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The Arizona Debacle — A Physician’s Perspective To the Editor: Arizona Senate Bill 1062 was met with appropriate outrage. Ruling that a person may not be forced to act in a manner inconsistent with his or her religious beliefs, the proposal could have permitted people not to serve anyone who made them “uneasy.” Some persons were concerned that the bill intentionally targeted lesbian, gay, bisexual, and transgender Arizonans, and its proponents did little to quell this fear. State Senator Steven Yarbrough admitted that the bill could be used to deny gay couples accommodations, and state Senator Al Melvin warned of an attack on the “pillars of society,” notably “traditional marriage.” A physician’s work is rooted in a commitment to each person’s worth, and this bill was anathema to our professional beliefs. Senate Bill 1062 would have permitted physicians to turn away certain patients, and the Arizona Hospital and Healthcare Association indicated that it threatened “the bedrock ideal that every patient is entitled to the best possible care.”1 The bill also would have reignited debate over “conscientious objection,” a movement that risks denying patients — particularly in underserved areas — access to safe, routine, and legal medications and procedures. Finally, this legislation would have sanctioned gravely consequential discrimination. Prejudicial social conditions have been linked to anxiety, depression, and suicidality in lesbian, gay, bisexual, and transgender communities,2 and being bullied — marked by isolation, degradation, and abuse — can lead to conditions requiring the use of psychotropic medication and attempts at self-harm.3,4 Arizona’s Senate Bill 1062 would have molded a damning and dangerous climate in which many people would have suffered. Physicians share a proud history of treating
and defending the marginalized and vulnerable, and our advocacy extends naturally from our examination rooms into sociopolitical arenas. Although Senate Bill 1062 is now history, I believe that our professional organizations should publicly denounce the slew of similar bills advancing through like-minded state governments. Furthermore, we physicians ought to carefully consider where we plan to hold our educational and academic conferences. In vetoing the bill, Governor Jan Brewer spared Arizonans the consequences of an economic boycott. The threat of physicians’ financial divestment may help sway other state governments toward greater temperance. Finally, I believe that individual physicians can and should continue to speak out against injustice, wherever it occurs. A professor once scolded my medical-school class for our relative political inaction. “If you see something you don’t like,” he chided, “you’re obligated to change it.” As I mature in my career and more fully grasp the ethical obligations that attend our work, I could not agree more. Michael D. Stillman, M.D. University of Louisville School of Medicine Louisville, KY Disclosure forms provided by the author are available with the full text of this letter at NEJM.org. 1. AzHHA requests veto of SB 1062. News release of Arizona
Hospital and Healthcare Association, Phoenix, February 25, 2014.
2. Meyer IH. Prejudice, social stress, and mental health in
lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003;129:674-97. 3. Lallukka T, Haukka J, Partonen T, Rahkonen O, Lahelma E. Workplace bullying and subsequent psychotropic medication: a cohort study with register linkages. BMJ Open 2012;2(6):e001660. 4. Fisher HL, Moffitt TE, Houts RM, Belsky DW, Arseneault L, Caspi A. Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study. BMJ 2012;344:e2683. DOI: 10.1056/NEJMc1402715
Tracheal Allograft after Withdrawal of Immunosuppressive Therapy To the Editor: Obstruction of the airway causes substantial morbidity, and with the increased use of artificial airways, the incidence of tracheal stenosis is increasing. A tracheal defect that is shorter than 5 cm usually can be closed by means
1568
of an end-to-end anastomosis.1,2 Allotransplanted tracheal segments provide a potential means of reconstruction in patients with longer airway defects. In 2010, we reported on the successful transplantation of a tracheal allograft after it had
n engl j med 370;16 nejm.org april 17, 2014
The New England Journal of Medicine Downloaded from nejm.org on November 7, 2015. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
n e w e ng l a n d j o u r na l
of
m e dic i n e
The Arizona Debacle — A Physician’s Perspective To the Editor: Arizona Senate Bill 1062 was met with appropriate outrage. Ruling that a person may not be forced to act in a manner inconsistent with his or her religious beliefs, the proposal could have permitted people not to serve anyone who made them “uneasy.” Some persons were concerned that the bill intentionally targeted lesbian, gay, bisexual, and transgender Arizonans, and its proponents did little to quell this fear. State Senator Steven Yarbrough admitted that the bill could be used to deny gay couples accommodations, and state Senator Al Melvin warned of an attack on the “pillars of society,” notably “traditional marriage.” A physician’s work is rooted in a commitment to each person’s worth, and this bill was anathema to our professional beliefs. Senate Bill 1062 would have permitted physicians to turn away certain patients, and the Arizona Hospital and Healthcare Association indicated that it threatened “the bedrock ideal that every patient is entitled to the best possible care.”1 The bill also would have reignited debate over “conscientious objection,” a movement that risks denying patients — particularly in underserved areas — access to safe, routine, and legal medications and procedures. Finally, this legislation would have sanctioned gravely consequential discrimination. Prejudicial social conditions have been linked to anxiety, depression, and suicidality in lesbian, gay, bisexual, and transgender communities,2 and being bullied — marked by isolation, degradation, and abuse — can lead to conditions requiring the use of psychotropic medication and attempts at self-harm.3,4 Arizona’s Senate Bill 1062 would have molded a damning and dangerous climate in which many people would have suffered. Physicians share a proud history of treating
and defending the marginalized and vulnerable, and our advocacy extends naturally from our examination rooms into sociopolitical arenas. Although Senate Bill 1062 is now history, I believe that our professional organizations should publicly denounce the slew of similar bills advancing through like-minded state governments. Furthermore, we physicians ought to carefully consider where we plan to hold our educational and academic conferences. In vetoing the bill, Governor Jan Brewer spared Arizonans the consequences of an economic boycott. The threat of physicians’ financial divestment may help sway other state governments toward greater temperance. Finally, I believe that individual physicians can and should continue to speak out against injustice, wherever it occurs. A professor once scolded my medical-school class for our relative political inaction. “If you see something you don’t like,” he chided, “you’re obligated to change it.” As I mature in my career and more fully grasp the ethical obligations that attend our work, I could not agree more. Michael D. Stillman, M.D. University of Louisville School of Medicine Louisville, KY Disclosure forms provided by the author are available with the full text of this letter at NEJM.org. 1. AzHHA requests veto of SB 1062. News release of Arizona
Hospital and Healthcare Association, Phoenix, February 25, 2014.
2. Meyer IH. Prejudice, social stress, and mental health in
lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003;129:674-97. 3. Lallukka T, Haukka J, Partonen T, Rahkonen O, Lahelma E. Workplace bullying and subsequent psychotropic medication: a cohort study with register linkages. BMJ Open 2012;2(6):e001660. 4. Fisher HL, Moffitt TE, Houts RM, Belsky DW, Arseneault L, Caspi A. Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study. BMJ 2012;344:e2683. DOI: 10.1056/NEJMc1402715
Tracheal Allograft after Withdrawal of Immunosuppressive Therapy To the Editor: Obstruction of the airway causes substantial morbidity, and with the increased use of artificial airways, the incidence of tracheal stenosis is increasing. A tracheal defect that is shorter than 5 cm usually can be closed by means
1568
of an end-to-end anastomosis.1,2 Allotransplanted tracheal segments provide a potential means of reconstruction in patients with longer airway defects. In 2010, we reported on the successful transplantation of a tracheal allograft after it had
n engl j med 370;16 nejm.org april 17, 2014
The New England Journal of Medicine Downloaded from nejm.org on November 7, 2015. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
