Saturday, November 21, 2009

Palliative Medical Training.

The Seattle Times reports on the increased number of medical schools offering palliative training.

Aid in dying is legal in Washington (and Oregon) and that legalization has made the two states leaders in hospice, palliative and other end of life care.

There are 62 medical-school programs across the country offering such training.

One is the University of Washington School of Medicine which, in partnership with Providence Hospice of Seattle, is piloting the only palliative fellowship program in the state.

Cofer, first physician to participate in the University of Washington program, said her interest in the humanistic side of medicine attracted her to palliative care.

"It was sort of a natural step for me," Cofer said. Palliative medicine "allowed me to practice medicine the way I was taught in medical school - you spend more time with people to talk about the things that contribute to suffering."

Most medical students are exposed to palliative and hospice care in school and in residencies, but until recently, formal training and certification in the field has not been widely available.

Palliative medicine was designated a subspecialty in 2006 by the American Board of Medical Specialties and Accreditation Council for Graduate Medical Education. The board offered the first certification exam last year.

Trainees in the yearlong program must complete a residency in one of 11 specialties that include internal medicine, anesthesiology, family medicine, and obstetrics and pediatrics. They must also train in hospitals, hospice settings and a long-term facility such as a nursing home.

That this type of care is becoming mainstream represents "a sea change for the practice of medicine," said Wayne McCormick, director of the University of Washington's Palliative Medicine Fellowship Program.

Still, many lay people may not know what hospice care is until they have a personal experience with a palliative-care team, he said. And "because it's so patient- and family-centered ... the value becomes palpable when you're actually in the middle of it."

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A Tough Sell: Thanksgiving is a Time to Talk about End of Life Wishes.

Nobody likes to talk about death. The UPI reports that, in light of November being National Hospice and Palliative Care Month, families should use Thanksgiving to discuss end of life wishes.

The American Academy of Hospice and Palliative Medicine offers assistance for such conversations to ensure death wishes are understood.

To help a family have end-of-life conservations:

-- Gather around a comfortable spot such as the living room or the dining room table.

-- Set aside a period of time, an hour should be enough, depending on how many family members participate.

-- Take turns discussing end-of-life wishes, including what level of treatment and whether every possible medical treatment should be performed, and when treatment should be stopped once quality of life is severely diminished, discussing quality of life means and whether resuscitation should be performed.

-- Discuss who should be a healthcare proxy, a person who will make medical decisions for a person who cannot.

-- Write end-of-life wishes down.

-- End-of-life issues should be discussed long before they need to be answered, and discussed more than once over the years.

To help prepare for an end-of-life discussion, such as developing an advance directive and designating a healthcare proxy see: http://www.aah


Aid in Dying and the Manhattan Declaration.

I've culled the Manhattan Declaration for language on aid in dying - so you won't have to! Excerpts below.
(I'd like to note, by the way, that as I write, the Declaration has about 6,000 signatures.)

Because the "slippery slope" argument allows that legalization of "euthanasia" occurred because of the legalization of abortion and the rise of the "culture of death," often "sanctity of life" language includes both abortion and aid in dying.

And a snide aside: I find the "render unto Caesar" stuff really tacky. These organizations use the first amendment to provide social services to the public, all the while enjoying tax exemptions and suckling at the federal government's teet to the tune of 50% of their hospital budgets. (See my prior post for a quote about tax evasion "civil disobedience.")

A culture of death inevitably cheapens life in all its stages and conditions by promoting the belief that lives that are imperfect, immature or inconvenient are discardable. As predicted by many prescient persons, the cheapening of life that began with abortion has now metastasized. For example, human embryo-destructive research and its public funding are promoted in the name of science and in the cause of developing treatments and cures for diseases and injuries. The President and many in Congress favor the expansion of embryo- research to include the taxpayer funding of so-called “therapeutic cloning.” This would result in the industrial mass production of human embryos to be killed for the purpose of producing genetically customized stem cell lines and tissues. At the other end of life, an increasingly powerful movement to promote assisted suicide and “voluntary” euthanasia threatens the lives of vulnerable elderly and disabled persons. Eugenic notions such as the doctrine of lebensunwertes Leben (“life unworthy of life”) were first advanced in the 1920s by intellectuals in the elite salons of America and Europe. Long buried in ignominy after the horrors of the mid-20th century, they have returned from the grave. The only difference is that now the doctrines of the eugenicists are dressed up in the language of “liberty,” “autonomy,” and “choice.”

We will be united and untiring in our efforts to roll back the license to kill that began with the abandonment of the unborn to abortion. We will work, as we have always worked, to bring assistance, comfort, and care topregnant women in need and to those who have been victimized by abortion, even as we stand resolutely against the corrupt and degrading notion that it can somehow be in the best interests of women to submit to the deliberate killing of their unborn children. Our message is, and ever shall be, that the just, humane, and truly Christian answer to problem pregnancies is for all of us to love and care for mother and child alike.

A truly prophetic Christian witness will insistently call on those who have been entrusted with temporal power to fulfill the first responsibility of government: to protect the weak and vulnerable against violent attack, and to do so with no favoritism, partiality, or discrimination. The Bible enjoins us to defend those who cannot defend themselves, to speak for those who cannot themselves speak. And so we defend and speak for the unborn, the disabled, and the dependent. What the Bible and the light of reason make clear, we must make clear. We must be willing to defend, even at risk and cost to ourselves and our institutions, the lives of our brothers and sisters at every stage of development and in every condition.

Our concern is not confined to our own nation. Around the globe, we are witnessing cases of genocide and “ethnic cleansing,” the failure to assist those who are suffering as innocent victims of war, the neglect and abuse of children, the exploitation of vulnerable laborers, the sexual trafficking of girls and young women, the abandonment of the aged, racial oppression and discrimination, the persecution of believers of all faiths, and the failure to take steps necessary to halt the spread of preventable diseases like AIDS. We see these travesties as flowing from the same loss of the sense of the dignity of the human person and the sanctity of human life that drives the abortion industry and the movements for assisted suicide, euthanasia, and human cloning for biomedical research. And so ours is, as it must be, a truly consistent ethic of love and life for all humans in all circumstances.

And the most oft quoted paragraph:

Because we honor justice and the common good, we will not comply with any edict that purports to compel our institutions to participate in abortions, embryo-destructive research, assisted suicide and euthanasia, or any other anti-life act; nor will we bend to any rule purporting to force us to bless immoral sexual partnerships, treat them as marriages or the equivalent, or refrain from proclaiming the truth, as we know it, about morality and immorality and marriage and the family. We will fully and ungrudgingly render to Caesar what is Caesar’s. But under no circumstances will we render to Caesar what is God’s.

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More Manhattan Declaration.

If you are so inclined, you may read the entire Declaration here, and even sign it.

Timothy Kincaid reminds us of the segment of religious society that the Declaration represents:

First, let us say what this document is not. It is not, as the NY Times described it, a situation in which “Christian Leaders Unite on Political Issues“. Indeed, this is but a segment of Christian thought, claiming the mantle of Christian history and tradition but excluding broad segments of the faith.

One need only glance at the signatories to know the nature of the alliance. Present are some who are well known names in the political culture wars who have long striven to impose their religious views by force of law on the unbelievers: Dr. James Dobson, Chuck Colson, Gary Bauer, and Tony Perkins. Some are religious leaders who have been recently shifting their realm of influence away from faith towards secular domination: Ravi Zacharias, Dr. Albert Mohler, and Jonathan Falwell.

But this is not just broadly social conservatives. There is, instead, a concentration of those who focus on “opposing the homosexual agenda”. There are a few religious activists who seem dedicated and committed (obsessed, one might think) to fighting equality for gay people: Ken Hutcherson, Bishop Harry Jackson, and Jim Garlow. And then, inexplicably, some who are not religious leaders at all but social activists whose primary occupation is in seeking the political institutionalizing of inequality to gay people: Maggie Gallagher, Frank Schubert, and William Donohue.

Perhaps the most difficult to explain, and by far the most troubling name present, is The Most Rev. Peter J. Akinola, Primate, Anglican Church of Nigeria.

There is no explanation provided as to what relevance Akinola has on what is a uniquely American collection. But his participation is not accidental. And, as I will discuss momentarily, his is perhaps the key that explains the true nature of this manifesto.

This could be seen as nothing more that “the usual suspects”, a rehashing of the Moral Majority or the Christian Coalition or any other of the loose groupings of religious authoritarians, were it not for one import inclusion. There are nine Catholic Archbishops who signed on to this document.

Ideologically as dissimilar as possible, these two Christian extremes – one whose doctrine is based in tradition, liturgy, and hierarchy, the other whose doctrine is based in reform, spirit-led worship, and direct divine revelation – have set aside ancient hostilities and theological beliefs that doubt the other’s right to be considered “Christian” and have now joined in a common purpose: denying your rights.

But as important as who is present, is who is absent.

Among the signatories I was unable to find any members of the United Church of Christ, Episcopal Church, Presbyterian Church (USA), Friends (Quaker), Disciples of Christ, Unitarian Universalists or American Baptists. There was one United Methodist minister.

In short, a whole branch of Christianity, Mainline Christianity, was missing, including many who no doubt would agree with the goals of banning abortion and forbidding same-sex marriage. This exclusion is, I believe, integral to understanding the true purpose of this manifesto.

Kincaid draws the conclusion that this is a declaration of war by one segment of faith in the US against another, a showing of jealousy at the power that "mainline" religion in the US has garnered:

Note the presence of the second signatory, Peter Akinola? He is the Nigerian Anglican who has been missionizing the United States in an effort to hurt the Episcopal Church. His inclusion is a very clear message sent to the EC that they are a target for the Catholic Church and the evangelical churches who will use whatever political power they may wield in the future to thwart her position in the nation.

This manifesto is, I believe, less a declaration of war on gay people and those with unplanned pregnancies than it is a declaration of war on other Christian faiths.


This manifesto says, in effect, “We are the Christians. We are the ‘heirs of a 2,000-year tradition of proclaiming God’s word’, and we alone will speak for the faith.”

Kincaid sees a clear agenda in the Declaration regarding the Kill Gays Bill in Uganda and AIDs in general:

Around the globe … take steps necessary to halt the spread of preventable diseases like AIDS

The situations in Nigeria and Uganda are not accidental nor unrelated to the efforts of conservative Americans. Although virtually all of the spread of AIDS in Africa is related to heterosexuality, this will be an excuse to pass draconian laws seeking to repress, incarcerate, or execute gay men and women.

In addition to being a slam against the Episcopal Church, the inclusion of Akinola announces that pogroms against gay Africans will have the endorsement of both the Catholic Church and conservative evangelical churches.

We should not expect the calls for criminal prosecution of gay people to be limited to foreign soil. Should such a fervor be fostered internationally, it is unquestionable that this will lend support to efforts to reinstate or bolster oppression here.

It is no longer a matter of curiosity that the Catholic Church has not spoken out against the Kill Gays bill in Uganda. Nor had Dr. Mohler or Dr. Dobson. Nor, indeed, has any signatory of this document.

From Newsweek:

Addressed not only to Christians, but to President Obama, Congress, and civil authorities, the treatise will be available online for individuals to sign as well. When asked whether nonpayment of taxes would be an acceptable form of protest, George, who is also a lawyer, said he was currently representing a West Virginia taxpayer who is refusing to pay the small percentage of her bill that might go toward state-funded abortions (“Litigation is still pending,” said George). Institutions were also called on to participate in the civil disobedience if, for example, if a Catholic hospital is under pressure to provide services that go against Catholic beliefs. Although conscience protections do exist for many institutions already, there are areas, cited on Friday, such as when the Catholic Charities of Boston halted adoption services, rather than comply with state law and allow children to be adopted by homosexual couples.

According to the Declaration, “We must be willing to defend, even at risk and cost to ourselves and our institutions, the lives of our brothers and sisters at every stage of development and in every condition.” Yet similar documents, such as last year’s Evangelical Manifesto, have been unveiled with great fanfare butlittle consequence. Civil disobedience, especially giving up a job, is a lot to ask in the current economy and is a hard notion, even for some signers of the Declaration.

Tony Perkins, president of the Family Research Council tells NEWSWEEK the point of the Declaration is really to avoid mistakes of the past, such as when religious leaders did not stand up early enough against no-fault divorce, which he says led directly to the breakup of families and high divorce rates. “I’m a former police officer, and I have hard time with civil disobedience, but if it comes to the point where our religious liberty is at risk, I’d not only participate but would encourage people to resist.”

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Details from Reid's Health Care Bill.

Yesterday the AP reported on some details in the health care bill that will be presented before the Senate. Tonight, senators will vote on whether or not to vote on the bill. I post this because it concerns a pet interest of mine, generic drugs, and because it continues the "murky" characterization given to "assisted suicide."

To clarify the sloppy reporting, there is nothing murky about Oregon or Washington's Death with Dignity bills. They are strict and clear; legal services approved by a majority of the states' citizens. And according to studies, they work very well, thank you. What may be yet unclarified is the pending case in Montana where aid in dying could, by the end of the year, be declared constitutional by the Montana Supreme Court. How that constitutionality is then defined remains to be seen:

In the latest round of a bitter struggle over the country's $46 billion market for biological drugs, the Senate bill extends the protection some brand-name manufacturers would get from generic competitors.

The drugs, made from living cells, are a growing part of the pharmaceutical market. Benefiting from a well-financed lobbying campaign and influential supporters, the manufacturers won language in the Senate health committee bill — and in the House-passed health overhaul legislation — giving them 12 years of protection from generic competitors.

Reid's bill would add another six months of protection for drugmakers who also test those products for use by children. Generic companies want to be able to compete immediately.

Kathleen Jaeger, president of the Generic Pharmaceutical Association, said Reid's decision represents "a total hijack" by drug manufacturers that she said will keep consumers' costs higher for a longer time. Ken Johnson, a senior vice president for the Pharmaceutical Research and Manufacturers of America, said drugmakers pursued the issue with senators and that the extra six months of protection gives companies an incentive to make products for children.

The bill also has language prohibiting the government from discriminating against health care providers that refuse to provide services for assisted suicides.

Similar provisions were included in earlier versions by Sens. Tom Coburn, R-Okla., and Orrin Hatch, R-Utah. The legal status of the practice is murky in much of the country, with Oregon and Washington the only states with voter-approved assisted suicide laws and a court case pending in Montana.

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Human Rights Campaign Fires Back at "Manhattan Declaration"

“This declaration simply perpetuates the fallacy that equality and religious liberty are incompatible and that every step toward fairness for the lesbian, gay, bisexual and transgender community is another burden on religious people. In reality, non-discrimination laws are working all over this country, where religious freedom is existing side-by-side with equal opportunity,” Harry Knox, director of the Human Rights Campaign’s Religion and Faith Program, said in a statement. “Advocates of LGBT equality have taken great pains in their legislative efforts to ensure that the rights of religious organizations and people under the First Amendment are protected. It is deeply cynical for the authors of this document to paint themselves as victims because they cannot have a free hand to discriminate, including with taxpayer dollars.”

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