Dismembering the Ethical Physician
Genuis, 2006. Postgrad Med J.
"Informed consent is not an objective reality that secures autonomy and negates paternalism, but a subjective interpretation heavily influenced by the state of knowledge and perception of the educating clinician, which in turn may reflect the values and perspective of that individual doctor."
Slacks redesign is a complete disaster. I'm not sure who they think this is for, but it's not me or anyone I know. What real world problem were they trying to solve? So many basic UI screw ups I wonder if they tested this at all.
Here’s how the “Kansas two step” works:
following a traffic stop (often for pretextual reasons), the trooper will hand a citation/warning to the driver and say something noncommittal like “We’re good here.”
A noncommittal phrase is essential. It does not affirmatively state the driver is free to go.
The driver, hearing this statement, may assume they’re free to go. That’s when the second step kicks in. Troopers will then say something like, “Oh, hey, one more thing…” and move on towards more questioning of the driver.
The driver at this point isn’t sure what their legal rights are. They have never been advised of them by the troopers. And despite being told something that somewhat equates to “you’re free to go,” they’ve never been told in plain English they’re free to go.
So, they re-engage (despite having no desire to) with the trooper.
The questions become more direct. The push towards obtaining consent for a search escalates from conversational to the law enforcement equivalent of a hard sell.
"'This is not just a problem of the #AlgonquinNation but all people on the #OttawaRiver. Why are we trying to put a radioactive mountain adjacent to the drinking water of millions of people that are south of this NSDF site?'
"Verna McGregor, a Kitigan Zibi #Anishinabeg elder, plans to explain at the CNSC licensing hearing how the #Algonquins were bypassed in the establishment of the original #ChalkRiver nuclear site on their unceded territory in the 1940s, and regard the river as sacred to their culture."
"Maine last month became the first state to ban the practice of spreading PFAS-contaminated sewage sludge as fertilizer.
"But it’s largely on its own in the US, despite a recent report estimating about 20m acres of cropland across the country may be contaminated.
"Most states are only beginning to look at the problem and some are increasing the amount of sludge they spread on farm fields despite the substance being universally contaminated with PFAS and destroying livelihoods in Maine.
"'Maine is at the forefront of this because we’ve seen first-hand the damage that sludge causes to farms,' said Patrick MacRoy, deputy director of the non-profit Defend Our Health Maine. The new law also prohibits sludge from being composted with other organic material.
"PFAS, or per- and polyfluoroalkyl substances, are a class of chemicals used across dozens of industries to make products resistant to water, stains and heat. Though the compounds are highly effective, they are also linked to #cancer, #KidneyDisease, #BirthDefects, decreased #immunity, #liver problems and a range of other serious diseases.
"Sewage sludge is a semi-solid mix of human excrement and industrial #waste that water treatment plants pull from the nation’s sewer system. It’s expensive to dispose of, and about 60% of it is now lightly treated and sold or given away as 'biosolid' fertilizer because it is high in plant nutrients.
"Maine and #Michigan are the only two states that are routinely checking sludge and farms for PFAS, and both are finding contamination on farms to be widespread.
"Maine’s legislature banned the practice of spreading sludge as fertilizer in April [2022] after environmental officials discovered astronomical levels of PFAS in water, crops, cattle and soil on farms where sludge had been spread, and high PFAS levels have been detected in farmers’ blood.
"#Contamination from PFAS-tainted sludge has already poisoned well water on around a dozen farms, and has forced several Maine farms to shutter. The state is investigating about 700 more fields where PFAS-contaminated sludge was spread in recent years. Farmers have told the Guardian that many of their peers with contaminated land won’t alert the state because they fear financial ruin.
"Maine also approved the creation of a $60m fund that will be used to help farmers cover medical monitoring, for buyouts and for other forms of financial assistance.
"'Folks have been left out to dry without any real help so we’re grateful to see that,' MacRoy said. The sludge legislation comes after Maine last year enacted the nation’s first ban on non-essential uses of PFAS in products. It goes into effect in 2030.
"In Michigan, environmental officials have downplayed the detection of PFAS in sludge and on farms, and although the state prohibits highly contaminated sludge from being spread, it allows higher levels of the chemicals in sludge than Maine. State regulators have also identified PFAS polluters and required them to stop discharging the chemicals into the sewers.
"Questions remain about whether that’s enough to keep PFAS out of Michigan’s food supply. Instead of implementing a wide-scale program to test livestock, crops and dairy, the state identified 13 farms it considered most at risk and has claimed contamination on other farms isn’t a risk.
"Michigan is ahead of most other states. In #Virginia, environmental regulators are considering permitting an additional 6,000 acres worth of sludge to be spread and have so far resisted public health advocates’ calls to test for PFAS and reject new sludge permits.
"In #Alabama, the state’s department of environmental management said in 2019 that 'the best use of biosolids is as a [fertilizer].'
"Even as the crisis unfolds in Maine, officials in Alabama are increasing the amount of out-of-state sludge that’s imported and spread on fields or landfilled, and the state in 2020 updated its biosolids rule to 'encourage' the use of #biosolids as fertilizer. Alabama does not test sludge for PFAS."
"On March 27th [2010] Citizens for Sludge-Free Land sent a letter to the #Virginia Department of Environmental Quality and US #EPA Region 3 that information provided to Virginia landowners about using sewage sludges as #fertilizer is deceptive. Land application permits are being granted in several Virginia counties without informing farmers of the serious risks associated with this practice. The VA code specifies, that to be valid, these permits can only be granted with the #InformedConsent of the landowner.
"The Federal #CleanWater Act defines sewage sludge as a #pollutant. Most of the pollutants that sewage treatment plants remove from wastewater concentrate in the resulting sludge. Exempt from #hazardous and solid waste laws, sludge is being spread on #agricultural land, despite mounting scientific evidence and field reports that using this contaminated waste as a cheap fertilizer is neither safe, beneficial, nor sustainable.
"The Virginia Cooperative Extension Service as well as Nutri-Blend Inc., the company that needs permits to spread sludge, are failing to provide landowners with the necessary facts, so they can make an informed decision whether or not to treat their land with sludge. The widely distributed Extension Service biosolids fact sheets-- although deceptively dated May 9, 2009-- provide out-dated, inaccurate, incomplete, and in some cases, misleading information. They overstate the alleged benefits and totally ignore the known risks and recent documented evidence of adverse health and #environmental impacts linked to sludge use. The fact sheets and brochures give the illusion that land applying sewage sludge, a complex and variable mixture of #HumanWaste and thousands of industrial #chemicals, many of which are #toxic and persistent, is a safe and normal agricultural practice.
"The information provided to landowners deceptively downplays the health risks of exposure to odors, odorant compounds, endotoxins, bacteria-laden dusts, and toxic gases at land application sites that can cause severe and permanent #lung damage. Nor are farmers told that typical sludges generated in industrialized urban areas contain not only pathogens, but also #PCBs, #dioxins, #carcinogens, #pharmaceuticals, flame retardants [#PFAS], and hormone disrupting chemicals that can damage developing organisms in parts per trillion. Many of these pollutants do not break down once they are applied to land. Worse, partial breakdown products are often more toxic than the parent material. Yet federal regulations require testing and standards for only nine toxic metals. Perhaps most important, the information provided to farmers fails to disclose that the National Academies of Science has indicated that while there are serious health concerns associated with many of the constituents of sewage sludge, there is too much uncertainty to scientifically predict the true health and environmental risks, when this complex waste mixture is applied to land.
"Finally, farmers are not told that sludge-exposure has been linked to illnesses, human deaths, livestock mortalities, groundwater pollution, and permanently degraded land. Unless there is a true and accurate disclosure of all the risks associated with this practice, there can be no true consent.
"Without informed consent, the state should not be issuing permits."
I don't need a psychological evaluation to have my dick enlarged or my entire back tatooed and neither should anyone else be required to have anything beyond self-signed consent form.