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The differential impact of the COVID‐19 pandemic on communities of color in the United States along with the civil unrest taking place in 2020 in response to the killing of unarmed Black men and women by the police have increased awareness of the structural racism pervading US society. These developments have reraised the issue of reparations for Black Americans, usually proposed in the context of providing financial compensation for the injustices of slavery to the descendants of those who were enslaved. This paper will discuss the systematic racial inequality and structural racism in US society that have significantly disadvantaged racial and ethnic minorities while giving advantages to white Americans, which most recently have resulted in significantly higher mortality and morbidity among Black, Hispanic, and Native Americans during the pandemic. The paper will conceptualize reparations within the context of theories of reparative justice. It will also consider whether reparations are owed, and if so, by whom, to whom, and in what form. The final section will offer a proposal for collective reparations to the Black community and other people of color. [ABSTRACT FROM AUTHOR]

Racism has resulted in significant disproportionality and disparity in the US child welfare system. Being Black is not an inherent risk factor for child abuse and neglect yet Black children are almost twice as likely to be victims of substantiated abuse and neglect claims compared to other racial groups. Addressing the disproportionality within the child welfare system due to systemic racism falls squarely under the purview of bioethics. In this paper, we briefly review the impact of racism on child welfare. We then discuss some ethical considerations that mandatory healthcare reporters should think through when determining whether to report potential abuse and neglect. Specifically, we discuss the need for a broader consideration of what constitutes harm. We then present a hypothetical composite case to illuminate where and how bias can enter the process of referral to child protective services (CPS). We encourage thoughtful reporting with consideration of social and historical context and alternative explanations for worrisome findings. We recommend using evidence, avoiding assumptions by seeking clarification from families and ensuring internal consistency. When contemplating CPS referral, medical providers should feel empowered to ask questions if there is concern for potential bias. The ultimate goal is to protect children from harm. If there are clear safety concerns—they must be addressed. However, in the many cases where the safety concern is less tangible, we need to expand our considerations of the harms that can befall children, especially children of color. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has had a disproportionate impact on the health of Black Americans, Latinx or Hispanic Americans, and American Indians. These disparities are deeply unjust, in part, because they are the causal result of racism at both the interpersonal and structural levels. This paper argues, however, that establishing a causal connection between racism and health disparities is not the only way to explain the injustice of these disparities. The COVID‐19 health disparities are arguably unjust because health equity is a "free‐standing" demand of justice, an obligation of reparative justice, a remedy to structural injustice, and part of dismantling pernicious racial concepts. Identifying multiple accounts of injustice may lower the evidentiary bar for our normative claims and help us to identify alternative policy pathways for ending health inequity. [ABSTRACT FROM AUTHOR]

The first baby has successfully been born by uterus transplantation (UTx) in the United States and the procedure is swiftly becoming a viable clinical option for patients with uterine factor infertility (UFI). This raises a practical ethical question: should health insurers finance UTx and what issues should they consider in coming to this decision? The article lays forth some of the factors that shape the decision over whether to finance UTx in the United States, including what procedures must be covered, whether UTx is more like organ transplantation or infertility treatment (which are treated differently in the United States), and the benefits and alternatives of the procedure. Then, the article explores arguments around why UTx should be financed, or at least considered along with other important medical needs. The paper argues that UTx ought to be considered along with other competing claims for healthcare services. In countries that generously cover other infertility services, it may logically follow that medical services that enable gestation should be insured when the healthcare system covers services to conceive. In the United States, however, many groups have long suffered inadequate access to medical care, in the context of infertility and more broadly. U.S. healthcare may need to be made more widely equitable, before covering UTx is seen as financially or politically possible. [ABSTRACT FROM AUTHOR]

Aim: This study examined cross-sectional population-based rates in reported need and unmet need for occupational, physical, and speech therapy services in children with autism spectrum disorder (ASD) compared with children with attention-deficit-hyperactivity disorder (ADHD) and cerebral palsy (CP).Method: The 2005-2006 and 2009-2010 (USA) National Survey of Children with Special Health Care data sets were used to compare therapy need and unmet need among children younger than 18 years with ASD (n=5178), ADHD (n=20 566), and CP (n=1183). Bivariate approaches and multivariate logistic regression using imputed data were used to identify associations between child and family characteristics, and access to therapy services.Results: After adjusting for other variables, children with ASD had a significantly greater likelihood of having an unmet therapy need compared with children with ADHD (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.36-2.03), but a similar unmet need as children with CP (OR 1.30, 95% CI 0.97-1.74). Factors associated with unmet need included survey year, younger child age, no health insurance, and increased functional and behavioral difficulties.Interpretation: Children in our sample had greater unmet therapy needs in 2009 than in 2005. Caregiver-reported reasons for unmet need included cost and school resources. Research examining future trends in therapy access are warranted for children with ASD and CP.What This Paper Adds: Children with complex diagnoses of autism spectrum disorder and cerebral palsy had reported unmet need for therapy services. High costs of therapy were the primary reported reason contributing to reduced access among children. [ABSTRACT FROM AUTHOR]