Sunday, November 22, 2009

Oh Margaret Somerville, It's Not About Your Dignity, It's About My Suffering!

For three decades women argued that abortion should be legal because a woman should have a choice over her body and reproduction. Because of this stance on abortion, the "pro-life" camp was able to steal the moral thunder of the argument.

Now we've got a culture where women are afraid to admit they've had abortions, where the church is ceded the moral high ground on the issue even through their policies subjugate women, particularly the poor. The framing of abortion has become such that Hillary Clinton has said we should work to decrease the number of abortions, missing the point that there is no moral ground for those who argue for it's illegalization.

When I hear arguments for aid in dying being based on dignity, I get a little nervous, afraid that the same framing we have seen around the abortion issue (and what has perpetually kept us on the brink of losing abortion rights) could be applied - is being applied! - to end of life rights.

In the below excerpt from an article in Canada's The Gazette, hyper-conservative bioethicist Margaret Somerville (no same-sex marriage, no reproductive rights for women, no patients' rights...) takes apart the idea of dignity in her defense of imposing religious ideology on patients.

Despite the oral arguments in the recent Baxter v. Montana case, I would say that framing aid in dying as an issue of dignity is going to get us nowhere in this global discussion. We all define dignity in very subjective ways.

What people are contesting in the fight for aid in dying is: Who Has Jurisdiction Over Suffering? Of course suffering comes in many forms. But no one but the patient can tell you what is suffering and what is not. And no one but the patient can tell you what suffering they can handle and what they can not. The problem with Somerville's argument is that she wants to defend the state's or the church's or the medical professions jurisdiction over suffering. These institutions have a vested interest in telling patients what they will and won't suffer for reasons that include: punishment, religious redemption, and professional pride and profit.

Don't miss me here, I'm talking about institutions, not individuals. If someone tells you they will decide how much you're going to suffer, no number of claims for human dignity are going to stop them. Suffering is sacred and powerful.

Let's make certain that the aid in dying movement doesn't lose site of the role suffering must play in this discussion; not just dignity, personal rights, autonomy, and choice. I would hate for those with other purposes to frame the argument in a way that sets back the movement thirty years.

Euthanasia advocates argue respect for human dignity requires that euthanasia be legalized and opponents of euthanasia argue exactly the opposite, that respect for human dignity requires it remain prohibited. In short, the concept of human dignity and what is required to respect it is at the centre of the euthanasia debate, but there is no consensus on what we mean by human dignity, its proper use, or its basis.

American political scientist Diana Schaub says "we no longer agree about the content of dignity, because we no longer share ... a 'vision of what it means to be human'." She's correct. So what are the various interpretations of dignity and what can they tell us about "what it means to be human"?

Intrinsic dignity means one has dignity simply because one is human. This is a status model - dignity comes simply with being a human being. It's an example of "recognition respect" - respect is contingent on what one is, a human being.

Extrinsic dignity means that whether one has dignity depends on the circumstances in which one finds oneself and whether others see one as having dignity. Dignity is conferred and can be taken away. Dignity depends on what one can or cannot do. Extrinsic dignity is a functional or achievement model - dignity comes with being able to perform in a certain way and not to perform in other ways. It comes with being a human doing. This is an example of "appraisal respect" - respect is contingent on what one does.

These two definitions provide very different answers as to what respect for human dignity requires in relation to disabled or dying people, and that matters in relation to euthanasia.

Under an inherent dignity approach, dying people are still human beings, therefore they have dignity. Opponents of euthanasia believe respect for human dignity requires, above all, respect for human life and that while suffering must be relieved, life must not be intentionally ended. Taking life, except where that is the only way to save life as in justified self-defence, offends human dignity. That is why capital punishment is wrong and why euthanasia is wrong.

In fact, the original primary purpose of the concept of dignity was to ensure respect for life. It's ironic that it has been turned on its head by pro-euthanasia advocates to promote exactly the opposite outcome.

Under an extrinsic dignity approach, dying people are no longer human doings - that is, they are seen as having lost their dignity - and eliminating them through euthanasia is perceived as remedying their undignified state.

Pro-euthanasia advocates argue that below a certain quality of life a person loses all dignity. They believe that respect for dignity requires the absence of suffering, whether from disability or terminal illness, and, as well, respect for autonomy and self-determination. Consequently, they argue that respect for the dignity of suffering people who request euthanasia requires it to be an option.

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The Immorality of Futile Care.

Thanks, Jacob Appel, for breathing some sense into end of life care dialogue. And by the way, it's great to hear that Texas is doing something right.

Of course, a true utilitarian will argue that a just society should spend and ration its resources sensibly in order to save as many lives as possible. One does not have to adopt such an unforgiving position to acknowledge that care, beyond a certain point, is unreasonable. A grim prognosis does not necessarily justify an end to care, but a truly futile prognosis is another matter. Hospital ethics committees, which have the insight of collective experience to guide them, are well-suited to make these determinations. In contrast, families are often driven by false hope, or guilt, or a basic misunderstanding of the cruel realities of the patient's prognosis. By allowing for input by ethics committees, which often draw members from a wide range of disciplines including medicine, nursing, law, theology and social work, the Texas model offers an excellent blueprint for other states to follow.

Unfortunately, a peculiar orgy of bedfellows -- ranging from anti-abortion crusaders to a letterhead disability rights organization called "Not Dead Yet" -- have joined forces to derail the expansion of medical futility statutes. Most recently, this motley band fended off efforts to adopt a Texas-style statute in Idaho. The great irony is that these same groups often argue for a healthcare provider's "right of conscience" to refuse participation in well-established medical therapies such as the prescription of birth control. However, they are unwilling to accept that many physicians find providing futile care to be not merely inconvenient, but morally repugnant. In all states, a medical resident has a right to refuse to participate in an elective abortion. In most states, a medical resident who is unwilling to provide futile care can be fired. The same groups that argue for the autonomy of physicians and private hospitals refuse to allow those hospitals a right to decide that certain patients are truly beyond hope.

In an ideal world, every patient who entered a hospital could be restored to full health. (Unlike the conservative humanist Leon Kass, I see nothing ethically wrong -- and only pure unadulterated good -- in extending the human life expectancy by as many years as possible.) The stark reality is that some patients are leagues beyond hope. If they are not dead yet, they are certainly darn close: accumulations of failed organs supporting permanently unresponsive brains, fed through stomach tubes, hydrated via IVs, often with the help of artificial lungs and artificial kidneys and, increasingly, ventricular assist devices to replace damaged hearts. Some physicians, examining such patients every day, inure themselves to a task they view as pointless but unavoidable. In contrast, I cannot help thinking of the desperate patient on a gurney in the emergency room, waiting for a hospital bed, whose care is delayed because -- in all states but Texas -- first come is still first served.

We have witnessed considerable public controversy in the past months over claims that the relatively benign end-of-life counseling provisions advanced by Republican Senator Johnny Isakson of Georgia and Democratic Congressman Earl Blumenauer of Oregon amount to "death panels" -- assertions which everyone other than Sarah Palin now seems to recognize as patent nonsense. That does not mean that there is no role for ethics panels to determine that some patients are beyond medical hope. If these are "death panels," then I support them wholeheartedly, as did George W. Bush and many conservative Texans. As physicians, we are in the business of saving lives, not pandering to ideologies. A national medical futility law, modeled on the Texas Advance Directives Act of 1999, is a long-ovderdue and life-saving measure.

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Crowley, Bork and the Question of Conservative Libertarianism. Oh My!

Be alarmed when Crowley is quoted quoting Rabelais and Bork is asked to weigh in on "rights," all in the same discussion about the compatibility of Conservatives and Libertarians. You can, should you wish, find the entire post here.

And if you don't wish, as I would fully understand, I clip the part pertinent to "euthanasia" and the "inevitable" but ridiculously unsubstantiated "slippery slope" argument that if you give those killing liberals an inch they'll take your granny.

There is no logical reason for the Libertarian belief in the absolute autonomy of the individual to supplement the desire for this freedom with a caution “avoid harming others”. A conservative belief in an authority beyond the self, a spiritual authority, has for centuries been instrumental in forming the laws by which our society functions. In this context, man is not considered “the measure of all things”, nor is he thought of as the final arbiter. Without this underpinning, there is no possible reason why everyone should not do exactly what pleases him regardless of the convenience of others, or, as Alistair Crowley puts it, quoting Rabelais: “Do what thou wilt shall be the whole of the law”. What is presented as a call for liberty is actually an excuse for license, blurring the distinction of what is and what is not morally acceptable. Anyone acknowledging a morality, external to himself, will find that the requirements of that morality are not always in accord with his natural inclinations.

Robert Bork identifies the impossibility of a Libertarian being a conservative in this extract from his book being a short essay on both pornography and drugs where he wrote:

“Modern liberals employ the rhetoric of ‘rights’ incessantly, not only to delegitimate the idea of restraints on individuals by communities but to prevent discussion of the topic. Once something is announced, usually flatly or stridently, to be a right –whether pornography or abortion or what have you– discussion becomes difficult to impossible. Rights inhere in the person, are claimed to be absolute, and cannot be diminished or taken away by reason; in fact, reason that suggests the non-existence of an asserted right is viewed as a moral evil by the claimant. If there is to be anything that can be called a community, rather than an agglomeration of hedonists, the case for previously unrecognized individual freedoms (as well as some that have been previously recognized) must be thought through and argued, and “rights” cannot win every time. Why there is a right for adults to enjoy pornography remains unexplained and unexplainable.” (6)

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Oh Those Poor, Helpless, Vulnerable, Duped, Coerced, Unprotected Seniors!

Don't get me wrong. I think it's easy to take advantage of seniors. They are from a generation that processed information differently than ours, the world of their middle years is in many respects long gone. Just think: they've known times before TV!

But all the hand-wringing over the sad plight of vulnerable seniors is a bit infantalizing, no? I completely empathize with seniors who are being told that the state and the church and the medical profession are only looking out for their best interests by telling them how to die. I really do!

I'm a woman, after all. I've been told how to screw, dress, talk, eat, look, and care for my body for a long time. And by the same patriarchal systems that are bossing seniors around.

When I see articles like this one from Anglican Mainstream I want to say, Hey, Give seniors some credit! Value their wisdom, self-determination, and autonomy! And stop counting all seniors as disabled or impaired beyond the ability to make health decisions for themselves! Geesh.

The article refers to the current kerfluffle in Britain that puts poor Director of Public Prosecutions, Kier Starmer, between a rock of a conservative contingent hell-bent on imposing their ideology on the rest of the population and the hard place patients who simply want to have their rights upheld. The chaos started over the summer when Debbie Purdy won the right to have her husband assist her travels to Switzerland for aid in dying, without the threat of prosecution when he returns. It's not that Omar wants to kill his wife. And it's not that Purdy, who has multiple sclerosis, wants to die. But she knows it comes and she wants to decide how.

Now, since the courts upheld Purdy's cause, Starmer's been since scrambling to review the assisted suicide prosecutorial guidelines. Try enforcing patients' rights when you've got the "pro-life" coalition, so deeply invested in imposing its ideology on patients, breathing down your neck.

The group says that the new guidance is ‘not fit for purpose’. They signed up to a hard-hitting response to the proposals from campaign group Care Not Killing, in which it warns that changes to the law could mean that the lives of stroke-sufferers, disabled people and those with arthritis, could be at risk.
(See also their letter to The Times)
The Daily Telegraph reports that the group’s response says:
‘Among the factors proposed as tending against prosecution are that the deceased was seriously ill or incurably disabled or had a history of suicide attempts. In Care Not Killing’s view these proposals are discriminatory as well as dangerous.’
The proposal that serious illness or disability might be a mitigating factor in whether to prosecute someone for assisting a suicide ‘flies in the face of the declared will of Parliament’, which has twice in the past four years rejected legalisation on assisted suicide in such cases.
Peter Saunders, the director of Care Not Killing, said:
‘The current law acts as a powerful deterrent against abuse and exploitation of vulnerable people and has been firmly upheld by Parliament.
‘Removing these safeguards could lead to increase in vulnerable and disabled people being pressured into ending their lives.’

It will be interesting to see if the British have any more sense for patients' rights than we've got here in the US. Which means basically none. Just don't, whatever you do, get arthritis!

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My Frustration at Steven Ertelt's Relentlessness.

From Steven Ertelt at LifeNews, who apparently lives in a world other than the rest of us. Yes, I get his emails every day. And yes I try to relate to the outrage at the legal service of abortion. But today, I can't give any credence to this incessant whining that removes the health needs of women - and the legal service of abortion - from a health care bill. All this desperate - and effective - desire to impose religious ideology on the entire population is really just too much for me this afternoon:

Washington, DC ( -- With the bare minimum needed, Senate Democrats voted on Saturday night to begin the official debate and amendment process for a health care reform bill that allows for massive abortion funding. The measure sponsored bySenate leader Harry Reid could fund hundreds of thousands of abortions.

The vote split entirely on party lines with 60 Democrats voting to break the Republican filibuster supported by 39 party members in the Senate.

Several Democrats who may ultimately vote against the bill supported cloture to end debate on the Motion to Proceed.

They included Sens. Ben Nelson of Nebraska and Bob Casey of Pennsylvania, the only Democrats in the Senate who call themselves pro-life and pro-abortion Sen. Kent Conrad of North Dakota, who joins then in wanting a Stupak-like amendment to ban the abortion funding.

Democrats in swing states, like Arkansas' Blanche Lincoln and Mary Landrieu of Louisiana, and independent Sen. Joe Lieberman -- each of whom could ultimately vote against the bill -- also supported cloture and the Motion to Proceed on debate. They said they hope to see the bill amended to correct some of their concerns.

But Senate Republican Leader Mitch McConnell of Kentucky said the best opportunity to change the bill is to defeat it.

"The best opportunity to change the bill would be at the beginning," he said. "Denying the majority leader the vote he needs to start the bill would have empowered any Democratic senator who is truly interested in making a change, whether the change was on abortion [or other issues] ... The time of maximum leverage would have been prior to tonight's vote."

The abortion funding comes in both the public option as well as through the affordability credits.

Americans United for Life Action president Charmaine Yoest talked with about the vote.

“Senator Reid’s bill provides for an unprecedented expansion of federally-funded abortion," she said. "The majority of Americans who oppose federal funding of abortion will not stand for policies that force them into paying for abortions under the guise of health care reform.”

She said the bill contains five major threats to pro-life principles.

The bill allows the HHS Secretary to require coverage of any and all abortions through the public option, creates new federally-funded subsidies for private health plans that cover abortion, and requires every insurance market to include a private plan that covers abortion, Yoest explained.

The Senate health care bill also fails to sufficiently protect health care entities from discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions and fails to prohibit federal funding of assisted suicide.

Yoest confirmed that the Senate bill does not contain the Stupak amendment that the House added on a lopsided bipartisan vote.

“The Reid language in the new Senate health care bill is not the Stupak-Pitts language barring federal funds from going to abortion in health care. It is the opposite of the pro-life Stupak-Pitts language," she told

The representative of the Catholic bishops has also blasted the pro-abortion provisions in the bill, saying the Senate bill "is actually the worst bill we've seen so far on the life issues."

Other leading pro-life groups like Americans United for Life, National Right to Life, the Family Research Council and Susan B. Anthony List have come to the same conclusion about the abortion funding in the Senate bill.

Richard Doerflinger, associate director of the bishops' conference Secretariat of Pro-Life Activities, called it "completely unacceptable," adding that "to say this reflects current law is ridiculous."

Senator Orrin Hatch, a Utah Republican, has said he would propose an amendment similar to the Stupak amendment, to remove the abortion funding from the legislation.

The bill has also comes under fire for raising taxes on special needs children and their families at a time when 90 percent of babies with disabilities are killed in abortion.

If anyone can tell me what the "opposite of Stupak-Pitts" actually means, I'd like to know. See, abortion of any kind - "on demand," for the life of the mother, after rape, you name it - is legal in the US. And it has been since 1973. And it's a health care service. So if Stupak-Pitts strove to prevent women from paying for their own insurance for a legal service - and all her other, personal health care services, what is the opposite of that? Wish it were religious ideology being taken off my body. But, alas, state restrictions to abortion exist, Hyde exists, moral stigma exists, and folks like Steven Ertelt and others still think its their business to punish women for having sex.

If these folks want to make abortion illegal, unobtainable, impossible for a poor woman to get - they ought to get their own bill to challenge R v W. Women's health matters.

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Looking At the Manhattan Declaration from Abroad.

From Thaindian News:

Washington, Nov. 22, (THAINDIAN NEWS) The “Manhattan Declaration: A Call To Christian Conscience” was publicly announced on Friday. The declaration has a set of appeals to a rapidly tolerant society that seems to agree to those that the Christian faith allegedly condemns. The declaration clearly states that the followers would even resort to a civil disobedience movement if required, in order to uphold the principles guide-lined in the declaration. Needless to say, the declaration came as a huge threat to the LGBT community as it denounced marriage between the same sex.

The declaration also denounced anything that hinders the normal process of life, will not be followed by the Christian institutions. By “anti-life”activities, the declaration stated euthanasia, that is touted as “assisted suicide”, abortion and “embryo destructive research.” Relationships between a man and a man or a woman and a woman or between transsexuals and bisexuals were tagged as immoral by the declaration. The declaration made it very clear that such relationships will in no way be treated as normal or as marriages. The declaration also made it pretty clear that the Catholics and the Evangelists would not refrain from preaching the ideals that they have taught so far, no matter what the state decides on such matters.

The Manhattan Declaration is a direct blow to the existing system of tolerance that seems to prevail in the atmosphere regarding same sex, transsexual and bisexual relationships. It also delivers a major punch to the fact that the states are already pushing for legal euthanasia. The leaders of the Catholic, Evangelist and the Orthodox groups supported their views by saying that these convictions are the basis of their religion and that its a necessity to follow them.

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Marker Weighs In on Swiss Revisions of Assisted Suicide Tourism.

Rita Marker, Wesley J. Smith's long-time side-kick, has got a few fears to monger about the Swiss government's recent comments regarding assisted suicide tourism there.

"Although many people think, 'Ah, the Swiss are getting with it. At least they're going to put some restrictions on,' it's not a done deal," she explains. "And in fact, there are three things going on: Two proposals to tighten up and put some restrictions on it, and the other one to force nursing homes to allow assisted suicide at the nursing homes."

Marker does not believe the Swiss are really worried about their international image.

"They're not really getting a bad rap," Marker notes. "I think people began to become aware of what they were allowing there and what was taking place there, and now they're trying to save face by putting on what they are going to call 'restrictions,' making it sound like they are tightening up the restrictions -- but really it's not really going to be that much."

It's a shite article from a religious publication that makes no bones about not reporting statistics and facts, just ideology. But watch the blogosphere and the aid in dying landscape for Marker to show up when a factless quote or two is necessary to further ignorance about a life and death issue.

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Understanding Health Care Reform Requires Compassion and A Clear Look at the Facts.

Here's a typical complaint about health care reform from A Conservative Teacher. The writer begs to understand how anyone would support health care reform, yet refuses to give credence to any supporter's views because they counter his own. Oh, and he fails to listen to the facts. If he were truly interested in understanding why others support the health care bill, don't you think he would have a comments section on his blog??

The healthcare debate frustrates me and confuses me because I simply don't understand why certain groups are supporting the drive for nationalized healthcare. The AARP is urging its dwindling members to back a proposal that will cut from Medicare, provide funds for assisted suicide and death panels, and encourage the system to start rationing healthcare. Why would the AARP support this agenda? Why are you still a member of the AARP?

AARP has lost about 60,000 members since the summer but that's a drop in the bucket when you consider their overall membership is about 38 million members and growing thanks to boomers. Sadly, those seniors who left AARP were vulnerable; the "death panel" and rationing lies scared them away from a good program. The rationing of care is a myth, so too is the funding of assisted suicide and death panels.

Where aid in dying is a legal service, yes, that legal service will be noted in literature and covered by insurance, as all legal necessary services should be. The "cuts" in Medicare and "rationing" are simply proposed regulations that will prevent insurance companies from dropping patients when they feel like it and will prevent the medical industry from continuing to over-treat, over-medicate, and over-test Americans.

Why does the UAW support the healthcare plan by the Democrats? If I'm GM or Chrysler or Ford and I have two options of paying for healthcare for my employees or shoving them on the government plan and saving all that money, I'm shoving them on the government plan. The UAW is supporting a plan that would trade the quality coverage it has already bargained for with the government plan.

Although perhaps UAW understands that the fix is in- the government plan will a better plan than whatever the UAW has, because it will be funded on the backs of taxpayers to the cost of trillions of dollars over ten years, and trillions more over the next 10 years, if the United States lasts that long as a nation with that kind of spending and debt.

The Conservative Teacher failed to catch the fact that the health care bill is budget neutral. In fact, it will save American taxpayers in the long run by creating greater competition in the system and bringing down medical prices. Currently, we're the only country that doesn't barter drug prices with big pharmaceuticals, for instance. Cutting the fat, the UAW knows, will take some of the burden off businesses, will standardize care, and will bring in those citizens on the margins who don't have care now. There's no shoving going on here.

I don't understand the debate at all- there is no money for this program, it will raise costs, it will cause millions to be dropped from current plans, it will destroy the private insurance industry and lead to a loss in all of those tax dollars that industry provides, and it has many controversial and polarizing provisions in it like money for abortions (cut out of House version but in Senate version), money for assisted suicide, money for death panels, and many other controversial provisions.

Again, The Conservative Teacher is buying the opponents' line that this will cost more. And he's got an impractical soft spot for insurance industry. Those in the public plan will pay premiums for their insurance that are much lower than standard rates. And the plan will primarily be supported by those premiums. The only polarization of abortion is contrived; the plan (without the draconian Stupak-Pitts) will maintain the same standard of funding as before, mandated by the Hyde amendment. In other words, if you want to end abortion, work at it in other ways, not via the health care plan. Get your own bill.

The way this bill is being sold is by having people each share their sob story- that's anecdotal evidence that is nice, but should not be determining whether the bill is passed or not. Senator Debbie Stabenow is running a special interest lobbying group on her official Senate webpage (is that legal?) called Health Care People's Lobby (people's lobby... paging Soviet Russia...) where she encourages people to email her their sob stories about dealing with the insurance industry. Almost 10,000 people have emailed her various stories of how they where not able to take more advantage of an insurance system and how they were not able to get someone else to pay for their health-related procedures. This is the kind of 'evidence' that is being pushed as a reason to nationalize healthcare? I just don't understand why people are falling for this garbage argument.

Oh god the Soviet accusations are so tired. If you have no bit of compassion in you, like The Conservative Teacher, you don't give two shits about the 45 million uninsured Americans, not the 25,000 who die each year because they are uninsured. If you understand how the insurance industry works, for profit, and why it exists, to cover catastrophic issues that no single person could ever pay for themselves, you will scoff his callousness as missing the "but for the grace of god" stuff.

Health care should be a basic human right. And that alone makes "this garbage argument" a sad example of how snowed some Americans are regarding health care.

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