Early signs suggest the number of suicides in the U.S. crept up during the worst recession in decades, according to a Wall Street Journal survey of states that account for about 40% of the U.S. population.
Available data, still incomplete, suggest that this recession, like past ones, coincided with an uptick in suicides. The data from 19 states find an increase in suicides in the recessionary year of 2008 from 2007. Those states historically account for about half of annual suicides in the U.S. Calls to suicide hotlines are rising. And suicides in the workplace and the military -- a small sliver all of self-inflicted deaths -- were up in 2008.
Official data on suicides in the U.S. lag, and a 2008 national tally isn't yet available. In 2007, there were 33,185 suicides, according to preliminary estimates from the U.S. Centers for Disease Control and Prevention, compared with an average of about 32,800 in the previous three years.
A Journal survey of the 33 largest states by population found 19 have data for 2008. In all, those 19 reported a total of 15,335 suicides in 2008, up about 2.3% from the previous year.
Thirteen states, accounting for 30% of the U.S. population, reported more suicides in 2008. In Florida, for instance, suicides were up 6%, in Georgia, up 2.3%, and in North Carolina, up 7.8%. In six smaller states, which account for about 9.5% of the population, the number of suicides fell.
Last week, Sarah Palin made a strange comment defending Israeli settlement construction by warning that “more and more Jewish people will be flocking to Israel in the days and weeks and months ahead.” Since worldwide Jewry is unaware of such an imminent threat that would prompt mass immigration to Israel — and certainly not immigration specific to the West Bank – that sounded like some kind of dogwhistle to Christian Zionists, a cohort that promotes unconditional American support to Israel in order to bring about the end of the world and the return of Jesus Christ to earth. Not, in other words, something particularly high on the Jewish or Israeli agendas, but Christian Zionists represent a pretty sizable bloc within the Republican coalition and could, say, help someone win a presidential nomination were someone so inclined.
Palin’s apparently eschatological comment doesn’t appear to be an accident. The Charlotte Observer reports that she’s taking dinnertime advice on Israel from the Graham family:
The former Alaska governor and 2008 GOP vice presidential candidate told Billy Graham about how she came to faith in God as a girl in Bible camp.
She quizzed him on the presidents he’s known and wanted his take on what the Bible says about Israel, Iran and Iraq, Franklin Graham reported.
The Rev. Billy Graham is a credit to this country, and has for all of his life eloquently melded evangelical Christianity with a civic-mindedness and a broadmindness that have appealed to people of all faiths and no faith. (Heapologized for an unfortunately antisemitic comment with President Nixon that was caught on tape and recently released.) Franklin Graham is a much different story. AChristian Zionist leader, Franklin has described Islam as “a very evil and wicked religion” and suggested erroneously that the Christian God and the Muslim God are two different deities. He even asked President Obama on the campaign trail if he was a Muslim. And unfortunately, Billy Graham is not long for this world, so if Palin is trying to yoke herself to the Grahams, then she’ll be palling around with Franklin more and more.
FAMILY MEMBER: She’s been fighting cancer for five years, twice. She has emphysema of the lungs real bad. It’s gotten worse, they said, since she’s been in here, and right now she is fighting a bad stroke. They are not sure, but they are saying something like it could affect her left side and maybe her brain.
BETTY ROLLIN, correspondent: Did she leave any instructions about what to do?
FAMILY MEMBER: No, she did not.
ROLLIN: And that’s a major problem, says Dr. Jeff Gordon, an internist at Grant Medical Center in Columbus, Ohio. Dr. Gordon has had dying patients who have not made their wishes known and haven’t realized that some extreme measures are almost always futile.
DR. JEFF GORDON (Grant Medical Center): Most people think, that is for elderly people especially, that heroic measures like CPR and ventilator support is really effective, and the truth is, in older people with complicated medical problems, it just doesn’t work effectively, so the bottom line is people suffer needlessly at the end of life.
Ventilator–there is a plastic tube that goes through the mouth into the windpipe, and just imagine the gagging kind of feeling. Now we give high levels of sedation to inhibit that, but that alone, now think of yourself, these people typically have to be restrained so that they don’t just reflexively reach up and pull that tube out, and so they have their arms restrained. They can’t move freely, and think of yourself being on your back restrained, just the muscle aches and pains that you would develop.
ROLLIN: Dr. Gordon points out that sometimes aggressive treatment is a good idea.
DR. GORDON: Intensive care and heroic measures are awesome when they are used in the right people. The right people typically are younger people that have a chance of survival and having a good outcome.
ROLLIN: Dr. Philip Hawley, who is director of the intensive care unit, says the state mandate is to keep life going no matter the cost, so although doctors think their patients should be allowed to die peacefully, their hands are tied by custom and law.
DR. PHILIP HAWLEY (Grant Medical Center). We have people who are terminal on aggressive life support measures. Clearly they are not going to survive. We are spending all this time and money taking care of them. They are suffering, and it’s completely inappropriate.
DR. GORDON: What people need to do is talk about this with their family, with their physician, in advance. If they get a life-threatening illness, a lot of times they won’t be able to. Maybe they won’t be coherent, or they’ll be on a life-support machine. They can’t express their wishes, then they put their family in a bind, so they feel guilty, they don’t know for sure, and then what often happens is the sort of default is, well, let’s do everything, as much as possible.
ROLLIN: And sometimes families disagree about what to do. It’s hard for some to let go, which complicates things further.
DR. HAWLEY: If we could get families to deal with this we would not have this problem. We feel we as physicians should be able to step in and say we’ve got to stop the madness.
DR. GORDON (speaking at church service): Lord, help us have perspective. That’s what changes lives. That’s what gives us hope.
ROLLIN: Dr. Gordon, who is also a nondenominational pastor, was surprised to find that patients who are religious often want more aggressive treatment at the end of life than others.
DR. GORDON: I have even encountered people that are people of faith, and they are, what I think, pursuing futile-type measures, and they say well, we are going to let God have his way here, and I try as gently as possible to say we are not really letting God have his way. We are forcing the issue here.
(speaking to patient): Has anyone talked to you about this?
PATIENT: Oh, no.
DR. GORDON: No, no. It’s a topic that doesn’t get talked about.
ROLLIN: Dr. Gordon practices what he preaches by getting patients, as well as their families, to talk about what they want at the end of life while they still can, and he tries to make both patients and families aware of realistic rates of recovery.
DR. GORDON (speaking to patient): I just want you to understand is that those kind of things like CPR and breathing machines in somebody that’s got the problems that you have are not very effective. You need to decide whether that is something you would want or not, but you need to have all the facts about it, too.
ROLLIN: One of the reasons conversations like this rarely happen between patients and physicians, says Dr. Gordon, is that physicians are paid to treat, not to talk, which is not to say that some don’t talk anyway.
DR. GORDON: The person that needs to have this conversation is the primary care physician. They are going to have to call family members, they are going to have to gather these people, and besides that it’s a very difficult conversation, and so we are underpaying them. They are going to have to make a financial sacrifice to have this discussion, and then we wonder why it’s not happening.
ROLLIN: There are three things people can do to make their end-of-life wishes clear: Sign a durable power-of-attorney naming a person to make decisions if they are unable; sign a living will which is about long-term life-sustaining treatments; and deal with the DNR question—whether if your heart stops you want to be resuscitated or not.
Jill Steuer, who has metastatic breast cancer and has been given four months to live, has decided to stop any kind of treatment and receive hospice care.
JILL STEUER, RN: I’ve been through all the chemotherapy, and there is no chemotherapy to help me anymore. I don’t want to be stuck. I don’t want to have any extra medications. I want to just go peacefully. The only medications I want are going to be the ones that are going to comfort me. That’s all I want.
ROLLIN: Jill Steuer is a nurse and researcher at Grant Hospital.
JILL STEUER: I’ve seen patients who have died horrible deaths, where their families wanted everything, the doctors wanted everything, but it was not to be, and that scared me. I’m not sure they realize that it’s okay to say “I’ve had enough.” Even now people will stop me in the hallway and they’ll say keep up the good fight, keep up the good fight, and I think some people are afraid that they are going to disappoint others if they just say let’s have nature take its course. I’m putting up a good fight, but my goal is not to live a long and painful year or two. I would much rather say at this point in time I want the next four months to be as interesting as the last 57 years have been.
For Religion & Ethics NewsWeekly, I’m Betty Rollin in Columbus, Ohio.
This just in, from AARP and the American Medical Association:
This may sound like just another press release about just another interest group, or groups, launching ads on health care reform. But it's far more important than that. No bloc of voters spooks reform advocates more than senior citizens. The polls have shown seniors to be the most suspicious of reform. And with hundreds of billions of dollars in Medicare reductions on the table, confirming those suspicions isn't too hard for the opponents of reform to do.
That's why the White House and its congressional allies have worked so hard to court AARP and AMA (and why, at the end of the day, Congress will do something about the "Sustainable Growth Rate" adjustments to Medicare payments.) Interest group endorsements aren't always as important as they might seem, but veteran political operatives I know all seem to think these two groups really do have a lot of sway over the way seniors think.* Having them vouch for reform goes a long way toward undermining the death panel talk.
*Why? I'm not sure, but it may be that older Americans are from a generation more accustomed to taking political cues from elites and organizations they know.
Labels: manhattan declaration
But I signed The Manhattan Declaration. Indeed, I am among the original signatories to that statement, released to the public at the National Press Club last Friday. Why?
There are several reasons, but they all come down to this -- I believe we are facing an inevitable and culture-determining decision on the three issues centrally identified in this statement. I also believe that we will experience a significant loss of Christian churches, denominations, and institutions in this process. There is every good reason to believe that the freedom to conduct Christian ministry according to Christian conviction is being subverted and denied before our eyes. I believe that the sanctity of human life, the integrity of marriage, and religious liberty are very much in danger at this very moment.
The bishops said Keir Starmer, director of public prosecutions, was creating categories of people whose lives would be legally considered less worthy of protection than other members of society.
They said his "interim policy for prosecutors" in cases of assisted suicide stigmatized the disabled, the terminally ill, the depressed and the aged and "could encourage criminal behavior" by sending the message that it was acceptable to help such people to kill themselves. They made their remarks in a submission to a public consultation on a clarification of Britain's assisted suicide law.
They criticized Starmer, head of the Crown Prosecution Service -- the organization that decides if criminal charges are to proceed to trial -- for exceeding his powers by ignoring the will of Parliament, which has twice in 18 months rejected attempts to change the law on assisted suicide and euthanasia.
We have become a culture that tells the elderly, people with disabilities, and others who need care and support that they are “burdens.” Indeed, in my recent debate in Edinburgh with Dr. Libby Wilson, my opponent explicitly supported legalizing assisted suicide so that the ill and disabledcould give their families the “gift” of not being a burden.This is why I think that the assisted suicide/euthanasia agenda is a culture-changing issue that will–if it succeeds–radically and adversely transform the way we interrelate as members of society and as family members. And when you read about murder/suicides motivated by the “burden” fear, it really raises the alarm. From the story:An elderly husband killed his poorly wife then committed suicide because he feared she would outlive him and become a ‘burden’ on their family. When Eileen Martin, 76, developed dementia, her husband of more than 50 years, Kenneth, cared for her at their home. But when he developed cancer he vowed not to leave his sick wife behind for the family to care for. Kenneth Martin and his wife Eileen. He hanged himself after killing her He warned his children: ‘I won’t leave you with the burden of your mother. When it’s my time to go, it’ll be her time to go.’The message that it is worse to be a burden than dead is being broadcast and received–and stories like this tragedy, I believe, are a direct consequence. It’s a very scary time to be old, disabled, or needing care.
Here’s another example of intolerance of medical conscience: In the waning days of the Bush Administration, the Department of Health and Human Services issued a rule preventing employment discrimination against medical professionals who refuse to perform a medical service because it violates their religious or moral beliefs. Based on the decibel level of the opposition, one would have thought thatRoe v. Wade had been overturned. “That meddlesome regulation encouraging healthcare workers to obstruct needed treatment considered offensive,” Barbara Coombs Lee, the head of Compassion and Choices, railed on her blog, “allows ideologues in health care to place their own dogmatic beliefs above all.” Protecting the consciences of dissenting medical professions is “dangerous,” she wrote, because “it’s like a big doggy treat for healthcare bulldogs who would love to sink their teeth into other people’s healthcare decisions.”
It wasn’t just overt true believers like Lee. Even before the final rule was published in the Federal Register, Hillary Clinton and Patty Murray introduced a bill to prevent the rule from going into effect. Immediately following its promulgation, Connecticut—joined by California, Illinois, Massachusetts, New Jersey, Oregon, and Rhode Island, and supported by the ACLU—filed suit to enjoin the regulation from being enforced. One of the Obama administration’s first public acts was to file in theFederal Register a notice of its intent to rescind the Bush conscience regulation.
Newspaper editorial pages throughout the nation exploded, opening another front against the rule. The New York Times called it an “awful regulation” and a “parting gift to the far right.” The St. Louis Post- Dispatch went so far as to state: “Doctors, nurses, and pharmacists choose professions that put patients’ rights first. If they foresee that priority becoming problematic for them, they should choose another profession.” In other words, physicians and other medical professionals who want to adhere to the traditional Hippocratic ethic should be persona non grata in medicine—an astonishing assertion.
Society is approaching a crucial crossroads. It seems clear that the drive to include death-inducing techniques as legal and legitimate methods of medical care will only accelerate in the coming years. If doctors and other medical professionals are forced to participate in these new approaches or get out of health care, it will mark the end of the principles contained in the Hippocratic Oath as viable ethical protections for both patients and medical professionals.
In other words, it is a conscience clause protecting medical professionals who don’t commit assisted suicide. There is no prohibition on promoting it or having it paid for under the plan.Why need a conscience clause? Get this clause under the section 1323 of the bill creating the public option (p. 183), beginning at page186:(F) PROTECTING ACCESS TO END OF LIFE CARE.—A community health insurance option offered under this section shall be prohibited from limiting access to end of life care.If assisted suicide, or even euthanasia, are legally considered forms of “end of life care” in a particular state–as it is now in Oregon, Washington, and Montana–it seems to me that the area’s community health insurance option would be required to provide “access” to it under this clause. How else can the provision be read? And because it would have been passed later in time, this clause could be construed to subsume existing federal law that prevents federal funds from being used in assisted suicide.None of this is by accident. The next question becomes: Why might that be?
A car crash victim diagnosed as being in a coma for the past 23 years has been conscious the whole time.
Rom Houben was paralysed but had no way of letting doctors know that he could hear every word they were saying.
'I dreamed myself away,' said Mr Houben, now 46, who doctors thought was in a persistent vegatative state.
He added: 'I screamed, but there was nothing to hear.'
Mr Houben described the moment as 'my second birth'. Therapy has since allowed him to tap out messages on a computer screen.
Mr Houben said: 'All that time I just literally dreamed of a better life. Frustration is too small a word to describe what I felt.'
His case has only just been revealed in a scientific paper released by the man who 'saved' him, top neurological expert Dr Steven Laureys.
'Medical advances caught up with him,' said Dr Laureys, who believes there may be many similar cases of false comas around the world.
The disclosure will also renew the right-to-die debate over whether people in comas are truly unconscious.
Mr Houben, a former martial arts enthusiast, was paralysed in 1983.
Doctors in Zolder, Belgium, used the internationally accepted Glasgow Coma Scale to assess his eye, verbal and motor responses. But each time he was graded incorrectly.
Only a re-evaluation of his case at the University of Liege discovered that he had lost control of his body but was still fully aware of what was happening.
He is never likely to leave hospital, but as well as his computer he now has a special device above his bed which lets him read books while lying down.
Mr Houben said: 'I shall never forget the day when they discovered what was truly wrong with me - it was my second birth.
'I want to read, talk with my friends via the computer and enjoy my life now that people know I am not dead.'
Dr Laureys's new study claims that patients classed as in a vegetative state are often misdiagnosed.
'Anyone who bears the stamp of "unconscious" just one time hardly ever gets rid of it again,' he said.
The doctor, who leads the Coma Science Group and Department of Neurology at Liege University Hospital, found Mr Houben's brain was still working by using state-of-the-art imaging.
He plans to use the case to highlight what he considers may be similar examples around the world.
Dr Laureys said: 'In Germany alone each year some 100,000 people suffer from severe traumatic brain injury.
'About 20,000 are followed by a coma of three weeks or longer. Some of them die, others regain health.
'But an estimated 3,000 to 5,000 people a year remain trapped in an intermediate stage - they go on living without ever coming back again.'
Supporters of euthanasia and assisted suicide argue that people who have lain in persistent vegetative states for years should be given the opportunity to have crucial medical support withdrawn because of the 'indignity' of their condition.
But there have been several cases in which people judged to be in vegetative states or deep comas have recovered.
Two things here: We have the technology now to determine the brain activity of patients in unconscious states. A few miraculous cases, however, don't represent the nature of all cases. The argument presented after the presentation of a case like this is, "See! Miracles happen." I would argue that a science-based and fact-based approach to treatment of "unconscious," persistent vegetative state, "coma" patients. Let's continue the technological advancements that teach us more about these patients.
But let's use science and fact - what has revealed Mr. Houben's fortunate state - and not vilify families that have the most difficult decisions to make when their loved ones fall into unconscious states after terrible trauma. Without patient directives, family members and doctors are put into the most emotionally difficult situations. False hope is a tragedy. Miracles are wonderful and very, very rare.
As well, it is important to remember what the Death with Dignity bills say, only because many "pro-life" advocates tend to confuse removal from artificial life support with aid in dying. Death with Dignity is a dying patient determining, under strict regulation and doctor consultation, how they die.
I am overjoyed for Mr. Houben and his family. But one miracle does not a prognosis make. False hope and futile care should be countered by fact-based, science-based decision-making. For the sake of the patient and their family.
Update: That didn't take long. Terri Schiavo was killed and Mr. Houben's case proves it.