Status foe: a psychobiographical investigation of Ida B. Wells.

Ida B. Wells (1862-1931) led an extraordinary life as a journalist, educator, and activist while navigating the intersecting social realities of race, gender, and class. She embodied courage, advocating for the civil rights of Black Americans in an uncompromising fashion.Building on decades of research in social psychology, sociologist Cecilia L. Ridgeway presents (2019) a cultural schema theory of status. She contends that issues of status in interpersonal contexts are an unavoidable aspect of the human condition. Despite the ubiquity of status as a sociocultural force, Ridgeway believes that status hierarchies may be undermined.The present study is a psychobiographical exploration of Wells through the lens of Ridgeway's status theory. It explores: the development of Wells' cultural schemas; how Wells navigated her own status; the inter-relationship between Wells and her sociocultural context; and how Wells undermined and overcame status hierarchies.

Against visitor bans: freedom of association, COVID-19 and the hospital ward.

To ban or significantly restrict visitors for patients in hospital could seem to be simply a sensible and easy precaution to take during a pandemic: a policy that is unpopular, perhaps, and even unfortunate, but not something that wrongs anyone. However, I argue that in fact such restrictions on visitors infringe upon a fundamental right, to freedom of association. While there may still be permissible restrictions on visitors, making the case for these becomes highly demanding. One common way to understand the purpose of the fundamental liberties is as protecting us from interference in a core set of freedoms, even when such interference would be to our benefit or would promote the general good. This reframing of the importance of visitors in terms of a right also has implications for how to run hospitals beyond the pandemic era: it supports a rapid expansion of visitor access and suggests that any decision to significantly restrict visitors ought not be left in the hospital, or hospital trust's, hands.

On the importance of consistency: a response to Giubilini et al.

Giubilini et al offer some helpful reflections on the conscientious provision of medical care and whether and in what circumstances professional associations ought to support the conscientious provision of abortion in circumstances where abortion is banned or heavily restricted. I have several reservations, however, about the argument developed in the article. First, the essay makes questionable use of the case of Savita Halappanavar to justify its central argument about conscientious provision. Second, there is an apparent inconsistency between this article and the authors' statements elsewhere about the conscientious refusal of care. Third, there are risks that attend to professional associations supporting practitioners who break the law, and yet Giubilini et al do not give sufficient attention to this. This response will briefly discuss these three concerns.

Black dreams matter: Exploring the polyphonic realms of the Black Radical Imaginary.

OBJECTIVE: Charles Cobb Jr. and Alex Davis are two Black American men who have never experienced the full capacity of freedom. The routine denial of their full humanity, or social equity, has counterintuitively sparked an impetus inside of them both to commit their lives to seek to dismantle oppressive systems. METHOD: Through a series of oral histories with both organizers, I learned that they have been engaged with radical dreaming and imagination as a survivalist movement strategy. RESULTS: Despite the dehumanizing violence of slavery, the political humiliation of Reconstruction, the brutal segregation and state terrorism of Jim Crow, and the many Civil Rights successes and Neoliberal disappointments that have followed, Cobb and Davis have embodied a steadfast commitment to freedom, unwavering trust in their people, in some contexts, a just daring that defies current dominant reason. CONCLUSION: I argue that by drawing through lines between the meaning-making experiences of Charles Cobb Jr. 's and Alex Davis' incredible lives we can better understand their critical consciousness and sociopolitical development have influenced their dreams of freedom, cultivated their radical imaginations, and sustained their collectivism.

Potential Effects of Dobbs v. Jackson Women's Health on Civil Commitment Law.

Since the publication of the U.S. Supreme Court's decision in Dobbs v Jackson Women's Health in June of 2022, much attention has been paid to the direct effects of that decision on reproductive health care for pregnant or potentially pregnant individuals; and to the potential effects of the Court's approach in Dobbs to other established precedent related to privacy and autonomy, such as rights to contraception and marriage equality. This Article will explore another potential negative consequence of Dobbs; its potential effect on the constitutional parameters of the law of civil commitment and involuntary medication of the mentally ill.The foundational Supreme Court case establishing the parameters of the State's right to involuntarily commit an individual to a mental institution was decided only two years after Roe v. Wade. In 1975, the Supreme Court in O'Connor v Donaldson held that an individual has a liberty interest in "prefer[ring] one's home to the comforts of an institution," and that a State could not, "without more," confine a non-dangerous individual. The two-prong test of requiring a showing of both mental illness and dangerousness to one's self or to others has remained the cornerstone of civil commitment law ever since.The language and analysis of O'Connor is similar to that of Roe, the abortion rights case overturned by Dobbs. In particular, the grounding of the right to avoid civil commitment in the individual liberty and privacy interests are common themes in the two cases. The current Court, in its decision in Dobbs, has cast substantial doubt on the continued vitality of that analysis; and one can easily imagine a reconceptualization of O'Connor along the lines of Dobbs that substantially alters the requirements for civil commitment. In particular, the reliance in Dobbs and other recent Supreme Court opinions on historical precedent as a linchpin of originalist analysis could lead the Court to search for justifications in colonial or 19th-century mental health practices, time periods which predate modern psychiatric science.This Article will explore the parallels in approach between Roe and O'Connor, and will suggest ways in which the post-Dobbs Supreme Court majority might disrupt the civil commitment status quo, including potential expansion of civil commitment or other detention of pregnant individuals for the protection of the fetus; and possible relaxation of the dangerousness requirement for civil commitment articulated in O'Connor.

What Does "Least Restrictive" or "Less Restrictive" Mean in Mental Health Law? Contradictions and Confusion in the Case of Queensland, Australia.

Most legal systems in the West allow for involuntary treatment of mental illness, usually on the basis that without such treatment the person would be a danger to themselves or others. While historically the mental health law jurisdiction has been a protective one, it has become increasingly influenced by civil rights and international human rights law, which privilege the value of autonomy and the right to personal liberty.In this regard, an important principle that has developed is that decisions about treatment for mental illness must be the "least restrictive alternative" available. This may mean, for example, that a person is supported to make a decision on treatment for their mental illness, according to evolving practices of "supported decision-making," so that their legal capacity is still recognized. If involuntary treatment is required, the "least restrictive" approach demands that the liberty and integrity of the person be respected to the greatest extent possible.The Mental Health Act 2016 (Qld) ("MHAQ") prescribes that decision-making on non-consensual treatment should preferably be done according to what it calls the "less restrictive way." However, the "less restrictive way" is defined as decision-making by patients under advance directives, and also by substitute decision-makers, including by attorneys or guardians not appointed by the patient, usually a family member. The MHAQ states that these arrangements are distinguished from and prioritized over what it calls "involuntary treatment and care," where the decision for non-consensual treatment is made by the treating team.However, we argue that these arrangements are not in fact "less restrictive" of the person's autonomy, but are less accountable forms of decision-making. Decision-making by treating teams under involuntary treatment provisions is subject to higher levels of transparency and accountability. In Australian states these decisions are reviewed regularly by a specially constituted, independent mental health tribunal. By contrast, treatment decisions made under the "less restrictive way" are not even defined as constituting involuntary treatment, and are outside the scope of the tribunal's review.In the case of decision-making by advance directive, we acknowledge that this is widely considered to be "less restrictive" of a person's right to legal capacity and autonomy. However, in these cases, the patient may actually be refusing treatment at the time the advance directive is relied upon. This raises serious questions as to whether such "voluntary" admissions and treatment should not be subject to the same oversight and accountability as involuntary ones. Patients have a right to less restrictive forms of decision-making, but when deprived of their liberty, they also have a right to adequate safeguards established by law.The term "less restrictive" in the MHAQ is largely misplaced and misleading. In the case of advance directives, it deflects attention from the potentially restrictive nature of the treatment and the lack of accountability. Even more problematically, the privileging of private substitute decision-making under the less restrictive way ignores the real risk of abuse and undue influence within the personal and family sphere. We argue that the "less restrictive way" under the MHAQ is a step backwards for the rights of patients, in that it shifts power to family on the risky assumption that decision-making by these less supervised individuals is more likely to uphold human rights. We believe that this reflects a pre-feminist assumption that the informal, family, private sphere is nearly always safe. This is a contentious assumption, which nevertheless underpins much unproblematized thinking and advocacy on supported decision-making. This issue also highlights the need for further elucidation and discussion on what least restrictive means in the context of involuntary treatment for mental illness.

Does legal freedom satisfy?

Much political conflict in the world revolves around the issue of how much freedom to accord people. Liberal democracies are characterized by, e.g., the rule of law and a strong protection of civil rights, giving individuals a great deal of legally guaranteed freedom to lead their lives as they see fit. However, it is not known whether legal freedom suffices to make people satisfied with freedom. Our study explores that issue by relating seven indicators of legal freedom to the satisfaction people express with their freedom of choice. Using a sample of 133 countries over the period 2008-2018, and taking a panel-data approach, we find no robust baseline relationship. However, when exploring conditional associations by interacting the indicators with social trust, the rule of law is positively and increasingly related to satisfaction with freedom above and below a threshold level. Freedom of assembly is more positive for satisfaction with freedom the higher the GDP per capita and in democracies. Thus, for some types of legal freedom, formal legal institutions are complementary with culture, income and the political system in generating satisfaction with freedom.

COVID-19 vaccine boosters for young adults: a risk benefit assessment and ethical analysis of mandate policies at universities.

In 2022, students at North American universities with third-dose COVID-19 vaccine mandates risk disenrolment if unvaccinated. To assess the appropriateness of booster mandates in this age group, we combine empirical risk-benefit assessment and ethical analysis. To prevent one COVID-19 hospitalisation over a 6-month period, we estimate that 31 207-42 836 young adults aged 18-29 years must receive a third mRNA vaccine. Booster mandates in young adults are expected to cause a net harm: per COVID-19 hospitalisation prevented, we anticipate at least 18.5 serious adverse events from mRNA vaccines, including 1.5-4.6 booster-associated myopericarditis cases in males (typically requiring hospitalisation). We also anticipate 1430-4626 cases of grade ≥3 reactogenicity interfering with daily activities (although typically not requiring hospitalisation). University booster mandates are unethical because they: (1) are not based on an updated (Omicron era) stratified risk-benefit assessment for this age group; (2) may result in a net harm to healthy young adults; (3) are not proportionate: expected harms are not outweighed by public health benefits given modest and transient effectiveness of vaccines against transmission; (4) violate the reciprocity principle because serious vaccine-related harms are not reliably compensated due to gaps in vaccine injury schemes; and (5) may result in wider social harms. We consider counterarguments including efforts to increase safety on campus but find these are fraught with limitations and little scientific support. Finally, we discuss the policy relevance of our analysis for primary series COVID-19 vaccine mandates.

From self-management to depathologisation: the evolution of transgender health care and rights in Spain between 1970 and 2020.

Even though transgender people continue to experience violence and discrimination in many aspects of life, there has been progressive recognition of their experiences and demands in recent decades. This article analyses the process of claiming civil rights and the evolution of health care for transgender people in Spain, from the mid-1970s to the present day, paying particular attention to the narratives of key actors involved. To this end, three socio-historical periods are identified: (1) the travesti period (the mid-1970s to the early 1990s), characterised by strong social and institutional transphobia and resulting self-care practices; (2) the transexual period (mid-1990s to the 2000s), when demands for health care were institutionalised under a pathological medical model; and (3) the transgénero or trans period (2010s until the present) when identity and bodily autonomy have been re-claimed through a socio-cultural prism that has denounced pathologisation. At each stage, political, social and economic factors intervened at both national and international levels to trigger an ongoing negotiation between transgender movements and dominant social institutions, all within a changing universe of social values.

Born on U.S. Soil: Access to Healthcare for Neonates of Non-Citizens.

INTRODUCTION: The 14th amendment of the United States (US) Constitution guarantees citizenship to infants born in the US. With documentation of citizenship, typically through a birth certificate, neonates gain official identity and the opportunity to qualify for services like healthcare. Most guidance on caring for immigrant children assumes that access to health care is guaranteed for babies born in the US. In practice, some infants born to non-citizen mothers face barriers in obtaining services fundamental to neonatal health. METHODS: We conducted a review of the literature to identify articles on access to care for infants born to non-citizen mothers in the US. Because of the scarcity of relevant peer-reviewed published literature on this topic, the search was broadened to grey literature including news articles, online articles, and legal reviews. Using these aggregated sources, we created a framework for understanding maternal immigration status and barriers to healthcare for neonates born in the US. We discuss risk factors from the public health, historical and ethical perspectives. RESULTS: Barriers exist for some mother-infant dyads in obtaining services such as healthcare, health insurance and supplemental nutrition programs. At-risk dyads include neonates of undocumented immigrants and birth tourists as well as neonates born to women on visas. The impact of these barriers on health-seeking behaviors, access to care, and health outcomes for these neonates is largely unknown. DISCUSSION: The framework for understanding challenges of non-citizen mothers and their infants that we present in this article provides a resource for physicians and public health professionals serving this population. That much of the literature exists outside of healthcare highlights the need for more scholarly work on this problem. Future research will better inform advocacy and public health efforts to protect this vulnerable population of newborn citizens and their mothers.

How the Trump Administration's Pandemic Health Care Response Failed Racial Health Equity: Case Studies of Structural Racism and a Call for Equity Mindfulness in Federal Health Policy Making.

CONTEXT: The racial health equity implications of the Trump administration's response to the COVID-19 pandemic. METHODS: We focus on four key health care policy decisions made by the administration in response to the public health emergency: rejecting a special Marketplace enrollment period, failing to use its full powers to enhance state Medicaid emergency options, refusing to suspend the public charge rule, and failing to target provider relief funds to providers serving the uninsured. FINDINGS: In each case, the administration's policy choices intensified, rather than mitigated, racial health inequality. Its choices had a disproportionate adverse impact on minority populations and patients who are more likely to depend on public programs, be poor, experience pandemic-related job loss, lack insurance, rely on health care safety net providers, and be exposed to public charge sanctions. CONCLUSIONS: Ending structural racism in health care and promoting racial health care equity demands an equity-mindful approach to the pursuit of policies that enhance-rather than undermine-health care accessibility and effectiveness and resources for the poorest communities and the providers that serve them.

"This Isn't Just a Police Issue": Tensions between Criminal Justice and University Responses to Sexual Assault among College Students.

Sexual assault among college students is both a crime and a civil rights violation under U.S. federal Title IX policy, which prohibits discrimination on the basis of sex in educational institutions. The current study sought to understand the extent to which the criminal justice system influences university Title IX proceedings, as well as potential consequences of this influence. For this study, we conducted in-depth qualitative interviews with a sample of 22 multidisciplinary, nationally-recognized subject matter experts in the area of campus sexual assault response. The results indicated that criminal justice concepts and goals are indeed being conflated with and influencing university Title IX proceedings. Participants also reported that criminal investigations are often prioritized over or seen as higher quality than Title IX investigations. As a result, participants described diminished educational and civil rights protections for survivors. We discuss how the community psychology values of social justice, promoting health and well-being, and accountability to oppressed groups can guide future efforts to reduce the spread of criminal justice influence into Title IX, improve existing Title IX proceedings, and explore alternative models of accountability beyond traditional criminal and civil approaches.

Present-Day Mass Tourism: its Imaginaries and Nightmare Scenarios.

Present-day mass tourism uncannily resembles an auto-immune disease. Yet, self-destructive as it may be, it is also self-regenerating, changing its appearance and purpose. They are two modes that stand in contrast to each other. We can see them as opposites that delimit a conceptual dimension ordering varieties of present-day mass tourism. The first pole calls forth tourism as a force leaving ruin and destruction in its wake or at best a sense of nostalgia for what has been lost, the other sees tourism as a force endlessly resuscitating and re-inventing itself. This paper article highlights both sides of the story. These times of the Covid-19 pandemic, with large swathes of public life emptied by social lock-down, remind us of a second, cross-cutting conceptual dimension, ranging from public space brimming with human life to its post-apocalyptic opposite eerily empty and silent. The final part of my argument will touch on imagined evocations of precisely such dystopian landscapes.

Legal Remedies to Address Stigma-Based Health Inequalities in the United States: Challenges and Opportunities.

Policy Points Stigma is an established driver of population-level health outcomes. Antidiscrimination laws can generate or alleviate stigma and, thus, are a critical component in the study of improving population health. Currently, antidiscrimination laws are often underenforced and are sometimes conceptualized by courts and lawmakers in ways that are too narrow to fully reach all forms of stigma and all individuals who are stigmatized. To remedy these limitations, we propose the creation of a new population-level surveillance system of antidiscrimination law and its enforcement, a central body to enforce antidiscrimination laws, as well as a collaborative research initiative to enhance the study of the linkages between health and antidiscrimination law in the future. CONTEXT: Stigma is conceptualized as a fundamental cause of population health inequalities. Antidiscrimination law is one important lever that can influence stigma-based health inequities, and yet several challenges currently limit the law's potential to address them. METHODS: To determine whether antidiscrimination law adequately addresses stigma, we compared antidiscrimination law for its applicability to the domains and statuses where stigma is experienced according to the social science literature. To further examine whether law is a sufficient remedy for stigma, we reviewed law literature and government sources for the adequacy of antidiscrimination law enforcement. We also reviewed the law literature for critiques of antidiscrimination law, which revealed conceptual limits of antidiscrimination law that we applied to the context of stigma. FINDINGS: In this article, we explored the importance of antidiscrimination law in addressing the population-level health consequences of stigma and found two key challenges-conceptualization and enforcement-that currently limit its potential. We identified several practical solutions to make antidiscrimination law a more available tool to tackle the health inequities caused by stigma, including (1) the development of a new surveillance system for antidiscrimination laws and their enforcement, (2) an interdisciplinary working group to study the impact of antidiscrimination laws on health, and (3) a central agency tasked with monitoring enforcement of antidiscrimination laws. CONCLUSIONS: Antidiscrimination law requires better tailoring based on the evidence of who is affected by stigma, as well as where and how stigma occurs, or it will be a poor tool for remedying stigma, regardless of its level of enforcement. Further interdisciplinary research is needed to identify the ways in which law can be crafted into a better tool for redressing the health harms of stigma and to delimit clearer boundaries for when law is and is not the appropriate remedy for these stigma-induced inequities.

"Alone in a Sea of Rib-Tips": Alvenia Fulton, Natural Health, and the Politics of Soul Food1.

While the intersection between alternative medicine and the natural food movement in radical white communities of the 1960s and 1970s is well known, the connection between these traditions and the simultaneous revolution in the black foodscape has not received adequate attention. This paper addresses this gap by exploring how an alternative healer and minister from the rural South, Alvenia Fulton, rose to prominence in Chicago during the 1960s and 1970s as one of the major figures in the transformation of the black diet by harnessing the star power of her celebrity clients. Fulton hybridized her apprenticeship in slave herbalism with concepts from white Protestant health food lectures into a corrective nutrition program to bring health and renewal to black communities that were struggling under the burden of structural and medical racism. When, in the 1960s, coronary heart disease peaked for black Americans, soul food became the iconic diet of the civil rights movement. To help her community while respecting their culture, Fulton struck a careful bargain to encourage more black Americans to eat raw, natural, vegetarian food by subtly reimagining the historical contents of the slave diet.

Predictors of health related-quality of life among elderly with disabilities.

AIM: There have been no previous studies of health-related quality of life (HRQOL) among adults aged 65 years and older with disabilities in Serbia. The aim of study was to identify predictors of HRQOL in the context of sociodemographic characteristics, disability aetiology, comorbid diseases, indices of comorbidities, realization of social rights, and domestic violence. METHODS: The cross-sectional study involved 275 consecutive elderly outpatients with disabilities. They were recruited by general practitioners at Primary Health Centers in Belgrade, Serbia, from March to May 2015. Data were acquired through face-to-face interviews and general practitioners' charts, while the generic 36-item Short Form Health Survey was used to assess HRQOL. In statistical analysis, Student's t-test, Z-test, Spearman's correlation test, and both univariate and multivariate linear regression were performed. RESULTS: Multivariate analysis revealed that a higher Functional Comorbidity Index (ß = -0.194, P < 0.01) and not asking for realization of right to assistance and care financial benefits (ß = -0.142, P < 0.05) were predictors of a lower scores Mental Composite Score (F = 9.262; P < 0.001). Not asking for realization of right to assistance and care financial benefits (ß = -0.187, P < 0.01), congestive heart failure (ß = -0.123, P < 0.05), and stroke (ß = -0.120, P < 0.05) were predictors of a lower Physical Composite Score (F = 7.169, P < 0.001). CONCLUSIONS: This study provides valuable data for better understanding the underlying factors associated with the HRQOL of elderly persons with disabilities, and currently, these are the only available data of their kind in Serbia. National authorities could identify predictors of HRQOL as a basic starting point for improving the social welfare and health-care systems. Better prevention and management of clinical factors, increased access to social services, and enhanced delivery of social services will improve the ageing process and HRQOL of this vulnerable population.

Rights language and disorders of consciousness: a call for advocacy.

Drawing upon sources in neuroethics, civil rights, and disability rights law, we argue for the reintegration of people with severe brain injury back into the nexus of their families and communities consistent with the Americans with Disabilities Act (ADA) and the UN Convention on the Rights of Persons with Disabilities, both of which call for the maximal integration of people with disability into society. To this end, we offer a rights-based argument to address the care of people with severe brain injury. Instead of viewing the provision of rehabilitation as a reimbursement issue, which it surely is, we argue that it can be productively understood as a question of civil rights for a population generally segregated from the medical mainstream and from society itself. Their segregation in the chronic care sector constitutes disrespect for persons, made all the more consequential because recent advances in brain injury rehabilitation make reintegration into civil society an aspirational, if not achievable goal.

Viewing Health Equity through a Legal Lens: Title VI of the 1964 Civil Rights Act.

Enacted as part of the watershed Civil Rights Act of 1964, Title VI prohibits discrimination by federally assisted entities on the basis of race, color, or national origin. Indeed, the law is as broad as federal funding across the full range of programs and services that affect health. Over the years, governmental enforcement efforts have waxed and waned, and private litigants have confronted barriers to directly invoking its protections. But Title VI endures as the formal mechanism by which the nation rejects discrimination within federally funded programs and services. Enforcement efforts confront problems of proof, remedies whose effectiveness may be blunted by underlying residential segregation patterns, and a judiciary closed to legal challenges focusing on discriminatory impact rather than intentional discrimination. But Title VI enforcement has experienced a resurgence, with strategies that seek to use the law as a basic compliance tool across the range of federally assisted programs. This resurgence reflects an enduring commitment to more equitable outcomes in federally funded programs that bear directly on community health, and it stands as a testament to the vital importance of a legal framework designed to move the nation toward greater health equity.

The Role of Courts in Shaping Health Equity.

United States' courts have played a limited, yet key, role in shaping health equity in three areas of law: racial discrimination, disability discrimination, and constitutional rights. Executive and administrative action has been much more instrumental than judicial decisions in advancing racial equality in health care. Courts have been reluctant to intervene on racial justice because overt discrimination has largely disappeared, and the Supreme Court has interpreted civil rights laws in a fashion that restricts judicial authority to address more subtle or diffused forms of disparate impact. In contrast, courts have been more active in limiting disability discrimination by expanding the conditions that are considered disabling and by articulating and applying the operative concepts "reasonable accommodation" and "other qualified" in the context of both treatment and insurance coverage decisions. Finally, regarding constitutional rights, courts have had limited opportunity to intervene because, outside of specially protected arenas such as reproduction, constitutional law gives government wide discretion to define health and safety goals and methods. Thus, courts have had only a limited role in shaping health equity in the United States. It remains to be seen whether this will change under the Affordable Care Act or whatever health reform measure might replace it.