Tuesday, October 27, 2009

Can It Ever Be Ethical to Let a Woman Die? Australia Debates The Conscience Clause.

From Crickey comes a story by Leslie Cannold about the struggle in Australia over a proposed conscience clause law which would require doctors to only perform an abortion if the life of a woman is in jeopardy:

...opponents of legal abortion argue that rights of medical professionals and Catholic health institutions to refuse care to women seeking abortions is absolute. Even where such denial could see a woman die, they maintain that refusing to provide an abortion is the right, and their right, to do.

There is much that is offensive, even shocking, about the absolutist nature of such assertions. However important is religious freedom, it does not trump other rights. However important medical professionals are, their rights are no weightier than those held by others — certainly not their patients to whom they owe a duty of care. In fact, even if religious and conscience rights were trumping, there’s still arguments about whose religion or conscience — the doctor’s or the woman’s — should prevail when conflicts arise over abortion care.

Where the rights of women seeking abortions are taken seriously (and these include their right to follow the dictates of their conscience, to informed decision making about their health, to timely medical care and to life), the absolutist approach seems inadequate at best. At worst, it seems to disregard the pregnant woman’s basic humanity.

Perhaps this fact is why most of those arguing for a change to Victoria’s conscience clause rarely mention women by name. They don’t directly say, “we don’t care if women die, doctors conscience rights are supreme”.

Labels: ,

Britain Fails to Adopt Change to Assisted Suicide Laws.

From the happy AnglicanMainstream, news that the recent attempt in Britain to change the laws regarding prosecution of those who assisted mentally competent, terminally ill patients to hasten their deaths has failed:

Thank you for your prayers and action. Last night Lord Alderdice’s amendment to the Coroners and Justice Bill was withdrawn. The amendment sought to remove the possibility of prosecution for those who help a person to die where that person has an incurable and disabling illness and a coroner has certified that the person has a free and settled wish to die.

Labels: ,

Two Cuts Are Too Much: Hospice Under the Knife.

From the fantastic GeriPal regarding proposed cuts to hospice care:

The high-quality, compassionate end-of-life care Americans depend upon is threatened by not one but two devastating rate cuts. Already bracing for a 3 percent regulatory rate cut starting this month (the Budget Neutrality Adjustment Factor or BNAF), hospice, along with most other Medicare providers, is also facing additional cuts through a “productivity adjustment” to help finance health care reform.

These new reductions would slash rates by a damaging 11.8 percent throughout the next 10 years to fund new health care initiatives written into the bill. Combined, the impact of these two cuts would mean an astounding 14.3 percent loss to hospice. Considering hospice, as sited by MedPac, already operates on a very small profit margin of 3.4 percent, this means programs will go broke, doors will close, and Americans will be left without or with limited options of having hospice at home. In response to the proposed cuts, The Alliance for the End of Life Care and the National Hospice and Palliative Care Organization (NHPCO) have launched “Two Cuts Are Too Much,” a grassroots campaign.

For an industry already just getting by on bake sales and fundraisers, this would be a blow.

Labels: ,

What does it mean to be Anabaptist?

The YoungRadicalAnabaptists spell it out for us:

1. Jesus only
“No one knows the Father except the Son”
Anabaptists hold to no theology except that stated by Jesus himself. Even as Jesus supersedes the Old Testament law, Jesus also rules over all theology that the church itself created, whether that by Paul or by Calvin or by N.T. Wright. And the focus of our belief is not a Jesus we create—such as a glorified, theological Jesus or a model of a historical Jesus or a cultural Jesus—but the Jesus of the gospels. Thus, the four gospels lead us to interpret all things through the words and life of Jesus.
Since Anabaptists affirm the superiority of Jesus, we also recognize the weakness of all things human to achieve truth or justice. Thus, any particular denomination or creed is only in a process of getting closer to or further from Jesus, but no church could ever be complete in and of itself. Various governments may attempt to achieve justice, but they all fail. Schools attempt to teach truth, but no matter how precise they are, they fail to achieve the full truth that Jesus gives us.

2. Peace
“Have salt in yourselves and be at peace.”
Anabaptists are a peaceful people. We wish to make changes in the world, but not through violence or hate speech. Rather, we believe that we need to display the actions we want in others. If we want peace in the world, we cannot create peace through violence. Yes, dramatic change must happen for the world to have peace, but God can create the dramatic change—it is our responsibility to be the ideal community the world must become.

3. Community
“Love one another”
Following Jesus cannot be done separated from others. Jesus, again and again, commands us to “love” and love cannot be done in isolation. We must support each other in communities and our communities must reach out to others outside of our community to display our love. We must also support and provide hospitality so that no one within our community has need.

4. Believer’s Baptism
“Those who believe and are baptized are saved.”
Today, it may not seem as important as an issue, but the Anabaptist communities originally began as groups who baptized only those who could understand and be faithful to Jesus. Thus, Anabaptists don’t baptize infants or assume that everyone within a particular social group is a follower of Jesus. That is a personal commitment that each person must determine individually, and lives out in their own lives.

5. Love of Enemies
“Do good to those who despitefully use you.”
Because we will not cause others to be afraid of us, that makes us vulnerable to others. Jesus showed us that even if people do disrespectful, hateful or even violent acts, that does not mean that we should return such acts in kind. Rather, we are to display God’s love even—nay, especially—to those who do terrible things to us. In order to have security, we do not depend on our strength, but on God’s.

6. Communion with the outcast
“The Son of Man came to seek and save the lost.”
Anabaptists know what it means to be outcast, because they have been rejected. But we are also to reach out to those who have been rejected by society. Rather than create another outcast group, the Anabaptists connect with those who are hated, and welcome them as Jesus would.

7. Assistance to the poor
“Sell your possessions and give to the poor.”
Jesus helped the poor with what resources he had, so also do Anabaptists. We see the needs of the poor, and rather than simply ignoring their basic needs, we meet them with love in relationship. We understand that it isn’t enough just to give to the poor, but to connect with them as well, because without relationship we cannot love.


Lutherans to the Mennonites: We're Sorry!

Well, it's about time!

The Lutheran World Federation has drafted a statement meant to apologize to Anabaptists for past wrongs, reports ChristianToday. It's an old beef that the LWF wishes to apologize for as they work to, under the auspices of the Lutheran-Mennonite Study Commission, established in 2002, to look at how the two churches can better work together.

What did they do that warrants an apology? Only persecute, torture, and kill Anabaptists from the time of the Radical Reformation in the 16th century and endorse "theological arguments" for continued persecution throughout the following centuries.

The LWF, wrapping up a five day meeting in Geneva, Switzerland, drew up the statement and hope to adopt it at their 2010 assembly in Germany.

The unanimous vote in favour of the statement was welcomed by the general secretary of the Mennonite World Conference, the Rev Dr Larry Miller, who suggested that the request for forgiveness also required change within the MWC.

“You are not applauding for yourselves,” said Miller. “You are applauding for the grace of God in our midst. Mennonites have learned from Lutherans that we are justified by faith alone, because we know that justification produces not only relations between oneself and God but also communion between the churches.”

For more read Ekklesia.

Labels: ,

More Training in Pain Relief As A Vet Than A Doctor.

The British TimesOnline reports a recent study, funded by The National Council for Palliative Care and printed in the Journal of Pain and Symptom Management that looks at continuous deep sedation (CDS) and how it is used by doctors to manage pain and suffering during the last days of a patient's life.

As I've written, CDS is legal because relief of pain is the objective and death is only a secondary outcome. In the US, what is called the "double effect" prevents doctors from being prosecuted for CDS.

The study polled 3,000 doctors and found that about 1 in five administered "infusions of drugs to keep patients unconscious for hours or days at a time."

In appropriate doses, sedatives and strong painkillers are considered a valuable way of easing the pain and anxiety of patients who are dying with conditions such as cancer.

But 18.7 per cent of British doctors polled said they used drugs to invoke “continuous deep sedation” in a dying patient, a practice which in other countries is seen as an alternative to legalised euthanasia


The study also found that of those surveyed, those who supported legalization of assisted suicide were 40% more likely to use CDS. Those doctors with strong religious beliefs or who were opposed to legalizing AS were less likely to use CDS.

Yet, the report's findings may be skewed by what experts consider a lack of understanding among general practitioners of how various drugs work. In other words, some may think they are using CDS when they are not or vice versa.

“Some doctors who are not specialists may be confused and incompetent in using these drugs but the study suggests they are misunderstanding what they are doing as well.

"Dying patients are more likely to be drowsy or asleep in their final days and doctors might assume wrongly that this is a result of medication.

“It does not mean that they are hastening a patient’s death. But we do have ample evidence that many doctors do not know what they are doing when it comes to palliative care, and whether or not [dying patients] get good control of their pain and symptoms is a lottery.”

The article concludes with this haunting quote:

Simon Chapman, director of policy at the council, said that sedation was recognised as an appropriate part of end of life care for some patients.

An official for the Patients Association said: “There is no doubt that the vast majority of patients’ families who contact us after a death do so because they are haunted forever by watching their loved one not have the necessary care, including sedation.

“It is imperative that everyone considers making a living will to make your views about end of life care clear and understood.

“At the moment you have more training in pain relief as a vet than a doctor.”

Labels: , , , , ,

British Doctor Explains Change of Position on PAS.

A British doctor, Raymond Tallis, writes for The Times today that he has changed his mind about assisted suicide and cites the example of Oregon, where Death with Dignity has been legal since 1994, for his conversion.

Tallis will join Debbie Purdy, the multiple sclerosis patient who recently won a court case in Britain to allow her husband, Omar, to assist her travels to Switzerland for assisted suicide, before a panel at the Battle of Ideas in London to argue for physician-assisted suicide (PAS).

Once a staunch opponent to assisted suicide, while serving as chairman of the Committee on Ethical Issue in Medicine at the Royal College of Physicians, Tallis explains why he has since changed his mind.

The case for such a Bill to me now seems clear. Unbearable suffering, prolonged by medical care, and inflicted on a dying patient who wishes to die, is unequivocally a bad thing. And respect for individual autonomy — the right to have one’s choices supported by others, to determine one’s own best interest, when one is of sound mind — is a sovereign principle. Nobody else’s personal views should override this.

So where did my initial opposition come from? I was in thrall to numerous incorrect assumptions. But the evidence changed my mind.

Culled from Tallis' article, here are his reasons to support assisted suicide:

1. Palliate care does not eliminate need for PAS because it cannot eliminate suffering among all patients and because PAS has shown to actually improve palliative practices

2. Availability of PAS has not inhibited advancements in palliative care, in fact, Oregon has the best palliative care in the US

3. Writes Tallis:

I also shared the worry that legalising assisted suicide would break down trust between doctor and patient. This is not borne out by the evidence. A survey of nine European countries put levels of trust in the Netherlands at the top. And this is not surprising: in countries with assisted dying, discussion of end-of-life care is open, transparent, honest and mature, not concealed beneath a cloud of ambiguity, as it is in the UK. And the knowledge that your doctor will not abandon the therapeutic alliance with you at your hour of greatest need will foster, not undermine, trust.

4. Legalizing PAS doesn't lead us down a slippery slope to involuntary euthanasia because legislation prevents it from doing so.

5. The legalization of PAS in Oregon and elsewhere didn't create a mad rush to die. Few elect the hastening of death.

6. Lastly, Tallis notes:

As a geriatrician, I was also worried that assisted dying would be offered to, or imposed upon, those who are most disempowered. A very detailed analysis of the data in Oregon has shown that there is an under-representation of those groups and an over-representation of comparatively well-off, middle-class white people — feisty characters who are used to getting their own way.

He continues:

Well, I happen to believe that even small numbers of people going through unbearable hell are important. The availability of assisted dying would bring much comfort to many more sufferers than actually use it because it brings a sense of having some control.

Death from dehydration and starvation in patients who have no means of securing an end to their suffering other than by refusing food and fluids, or botched suicides, reflect the unspeakable cruelty of the present law. To accede to someone’s request for assisted dying under the circumstances envisaged in the Joffe Bill is not to devalue human life, or devalue the life of a particular human being, or to collude in their devaluing their own life. It is to accept their valuation of a few remaining days or weeks of life that they do not wish to endure.

Labels: , , ,

Our Proud American Tradition of Burning People in Effigy.

Attention whore, anti-abortion activist, and founder of Operation Rescue, Randall Terry, is now calling for like-minded people to burn over-sized images of Pelosi and Reid, Senate and House Majority Leaders, in effigy to show what will happen to them when they get to hell for submitting health care proposals that include funding for abortion (a legal, cost-effective, safer-than-birth, most commonly practiced surgical procedure in the US, currently covered by health insurance for 85% of American women).

via CBSNews.

Labels: , ,

Messing Up the "Pro-Life" Message: Hospice and Palliative Care.

Cicely Saunders, a student of the Christian writer C.S. Lewis, founded the first modern hospice in Britain in 1967 as a “powerful force for undercutting the movement for active euthanasia," yet today, many "pro-life" and Catholic organizations are expressing concern about not only the (slow) advance of palliative services and hospice facilities, but also the encouragement of end of life discussions, advance directives, and living wills as fit tools for "government-encouraged euthanasia."

While the health care debate over the summer caused these groups to come out staunchly against reform and end of life discussions, many are now backtracking to convey a more nuanced view of end of life care, including hospice and palliative medicine. The fear-mongering hasn't ceased, it's just been ameliorated by more reasonable voices.

In an article today in CNSNews titled, "End of Life Care Should Not Not End Life," that best demonstrates cultural conservatives' fumbling through the end of life care conversation, Ken Connor notes two new National Institute of Health studies that show, "sometimes less [aggressive treatment at the end of life] is better."

The studies, featured in the New England Journal of Medicine, document how certain medical therapies implemented in the final months of a patient's life often cause emotional and physical stress and pain, effectively negating any positive benefits associated with such treatments.

But quickly he lays out the concerns "pro-life" advocates have with embracing the results of these studies:

However, those worried that a government takeover of health care will result in health care rationing in keeping with Dr. Ezekiel Emanuel's"complete lives" theory view these studies with alarm—and for good reason.

In a culture where "quality of life" is increasingly viewed as the predominant justification for abortion, assisted suicide, and even
infanticide, there is a legitimate concern that these kinds of studies will be used by the government to advance policies that endanger society's most vulnerable members.

According to Connor, what determines the ethical use of treatment at the end of life is who makes the decisions. He argues (with a point straight out of Luntz's Republican talking points on health care reform) that government-run health care puts bureaucrats between the patient and the doctor by asserting protocols regarding what treatments work best.

More than one commentator has noted that this argument puts "pro-choice" groups in a strange position. Michelle Bachman, after all, echoed the pro-choice activists' call when she stated in August:

"That's why people need to continue to go to the town halls, continue to melt the phone lines of their liberal members of Congress," said Bachmann, "and let them know, under no certain circumstances will I give the government control over my body and my health care decisions."

As "pro-life" groups work to elevate the issue of euthanasia on their platform (at the PA Pro-Life Conference in Scranton this week, again and again speakers urged activists to expand their efforts to include euthanasia and not just abortion), some find that their arguments must be retooled. The traditional straight-ahead argument that God has jurisdiction over life from conception to "natural" death is compromised by the issue of euthanasia when government is seen as the perpetrator. Until now, government has been appealed to to stop abortion and has been seen as the best enforcer of "pro-life" positions. How gratifying it is for those of us who have supported individual choice for abortion to have "pro-life" groups take up the choice banner for end of life care, even if their arguments for choice are skewed by misinformation and lack of a definition for "natural" death.

The elevation of "euthanasia" to a more prominent position on the "pro-life" platform can be contributed to both an incoming Democratic administration focused on reforming health care, but also to successes by Death with Dignity advocates in Montana, where the Supreme Court is currently debating the constitutionality of aid in dying, and in Connecticut and New Hampshire, where a case has been brought before the courts and a bill is in committee.

Since the fervor of the summer months, when "death panel" and "rationing" talk rallied and united "pro-life" groups against end of life discussions and "euthanasia", public opinion, numerous studies like those noted by Connor, and those willing to discuss the benefits of end of life care have brought back some gravity and nuance to the discussion. (Studies show that patients prefer choice in dying, even those who ascribe to conservative values. In 2005, during the Terri Schiavo media storm, studies found that an overwhelming majority of the population opposed the Bush administration's efforts to keep Schiavo alive.)

Hence articles like Connor's which admit that aggressive treatment may not be the best thing for all patients (undermining the popular accusations that rationing will occur under a new plan), but that health care reform still jeopardizes "society's most vulnerable members." His example of what will happen comes straight from Wesley J. Smith:

At many hospitals and nursing homes in the United Kingdom, for example, elderly patients deemed close to death are placed in a "care pathway" designed to ease the dying process and conserve medical resources.

Once it is determined that a patient is near death, life sustaining fluids and medicines are withdrawn and the patient is placed under heavy sedation.

As bioethicist Wesley J. Smith
describes it, "the Pathway misuses the legitimate treatment of palliative sedation, and mutates it in some cases into a method of causing death, known as terminal sedation.

This means that sedation is sometimes administered, not because the individual patient actually needs the procedure, but because he or she has been reduced to a
category member, and that's how members of the category are treated."

I don't know where Smith gets his information and I highly doubt that British hospices operate under greatly different guidelines than US hospices do. But I do know (from studies and my own personal experience) that terminal sedation is a regular practice in hospices across the US - often without the consent of patients or their family. Rather than allow a terminal patient to suffer, doctors sedate them to the point of unconsciousness. Feeding and hydration are stopped. The patient dies in an unconscious state. Doctors are permitted to use terminal sedation, or continuous deep sedation (CDS) because pain relief is the objective, not death, and doctors cannot be prosecuted for this treatment under what is called the "double effect."

As Mark Connell, attorney for Baxter in the Baxter v. Montana Death with Dignity case, stated in oral arguments to the Montana Supreme Court:

We're not working on a blank canvas here. Montana recognizes multiple situations where it's alright for a doctor...to hasten death. This happens...every day in our hospitals. This double effect doctrine is when a doctor goes to a patient and his family and says, "You're in suffering and I'm gonna put you out of that suffering. Here's the morphine that can do the job." This is done deliberately so. So our law recognizes there are certain situations because of the paramount duty doctors have and the state recognizes to alleviate suffering medicine can proceed to the point where death is hastened.

And here, beyond basic misunderstanding of hospice or palliative care, is where "pro-life" groups are left to wrestle with end of life care: over suffering. The horse is out of the barn because of CDS. If Death with Dignity is upheld in Montana, the courts, at least in that state, will have determined that the line between CDS and Death with Dignity is slim. The highlighting of CDS in this way makes people like Smith and Connor nervous because they may argue for patient choice but they know they don't really mean it.

The institution of hospice and it's common - and legal and accepted - practice of CDS exposes their agenda of imposing suffering on terminal patients, even as it undermines "pro-life" groups' calls for personal choice in end of life care.

Labels: , , , ,

Saving the Family to Save the Church.

In today's Morning Bell newsletter, The Heritage Foundation, in promotion of their upcoming event "Religious Practice and the Family," writes:

But you don’t have to be a sociologist to notice that marriage and parenting often serve as an impetus, specifically for men, to get more involved with church. In a new research paper to be presented at Thursday’s conference, Wilcox examines the data and makes a further claim.

His study provides substantial evidence for the idea that “the fortunes of American religion rise and fall, at least in part, with the fortunes of the intact, married family,” Wilcox says. So if the nation’s retreat from marriage continues, his work suggests, American churches will be weakened.

Using data from the General Social Survey, Wilcox concludes that unmarried parents are 23 percent less likely to attend church on a weekly basis than are adults who don’t have children. However, men and women who are married and have children are 62 percent more likely to attend church than unmarried peers who are childless.

“Clearly,” Wilcox says, “adults who combine marriage and parenthood in a conventional manner are most likely to attend religious services.”

The fight for "traditional family values," as if they ever really existed, is a fight to save the church. Homosexuality? Divorce? Abortion? All enemies of the church, in this construct.

Labels: , ,

Sarah Posner Blogging at ReligionDispatches.

The fabulous Sarah Posner, author of God's Profits: Faith, Fraud, and the Republican Crusade for Values Voters and former keeper of the FundamentaList has a new blog at RelgionDispatches.

In her inaugural post she writes:

Welcome to my new RD blog, which will cover the intersection of religion and politics in Washington and beyond. I will report on and analyze a wide range of topics, including the most recent maneuvering of the religious right, how religious interests are influencing legislation and policy, threats to the separation of church and state, the influence of religion in elections, and more.

Labels: ,

"Purpose-Driven" Uganda.

Don't miss Nick Street's story at ReligionDispatches on "Purpose-Driven" Uganda, a country wallowing in homophobia and US-encouraged theocracy.

Uganda, described by Rick Warren as a “purpose-driven nation,” is in many ways an experiment in right-wing Christian social thought. Its endemic poverty and location at the frontier between Islam and Christianity in Africa have made Uganda—with a population of 30 million in an area about the size of Georgia and South Carolina combined—a focal point for missionary work across the denominational spectrum.

The country’s evangelical president-for-life, Yoweri Museveni, has received praise from George W. Bush, at whose encouragement Museveni narrowed the focus of Uganda’s HIV-prevention policy largely to exclude condom use in favor of abstinence, as well as Doug Coe, who described Museveni as “a good friend of the Family” in a story recounted in Jeff Sharlet’s book about Coe’s organization.

Labels: ,

Almost 1/3 of Churches Report Decline in Giving.

A new study by the Lake Family Institute looks at how the recession has impacted church fundraising and concludes that most churches, although not randomly selected, are doing fine:

In new study of 1,500 congregations, most said fundraising increased or held steady, but the number experiencing declines grew compared to 2008

INDIANAPOLIS -- More than two-thirds of congregations in a new study on congregational finances in the current recession reported that their fundraising receipts increased or remained the same in the first half of 2009 compared to 2008, even as the recession was worsening.

The findings are part of the 2009 Congregational Economic Impact Study, a joint project of the Lake Institute on Faith & Giving at the Center on Philanthropy at Indiana University and the Alban Institute, based in the Washington, DC area. The study was based on more than 1,500 responses, nearly all from the membership of the Alban Institute.

Almost 37 percent of congregations reported an increase in fundraising for the first half of 2009 over 2008. Another 34 percent reported that fundraising receipts stayed the same between 2008 and the first half of 2009.

Nevertheless, nearly 30 percent of congregations experienced a decrease in giving in 2009. This is 8.1 percentage points more than reported a decline in 2008.

"The recession has affected many congregations throughout the United States," said Una Osili, research director at the Center on Philanthropy. "One-third of responding congregations reported making budget cuts in 2009 and another quarter kept their operational budget the same, not allowing for any increases in the cost of living."

Congregations responded to the recession in a wide variety of ways, from feeding the homeless and providing emergency cash assistance to those in need to hosting community gardens, offering support groups and networking events for the unemployed, helping with financial planning, and increasing partnerships with other community groups.

Some congregations fared better than others. "Growth congregations," those where attendance and finances have been growing over the past five years, were more likely to report positive fundraising results. Congregations with $600,000 to $999,999 in revenue, weekly attendance of more than 300 people, younger congregants (average age under 50), and those reporting a higher average income of congregants (greater than $60,000) were more likely to report an increase in fundraising receipts.

"Survival congregations," those where attendance and finances have dropped by more than 10 percent over the past five years, were more likely to report a decline in fundraising. Other congregations that were more likely to report a decrease included those with annual revenue of less than $150,000, weekly attendance of less than 100 people, older congregants (average age 61 or older), and those where the average income of congregants was less than $40,000.

"This is one of the first looks we have had into the economic realities faced by American congregations during a time of global financial crisis," said Dr. James Wind, president of the Alban Institute. "We are pleased to have partnered in opening up a fascinating and complex story of national significance. The survey results demonstrate that local congregations, which we often take for granted and treat with misleading conventional wisdom, are much more dynamic, creative, and strong than many people think. Clearly, not all congregations are alike -- that is one of the major discoveries of the survey. Some are clearly struggling to make ends meet. But many more - and this will be a surprise to many -- are holding their own and growing during one of the toughest seasons in our national history. More than that, the survey reveals the great variety of ways they are ministering to an overextended nation."

The 2009 Congregational Economic Impact Study, with 1,540 respondents, is not a nationally representative study of all congregations in the U.S., but rather is drawn primarily from the Alban Institute's membership. More than three-fourths of respondents were from Protestant denominations.

From ReligionNews.