Tuesday, November 10, 2009

In the Shadow of Abortion, End of Life Care Still Issue for "Pro-Life" Health Care Opponents.

This is big.

Yesterday, in my anger at Stupak and reading Catholic and pro-choice reporting on Stupak, I was trying get at reasons for the dissatisfaction among conservatives over the amendment.

Their objective is to end legal abortion in America; any missed chance to do so is a disappointment. No effort goes far enough. But there are other "pro-life" motivations to conservatives' dissatisfaction with the Health Care bill and Stupak. Dan Gilgoff says it best:

Antiabortion groups winced as they released weekend statements applauding the inclusion of an amendment offered by Democratic Michigan Rep. Bart Stupak and Republican Pennsylvania Rep. Joe Pitts in the House bill. In addition to doubting the inclusion of Stupak-Pitts language in the final healthcare bill, most antiabortion groups oppose that bill on other grounds, like cost and concerns about end-of-life care.

Like every pro-choice woman in the country, I've been reeling since Saturday night's "back of the hand" treatment, as Wasserman-Schultz calls it. The regression of access for women, particularly those in the lowest income brackets who already suffer access and financial challenges to reproductive health care, is astonishing. Particularly because it comes under a Democratic administration and house and senate majorities.

Yet, as I work on a story about hospital mergers and the imposition of Ethical and Religious Directives (ERD) on communities and patients, I find that the government's position, both federal and local is still set to a pro-life default. Any questions of conscience, rights, bodily autonomy, or privacy for a patient beyond these basic "laws" of care are labeled "elective," or shameful.

In some merger cases where a Catholic and secular hospital combine, a separate facility is created where abortions (of all kinds, medically necessary or "elective"), tubal ligations, sterilizations and other non-ERD compliant services are offered. In one case, other services were added to the separate facility so that workers and patients there wouldn't be harassed. How have we gotten to a place where abortion is morally repugnant?

But the second front for "pro-life" groups is aid in dying, a service for which no separate facilities are being constructed, a personal right that is overshadowed by the issue of abortion. As the conservative CNS news writes this morning:

The Democrats' health-care bill, which cleared the House on Saturday, says federal funds cannot be used to promote assisted suicide. But Rep. Charles Boustany, Jr. (R-La.), a surgeon and congressman, says the bill does not rule out the use of federal funds to reimburse doctors who provide “end-of-life care” that involves removing food and water.

“H.R. 3962 does not rule out using federal funds to reimburse health providers should they withhold nutrition or hydration,” Boustany spokesman Rick Curtsinger said.

“The bill says end-of-life care planning materials may not promote “assisted suicide,” but it leaves this term intentionally vague so the ban might not apply in states with ‘death with dignity’ laws.”

Michael Steel, press secretary for House Minority Leader John Boehner (R-Ohio), agreed, saying, “Our understanding is that this sort of thing would be allowed.”

Assisted suicide has been approved by voters in two states, Oregon in 1994 and Washington in 2008, and cleared by a lower court in Montana.

Sec. 240 of H.R. 3962, titled “Dissemination of Advance Care Planning Information,” stipulates the kind of end-of-life planning that health providers in the government-exchange insurance program may provide to patients.

The bill reads, “Nothing in this section shall be construed . . . to promote suicide, assisted suicide, euthanasia, or mercy killing.”

The section continues, “(Nothing) shall be construed to apply or to affect any option to --(A) withhold or withdraw of medical treatment or medical are; (B) withhold or withdraw of nutrition or hydration.”

It further says, “Nothing in this section shall be construed to preempt or otherwise have any effect on State laws regarding advance care planning, palliative care, or end-of-life decision-making.”

Another section of the bill, Sec. 1233 titled “Voluntary Advance Care Planning Consultation,” lays out acceptable procedures for end-of-life planning.

Aaron Albright, press secretary for the majority Democratic members of the House Education and Labor Committee, told CNSNews.com the bill does not address the question of end-of-life care. “We leave the current system intact,” Albright said.

When asked if the health-reform bill would rule out the use of federal funds to reimburse health-care providers who withdraw or withhold nutrition or hydration, Albright said it was a “false question.”

“We do not change any practice, or any law, or anything like that,” Albright said. “(End of life decisions) will be left up to the patient and their doctor and their family.”

Albright said that assisted suicide is a “very difficult” and “intensely personal” decision, to be made by patients, families and doctors. End-of-life counseling and the use of advanced directives can guarantee a person’s wishes will be carried out, he said.

“I think by making sure what patients want at the end of their life that this could help a lot of people,” he said. “These heart-wrenching decisions, you know, a lot of families won’t have to go through this because they know exactly what their family member wanted.”

But a source close to Republican members of the committee, said that it would be up to the government -- Medicare and the Department of Health and Human Services -- to develop guidelines to specifically prevent government-funding going toward withdrawal of feeding tubes and water. Those guidelines are unlikely to occur.

David O’Steen, executive director at the National Right to Life Committee, said he finds it troubling that the bill does not include language to protect individuals from discrimination based on age, illness, or disability.

O’Steen noted that Medicare, which under the bill would pay health-care professionals to counsel seniors on "advance medical directives," is hoping the counseling sessions would save “a lot of money.”

While advanced directives are positive when they promote life, O’Steen warned, “This factor of an older person being counseled by an authority figure like a doctor and being nudged towards signing away their right to life-saving treatment is chilling.”

At the same time that it could make doctor-assisted suicide more frequent, the bill contains other elements that could make euthanasia more frequent, including health-care rationing, O'Steen said..

Opponents to end of life choice construe end of life care options as coercion or pushing the elderly and terminally ill into what they call euthanasia.

I've written it again and again: Where Death with Dignity is legal, in Oregon and Washington, literature may show that it is an option in those states (I'll have to confirm this) but as the laws are written, no doctor may approach a patient with Death with Dignity. The DwD laws says as much.

What concerns "pro-life" groups is that other laws are coming up through state legislatures that may not include the same restrictions as Oregon and Washington's. In Montana, the State Supreme Court is set to decide the constitutionality of aid in dying by the end of the year. Because the decision does not come through the legislature like Oregon and Washington's laws, but through the courts, it does not have the same guidelines. And in Connecticut, a case was just brought before the courts that could also legalize aid in dying in that state.

As with abortion, "pro-life" groups see health care reform as a way to set the country back to their default "pro-life" position: God cuts the life thread and any effort to end suffering for the dying patient is an affront of God's jurisdiction. That's why they're not happy with Stupak. It doesn't make abortion illegal, state or federal laws be damned.

And that's why they are unhappy with the health care bill. Their objective, however misinformed, misconstrued, and misdirected, is to make aid in dying illegal. Health care reform doesn't do that because it honors state laws.

Prepare for all hell to break loose when Montana decides that aid in dying is constitutional - without restrictions that prevent a doctor from bringing it up to patients, and without a tough conscience clause - because "pro-life" organizations are going to employ their machine, mobilized and perfected as we've seen this week through the fight against abortion, to begin chipping away at aid in dying access across the country.

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