abortions to have hospital admitting privileges. It also required women’s health centers that offered abortion services to abide by certain surgical center requirements, causing many centers to close.

Proponents of the law claimed that it was an effort to maintain safety standards for women. However in a 5-3 vote, the Supreme Court concluded that the legislation imposed an undue burden on women attempting to obtain an abortion. Justice Breyer explained in his opinion that with the majority of clinics that offered abortions forced to close, the law would require women to travel long distances to the only “crammed-to-capacity” compliant facility. He further stated that nothing in the legislation provided any benefit to women’s health. Justice Ginsburg echoed this conclusion in her concurring opinion by explaining that complications from pre-viability abortions are rare and not life-threatening.

Justice Samuel Alito, Jr. wrote the dissenting opinion, which did not directly speak to the constitutionality of the law. Instead, he focused on the doctrine of res judicata, which prevents recurring litigation on a matter that has already been resolved. Justice Thomas affirmed this argument in a concurring dissent, claiming that the majority has repeatedly “distorted” the law and given preference to pro-choice arguments.

This is the first case the Supreme Court has decided regarding abortion rights in nine years, and while it was by no means a unanimous decision, it affirmed that the undue burden test established in Planned Parenthood v. Casey in 1992 continues to control the constitutionality of abortion laws.

Source: http://www.nytimes.com/2016/06/28/us/supreme-court-texas-abortion.html?_r=0; Marcia Coyle & Tony Mauro, High Court Strikes Down Curbs on Texas Abortion Clinics, N.Y. L.J., June 28, 2016, at 1–2.

 

Should Children Make Their Own Medical Decisions?

Julianna Snow, a 5 year old girl who suffered from an incurable neuromuscular disease, died on June 14, 2016 after a long, hard fight that sparked a great deal of debate among bioethicists. Julianna was diagnosed at 2 years old with Charcot-Marie-Tooth disease, and by 4 years old she could not use her arms or legs and had to use a feeding tube. However, the effects of her illness were only physical and not mental. After being in and out of the hospital, Julianna’s parents were informed they would need to make extremely difficult medical decisions the next time Julianna got an infection that would make it hard for her to breathe.  Even though Julianna was only 4 years old, her parents decided to include her in such medical decisions. To honor her wishes to “go to heaven” and not go back to the hospital, her parents decided to care for Julianna in the comfort of her own home.

This decision was highly criticized by some who believed Julianna’s parents “painted a coercive picture” to influence their daughter’s decision to “go to heaven.” Bioethicist Arthur Caplan, for example, argues that a 5 year old child is incapable of making this kind of decision especially in light of the case of Cassandra C., a 17 year old girl who refused chemotherapy but was mandated to receive treatment when a court concluded she lacked capacity to make such decision. Yet, the doctors who were most involved in Julianna’s care supported her parents’ decision. Even Bioethicist Arthur Caplan admitted after meeting Julianna that “she taught [him] and others that even a child can become very knowledgeable about a challenging illness and can convey thoughtful and remarkable feelings about her illness and her ideas.”

Julianna received hospice care for the last 18 months of her life and in that time she celebrated her fifth birthday as a princess. She died in her mother’s arms at home in her princess room.

 

Sources: http://www.cnn.com/2016/06/14/health/julianna-snow-heaven-over-hospital-death/

http://www.bioethics.net/2015/10/can-a-5-year-old-refuse-treatment-the-case-of-julianna-snow/

Should Terminally Ill Patients have the Right to Decide When They Die?

In June 2016, California joined three other states – Washington, Vermont, and Oregon – in enacting legislation that legalizes physician-assisted suicide for terminally ill patients. Conversation surrounding such end-of-life decision-making sparked in 2014, when Brittany Maynard, a California schoolteacher diagnosed with brain cancer, decided to move to Oregon to die on her own terms.

The new California legislation allows a physician to prescribe lethal doses of medication only when requested by a terminally ill patient who is likely to have less than 6 months left to live. However, unlike other states that have similar laws, California is allowing physicians to demand that requests be made in writing.  Moreover, physicians are not required to prescribe the medication, nor are they required to refer the patients to another physician willing to do so. Catholic hospitals and other religious health groups have already expressed their unwillingness to participate, stating that “[w]e are crossing a line — from being a society that cares for those who are aging and sick to a society that kills those whose suffering we can no longer tolerate.” Some physicians say that they will require patients to go through rigorous psychological evaluations before prescribing the medication. Yet, the majority of patients with incurable diseases support the legislation, explaining that it will allow them not to be a burden to their families as their diseases progress.

While the enactment of the legislation has certainly not ended the debate over end-of-life decision-making in California, health care systems in the state are drafting new policies to help physicians and patients adjust to the new option for end-of-life care.

Source: http://www.nytimes.com/2016/06/10/us/assisted-suicide-california-patients-and-doctors.html?rref=collection%2Fsectioncollection%2Fhealth