Wednesday, September 16, 2009

Let the Adults Discuss End of Life Care.

"Will Congress ultimately trust that American adults are capable of deciding important matters in their lives and eventual deaths? Or will they conclude that we don't want to know about our choices, can't handle important end-of-life decisions, and are better off without such considerations in the public dialogue?" asks Barbara Coombs Lee, president of Compassion and Choices in a post for Huffpo on September 8.

She continues:

Powerful forces resist bestowing authority on individuals to choose appropriate medical care for themselves. Behind the hyperbole about "death panels" lies a more nuanced attack on advanced directives themselves. The language is more subtle but its intent is unmistakably patronizing. These advocates would "protect senior citizens," from their own stated wishes, claiming seniors are "vulnerable people," "easily susceptible to pressure," and not capable of making important decisions. This line of thinking asserts advance directives should be "only one factor a doctor takes into consideration" because the patient who wrote it "didn't know at the time what it would be like." Some even assert your living will should be ignored completely because others know what's best for you. Father knows best.

Think for a second that she is overblowing the paternal tone that opponents to health care reform - or Death with Dignity - have adopted? Check out The American Life League sadly proving Coombs Lee's point with a video on the covert agenda of the "culture of death" agents and cronies (aka Senators) behind health care reform.

If it's necessary, here are a few debunked silly conflations from the video:

*end of life care is not euthanasia

*giving seniors choice in how to die is not the government "agreeing to deny artificial nutrition and hydration" (ANH)

*self-selected denial of ANH has nothing to do with Terri Schiavo

*stakeholders is a legal term, duh

*consulting with your family about end of life choices doesn't only "mean money"

*allowing seniors to direct their medical choices is not a slippery slope to mass government killing of, well, anyone

*"linguistic acrobatics" are apparently not only the purview of health care reformers

The recent putsch-ing by conservatives could perhaps be halted by a little time out? Let the adults discuss end of life issues for a while.

via Catholicfire blog.

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Blaming the Racist, Misogynic, Paternal Messenger.

A new survey shows our news, as delivered by the most influential media writers and commentators, is predominantly written by white men. What about the women and the minorities? Slim to practically none. Old news, right?

Now graft this onto yesterday's media revelation, finally delivered by a white man, former President Jimmy Carter, that - gasp! - much of the opposition we see to Obama's health care reform is because he is, ahem, a black man. Women and minority writers have been calling this for months, yet the big media slept through those accurate analyses. It's taken the white folk, one a white woman (who's getting "racist" thrown at her ever since) and one a former president from the south (now getting what Fox calls "widespread criticism"), to call it for what it is. Not that either is being deemed credible; pitch, as it were, sticks to anything that gets close to it.

How are Republicans reacting? "What's that black president doing in our house?" Michael Steele, the token black Republican and apparently the only man alive able to define racism, is denouncing Carter as "playing the race card."

Let's see how white media process that. I assume it will be same as it ever was. But that's what you get when white paternal authority presides: no voice for the other. (Incidentally, I wonder what else the Republicans will pull out to damage health care reform. Rather than resort to discussions on policy, I am afraid we may get the kitchen sink.)

Who's the deliverer of the poll showing this great disparity in how our news is created? The Atlantic Monthly, hardly a bastion of egalitarianism and fairness itself.

via Lucinda Marshall at Feminist Peace Network

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Homicide, God and the State of Montana.

In an editorial to the Helena Independent Record, Annie Bukacek, a physician and the president of Montana ProLife Coalition, writes today that the Baxter v Montana case, upheld by Helena District Court Judge Dorothy McCarter asserting the constitutionality of assisted suicide in Montana and currently on appeal before the Montana Supreme Court, is a case of judicial activism.

The state has argued that under Montana's homicide law, assisted suicide, also known as death with dignity (made legal by legislation in Oregon and Washington) or aid in dying, is illegal. It is the same, they claim, as a man buying a hand gun and telling the salesman that he wants it to kill his wife. The salesman is therefore party to the eventual murder.

The state has also claimed that while privacy of citizens is tantamount, the state's interest in life overrides personal privacy when it comes to a good death.

As Baxter, et al, including Compassion & Choices, the nation's largest aid in dying advocacy group and the former Hemlock Society, argued before the court in orals on September 2, the state of course has an interest in protecting life but, as that life comes to an end, lawyer Mark Connell asked "what could possibly be the state's interest in prolonging that death and protecting that very short life of misery in contravention of the patient's own desires."

Baxter plaintiffs chose to base their argument on dignity of life as guaranteed under Section 4 of the Montana constitution (adopted in 1972):

Individual dignity. The dignity of the human being is inviolable. No person shall be denied the equal protection of the laws. Neither the state nor any person, firm, corporation, or institution shall discriminate against any person in the exercise of his civil or political rights on account of race, color, sex, culture, social origin or condition, or political or religious ideas.

Bukacek cites several reasons why the state does indeed have interest in even the last days, weeks or months of a dying person's life. "Autonomy and freedom do not include the right to do harm to other humans, including to ourselves," she writes, though Montana does not have a law against suicide.

She expresses concern for violations to the Hippocratic Oath and the Montana Medical Association's policies, though continuous deep sedation (CDS) is a common medical practice which includes sedating a dying patient to the point of death to relieve suffering. The "double effect" protects doctors from prosecution under the homicide law for this practice because relief of pain and not death is the objective.

Connell argued before the Supreme Court that there is no "bright line" between this common practice and aid in dying, which involves a physician prescribing lethal drugs to be self administered by a terminal, mentally competent patient.

Bukacek gets to her beef at the end of the third paragraph: "Laws against suicide are based on our nation's founding principle that life comes from God, as the Declaration of independence asserts, not from government and not from us."

(Incidentally, Section 5 of the constitution guarantees "Freedom of religion. The state shall make no law respecting an establishment of religion or prohibiting the free exercise thereof.")

Bukacek's argument, in other words, hinges on "the principle that life comes from God." Or rather, perhaps that suffering comes from God? "We have the means to control pain and anxiety from terminal illness" she offers as a further disqualification of the plaintiff's arguments. Yet, while we may have the means to relieve most patients of suffering at the end of life, palliative medicine and hospice care have been shown to alleviate pain in 9 out of 10 patients. Not bad but not complete. Further, a death via CDS is hardly appealing to a patient who has suffered for months or even years, has made peace with their family, their medical caretakers, their god, and their death.

Bukacek would argue for letting God cut the thread that binds us to this earth. He gives us only the suffering that we can handle, she might contend. Yet, what if one's god is not a god of suffering? Or no god at all? Who cuts the thread then? The state? Your neighbor's god? Your doctor? Or you, who knows the extent of your suffering and is protected by your constitution against the indignity of pain and the authority of others?

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