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Diversity's Pandemic Distractions. 多样性的流行干扰。
Jonathan Kahn
<p><p>Pandemic diseases have a nasty history of racialization. COVID-19 is no exception. Beyond the obvious racist invocations of the "China virus" or the "Wuhan Flu" are subtler racializing dynamics that are often veiled in more benign motives but are nonetheless deeply problematic. The racialization of COVID-19 proceeded along two distinct trajectories each of which threatened to reinforce inaccurate biologized conceptions of race while diverting attention from the social, legal, and political forces historically structuring race-based health disparities. First, early on as significant racial disparities in disease incidence and mortality became evident, a frame of race-based genetic difference came to the fore as a possible explanation. Second, as vaccine development ramped up there came widespread calls for racially "diversifying" clinical trials for the vaccines being tested. The rationales for such diversification were varied but tended to reinforce genetic frames of racial difference. Most common was the assertion (without substantial evidence) that vaccines might work differently in Black or Brown bodies and so racial diversity in trials was imperative for reasons of safety and efficacy. Derrick Bell cautioned 20 years ago that "the concept of diversity … is a serious distraction in the ongoing efforts to achieve racial justice." (Derrick Bell, <i>Diversity's Distractions</i>, 103 Colum. L. Rev. 1622, 1622 (2003).) This article explores the dynamics of how the concept of "diversity" racialized responses to COVID-19 and considers their broader implications for understanding and responding to racial disparities in the face of pandemic emergencies and beyond. In the short term, vaccine developers did a decent job of enrolling minorities in their clinical trials and the vaccines have proven to have the same safety and efficacy across races. In the long term, diversity in the biomedical context of pandemic response not only distracts attention from important structural causes of health injustice, but it also focuses attention on the genetics of disparities in a manner that has the potential to reinforce pernicious and false ideas of essential biological difference among racial groups. This article argues that an uncritical embrace of the idea of diversity in analyzing and responding to emergent health crises has the potential to distract us from considering deeper historical and structural formations contributing to racial health disparities. It proceeds first by exploring the dynamics through which initial responses to racial disparities in COVID-19 became geneticized. It will then move on to unpack the rationales for such racialization, examine their merits (or lack thereof), and consider their implications for developing an equitable response to pandemic emergencies. The next section will examine the subsequent racialization of clinical trials for COVID-19 vaccines through the concept of "diversity." It then moves on to explore how the gene
流行病有种族化的恶劣历史。新冠肺炎也不例外。除了对“中国病毒”或“武汉流感”的明显种族主义称呼之外,还有更微妙的种族化动态,这些动态往往隐藏在更善意的动机中,但仍然存在严重问题。新冠肺炎的种族化沿着两条不同的轨迹发展,每一条轨迹都有可能强化不准确的生物种族概念,同时转移人们对历史上构建基于种族的健康差异的社会、法律和政治力量的注意力。首先,在疾病发病率和死亡率方面的显著种族差异变得明显的早期,一种基于种族的基因差异框架就成为了一种可能的解释。其次,随着疫苗开发的加快,人们普遍呼吁对正在测试的疫苗进行种族“多样化”的临床试验。这种多样化的理由多种多样,但往往会强化种族差异的遗传框架。最常见的是(在没有实质性证据的情况下)断言,疫苗在黑人或棕色人种体内的作用可能不同,因此出于安全性和有效性的原因,试验中的种族多样性是必不可少的。Derrick Bell在20年前警告说,“多样性的概念……严重分散了正在进行的实现种族正义的努力。”本文探讨了“多样性”概念如何使对新冠肺炎的反应种族化的动态,并考虑了它们对理解和应对疫情紧急情况及其后的种族差异的更广泛影响。在短期内,疫苗开发商在招募少数族裔参与临床试验方面做得很好,而且疫苗已被证明在不同种族之间具有相同的安全性和有效性。从长远来看,应对疫情的生物医学背景下的多样性不仅分散了人们对健康不公正的重要结构性原因的注意力,而且还将注意力集中在差异的遗传学上,这种方式有可能强化种族群体之间本质生物差异的有害和错误观念。这篇文章认为,在分析和应对突发健康危机时,不加批判地接受多样性的概念,可能会分散我们对导致种族健康差异的更深层次的历史和结构形成的考虑。它首先通过探索对新冠肺炎种族差异的初步反应成为遗传的动力。然后,它将继续解开这种种族化的理由,审查其优点(或不足),并考虑其对制定公平应对疫情紧急情况的影响。下一节将通过“多样性”的概念研究新冠肺炎疫苗临床试验的后续种族化。然后继续探讨新冠肺炎种族差异的基因化如何为疫苗开发中类似的种族基因化奠定基础。它将争辩说,由于未能明确区分多样性的社会和生物学理由,这种框架虽然总体上是善意的,但却得不到很好的支持,并与新冠肺炎发病率和死亡率种族差异的基因化相结合,以找出少数族裔群体身心差异的原因;这再次分散了人们对造成这种差异的历史和结构力量的注意力。文章最后承认,在生物医学研究和实践中,特别是在公共卫生紧急情况下,使用种族问题存在一定的棘手性。它提供了适度的改进建议,如果研究人员、临床医生和政策制定者认真考虑,可能会产生重大的实际效果。
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引用次数: 0
Different but Same: A Call for a Joint Pro-Active Regulation of Cross-Border Egg and Surrogacy Markets. 不同但相同:呼吁对跨境卵子和代孕市场进行联合积极监管。
Sharon Bassan
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引用次数: 0
BORROWING FROM DORMANT COMMERCE CLAUSE DOCTRINE IN ANALYZING ABORTION CLINIC REGULATIONS. 借用隐商条款理论分析堕胎诊所法规。
Caitlin E Borgmann
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引用次数: 0
SNEAKING AROUND THE CONSTITUTION: PRETEXTUAL "HEALTH" LAWS AND THE FUTURE OF ROE V. WADE. 绕开宪法:借口“健康”法律和罗伊诉韦德案的未来。
Nancy Northup
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引用次数: 0
THE "UBERIZATION" OF HEALTHCARE: THE FORTHCOMING LEGAL STORM OVER MOBILE HEALTH TECHNOLOGY'S IMPACT ON THE MEDICAL PROFESSION. 医疗保健的“优步化”:移动医疗技术对医疗行业影响的即将到来的法律风暴。
Fazal Khan
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引用次数: 0
THE PREGNANCY PENALTY. 怀孕惩罚。
Michele Goodwin

Punishing pregnant women increasingly serves as a litmus test in political discourse, inviting more than a metaphor about state sanctioned violence targeted at women. In 2016, candidates for the United States presidency threatened to defund Planned Parenthood if elected and a leading candidate promised he would "punish" pregnant women who seek abortions. Other presidential candidates urged that even victims of rape and incest should be forced to carry their pregnancies to term, imposing yet another penalty or strike against sexually violated women and girls. Local legislatures and governors show equal contempt for and desire to penalize women in their states. In Utah, Gov. Gary Herbert took up the call to use a "very strong stick" in policing reproduction by signing into law the Criminal Homicide and Abortion Revisions Act, which applies only to pregnant women. The law seeks to punish pregnant women who "knowingly" commit acts that might result in miscarriages. In 2011, Texas Rep. Doug Miller authored and introduced a bill in his state legislature that would make it a felony to ingest any controlled substance during pregnancy. Wisconsin's legislature passed a law that forces pregnant women to receive vaginal probes as a pre-condition to receiving an abortion. To obtain an abortion without undergoing the vaginal probe is a punishable violation of law. Some women's groups compare vaginal ultrasound laws such as that in Wisconsin to state sanctioned rape with a rod. Other legislative efforts include establishing personhood in embryos and fetuses. Many of the laws seeking to punish pregnant women and regulate their pregnancies introduce criminal sanctions into gestational conduct, broadly criminalizing any behavior that could harm fetal health. All of these laws selectively target pregnant women.

惩罚孕妇越来越多地成为政治话语中的试金石,而不仅仅是一个关于国家批准的针对女性的暴力的隐喻。2016年,美国总统候选人威胁说,如果当选,将取消对计划生育组织的资助,一名主要候选人承诺,他将“惩罚”寻求堕胎的孕妇。其他总统候选人主张,即使是强奸和乱伦的受害者也应该强制怀孕,对性侵犯的妇女和女孩施加另一种惩罚或罢工。地方立法机构和州长对本州的妇女表现出同样的蔑视和惩罚的欲望。在犹他州,州长加里·赫伯特(Gary Herbert)响应号召,将只适用于孕妇的《刑事杀人和堕胎修订法案》(Criminal Homicide and Abortion Revisions Act)签署为法律,要求对生育问题采取“非常强硬的政策”。该法律旨在惩罚那些“故意”做出可能导致流产的行为的孕妇。2011年,德克萨斯州众议员道格·米勒(Doug Miller)在州立法机构起草并提出了一项法案,将怀孕期间摄入任何受管制物质定为重罪。威斯康星州立法机构通过了一项法律,强制孕妇接受阴道检查作为堕胎的先决条件。未经阴道探查而堕胎是应受惩罚的违法行为。一些妇女组织将威斯康辛州的阴道超声法与国家批准的用棍子强奸相比较。其他立法努力包括确立胚胎和胎儿的人格。许多旨在惩罚孕妇和规范其怀孕的法律将刑事制裁纳入妊娠行为,将任何可能损害胎儿健康的行为笼统地定为刑事犯罪。所有这些法律都选择性地针对孕妇。
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引用次数: 0
IMPROVING THE EMERGENCY MEDICAL SERVICES SYSTEM'S RESPONSE TO DOMESTIC VIOLENCE. 完善家庭暴力应急医疗服务体系。
Karen Oehme, Nat Stern, Elizabeth Donnelly, Rebecca Melvin
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引用次数: 0
AMERICA NEEDS THE TREAT ACT: EXPANDING ACCESS TO EFFECTIVE MEDICATION FOR TREATING ADDICTION. 美国需要治疗法案:扩大获得有效药物治疗成瘾的途径。
Barbara Andraka-Christou
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引用次数: 0
TANTAMOUNT TO FRAUD?: EXPLORING NON-DISCLOSURE OF GENETIC INFORMATION IN LIFE INSURANCE APPLICATIONS AS GROUNDS FOR POLICY RESCISSION. 等于欺诈?:探讨在人寿保险申请中不披露遗传信息作为保单撤销的理由。
Anya E R Prince

Many genetic counselors recommend that individuals secure desired insurance policies, such as life insurance, prior to undergoing predictive genetic testing. It has been argued, however, that this practice is "tantamount to fraud" and that failure to disclose genetic test results, or conspiring to secure a policy before testing, opens an individual up to legal recourse. This debate traps affected individuals in a Catch-22. If they apply for life insurance and disclose a genetic test result, they may be denied. If they apply without disclosing the information, they may have committed fraud. The consequences of life insurance fraud are significant: If fraud is found on an application, a life insurer can rescind the policy, in some cases even after the individual has passed away. Such a rescission could leave family members or beneficiaries without the benefits of the life insurance policy payment after the individual's death and place them in in economic difficulty. Although it is clear that lying in response to a direct question about genetic testing would be tantamount to fraud, few, if any, life insurance applications currently include broad questions about genetic testing. This paper investigates whether non-disclosure of unasked for genetic information constitutes fraud and explores varying types of insurance questions that could conceivably be interpreted as seeking genetic information. Life insurance applicants generally have no duty to disclose unasked for information, including genetic information, on an application. However, given the complexities of genetic information, individuals may be exposed to fraud and rescission of their life insurance policy despite honest attempts to truthfully and completely answer all application questions.

许多遗传咨询师建议,在进行预测性基因检测之前,个人应该获得所需的保险政策,比如人寿保险。然而,有人认为,这种做法“等同于欺诈”,不披露基因检测结果,或在检测前串谋获得一项政策,将使个人面临法律追索。这种争论使受影响的个体陷入了两难境地。如果他们申请人寿保险并公开基因检测结果,他们可能会被拒绝。如果他们在申请时没有披露信息,他们可能犯了欺诈罪。人寿保险欺诈的后果是严重的:如果在申请中发现欺诈,人寿保险公司可以撤销保单,在某些情况下甚至在个人去世后。这种撤销可能使家庭成员或受益人在个人死亡后得不到人寿保险给付的好处,并使他们陷入经济困难。虽然很明显,在回答有关基因检测的直接问题时撒谎等同于欺诈,但目前人寿保险申请中很少(如果有的话)包含有关基因检测的广泛问题。本文调查了不披露未经要求的遗传信息是否构成欺诈,并探讨了不同类型的保险问题,可以想象被解释为寻求遗传信息。人寿保险申请人一般没有义务在申请中披露未经要求的信息,包括遗传信息。然而,考虑到遗传信息的复杂性,尽管诚实地尝试真实和完整地回答所有申请问题,个人可能会暴露于欺诈和撤销他们的人寿保险单。
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引用次数: 0
THE CONSTITUTIONALITY OF SOLITARY CONFINEMENT: INSIGHTS FROM MASLOW'S HIERARCHY OF NEEDS. 单独监禁的合宪性:来自马斯洛需求层次的见解。
Lindley A Bassett
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引用次数: 0
期刊
Health matrix (Cleveland, Ohio : 1991)
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