Friday, November 27, 2009

Organ Donation and the Black Community.

I was at the most luscious Thanksgiving dinner last eve with some wonderful friends, old and new. At one point I was talking about my two book projects: a book about death in America; and a literary memoir about death grief and travel. Regarding the first, which I've only begun - and begun discussing - I received a comment I didn't expect from an African American lawyer in our company: the black community has long been wary of organ snatching from otherwise viable patients.

Wesley J. Smith, that font of pseudo-ethical "pro-life" banter, has been harping on the invasion of the organ snatchers for some time regarding end of life care and aid in dying. I've always poo-poohed it as hokum. Turns out the issue has legs, or shall I say guts, depending on who you're talking to. (I never cease to be amazed by the fears my white privilege has shielded me from!)

Today I've dug up a couple of interesting facts and studies regarding blacks and minorities and their views of medicine and organ donation. It seems that Smith, the evil genius, may have found yet another thread of fear in society on which to prey.

Here are some spooky myths, debunked by the Life Goes On Organ and Tissue Donation group in Illinois:

Myths About Organ Donation

MYTH: If I am in an accident and the hospital knows that I want to be a donor, the doctors will let me die.

FACT: Donation is not considered until all efforts to save a person have failed. Additionally, transplant surgeons and their staff are, by law, forbidden from taking part in a patient's care prior to organ donation. They only become involved after the person is declared dead and permission has been given by the family for organ donation.

MYTH: Whites are helped more than blacks.

FACT: Absolutely not. In fact, nine out of ten African-Americans who undergo organ transplant surgery receive an organ from a Caucasian donor. In addition, a computer system fairly matches organs with recipients' based on the recipients' time on an organ waiting list, the severity of the recipients' condition, blood type, size of the donated organ and, in some cases, the donor's genetic make-up.

MYTH: Wealthy and famous people are able to buy their way to a higher spot on waiting lists. Take Mickey Mantle for example. A match was found for him within days of being put on the waiting list.

FACT: Anyone who needs an organ transplant is eligible for one, but you cannot buy a higher spot on waiting lists. Mickey Mantle got his transplant so quickly because his blood type was the most common and because he was among the sickest patients waiting in his area.

MYTH: As African-American organ donors, our organs will go to white folks and never other African-Americans.

FACT: If you donate an organ, such as a kidney, for which genetic make-up is a critical factor in transplantation, then it is probable, though not guaranteed, that your organ will go to another African-American. In addition, African-Americans make up 36 percent of those on organ waiting lists in Illinois. Therefore, even if you don't donate an organ that needs to be genetically matched, the recipient may still be an African-American.

MYTH: African-American organ donors aren't necessarily needed.

FACT: African-Americans make up 36 percent of those on waiting lists in Illinois. Everyone on the waiting lists can benefit from more organ donors. However, African-Americans on waiting lists for kidneys will most likely benefit from African-American donors, because transplantation often is enhanced by matching organs between members of the same ethnic and racial groups.

In our recent survey, we found that white persons were significantly more likely than African- American persons to be unequivocally willing to donate their own organs (69.7% compared with 56.3%) and a relative’s organs (43.5% compared with 33.9%). To a surprising degree, this difference reflected concerns of African-American persons about knowing a relative’s wishes before agreeing to donation. Fully 36.3% of African-American persons would agree to donate a relative’s organs if they knew the relative’s wishes beforehand. In fact, if we combine those persons who would be willing to donate unequivocally with those who would do so if that were their family member’s wish, we find that the differences between white and African-American respondents nearly disappear; 73.7% of white re- spondents and 70.2% of African-American respon- dents would donate. Finally, this study found that African-American persons were less likely than white persons to have discussed their wishes about donation with their families (42.4% compared with 58.2%). This may partly explain lower rates of con- sent to donation by African-American families (Siminoff LA. African American perspectives on or- gan donation [Presented paper]. Fourth Interna- tional Society for Organ Donation Congress. 11 July 1997; Washington, DC). The current campaign to encourage persons to talk with their families about organ donation will probably be especially effective.

Or not, depending on the nature of the campaign.

Third, we believe that the negative opinions of African-American persons about cadaveric organ donation reflect a deeper distrust of the medical system. These perceptions are not directed specifi- cally at organ donation and transplantation; rather, they must be seen as part of the distrust that de- velops among persons who have been subjected to institutionalized racism and to a system that may unconsciously continue to reify the racism of the larger society—for example, the African-American experience as medical subjects in the antebellum South and in the Tuskegee Syphilis Study and as victims of exploitation after the Civil War. More- over, a growing number of recent studies have shown that African-American persons are still less likely to receive the full benefits of the health care system (16).

From another study in 2007:

Having been skeptical about organ donation in the past, I was riveted by the original communica- tion entitled “Many Facets of Reluctance: African Americans and the Decision (Not) to Donate Organs.”1 The study participants were 310 adult members of a New Jersey chapter of the NAACP. The results suggested that a decreased knowledge base about lung trans- plantation, a desire to maintain the integrity of the body, lack of trust of the medical community, and spiri- tuality all played a role in the deci- sion to donate organs.

And from the Mayo Clinic regarding the lack of matching donated organs among minority groups:

Being an organ donor can make a big difference, and not just to one person. By donating your organs after you die, you can save or improve as many as 50 lives. And many families who have lost a loved one who became an organ donor say that knowing their loved one helped save other lives helps them cope with their loss.

It's especially important to consider becoming an organ donor if you belong to an ethnic minority. Minorities including African-Americans, Asians and Pacific Islanders, Native Americans and Hispanics are more likely than whites to have certain chronic conditions that affect the kidney, heart, lung, pancreas and liver. Certain blood types are more prevalent in ethnic minority populations. Because matching blood type is necessary for transplants, the need for minority donor organs is especially high.

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Remonstrance of the Catholic Right.

Frank Cocozzelli at about the Catholic Right taking over the church:

Meanwhile, those of us who are uneasy about reactionary trends in the Church have yet to coalesce. There are those who do bravely speak up. But I believe that there are many more who remain silent not as much out of a sense of fear of retribution but more out of a sense of no support.

While many are tempted to just walk away, I say that doing so only empowers the reactionaries of the Catholic Right. It is exactly what they want. In fact, it is their plan for conquest throughschism. They want those of us who embrace religious pluralism in society and liberalization within the Church to leave a global religion, with its well-organized hierarchy and diplomatic nation-state status, and massive resources, property and prestige -- solely in their hands.

I say that now is the time for rank-and-file Catholic to revive the idea of remonstrance, and draw on the wisdom of James Madison, who provides us with timeless tools with which to understand and to combat theocratic wannabes. In this way, we can disrupt the disrupters, not rudely or condescendingly but with dignity and firmness.

Our remonstrance can help us confront clergy who use the pulpit as a vehicle to seek to restrict the rights and the freedom of conscience of others. Our remonstrance can remind the media that the dogmatically orthodox do not speak for Catholics, or for Catholicism, but for themselves. And our remonstrance can remind our elected officials that their allegiance is to safeguard the religious liberty of all from an increasingly out of touch Church hierarchy.

And our remonstrance is just the beginning.

Now is the time for bold action. Surrender or grudging compliance is unacceptable. Resistance in the form of a loyal thoughtfulness that seeks reform, not overthrow, is the only acceptable course of action. Arrogance and intolerance are our opponents' way, not ours'. But all the same, it is bold action that will give our remonstrance collective strength.

Our bold action will strengthen the hand of our allies within the hierarchy and hearten those clergy who are waiting to speak out for the Church we believe in. We will rebuke the reactionaries. Some of us may pay a price for our actions. But sometimes such prices must be paid in order to achieve progress.

There will be those who read this and accuse me of being ant-Catholic. But nothing can be further from the truth. I am a Catholic who desires a vibrant Church, one that exemplifies the tolerant, dissenting, and inquisitive nature of its Founder. I understand that a Catholicism that uses oppression via secular government to enforce its dogmas is itself insecure in its own position. And I know that when any one set of religious beliefs become dominant over others then the free practice of all faiths is also threatened.

That is why I am calling for remonstrance - now!

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Charitable Chocolate.

Say what you will about Hershey's Chocolate (or, from me, chocolate in general, ick) but old Milton, a Reformed Mennonite, knew what he was doing in some ways.

He didn't just form a company, he formed an community with hospitals, tree-lined streets, entertainment and schools. One could say his charitable faith informed his charitable work. The fact that he made his fate in Lancaster County, my home, does make me a little impartial, even if I refuse to eat the stuff.

Now it looks like the Hershey's Chocolate company is thinking of leveraging the charitable trust Milton formed in 1909 to give to the community in order to buy Cadbury.


Wait, Wait, Wait, "Euthanasia" is Not an Ideology.

From FamilyLifeNZ comes this rant of illogic:

Well, because our culture has fallen into a philosophical trap which completely confuses and rejects the great, and inalienable dignity and worth of the human person, and instead embraces the idea that your life only has worth if it meets a certain set of criteria – all of which are totally arbitrary.

So, according to this pernicious little ideology, if you’re seventeen and you’re relatively disease and disability free, then your life has great worth and it is too valuable for suicide.

But if you’re elderly, or disabled or sick, then your life all of a sudden has very little worth and suicide is the best thing you could do with your relatively valueless existence.

Sure, a sixty five year old person, or a person with a terminal illness is probably not going to live as long as a sixteen year old, and a disabled or elderly person can’t surf the break at Raglan, climb Mount Cook or compete in Dancing with the Stars, but so what?

Their life is no less valuable or less worthy of life than yours or mine, yet sadly, this is exactly the evil and false distinction that all pro-euthanasia ideologies proclaim.

Not only that, but at the heart of the pro-euthanasia ideology is a confused view of personal autonomy which believes that every human being should have the right to exercise total freedom and choice about how and when their life will come to an end.

Society has long deemed some members more worthy of protection than others. We're all aware of the "get the women and children out" approach to warfare and harms way. Of course, different values are placed on various societal constituents. But I would contend that women and children are also the last to be able to speak for themselves. In efforts to "protect" these segments of society (and the elderly and ill) we have assumed that "vulnerability" allows other bodies to speak for them, like government or the church or the medical profession.

What the writer is contesting is the lack of equal valuation of a 16 year old child - and I won't get into the cases she is referring to - and a 60 year old senior. She proposes that society is willing to speak for one and not the other. Yet, I contest that she is actually arguing for particular ideological groups to speak for the "vulnerable," and making the assumption that some are not able to speak for themselves. If compassion means paternalization, you can count me out.

And as for "euthanasia" being an ideology? Not a chance. The term is used by opponents of choice in death to conflate government-encouraged killing with patients' rights. Of course the former is sinister and the best way to silence the latter is to conflate the two. Those who fight for patients' rights don't care a fig about speaking for the discriminated segments of society, they want those who make up those segments to speak for themselves. That's not a system of philosophy which derives ideas exclusively from sensation; that's just human rights.

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Character of the Anabaptist Faith.

Not Just Movies uses a review of Carlos Reygadas movie Silent Light (my review for KillingtheBuddha can be read here) to ask if Anabaptist character directly reflects centuries of persecution:

(It should be noted, however, that the community does not seem concerned with condemning Johan for his actions. The Anabaptists were heavily dogmatic but also largely peaceful, but they also suffered horribly at the hands of both Catholics and Protestants. I wonder, then, if the persecution and atrocity they suffered in some way instilled an instinctive lack of judgment in its descendants. Their acceptance of Johan's feelings does not, however, lessen the tension of his wracked conscience.)


We Own The Poor and Infirm: They are Most Susceptible to Our Beliefs.

Because Catholic and other churches have long claimed represent and care for the "least of these," westernized governments around the world have allowed them to speak for the mentally ill, the poor, and minorities. It's old turf for religion to claim compassion in the face of infirmity.

From The Catholic Herald, a bishop addresses the British government's necessary review of the existing suicide laws to comply with the summer's decision in the Debbie Purdy case, asserting that the church knows what's best for the suffering:

They said Keir Starmer, the Director of Public Prosecutions (DPP), was creating categories of people whose lives would be legally considered less worthy of protection than those of others in society.

The bishops said his interim policy for prosecutors in cases of assisted suicide stigmatised the disabled and the mentally and terminally ill and could send out the message that it was acceptable to help such people to kill themselves.

Mr Starmer was exceeding his powers by ignoring the will of Parliament, they said, which has rejected two attempts in the last 18 months to change the law on assisted suicide and euthanasia.

"A sick or disabled person's life should merit the same degree of protection by law," said the bishops in a submission to the public consultation into the draft proposals, which they made public on Friday last week.

But often these religious bodies are not working to raise up the poor, ill, and infirm to be equal members of society. They are counting on them to be forced, by need, to comply with church doctrine, to become believers. Suffering has long been the door through which faith walks. Fox holes, hospital beds, and gutters have long been better than pulpits for winning hearts to God. Find a man who's hungry and you find a desperate soul willing to barter his faith for bread. Find an ill child and you get a believer in gratitude for healing medication.

For example, take the Christianization of Africa during and after colonialism. US and European churches sent millions of missionaries to the continent who offered westernized medicine, materials, food, and support in exchange for belief in God, capitalizing on those with nothing to lose to expand church influence and membership. Giant swaths of the continent were paternalized by the church. And the local governments were not about to stop the influx of aid, often because it came with hefty pay-outs and protection of rulership.

To me this is the great lie of missionary work, both here and abroad. After all, the same case is made again and again these past weeks in the US and Britain regarding Catholic hospitals and the so-called conscience clause and end of life choice. While studies show that these entities do no more charity work than other non-profit or public hospitals, they have long claimed to speak for the least of society. Want to stop provider refusal of services at Catholic hospitals and we will pull out of health care, they say. We are the church and we don't compromise for patients' rights.

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Killers All.

I come across a lot of this type of rhetoric:

Surprisingly, media accounts of the story have been quiet about the people who must have been pushing to have Houben put down over the past 23 years. Will these recent findings open the debate over ending the lives of people like Houben and Terry Schiavo?

It should, but don't count on it. Most of the extremists ardently pushing for euthanasia want one thing: to open the door a crack, just as they got a foot in the door on abortion to eventually turn the practice into a revolving door.

The legalization of abuses like euthanasia and abortion always starts with the hard cases. With abortion it began with instances of women's lives supposedly in danger. Then exceptions for mental health came along, then rape and incest, and now we're at the point where a Canadian MP was labelled an "extremist" in Parliament this week for supporting time limitations on abortion.

The assertion is repeatedly made that if one supports choice in dying and abortion rights (sadly, often conflated to mean other reproductive rights like contraception, sterilization, and AIDS and STD prevention counseling), one wishes to unleash a "culture of death" on innocent beings.

This demonization of others who believe in personal autonomy and patients' rights helps accusers to reduce the argument to a black or white thing. As well, it eliminates compassion for those who are suffering from the argument. As the rhetoric would have it, life is hard and if you don't believe in my God, well then, you should suffer for your immoral ways. Any expression of need outside the ordained realm of "Christian" care is vilified as aggression, and more importantly, as oppression of those imposing strictures. Personal autonomy becomes an affront to Christian society, an evil that the government is then colluded into stymying.

Hence, the preponderance of claims for the first amendment protections. Yet, freedom of religion means more than the reverence of one faith. Or the imposition of that faith, via government funded social services, on others who enjoy different beliefs. The more I study health care and provider restrictions on patients' rights, I find that the first amendment is being used by a powerful, vocal minority to subjugate an entire society. That's not freedom. That's plain discrimination at the hands of a government meant to protect all of our rights.

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Justifying the Cherry Picking of a "Pro-Life" Stance.

From American Catholic, apparently the church is justified in deciding what lives are worth living, regardless of how arbitrary those decisions may be:

Ed Stoddard of Reuters’ religion blog Faithworld carries a roundup of the skirmish between Congressman Patrick Kennedy, the son of the late Senator Edward Kennedy, has claimed that Rhode Island Bishop Thomas Tobin.

In conclusion, Stoddard asks:

This leads to a question about the consistency of views in the U.S. Catholic Church leadership. The Church opposes abortion and therefore liberal politicians who support abortion rights risk being refused communion. The Church supports a healthcare overhaul that would make the system more equitable. So does a conservative Catholic politician who opposes this reform risk being denied communion for ignoring the Catholic social teaching that justifies it?

How about support for capital punishment, which the Vatican says is unjustified in almost all possible cases, or for war? In the build-up to the Iraq war, Pope John Paul was so opposed to the plan that he sent a personal envoy to Washington to argue against it. Did bishops threaten any measures against Catholic politicians who energetically supported that war despite Vatican opposition?

The author’s questions reveal an elementary ignorance concerning the moral issues in question and their relationship to varying levels of Church teaching. While I am disappointed by his answer (Faithworld is generally one of the better and more educational “religion blogs” in the secular media), it is understandable — as even many Catholics find themselves confused on this matter.

The basic difference between abortion and capital punishment (or the waging of armed force) is that the Church has firmly and explicitly taught that the former is an intrinsic evil: the direct taking of innocent human life to be opposed everywhere and at all times, while the moral worth of the latter two measures are contingent upon specific criteria and circumstance.

In the case of capital punishment, see the Catechism of the Catholic Church’s discussion of the fifth commandment, specifically the matter of “legitimate defense” (sections #2263-2267); on the matter of the waging of armed force, the Catholic tradition’s criteria for a “just war” (sections#2307-2317).

But is it not true that the Church has explicitly opposed contemporary instances of capital punishment or war? — If so, why have the Bishops not sought to impose similar restrictions on communion on those officials in public life favoring the use of capital punishment, or expressing their support of U.S. foreign policy in Iraq — a conflict on which both Pope John Paul II and even our present Pope (then-Cardinal Ratzinger) made their opposition known? Aren’t such figures not in open dissent and in a state of obstinate sin against the Church as well?

It seems to me that the response lies in the following teaching of theCatechism on the delineation of responsibility:

With regards to the determination of moral criteria, the Catechism maintains “The evaluation of these conditions for moral legitimacy belongs to the prudential judgment of those who have responsibility for the common good.”

As to the nature of “prudential judgment”, Russell Shaw — himself a vehement critic and opponent of the Iraq War — provided the following explanation in “Iraq, Weigel and the Pope” (Catholic Exchange. March 31, 2003 — defending the ‘Catholic neocons’ legitimate right to disagree with John Paul II):

The notion of prudential judgment may need explaining. “Prudential” refers to prudence, and prudence these days has a bad name with people for whom it signifies lack of courage and failure of nerve. In the tradition, however, prudence is one of the cardinal virtues upon which other virtues depend. The function of prudence in this sense is to keep us in touch with morally relevant facts.

Given the limits of human knowledge, even prudential judgments by prudent people can be mistaken. In the present instance, the pope and Catholics who differed with him — conscientious and informed people like Novak, Weigel and Hudson — based their stands on an assessment of likely consequences of different courses of action. Since the assessments of what was more or less likely to happen in the future were different, so were the conclusions about what course of action to take.

To disagree with the pope in this manner is not dissent. It’s not as if Pope John Paul II had taught a definitive moral principle (e.g., direct attacks on noncombatants are ruled out) which the disagreeing Catholics rejected. They agreed with the principle. They disagreed about something contingent and by no means certain: what the future outcome of complex, competing scenarios was likely to be.

I believe that such an exercise of prudential judgment could equally be made in the exercise of capital punishment — where, for example, aCatholic public prosecutor might be compelled to respectfully disagree with a bishop in judgment of the means required in legitimate defense of society.

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The Washington Independent Profiles Randall Terry.

Read the entire article here.

The man who personified the anti-abortion rights movement of the 1980s and 1990s loves to kid around. It disarms reporters, and it wins over the activists who use the lower level of Terry’s home as the base for Operation Rescue-Insurrecta Nex. (In Latin, it roughly means “Insurrection Until Death.”) In May, People for the American Way released video of Terry closing a press conference on the murdered abortionist George Tiller — Tiller “reaped what he sowed,” said Terry. In response, Terry convened a new press conference where he served Guinness and chicken wings.

For several years, especially after Terry served as the spokesman for the parents of the late Terri Schiavo in 2005, his personality and his antics, as well as hisfinancial and legal decisions, led him to be ostracized from the movement. That’s fine by him — he’s suing the current leadership of Operation Rescue, his original organization, and without much prompting he’ll call leaders of groups like Americans United for Life “a bunch of harlots.” While they deride him or distance themselves from him, Terry is capitalizing on the conservative uprising against President Obama and congressional Democrats. When cameras show up to cover a Tea Party or a health care protest, Terry and his activists are there. If reporters pretend his protests don’t exist, Terry’s small staff churn out their own video and post it on YouTube.

“I think there is a certain element of the media that does not want us to be seen,” said Terry. According to him, the current and unexpected political trouble that pro-abortion rights activists have found themselves in — chiefly the Stupak Amendment that prohibits abortion funding in a public health care plan — is the result of ostentatious and unyielding pressure from activists like him. The newfound political role of Catholic bishops? That’s their attempt to undo the damage they did themselves by not opposing Barack Obama in 2008. “We’re not here for a place at the table. We’re here to take the table and smash it, turn it into firewood.”

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What Does It Mean to Have One Ideology Dictate Medical Services?

Currently 20% of patients in the US seek services from Catholic hospitals which operate according to Ethical and Religious Directives, designed and dictated by the USCCB and the Vatican.

As a society, we must ask ourselves what it means for the future of humane health care if one fifth of society's needs are dictated by one ideology.

From the Catholic Register, a quote from Margaret Somerville, whom I posted about recently, regarding training of "pro-life" doctors:

Canadian Physicians for Life hosted its sixth annual medical students forum in Calgary Nov. 20-22 to discuss abortion, euthanasia, conscience rights and medical pro-life clubs.

The lineup of speakers and workshop leaders — chosen to help equip pro-life medical students with knowledge and confidence on emerging issues of concern — was to include Margaret Somerville, professor of law and medicine at McGill University and founding director of McGill’s Centre for Medicine, Ethics and Law. She planned to speak to students about euthanasia and the topic of human dignity.

“The medical students are going to be the ones to make the decisions in the future, aren’t they, so it’s very important for them to understand what they’re dealing with,” she told The Catholic Register.

Somerville said many doctors in Quebec who responded to a survey about whether or not euthanasia was wrong do not understand what it is. Many indicated that euthanasia was synonymous with palliative sedation and adequate pain relief.

“The public is being lulled into the idea that all doctors think it’s OK but of course if you think it’s just palliative sedation or pain relief when it’s needed then of course you don’t think it’s a problem,” she said. “What we should be talking about is doctors being allowed to kill their patients.”

As a professor, she said, the idea of having to stand up in front of medical school students to teach them how to properly kill their patients is horrendous.

“I mean, if you’re going to do it, you’ve got to teach them to do it competently,” she said, citing an example in the Netherlands where a patient who survived a lethal injection then sued his doctor for malpractice. In the Netherlands, doctors can administer lethal injections to patients who are depressed and wish to die.

Somerville was also scheduled to give a talk about human dignity, a concept people on both sides of the euthanasia debate use to back up their ideas.

“The pro-euthanasia concept is that a person loses their dignity when they’re in a certain state and so dignity is restored by putting you out of that state. Whereas the anti-euthanasia argument is that all humans have dignity because we’re human and the respect for that dignity and to kill you is a failure to respect your dignity.”

Will Johnston, president of Canadian Physicians for Life and a family physician in Vancouver, said the medical students’ conference is the most important thing Canadian Physicians for Life does as an organization.

“This is the most important thing, which is to educate and support medical pro-life students so they can carry on the presence of a strong life ethic within the medical profession which is so easily hijacked by an amoral technocratic mindset.”

One of the presentations will revolve around how to create medical pro-life groups on campus. Johnston said these are very important because they allow students to have the direct support of colleagues.

“Non-medical pro-life groups are not in the course of their work going to be directly faced with being implicated in an abortion or picking up the pieces after an abortion or being criticized for not sending someone for an abortion and so forth,” he said. “It’s good for medical students to have a clear identity as making themselves distinct from the establishment position on abortion which is an unquestioning position

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Schindler, Brother of Terri Schiavo, Reacts to Houben Case.

This isn't the first time we've heard this or we've read that something like this has happened where someone has emerged from what doctors were saying...was a persistent vegetative state, and I think it illustrates why we need to stop dehydrating to death these people who are labeled in this highly subjective diagnosis," Schindler contends.

Doctors confirm that patients classified as being in a vegetative state are often misdiagnosed, and that "unconsciousness" stamp is one which patients rarely escape. This confirmation leaves one to wonder, says Schindler, if many people who have died in a "vegetative state" were misdiagnosed.

"There's no way of telling," Schindler notes. "But don't take my word for it about the inaccuracy of this PVS diagnosis. All you need to do is to look at some recent research that has been done where they have been finding that the Persistent Vegetative State diagnosis is misdiagnosed upwards of 50 percent of the time."

He says it is especially shocking because this diagnosis was used for euthanasia advocates to obtain the court order that killed his sister, Terri Schindler Schiavo, by removing her feeding and hydration tubes in March 2005.

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