Wednesday, January 20, 2010

"Pro-Life" Shame and Intimidation Campaign and the Making of Public Opinion. does something like a "this day in history" post on the 2008 decision by American Public Health Association to support Death with Dignity (the name of the bills in Oregon and Washington). And in noting their belated surprise at an faux-controversy, they mention the APHAs recent endorsement of "safe and legal abortion."

Which perfectly gets at how effective "pro-life" efforts have been at convincing not only the public but the "controversy seeking" profession of bioethics that abortion and aid in dying are, well, shocking controversies.

This sort of look at patients' rights issues - OMG medical associations actually find women's and elder's rights to be legitimate?! - may make for a great story but it denies the fundamental scientific and medical acceptance of these two issues as have been misconstrued by the noisy "pro-life" organizations in the country.

The latest story out of Montana, where aid in dying was ruled legal by that state's Supreme Court on New Year's eve, is that doctors are not rushing in to offer aid in dying to their terminal patients. It's no wonder they aren't. Since Baxter v. Montana was brought to the courts in 2008, "pro-life" interests have been working hard to make aid in dying untouchable by doctors, shaming them and their patients with the very same tactics that have so successfully worked to shame women. Even the four Catholic-hospital-employed doctors who filed the case with Robert Baxter and Compassion and Choices had their work telephone numbers published by ultra-conservative LifeNews.

Harassment is nothing new to "pro-life" groups. In fact, it is the fundamental aspect of their successful campaign against health care services they ideologically oppose.

Shaming doctors and their patients for using legal, medically-sound procedures has worked wonderfully for "pro-life" activists. Look at how women's reproductive service - not just abortion but the full spectrum from tubal ligations to sterilization to contraception - have been relegated to clinics. Women know that if they want to make their own health care decisions, they have to be prepared to face long travels, picket lines, shaming from their pharmacist, denial of both informed consent and referrals, and mass discrimination. Even the staunchest abortion supporters squirm when you ask them if they've had an abortion or not. Hillary Clinton has said that the number of abortions need to be reduced.

Why is this a significant but destructive meme? Because public opinion and the legislature, both state and federal, have been systematically made to accept abortion and aid in dying as hot button, controversial topics. Opponents work hard to misconstrue information regarding both legal services, their safety, even their legality. And the rest of society has bought the shame.

For nearly 40 years this "pro-life" work has paid off in creating an area of sound medicine that is considered unhealthy and controversial - and hence is harder to access for patients most in need, particularly the poor. When bioethicists, those who are supposed to be most in tune with science and medicine, fall for the "pro-life" line, advocates for patients' rights know they have a long way to go before justice in health care delivery is a reality.


A controversial 2008 decision by the American Public Health Association (APHA) to back "aid in dying" (ie, assisted suicide) slipped almost completely under the media’s radar at the time, even BioEdge’s. In retrospect, it seems like a highly significant decision.

Why? It means that the official policy of the "oldest, largest and most diverse organization of public health professionals in the world" – 30,000 of them – is to support assisted suicide to the hilt. Or, as they prefer to call it in Oregon, "patient-directed dying" or "physician aid-in-dying".

All the facts about the debate surrounding the decision have not emerged, but it may be significant that another policy adopted at the October APHA conference was strong support for safe and legal abortion. There must have been a lot of politicking going on behind the scenes.

Some of the major features of the APHA policy recommendations on assisted suicide are:

>>> [It] Supports allowing a mentally competent, terminally ill adult to obtain a prescription for medication that the person could self-administer to control the time, place, and manner of his or her impending death, where safeguards equivalent to those in the Oregon DDA are in place…

>>> [It] Rejects the use of inaccurate terms such as "suicide" and "assisted suicide" to refer to the choice of a mentally competent terminally ill patient to seek medications to bring about a peaceful and dignified death.

>>> [It] Supports measures to ensure that patients eligible to receive information about death with dignity and are able to choose alternatives such as aggressive pain and symptom management, palliative care, hospice care, and care to maximize quality of life and independence.

>>> [It] Supports the provision of information about the full range of end-of-life care options to terminally ill patients permitted by law in the state in which the patient is receiving care, including, for example, voluntarily stopping eating and drinking and palliative sedation…

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