I had never heard of DIC before, but I knew that patients had a right to refuse treatment even if it was detrimental to their health. After reading this article, it does make sense that people should have a right to self-medication. I’ve heard of instances before from family friends where a doctor denied them a certain prescription medication despite our friend knowing that something was wrong, which ended up harming them in the long run. This is very much applicable to my family; my mom has pulmonary arterial hypertension (the arteries that pump blood from her heart to her lungs are constricted and put too much pressure on her heart), which becomes life threatening very quickly if she doesn’t have a constant administration of medicine. There are several types of medicine, and a person’s response to the medicine is very individualistic. In this case, a doctor might prescribe one of the medications based on how her tests come back, but the only way to know if the medicine is working is if she feels her quality of life is the same as it was before (basically asymptomatic). Luckily our doctor is very nice and is willing to prescribe another medication if it means my mom will feel better, but it could be the case that he would refuse because he thinks he knows which medicine is best- even though the only person who can truly know is my mom. She should have the right to switch medications, because she’s the only one qualified to judge her well-being.

I also agree with Flanigan in that people should first be informed of all the benefits and risks before receiving the drug they request. Not everyone would research a certain drug before they request it, so for liability’s sake, they need to at least hear the risks even if they choose to ignore them.

I thought that Flanigan’s article brought up a lot of interesting points, but overall, I did not find it convincing. From the moment of reading the thesis/goal of Flanigan’s argument, I felt that changing the structure of the prescription process so that patients can legally self-medicate did not make sense because prescriptions exist for a reason. Prescriptions are supposed to be an expert telling another person what they need to do. Flanigan related prescriptions to paternalism because I think of paternalism as someone forcing their own cultures and/or beliefs on others. While technically a medical opinion is the doctor’s own “belief,” because the doctor is an expert who went through many additional years of schooling, he or she can be classified as an expert which makes it different.

Through the next section, I agreed with her entire support of DIC, but as she continued on to turn the logic towards self-medication, I started to take issue with her connections. For example, on page 582, she claims “prescription-only regimes actually encourage dangerous drug use,” I view this more as an issue with the FDA’s certification process because no exceptionally risky drugs are supposed to be allowed on the market in the first place.

To be fair, I did form an opinion about as soon as I read the thesis, so my reading of the remaining part of the article could have possibly been skewed by this.

The arguments presented by Flanigan were interesting to me because I am writing my research paper about the access to healthcare.  I believe we should increase access to healthcare, but I also understand the importance of having prescription laws. I don’t entirely agree with Flanigan’s argument because I believe that prescription laws prevent those from abusing medications and drugs, which can lead to an OD epidemic. However, I feel that if people cannot access to prescriptions, they will find any way to get it (i.e, the black market). People will get the medication regardless if they have a doctor’s approval or not. I have very mixed feelings about much access people should have to dangerous drugs.

One thing I believe should be mentioned more about this argument is those who do not have the access to refuse the medication.  If a patient was diagnosed with Diabetes and their doctor recommended them to take Insulin, what would happen if the patient did not have the finances to pay for insulin? They would take the Insulin but cannot afford it- is that risky refusal? Insulin prescription has skyrocketed and has become very expensive for many people to continue to take. This has led to many not taking the medication not because they do not want to but because they are unable to; it has also led many to find the medication other ways than through a doctor, or find a completely other alternative. How does this affect a doctor on giving a patient informed consent?

Throughout the reading, I continued to question the validity of many of the laws we have. I was especially interested in the point brought up in the Hidalgo reading about democratic societies tying us to unjust laws. I am kind of stuck on what to think about this. I agree with what Hidalgo is saying. We live in a democracy and ultimately our votes lead us to have certain laws. However, the entirety of the population is not going to agree with that law. I see the importance of having laws because there are certain rules that must be enforced in order for us to have a functioning society. There are some rules that come down to more moral issues that people are going to have very different views on. I agree with Hidalgo that it is acceptable to disobey laws surrounding immigration because to obey them would be unfair to people that should have a right to come here anyway. I would, on the other hand, be very uncomfortable with people disobeying gun control laws even though they might also have moral reasons for why they disobey gun laws. It seems an impossible line to draw in terms of what laws you can disobey which ones you cannot.

The Flanigan reading made me nervous. It makes me very nervous to think about people having open access to drugs that could be really harmful. I also am someone that knows I am not a doctor and would definitely rather have a doctor make decisions like these for me. To me, it just seems a lot safer to have doctors making medical decisions for us, but I also see where she is coming from. Some of the data she presented in support of a non-prohibitive drug system surprised me. Even when she provides information about their being fewer poisonings in countries where people can self-medicate my brain still does not want to believe it.

Last semester, my 102 class went to a talk given by Dr. Hidalgo on immigration law. Reading his paper gave me a deeper understanding to what he was explaining in his talk. I thought Hidalgo’s distinction between “doing” and “allowing” was very interesting. When thinking about moral arguments and dilemmas, especially ones concerning immigration, I agree with Hidalgo’s point about our moral duty to disobey the law if the punishment for us isn’t to the same standards as the consequences for others if we do follow it.

Another point I found particularly interesting was his argument for the revisionary view. He used an example of a woman named Linda, and gave two different examples of her moving from Chicago to LA, and then Chicago to London. He argues that the restriction of her moving not only infringes upon her rights, but the rights of the people in that city who would associate with her. By “conscripting” citizens to comply with federal law, through prohibiting them from hiring unauthorized migrants or not reporting them, the government is effectively restricting the rights of their citizens as well. I thought that argument was interesting, because within the issue of immigration, you rarely hear about the rights violations of citizens, only the migrants.

Reading Flanigan’s introduction to her paper, I was pretty adamant that I was going to disagree with her. The idea of giving people free access to all prescription drugs, including the opioids that have sparked an enormous addiction epidemic and other prescription drugs like Adderall that are frequently taken without prescription, seemed ridiculous to me. The idea that people know what drugs are best for them without physician advice seemed laughable. There’s a reason people attend medical school and residency and every other step along the way that puts them in a position to prescribe these powerful and sometimes addictive drugs.

But as much as I didn’t want to believe it, Flanigan made some very good points. Our whole medical system is based on the principle of non-paternalism, with the sharp exception of drug regulation. Everything else – most notably the Doctrine of Informed Consent – is based on the principle that patients have a right to make the decision they deem best for them, so her question of why that right suddenly stops with drugs is very valid. Flanigan also notes that a reason people take the opiates or other addictive drugs in the first place is because they assume they’re safe since a doctor prescribed them, even though there are serious risks associated with those substances. Also, countries that don’t have enforced drug regulation actually show lower mortality rates because patients can access medicines they need without restriction. While this idea of self-medication generally goes against everything I thought I believed, I have to agree that Flanigan made a strong case. She also provided useful solutions and alternatives to opposing beliefs. It was also interesting to see her use the same ethical argument forms like normative and deontic that we’re learning about in class and see that they have very real uses and applications.

I attended the “Jim Crow Cigarettes from Richmond to China: An intimate history” lecture presented by Dr. Nan Enstad. Enstad gave an extremely insightful analysis of how race relations allowed some people to thrive in the booming tobacco and cigarette trade of the 19^th and 20^th centuries and others to be stifled across the globe. Richmond has a special relationship to this industry, as it was one of the birth places of the tobacco boom. Enstad started her research on a local basis, talking to elderly ex-factory workers about their experiences. In all of her work, Enstad highlights the role of under-represented groups (women, African Americans, queer people) in history and this project was no different for her. A major topic in her book on the subject was the “gold rush” to farm the new strain of tobacco called Brightleaf. This was a very sensitive crop to plant, and recently freed African Americans had every reason to think that it would be their ticket to social mobility because they had all the skills to thrive at it. However, white men cunningly made sure that black people never had the chance. The corporate structure of white collar versus blue collar jobs was implemented. African Americans were forced into lower level positions due to left over structures of slavery and the lack of opportunity to acquire any land.

Enstad’s talk was a good example of why certain people were able to acquire leadership opportunities, like tobacco tycoons James Duke and Lewis Ginter. This general idea is still a problem today. We have been learning a great deal about how implicit biases, and while in the 19^th century it was blatant racism, people’s preconceived notions shaped an entire business structure. Enstad explained how slavery left people with the belief that black people should be excluded from higher management jobs, even though they were most knowledgeable about the product. There was a “Brightleaf Tobacco Network” of corporate workers of the same race (white) and class (middle) that perpetuated the cycle of white-male leadership. The biases were so deep rooted, that when the American tobacco/cigarette industry spread to China, the racism spread as well.

I enjoyed Enstad’s talk and I learned a lot about an unfamiliar topic. Even past the information she shared, Enstad emphasized the investigation structure of using local stories to examine global histories which I think is extremely useful in any field of study.

My 102 class went to a talk given by Hildago about civil disobedience to immigration laws, which introduced me to this topic. His paper was a more comprehensive explanation, and it gave me a deeper understanding. I found the distinction between “doing” and “allowing” to be very interesting. It is similar to what we talked about in class, that people are much more willing incur higher risks if it means they are allowing something to happen, rather than doing something that has lower risks. This distinction has even deeper levels when you consider the morality of the choice. When it comes to immigration laws, I agree with Hildago that the choice to not do something (as in not follow the law) is the more moral option, and worth the risk of punishment. In the talk he gave last semester, he discussed the different types of civil disobedience as well. People often have an idea that civil disobedience must be grand gestures that call a great deal of attention. However, with immigration laws in particular, civil disobedience can be much more discrete. There is merit and importance in public, attention-grabbing disobedience. However, people have a moral duty to disobey in daily life as well.

I was not familiar at all with the topic of Dr. Flanigan’s paper, but it was very informative. Initially, I was surprised because the only arguments on prescription use that I have been exposed to are in regard to the opioid crisis. She provides many compelling points like the DIC perspective, epistemic authority and bodily autonomy. The idea of deferring to the patient’s judgment about treatment options was something I have never considered, and while I imagine I would personally have some insecurities and doubts if I had the final say in choosing my medicine, it is a strong argument overall. She addresses the counter arguments of dangerous drugs and addiction, which are topics I would like to read more about. I worry that even a rational person could be told the risks and benefits of a drug, then still make a decision that is bad for their health because of their biases or unwillingness to change their mind. However, doctors have biases too so perhaps this is already the case. I cannot say whether I agree or disagree with Flanigan’s argument, but it is a topic that I would like to follow up on.

Paternalism:  thinking you know what’s best for others.

The medical industry has gotten the test results and from their perspective, and as TV host Murray would say, “You are the father.” However, we don’t live in a paternalistic society and we can refuse medical treatment as any time.  However, as the author points out ” Yet, if paternalist medical interventions are impermissible, why aren’t paternalist limitations on self-medication also impermissible?”

This becomes the puzzle. Theoretically, we can refuse the treatment for insulin and witch to a diet but we can’t refuse the diet and get the insulin. Then the questions becomes should we be able to?  I personally think that the limited paternalism surrounding the medical industry is in fact ethical. We aren’t all licensced medical professional and we just straight up have no clue about what is always best for us. Of course, this does come with its long list of EXCEPTIONS. However, so does all of life. In the long run the puzzle of the paternalism in the medical industry doesn’t seem much of a puzzle at all. We are all grown adults moved out and when we go back “home” ( seek medical help) then we are in somone else’s house with their own rules, regulations and paternalistic advice. Maybe, we should just respect the advice and take some and throw out the others. 

On Friday, February 28, 2020, I attended the Bonner Center for Civic Engagement’s Brown Bag Discussion titled “No Justice, No Peace! Building Student Power” with Kalia Harris. She recently graduated from George Mason University and works for the Virginia Student Power Network as a queer, femme, black activist. Her focus is on student organizing and coalition building at the VSPN on social, racial, economic justice campaigns. Coalition building can be defined as “when groups and/or individuals share decision-making, responsibility, and partnership to work together towards a shared goal” and Kalia discussed this in-depth with regard to creating an effective student campaign. The VSPN includes young organizers and allies interested in racial, economic, undocumented, LGBTQ+, women’s, educational, labor, and environmental justice. Kalia lives in Richmond and came to the Brown Bag Discussion to discuss why she is so interested in this topic, and why student organizing can be so effective.

Kalia Harris was aware of the racist incidents that have occurred on our campus and connected her experiences with using student power to make an impact. Not only did this CCE Brown Bag connect to me as a college student, but it can be applied in the greater leadership context. If you don’t have a shared goal (i.e. stopping racism on UR’s campus, and implementing an Africana Studies department at UR) you cannot end injustices; the politics can get in the way, but building on a universal goal can be what really makes the big impact. For example, multiple student groups on campus might have different structures and individual goals, but if a cohort of groups can come together with a common goal, that’s when real change can occur. Kalia said that the elements of a successful campaign are identifying the problem and the issues, creating a demand, framing the issues to the constituency, strategy for the campaign, and the tactic.

I really enjoyed Kalia Harris’s and the Virginia Student Power Network’s mission to evoke change through student movements. We can apply these methods to the issues we present in Critical Thinking and writing research papers that may push for change.

Anna Marston