USING SYSTEM DYNAMICS MODELING TO ASSESS THE IMPACT OF CONNECTICUT GOOD SAMARITAN LAWS: A PROTOCOL PAPER

Background We applied a participatory system dynamics (SD) modeling approach to evaluate the effectiveness and impact of Connecticut Good Samaritan Laws (GSLs) that are designed to promote bystander intervention during an opioid overdose event and reduce opioid overdose-related adverse outcomes. Our SD model can be used to predict whether additional revisions of the statutes might make GSLs more effective. SD modeling is a novel approach for assessing the impact of GSLs; and, in this protocol paper, we describe its applicability to our policy question, as well as expected outcomes of this approach. Methods This project began in February 2021 and is expected to conclude by March 2022. During this time, a total of six group model-building (GMB) sessions will have been held with key stakeholders to elicit feedback that will, in turn, contribute to the development of a more robust SD model. Session participants include bystanders who witness an overdose, law enforcement personnel, first responders, pharmacists, physicians, and other health care professionals who work in at least two major metropolitan areas of Connecticut (New Haven and Hartford). Due to the restrictions imposed by the COVID-19 pandemic, the sessions are being held virtually via Zoom. The information obtained during these sessions will be integrated with a draft SD model that has already been developed by the modeling team as part of a previous CDC-funded project. Model calibration and policy simulations will then be performed to assess the impact of the current GSLs and to make recommendations for future public policy changes. Discussion An SD modeling approach enables capture of complex interrelationships among multiple health outcomes to better assess the drivers of the opioid epidemic in Connecticut. The model simulation results are expected not only to align with current real-world data but also to recreate historical trends and infer future trends in a situationally relevant fashion. This will facilitate the work of policy makers who are devising and implementing time-sensitive changes to address opioid overdose-related deaths at the state level. Replicating our approach as described can be applied to make similar improvements in other jurisdictions. CONTRIBUTIONS TO THE LITERATURE - System dynamics (SD) modeling and group model-building (GMB) approaches enable the group to start with a simple concept model and apply the collective knowledge of the group to finish the session with a much more developed model that can produce impressively accurate simulation results. - The model will be used to understand the impact of Connecticut Good Samaritan Laws (GSLs), as well as their limitations, and to deduce factors to further improve public health laws to counter opioid overdose-related deaths. - The approach can be applied to other jurisdictions, taking into account local conditions and existing Good Samaritan legislation. KEYWORDS: System dynamics modeling, group model building, opioid overdose deaths, opioid use disorder, Good Samaritan laws

Assessing the impact of the Good Samaritan Law in the state of Connecticut: a system dynamics approach

Background Although Good Samaritan laws (GSLs) have been widely adopted throughout the United States, their efficacy in individual states is often unknown. This paper offers an approach for assessing the impact of GSLs and insight for policy-makers and public health officials who wish to know whether they should expect to see outcomes from similar policy interventions. Methods Utilizing a system dynamics (SD) modeling approach, the research team conducted a policy evaluation to determine the impact of GSLs on opioid use disorder (OUD) in Connecticut and evaluated the GSL based upon the following health outcomes: (1) emergency department (ED) visits for overdose, (2) behavioral changes of bystanders, and (3) overdose deaths. Results The simulation model suggests that Connecticut’s GSL has not yet affected overdose deaths but has resulted in bystander behavioral changes, such as increased 911 calls for overdose. ED visits have increased as the number of opioid users has increased. Conclusions The simulation results indicate that the number of opioid-related deaths will continue to increase and that the GSL alone cannot effectively control the crisis. However, the SD approach that was used will allow policymakers to evaluate the effectiveness of the GSL over time using a simulation framework. This SD model demonstrates great potential by producing simulations that allow policymakers to assess multiple strategies for combating the opioid crisis and select optimal public health interventions.

THE PARABLE OF THE GOOD SAMARITAN, CLERICALISM, AND THE SEXUAL ABUSE CRISIS IN THE AUSTRALIAN CONTEXT

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‘And Who Is My Parishioner?’ Residency, Human Rights and the Right to Burial in the Parish Churchyard

When asked by an expert in the law, ‘And who is my neighbour?’, Jesus answered with the parable of the good Samaritan (Luke 10:25–37). This was a radically inclusive answer: your neighbour could be anyone. By contrast, a priest who asks an ecclesiastical lawyer ‘and who is my parishioner?’ may be given a far less clear or satisfying answer.

Rule of Love and Rule of Faith in Augustine’s Hermeneutics: A Complex Dialectic of the Twofold Rules

Since the sixteenth-century Reformation, literal interpretation of the Bible has been deemed the best hermeneutical method to unearth the biblical writers’ original meaning. For the Reformers, allegorical interpretation was denigrated for reading an extraneous, or spiritual, meaning into any text. Although Augustine was among the first who champions a literal interpretation of the Scripture—as he outlined in his De doctrina christiana—until recent decades, Augustine is still being perceived as inconsistent in following his hermeneutical method as it is attested in his interpretation of the Good Samaritan. In his interpretation, Augustine seems to have allegorized the parable, thus his method was accused of being inconsistent. Is it really the case? This article attempts to contest such an accusation by showing that Augustine’s method of interpretation cannot simply be categorized as either entirely literal or allegorical. Augustine never professes as a literalist, an exegete who only applies what is now known as a historical-critical method. On the other hand, he did not recklessly legitimate the application of allegorical reading to any text. Taken as a whole, Augustine’s hermeneutics revolves around a complex dialectic of regula dilectionis (the rule of love) and regula fidei (the rule of faith) that allows both interpretations to be considered to be true.

The Good Samaritan or Non-Directed Donor

From the outset of kidney transplantation, some living donors were “Good Samaritan” donors—that is, individuals who donated a kidney without a specific recipient in mind. However, non-genetically related donors fell out of favor quickly because the results were no better than deceased donor grafts. As immunosuppression improved and graft outcomes from non-biologically related donors improved, attitudes changed (with greater and earlier support from the public than from transplant professionals and with greater support for spouses then friends then acquaintances, and then strangers). This chapter examines ethical controversies raised by Good Samaritan donors using a living donor ethics framework. It examines the moral justification for permitting living donation by strangers, the ethics of the donor and recipient selection and allocation processes, and whether Good Samaritan donors should be encouraged to catalyze a domino multi-donor-recipient pair chain rather than donate to a single candidate on the waitlist.

Conflicts of Doctor’s Duties in the Case of an Extreme Shortage of Intensive Care Beds and the Good Samaritan Clause from the Perspective of Criminal Law

The Covid-19 pandemic has exposed many weaknesses of healthcare systems. An example of a crisis situation is the case of a doctor who has to make a decision about qualifying a patient with COVID-19 for an intensive care bed when there are not enough such beds and when, out of the many obligations to save lives, he can choose and fulfil only one. The aim of this paper is to analyse the criteria of establishing the priority in access to intensive care, to settle the conflict of obligations in regard to criminal liability, with respect to Art. 26 § 5 of the Polish penal code regarding the doctor’s decision to provide, or to not provide, healthcare services including intensive care given the extreme shortage of the beds, to determine the scope of legal safety guarantees laid down in the good Samaritan clause and the relationship between the conflict of duties and the clause. The work is theoretical with the use of a formal-dogmatic and functional analysis of Polish criminal law.