Tuesday, December 29, 2009

Palliative Sedation: Resources.

Thanks to Saturday's New York Times article on palliative sedation by Anemona Hartocollis, there's a buzz in the blogs about the practice. I thought I'd link you to some additional sources so you could get your head around the issue from various angles:

Last-Resort Options for Palliative Sedation, Annals of Internal Medicine (September), Timothy Quill et. al., scroll for responses

Palliative Care Textbooks Come Of Age, Annals of Internal Medicine (1998), Timothy Quill, et. al., summary of the burgeoning practice of palliative training

What is Palliative Sedation? An info/resources page at the Journal of the American Medical Association

Wesley J. Smith tries to paint a bold, bright line between palliative sedation and aid in dying at lifenews.com

Definition, guidelines, and resources at the American Academy of Hospice and Palliative Medicine

A 2008 article from American Medical News with definitions and guidelines

Howard Friend's blog post about how he participated in a death panel and maybe an assisted suicide.

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Larry Elder Says the Poor, Uninsured Are On Their Own - 'Cause they Deserve To Be "Free."

More "health care is a privilege" and "let the paternalistically generous tend to the poor if they're so inclined" rubbish from Larry Elder at the unfortunately conservative and dated Orange County Register. With a couple of straw mans (liberals, FDR) and a heap of myths (Americans are the most generous people on earth) Elder sweeps the poor under the rug, unwilling to recognize that our glorious "free markets" have put them there and those of us who have are ruthless enough to keep them there.

This sort of ridiculous and circular logic takes all privilege out of the conversation and substitutes false ideas of freedom in its stead. Elder might as well have written "let them eat cake." So much for compassionate conservatism, huh? How this sort of shit even gets printed is beyond me. For all the damage and hatred Elder spews, I'd love nothing more than to see him run out of print - to some place like Somalia where there is no government and he can have all the glorious "freedom" he wants. Ungrateful, illogical, fabricated, discriminatory, elitist rubbish. If one asked him the question of why the poor (and more pertinent, how the uninsured) got that way, would he throw his hands in the air and said they're lazy and deserve to die without insurance? Hmmm:

This is not hypothetical. During the Great Depression, the Supreme Court struck down much of President Franklin D. Roosevelt's New Deal on constitutional grounds. No, said the Court, the federal governmentcannot use the Constitution's commerce clause to regulate virtually all economic activity. No, said the Court, the federal government cannot use the welfare clause to redistribute wealth, whether or not it accomplishes a socially or economically desirable objective.

The Court asserted that the Constitution meant what it said and said what it meant. This infuriated FDR. He threatened to expand the number of Court justices, adding jurists who saw the Constitution the way he did until he got the kind of decisions he wanted. Intimidated, the Court blinked. Actions by the federal government that the Court once had deemed illegal suddenly became permissible.

A liberal once asked me: "What should society do about the poor? Is your attitude 'just (expletive) them'?" I said: "Allow me to rephrase your question. Because of someone's plight, is he entitled to money from you?" "No," he said, "but it's the right thing to do." Yes, a moral, compassionate society cares for those who cannot care for themselves. This is, however, an entirely different matter from using the power of government to take from someone who has, to give to someone who doesn't. The Constitution does not provide that authority. Nor has it been amended to do so.

What about the poor? Through economic freedom and competition, we make goods and services cheaper, better and more accessible. Health care is less affordable because of well-intentioned rules and regulations. When government officials go beyond passing laws to protect us against force or fraud, they raise costs and hurt the poor.

Finally, what of charity? Americans are the most generous people on earth. The religious and those who believe in limited government are the most generous of all. By design, the federal government plays a limited role. The rest is up to us. Our country was founded in opposition to tyranny by government.

Today we submit to it.

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Disability on the Rise Among Elderly for First Time in 20 Years.

Healthfinder.gov, the site of US Health and Human Services reports that disability among seniors is on the rise for the first time in 20 years, increasing by 9 percent between 2000 and 2005:

The disability rate among U.S. senior citizens is on the rise, a surprise considering the rate had been falling since the 1980s, new research has found.

"People are living longer, but many are also living sicker," study co-author Amani Nuru-Jeter, an assistant professor of community health and human development at the University of California Berkeley School of Public Health, said in a university news release. "This study is providing an early warning sign that the decline in disability rates we've been hearing about might be ending."

After analyzing the period from 2000-2005, the researchers found a 9 percent increase in the number of non-institutionalized people aged 65 and older who said they have difficulty handling day-to-day activities, including dressing and bathing, because of a problem lasting six months or more.

"The combination of increasing disability rates, plus a growing population of older adults emphasizes the importance of prevention of the many chronic conditions giving rise to disability in the first place," the study's lead author, Esme Fuller-Thomson, a professor of social work at the University of Toronto, explained in the release. "There is evidence, for example, that the doubling of obesity rates over the last three decades may be linked to rising disability in older people, yet the obesity problem is largely preventable."

The findings are published in the December issue of the Journals of Gerontology.

More information

The U.S. Department of Health and Human Services has details on preventing disability in the elderly with chronic disease.

(SOURCE: University of California Berkeley, news release, Dec. 21, 2009)

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Beatifying the Holocaust Pope.

At Business Week, Celestine Bohlen asks why Benedict is rushing to beatify the controversial World War II Pope Pius XII:

Many experts think that Benedict is trying to reconcile the church with its own history, with teachings that prevailed before the Second Vatican Council, the historical gathering of church leaders convened by Pope John XXIII in the 1960s. That was when the Roman Catholic Church entered the modern age, adopting such principles as separation of church and state, freedom of religion, a more modern liturgy and a repudiation of anti-Semitism.

“Benedict wants to emphasize the continuity of the church’s teachings, to make the point that the Second Vatican Council was not a break with the past,” said the Reverend Thomas Reese, a Jesuit scholar and senior fellow at the Woodstock Theological Center at Georgetown University.

This isn’t a surprising line of thinking from a conservative pope who as a theologian, once kept watch over the church’s doctrine. But he didn’t need to add another pope to the roster of saints to make the point.

Of the 265 popes in history, 76 are already saints: six are blessed. Perhaps now is the time to declare a halt to the practice, for liberals like John Paul II and John XXIII, as well as for conservatives like Pius XII. As Father Reese aptly noted, popes cannot be examples for ordinary Christians: Popes can only be examples for other popes.

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Pharmacists and the Conscience Clause: If You Don't Want to Deal With Complex, Messy Human Life, Then Please Don't.

From Britain's Independent, an article on the damages that a provider refusals there would cause:

This goes against the idea of the pharmacy as a great democratic space, where we can ask a neutral guide questions about how our bodies do – or don't – work, without feeling embarrassed or bullied. If we are to be kind to ourselves, we need somewhere to buy Imodium and Tampax and corn plasters without feeling marginalised.

Levonelle 1500, the medicine currently used in the UK for the morning-after pill, needs to be taken 72 hours after sex. So the clock is ticking. Unsurprisingly, calls for the "conscience clause" to be scrapped have come from pharmacists themselves as well as groups such as the National Secular Society. In response, the Council for Healthcare Regulatory Excellence, a government quango that oversees the health professions, is asking whether the practice should continue. The consultation, which ends on 12 January, is part of plans to set up a new General Pharmaceutical Council to regulate the profession.

Predictably, conservative campaigners (who range from anti-abortionists to members of the Church of England) are up in arms about the potential scrapping of pharmacists' "right to say no". Some evangelical types even reject the idea of making an immediate referral to an appropriate alternative dispensing pharmacy – to help the customer – because they argue it's the same as forcing them to fill prescriptions that violate their beliefs.

Yet whatever your conscience, you should not have the right to refuse to dispense the morning-after pill, or any form of over-the-counter legal contraception. We have rights and expectations as health service users. Any doctor or pharmacist who refuses is not doing their duty. It is not up to the prescriber, or the dispenser: the matter rests with the patient. We already have the most teenage pregnancies in Western Europe. I don't want more young women feeling confused and desperate, or having unprotected sex because they are too embarrassed to ask about barrier contraception. A fragile group, who may have other problems in their lives, need better access to information. Not less.

In an age of Tesco-ification and mega chemists, I feel passionately about supporting independent and family-owned pharmacies. I don't want us buying online from dubious pharmaceutical wholesalers in America because we are too embarrassed to walk into a normal shop. Or getting prescription pads on the black market because it cuts out the moralistic middle man – or woman.

Private faith matters. I'm sure many are inspired to join caring professions because of their own compassionate beliefs. But we need help, too. If you don't want to deal with complex, messy human life, then please don't. If the way we love and work – and build alternative families – offends you, please don't become a key service worker. A job in a registry office that conducts same-sex civil partnerships may not be for you. Don't open a hotel or a B&B if you think you will want to turn away certain sections of the community. And most of all, please don't become a pharmacist. It's a job I value far too much.

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