Friday, October 2, 2009

Assisted Suicide Does Not Create Greater Grief and Depression in Family Members.

Oregon Health & Science University won't get much credit for this study, sharing a state where Death with Dignity is legal and all (see Oregon Health Plan get creamed for denying Barbara Wagner a medicine that wouldn't have saved her life anyway, thus, by state association, colluding with the "culture of death" crowd), but I do think the results of this study prove two things: that Death with Dignity doesn't put undue emotional stress and burden on the family of participating loved ones; and that Oregon does lead the medical industry in end of life care and research.

Published in the Journal of Pain and Symptom Management, the study shows the results of a survey of 95 families of Death with Dignity participants and 65 families of those dying with cancer or other terminal illnesses. Signs of grief and depression after the death of their loved ones were compared. Both groups exhibited similar grief and depression.

“Grief following the death of a loved one can be persistent, painful and debilitating,” said Linda Ganzini, M.D., a professor of psychiatry and medicine in the OHSU School of Medicine and lead author of the research paper. “Prior studies on suicides indicate high levels of shame, guilt, stigma and sense of rejection in surviving family members. However, until now, little was known about mental health outcomes in the family members of a patient who receives physician aid in dying. Based on our research, we know that family members of loved ones who pursue physician assisted suicide do not have different prevalence and severity of depression and prolonged grief compared to the general population.”

via Robert Glen Fogarty at Tech News Watch

The Catholic Church's Jurisdiction Over Suffering.

At the BC Catholic, Msgr. Pedro Lopez-Gallo weighs in on the rising assisted suicide movements in Canada, Britain and the US by reminding us of its roots: in the pagan world. Yet his analysis is messy. If assisted suicide (and suicide) are pagan acts, why did Christians of old practice it and receive martyr status?

Direct and indirect suicides also occurred during the early days of Christianity, when certain holy virgins and martyrs would kill themselves in defence of their virtue. In modern times, St. Maria Goretti chose to be killed rather than give up her virginity, and St. Maximilian Kolbe volunteered to take the place of a fellow prisoner about to be executed by the Nazis.

All these examples embody the supreme act of self sacrifice and the heights that love can reach: in Jesus’s words, “There is no greater love than to lay down one’s life for one’s friends” (John 15:13).

Lopez-Gallo goes on to note the Catholic Church's later condemnation of assisted suicide but offers backhanded compassion to those who chose it:

By the 19th century, free thinkers and modern philosophers were presenting suicide as the ultimate tool of self-determination and as proof that there is no eternal life, no afterlife and no soul. Our mother the Church condemned suicide and imposed serious penalties, denying ecclesiastical burials to those who died by their own hand (old Latin Code, c. 1240).

The Church no longer imposes such severe penalties because we now recognize that many of those who take their own lives are under extreme emotional and psychological distress and, most important, did not kill themselves in “odium fidei” (in hatred of the faith)

While the Catholic church now allows Mass for those who commit suicide - if only because no one is able to know if the dying proclaimed love for Christ in their last breath, assisted suicide and suicide, he concludes, are still an affront to God, to faith, and to the church.

He notes that others are led to assist suicide for monetary reasons and that some elect suicide because of mental infirmity, fully missing the legal and physical considerations surrounding the issue.

What he fails to state plainly is the jurisdiction the Catholic Church still seeks to assert, via opposition to assisted suicide, over the realm of suffering. The state, of course, would like that jurisdiction, as we see in the pending appeal case Baxter v Montana. So of course would the medical industry. It is this contested jurisdiction over suffering that has once again coalesced to deprive the suffering of their choice.

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C Street, Coming Around Again.

When Jeff published his book, The Family, over a year ago, there was little enthusiasm in its reception by the media. Then a few months ago, the C Street sex scandals of John Ensign and Mark Sanford hit the news in a big way, sending Jeff through the media gauntlet and his book to the top of the New York Times best sellers list.

Today an investigative piece by Eric Lichtblau and Eric Lipton (who was on MSNBC this afternoon) brings light again to the Family, the secretive, religious organization with its nefarious finger in nearly every government pot.

Sadly, the sex is the least scary and illegal of The Family's involvements. Paying off a mistress is nothing in my mind compared to running countries into the ground (Somalia) and undemocratically steering laws (on labor, say). That the Family is given a spotlight about it's sex scandals will lead to even more in depth investigations is my hope.

For a summary, see Adele Stan's piece at AlterNet. For an interview with Jeff by Bill Berkowitz see ReligionDispatches.

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The Imperative of Rationing.

Brave Leonard M. Fleck, in an editorial for The Detroit News today, enters into a discussion that few wish to engage as health care reform occupies our national attention: the need for rationing. (Look for my article at on the subject in coming days.)

Fleck does the math:

We spent $2.4 trillion on health care in the United States in 2008, about 17 percent of gross domestic product or national output, and projections call for that rising to $4.4 trillion in 2018, or 20.5 percent of likely GDP. A torrent of expensive new medical technologies drives costs upward.

As we discuss health reform, Americans ought to be able to talk to one another about excessively costly medical care yielding too little real benefit.

and rightly concludes:

Many Americans assert that human life is priceless (and rationing is morally objectionable), yet some criticize health reform, especially if it requires raising taxes. If the need for health care rationing is inescapable, then the real moral challenge is to determine how rationing can be done fairly and openly.

I agree. And I would clarify: We are the richest country in the world. The amount we spend on defense alone would ameliorate our health care cost concerns somewhat; but rationing is unavoidable and currently widely practiced without standard by insurance and medical companies. We now ration by class. Making how we ration more egalitarian is essential to a just and healthy society. Rationing must be discussed as a necessary, democratic and beneficial aspect of health care reform.

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Worldly Rubber Hits the Road in Iowa.

From the Iowa Globe Gazette, David Namanny reports on a new law in Mitchell County that will prevent Old Order Amish and Mennonites from eschewing worldly rubber tires on their buggies and tractors.

The law will prevent the use of metal wheels on county roads because of the surface damage they cause. Conservative Anabaptists, including some Amish and Mennonite sects refrain from using rubber because they consider the material worldly and against their religion.

While county leaders say the law is not intended to single out the Amish or the Mennonites, several concerned Old-Order Mennonite farmers were at the meeting to express their concerns.

“We’re not sure what we are going to do,” said farmer Peter Nolt, who said Mennonites do not use rubber tires as it is not allowed in their religion. “We will have meetings and discuss the matter, but I think it’s going to cause some problems.”

The Anabaptists encounter another collision between religious freedom and modern concerns. Either they adopt rubber or leave Mitchell County, repeating the choice Mennonites, Amish and other Anabaptists have faced since their formation during the Radical Reformation in the Low Countries in the 16th century and which has scattered them far and wide in search of tolerance and freedom of religion.

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Racism, Corporate Profit, Cynicism Define Republican Amendments to Health Care Reform.

Dana Milbank writes today at the Washington Post about the cynicism, unabashed capitalism, racism and denial of facts that underlie recent Republican amendments to the Senate Finance Committee's health care reform.

Consider Hatch Amendment F-7, which adds "transition relief for the excise tax on high-cost insurance plans for any state with a name that begins with the letter 'U.' " There's only one state that begins with the letter U, and that's Utah, home state of the amendment's sponsor, Sen. Orrin Hatch. He wanted to send a message that the Democrats were being "arbitrary."

Or consider Kyl Amendment D-6 (Modified 2): "An amendment to protect the First Amendment rights of health plans." Kyl, it seems, was concerned that the Medicare authorities had cracked down on Humana, a Medicare contractor, for sending out a letter to its Medicare recipients warning that health-care reform could harm "millions of seniors and disabled individuals."

Milbank gives a truncated run-down of the nearly 300 amendments that he says would "represent a most curious piece of social policy" and are being made in lieu of a full Republican proposal for health care reform. With his tongue in his cheek, Milbank writes,

Some of the Republican amendments are based in principle. Hatch, for example, sponsored an amendment spending $50 million on abstinence education, and another making sure that no money goes to support physician-assisted suicide.

Odd principles, indeed! It's no secret that abstinence education doesn't work and actually increases the rate of STD infection and pregnancy. And physician assisted suicide is only legal in three states at the moment.

It's no secret that Republicans have chosen the path of obstruction over sensical policy-making. Their base has been reduced like a rich sauce to a crazy, overzealous crowd. None of them have the balls to come back to reality. And because the Democrats have a ball problem of their own, the Republicans have been allowed to control the health care reform debate from their factless, racist, capitalist, unrealistic position.

Fifty million uninsured, poor, black, brown, underprivileged, disabled, infant, elderly and terminally ill will pay the proverbial price to the insurance industry. Which is just how the Republicans want it.

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Canadian Doctors Oppose Bill C-384, Favor Waiting for Miracles.

Today the Canadian Medical Association sent a letter to Parliament opposing bill C-384 which would "amend the Criminal Code so a doctor can assist a consenting terminally ill patient or a patient in severe physical or mental pain 'without any prospect of relief … to die with dignity.'"

The bill was introduced by MP Francine Lalonde in May and opposition has formed against it among "pro-life" groups and doctors.

Jose Pereira, the Chief of Palliative Care at an Ottawa hospital spoke at a news conference, using the case of assisted suicide in Switzerland and his experience working there as example of how palliative care is diminished when assisted suicide is legalized.

In a press conference, Pereira stated:

We must not abandon these vulnerable people through assisted suicide and euthanasia, but instead embark on a quest to find better ways to maintain their dignity and quality of life," he said.

While I agree with the statement on its face, I wonder at the media's inability to drill into details. The bill as proposed looks to be very much like the Oregon Death with Dignity Law which has proven to advance palliative care in that state. Unfortunately, the CBC reporter fails to cover how the bill in constructed and how that compares to the laws in Oregon or Switzerland. The structure of any assisted suicide law, like any other law, determines its effectiveness.

But the bit of his quote that concerns me deeply is the last sentence:

He added that he hears daily about patients recovering from dire situations, and said people should never lose hope.

This argument against assisted suicide abounds in the Westernized and predominantly Christian countries like Canada, Britain and the US where the courts are currently grappling with end-of-life issues, health care reform, and proposed laws. What underlies the need to "never lose hope" is the chance that a patient can recover from a "dire situation" miraculously, against all odds. It reeks not only of the unrealized magical powers of modern medicine (which I acknowledge but don't give full credence to; among the terminally ill, there is a difference between prolonging life and prolonging death) and the Judeo-Christian concept of God's ability to perform miracles.

Opposition to assisted suicide for the mentally ill, I understand. Depression and mental incompetence can preclude one from making sound decisions.

Opposition to regulated assisted suicide for the terminally ill because it may lead us down the "social slippery slope" to euthanasia or other unwarranted killing is really a lack of faith in government regulation.

And this lack of faith implies the religious argument for miracles and God's jurisdiction over suffering (when government asserts individual rights or is seen as unable to dictate moral standards) or a false hope for the powers of medicine. The former is an (in the US) unconstitutional imposition on the beliefs of others; the latter is a denial of scientific fact.

The issue of assisted suicide is complicated by the media's inability or reluctance to discern between varieties of assisted suicide (also called euthanasia, aid in dying or death with dignity by various parties in the debate) - how the laws are drawn and how they work - and who they should be applied to: the terminally ill; those like Terri Schiavo in persistent vegetative states; or the mentally ill or depressed.

Until the laws, miraculous notions and science are clearly discussed as distinguishable and separate factors in how we approach assisted suicide we will be forced to debate the subject with muddy arguments.

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New Targets in the Culture Wars?: Have British Doctors No Moral Backbone?

The Right is aghast at the recent events regarding assisted suicide and end of life care in their country. Women and doctors became their targets in the abortion battle. Who will be their targets in the battle over assisted suicide?

This summer Debbie Purdy, a multiple sclerosis patient, won a court case that would permit her husband, Omar, to help her leave the country for assisted suicide - which is illegal in Britain. The case asked for clarification of the 1961 Suicide Act. The Director of Public Prosecutions (DPP), in response to the Purdy case, was last week forced to clarify their position on how and when those who assist loved ones to commit suicide may be prosecuted. They have suffered deep and angry criticism.

British columnist Gerald Warner takes to task the creep of a "death culture" in today's Telegraph regarding the recent case of Kerrie Wooltorton. A 26 year old who was depressed over her inability to have a child and had attempted to commit suicide 9 times this year, Woolorton successfully committed suicide this week.

Wooltorton consumed poisons in her home, called an ambulance, and showed all medical staff her living will. She wished to be kept comfortable but not to be saved. In the wake of the Purdy case and new DPP guidelines, Wooltorton was not flushed of poisons this time. Doctors, fearing litigation under the 2005 Mental Capacity Act which allows patients to determine which types of lifesaving treatments they may receive, abided her wishes. From the DailyBeast:

In addition to her letter to medical personnel, she made her wishes verbally clear—at the inquest a coroner found that she "had the capacity to consent to treatment" but "refused such treatment in full knowledge of the consequences.

Warner echos many of the same arguments that we hear from the Right in the US regarding what he calls a society "perverted beyond all coherence, morality or even sanity." To blame are: the creep of socialized medicine; doctors who have lost their moral way; unclear lines regarding sanctity of life; an overzealous court system; the assertion of personal rights over the good of a (Christian) society; a permissive and blind media. He even manages to knock science and it's "climate change nonsense."

Because the Right, not only in the US but in Britain, Canada and other countries struggling with end of life concerns, has drawn their own goal posts in the discussion, setting the beginning and end of life according to their beliefs, the culture wars that began with the legalization of abortion (in the US in '73 and in Britain in '67) are being renewed in new territory. The concept of "whole cloth" fostered concerns of a "slippery slope," meaning the "compromise" of one area of the sanctity of life, from "womb to tomb" as Warner says, would lead to a total moral collapse of society. In the abortion culture wars, women and doctors were the targets, the corruptors of society.

Compromise over abortion has never come, despite the recent talk in the US of a (non-existent) "middle ground." A renewed Right in both Britain and the US challenges not only abortion but contraception (forcing them to side with doctors in a fight for conscience clauses); the suffering of the dying is a new battle ground in issues of health care reform, medical technology, and individual rights. Rather than face the failings of the medical industry (corporate entities with vested interest in prolonging the lives of the dying), the Right has chosen to couple "euthanasia" with abortion as two absolute poles on an eroding societal compass. Blaming women and doctors for abortion was easy; now the odd job of assigning blame for assisted suicide comes. It is a convoluted task, complicated by the political positioning in the US on health care reform, and in Britain by the court and government's hesitancy.

Wooltorton's death is a grave tragedy, without doubt. A woman alone, depressed, suicidal. One must ask what kind of treatment for depression and fertility she received after each of her prior nine suicide attempts. But I liken her case in the recent assisted suicide landscape to perhaps the murder of Dr. George Tiller: an anomalous, horrible tragedy not claimed as just by the majority on either side but used - grievously, disgustingly - to perpetuate the rancor of the culture wars.

Tiller was brutally harassed and murdered by those who held to the greatest extreme on the Right. I wonder who Warner's blind lashings will help to focus zealots on: doctors? court justices? politicians? Assisted suicide forms a new front in the culture wars. How the Right chooses to work their machine, created to oppose abortion and now employed to enforce the way those in pain die, is yet to be seen. We know who Warner is stirring up with his over-the-top rhetoric but we don't know yet who their targets will be.

Warner closes:

But English law no longer defends the weak; it is the plaything of self-consciously “progressive” busybodies, pseudo-moralists, bluestocking baronesses and knee-jerk opponents of the vestigial remnants of the Judaeo-Christian ethic. Welcome to Brave New World.

UPDATE: John Smeaton, director of the British Society for the Protection of Unborn Children (SPUC) urges prosecution of doctors in the death of Kerrie Wooltorton.

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