NURS 6050: Policy and Advocacy for Improving Population Health “Ethics and Advocacy”

NURS 6050: Policy and Advocacy for Improving Population Health “Ethics and Advocacy”

Program Transcript

PETER BEILENSON, MD, MPH: I’m sure that in the millions, several millions of needles that we’ve given out now, someone has probably overdosed with it. To that end, however, we did address an overdose effort as well.

If you look at the criminal justice system, and actually I’ve learned a lot about it as Baltimore’s health commissioner because so much of what we did in terms of social determinants of health touched on the criminal justice system and, in fact, the cabinet member that I worked most closely with during my entire tenure in the city as health commissioner was the police commissioner. So as an arrestee at central booking, you have more rights than someone who’s jailed. And once convicted, as an incarceree, you have fewer rights. So it’s on the scale.

So these were just arrestees that we were dealing with at central booking. They had simply been arrested. They had not been convicted. They actually had not been indicted. They had simply been arrested for probable cause, or for being seen doing something illegal. And so we had to get consent from them. In health care, you always want to get informed consent. And so in this case we got informed consent. In fact, I don’t think we ever got turned down by anybody in the thousands of people we tested, because who wants to have syphilis unkownst to them.

The ethical issues, and you’ve got to always look at them, and you have to think carefully about them. So, for example, immunizations. There is a religious exemption potentially. I can tell you that in 15 years, I think we got 20. That’s not the reason kids were not getting immunized. And most of the time, these sort of issues, or red herrings, it actually makes it worth looking at the ethics of things, because it usually will not defeat the purposes of what you’re doing, if you’re looking at it from a purely practical point of view. If you think, if I ask this question, then we’re going to destroy our initiative. But in reality, that doesn’t happen. Very, very few people opt out of things. Immunization is one one.

One interesting ethical quandary we had with needle exchange was, and actually it was an ethical legal one, that the mayor’s counsel actually recommended initially against doing needle exchange because we’re giving syringes, right, in needle exchange. Clean syringes, which we know are going to be used for injecting drugs. What if someone shoots up and overdoses using one of our needles? Aren’t we going to be liable, even though there’s tort claims protection as a jurisdiction? But what about ethically? And we came down on the side of, well, you look at the cost benefit, and clearly, many, many, many more people are going to not get HIV/AIDS, and we’re also tying it to drug treatment. So we were trying to get people into drug treatment through our needle exchange

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program. So that was harm reduction as well. Although we did have to live with the fact that, I’m sure that in the several millions of needles that we’ve given out now, someone has probably overdosed with it.

To that end, however, we did address an overdose effort as well. If you identify ethical conundrums or gaps, you can try and address each of them. And so we did with needle exchange. We got drug treatment available, basically on-demand for people who needed it, to try to them off drugs. Secondly, we did the needle exchange itself, which would decrease the risk dramatically of getting HIV. And third, we launched a project, which got a lot of attention, to avoid drug overdoses by training addicts how to give Narcan, which reverses opiates or heroin overdose quickly.

Because what was happening with overdoses– and, by the way, there were more overdoses than homicides in Baltimore, which is saying a lot, actually, in the late ’90s and early 2000s– we trained several hundred addicts in CPR, rescue breathing, and how to give Narcan and recognize a overdose. And we had hundreds of documented saves. The reason for that is that most addicted folks will have a shooting partner. And so they’ll be shooting in house and one of them overdoses, and what happened oftentimes is the partner who was not overdosed would pull the person out to the porch and maybe call 911 and then take off, because they were afraid of being arrested, and by the time the EMTs got there, they’d be dead from lack of breathing. So by training them to do Narcan, it can immediately reverse, or almost immediately reverse the effects. And we had hundreds of saves. So the point being that if you identify ethical quandaries, you can try to address them with potentially another program.

© 2012 Laureate Education, Inc. 2