Monday, January 4, 2010

Precise Reporting on Baxter v. Montana.

Chattahbox has a little bit about the Baxter v. Montana case that is swiped from NPR and which found me via the conservative Alliance Defense Fund.

This may seem nitpicky but it's not: Chattahbox, in their efforts to paraphrase the facts of the case, writes:

Ruling on Baxter v. Montana, a case filed by a Billings truck driver Robert Baxter (who has since died), but wanted his doctors to administer a lethal dose of medication after being diagnosed with leukemia, the court said it found “nothing in Montana Supreme Court precedent or Montana statutes indicating that physician aid in dying is against public policy:”

What's my problem with the report? Robert Baxter didn't approach the state after his diagnosis, he decided he would like the option of aid in dying after more than 10 years of trying to survive leukemia. NPR got it right. Chattah box could have too. Baxter exhausted all the existing treatments and suffered their horrible side effects. A decade of ups and downs and suffering. He had come to the end of an illness that without medical technology may have killed him years before.

But the same medical technology that keeps us alive has changed the possibility of what we call a natural death. Writing about contentious issue of aid in dying requires specificity. Baxter didn't want to kill himself. He didn't even want to die. He didn't get a bad diagnosis and run to the state for lethal meds. But after an extended fight, he knew he would die.

Or as Baxter writes in his affidavit for the case:

I am terminally ill with lymphocytic leukemia with diffuse lymphadenopathy, a form of cancer, which is a progressive disease with no known cure. It results in the bone marrow making an excessive number of lymphocytes, a type of white blood cell, which crowd out normal blood cells, suppress the immune system, and render the body unable to fight off infections as effectively as normal. It is treated with multiple rounds of chemotherapy, which typically become less and less effective as time passes.

As a result of the leukemia and the treatment I have received to combat it, I have suffered varying symptoms including anemia, chronic fatigue and weakness, nausea, night sweats, intermittent and persistent infections, massively swollen glands, easy bruising, significant ongoing digestive problems, and generalized pain and discomfort. These symptoms, as well as others, are expected to increase in frequency and intensity as the chemotherapy loses its effectiveness and the disease progresses.

Given the nature of my illness, I have no reasonable prospect of a cure or recovery. As the cancer takes its toll, I face the progressive erosion of bodily function and integrity, increasing pain and suffering, and the loss of my personal dignity.

I have lived a good and long life, and have no wish to leave this world prematurely. As death approaches from my disease, however, if my suffering becomes unbearable I want the legal option of being able to die in a peaceful and dignified manner by consuming medication prescribed by my doctor for that purpose. Because it will be my suffering, my life, and my death that will be involved, I seek the right and responsibility to make that critical choice for myself if circumstances lead me to do so.

Labels: , , ,

Smoking Gun? No, Just The Discovery Institute Instigating Persecution.

Oh the Discovery Institute is so invested in disseminating pseudoscience - in this case intelligent design - that it's making a giant hyperbolic issue out of the California Science Institutes refusal, unfortunately at the last minute, to show Darwin's Dilemma, a film that dresses up unprovable mythology in scientific language. My guess is that the scheduler heard the title and thought they were in for an excavation of Darwin, his methods, his studies, something fact based. Then when they found out that Darwin's Dilemma was really a religiously motivated attack on science they decided to pull the plug. Then got afraid that exactly what is happening now would happen.

Poor management, yes. "Tip of the proverbial iceberg?" Two forked assault on the first amendment? "Smoking gun?" Persecution of intelligent designers? They're kidding, right?

But the Discovery Institute, that well-funded, bully purveyor of religious ideology wrapped in science-ese, has a reason to make such a giant issue out of this whole situation. First, they get to claim the wronged position - My God! Violation of the Establishment clause! - and they posit themselves as great upholders of the law. Self-righteousness is what they do best and they are all a-glory with accusing the Science Center of denying "the people" access to information, even if it is at the core religious missionizing disguised as a National Geographic special.

It's a real shame that organizations like Discovery aren't run out of existence for duping the gullible public into snuggling down in their own ignorance. Denying science isn't a very strong position to fight from unless you're doing so from a stage spied by the uneducated.

From the Discovery Institute's site:

There are two big stories arising from the California Science Center’s censorship last October of the pro-intelligent design film Darwin’s Dilemma. The first big story, which was the primary focus of a Los Angeles Times article last week, is the act of censorship itself. As an agency of state government in California, the Science Center is required to abide by the First Amendment’s guarantee of free speech. The Science Center didn’t have to rent its facilities to the public, but once it did so, as a government agency, it was legally obliged by the First Amendment to treat all citizens equally.

But there is another big story tied to the Science Center that hasn’t received sufficient attention yet: The Center’s illegal cover-up.

The California Science Center has flagrantly violated California’s open records law in an apparent effort to hide the real story behind its censorship of Darwin’s Dilemma. The Center’s evasion of the law is the reason for the open records lawsuit recently brought by Discovery Institute against the Center. In October, the Institute filed a comprehensive open records request demanding that the Science Center turn over all documents relating to its abrupt decision to cancel the privately-sponsored screening of Darwin’s Dilemma. In early November, the Science Center released 44-pages of documents in response to the records request. At that time, the Center assured Discovery Institute that it had turned over "all documents" and that "no documents have been withheld," apart from a few e-mail addresses that were redacted. The Science Center did not tell the truth. Discovery Institute independently obtained incriminating emails involving Center officials that should have been turned over by the Center but weren’t.

Most importantly, the Institute obtained a smoking-gun e-mail confirming that the censorship ofDarwin’s Dilemma was connected to the Science Center’s relationship with the Smithsonian Institution. In an Oct. 6 email to the American Freedom Alliance, Science Center Vice President Christine Sion specifically cited alleged damage to the Center’s “relationship with the Smithsonian” as the reason for canceling the Darwin’s Dilemma screening. In its open records request, Discovery Institute had asked for all documents relating to the screening cancellation that referenced the Smithsonian. The Christine Sion e-mail was clearly covered by that request and therefore should have been produced. It wasn’t. Another email from a Smithsonian official to the Science Center complaining about the screening was likewise suppressed.

Labels: , , , ,

Doctors' Role Drift and End of Life Care.

Tim Cousounis at Palliative Care Success makes an interesting observation about "role drift" and the challenges faced by doctors, palliative doctors and hospice organizations when coordinating patient care:

I've been intrigued recently by the spate of articles and seminars concerning themselves with the relationships between physicians and hospitals. Of course, hospital-medical staff relationships have been contentious for years, and consultants advising hospital executives on the most effective ways to align physician objectives with hospital goals is hardly a recent development. So, what do I find intriguing? That similar concerns are surfacing with greater frequency among hospices and palliative medicine physicians, as hospices build their medical staffs and expand the role of physicians within the hospice's clinical and administrative activities.

What we're seeing can best be described as role drift, where there is a disconnect between what the physician sees as his/her role, and what the executives and/or other clinical staff see as the physician's role. Such role drift is magnified in those palliative care organizations where resources are strained. I don't mean to oversimplify, but one will generally find fractious relationships in organizations where the HPM physician does not have:
-Clear roles, responsibilities, expectations and accountabilities
-Well-established performance measures and standards
-Performance management system that tracks performance and offers feedback.

I'm curious to hear your experiences, and what methods you've used to build a high-performing hospi
ce medical staff.

Labels: , ,

Frailty and the Elderly.

GeriPal looks at how we fail to prepare the elderly for the frailty that often comes at the end of life.

Paula Span raises a number of interesting issues in this post on the NY Times New Old Age Blog. She presents the story of an active 70 something man who was very comfortable discussing the possibility of his death, but seemingly unable to discuss the possibility of being frail and needing help caring for himself.

As the post notes, most people will have a period (often quite long) of frailty at the end of their lives in which they will need the help of another person for some tasks of daily living. I think the popular media and many in the medical profession sometimes try to suggest otherwise, suggesting that frailty is avoidable if you just do the right things. The evidence overwhelmingly suggests otherwise. It is certainly right to encourage good health habits, including good nutrition and exercise. But it is more likely that healthy living will delay frailty--not avoid it.

I think even in Geriatrics, we sometimes oversell our ability to prevent functional decline and frailty. In our enthusiasm, we point to some intervention studies that have reduced the risk of disability. These intervention can clearly enhance the well being of older persons, and it is a shame they are not more widely implemented. But if one looks closely at these studies, the effect sizes tend to be modest, and they slow down trajectories of decline rather than stop these trajectories.

Labels: , ,

Texas Textbook Writers Keeping Unreason in Schools.

I'm reading Susan Jacoby's The Age of American Unreason right now and this issue is one that she raises as the greatest contribution to our American anti-intellectualism: education has failed to promote critical thinking and science; there is a regional, fundamental bias to education that keeps children from learning the difference between scientific fact and faith; the rise of religious schools (both Catholic and fundamentalist) is a travesty for our future advancement as a country.

Now an article at the Washington Monthly by Miriah Blake that should be distributed far and wide. In direct violation of the separation of church and state (which amazingly is still a debated issue! easy to deny facts when your ideology doesn't require any!) these boards impose religious concepts on the nation and leave American intellectual achievement behind.

(h/t @GregMitch)

Photo: Jana Birchum

Don McLeroy is a balding, paunchy man with a thick broom-handle mustache who lives in a rambling two-story brick home in a suburb near Bryan, Texas. When he greeted me at the door one evening last October, he was clutching a thin paperback with the skeleton of a seahorse on its cover, a primer on natural selection penned by famed evolutionary biologist Ernst Mayr. We sat down at his dining table, which was piled high with three-ring binders, and his wife, Nancy, brought us ice water in cut-crystal glasses with matching coasters. Then McLeroy cracked the book open. The margins were littered with stars, exclamation points, and hundreds of yellow Post-its that were brimming with notes scrawled in a microscopic hand. With childlike glee, McLeroy flipped through the pages and explained what he saw as the gaping holes in Darwin’s theory. “I don’t care what the educational political lobby and their allies on the left say,” he declared at one point. “Evolution is hooey.” This bled into a rant about American history. “The secular humanists may argue that we are a secular nation,” McLeroy said, jabbing his finger in the air for emphasis. “But we are a Christian nation founded on Christian principals. The way I evaluate history textbooks is first I see how they cover Christianity and Israel. Then I see how they treat Ronald Reagan—he needs to get credit for saving the world from communism and for the good economy over the last twenty years because he lowered taxes.”

Labels: , , ,

Contrived Story: Death with Dignity and the Estate Tax.

Ok, I admit to having avoided this meme for a while now because I was unwilling to honor its absurdity with a post. But it seems to unfortunately have legs because few journalists are examining the facts and, well, get a great punch up from the emotions the "concern" garners.

The contrived story is: changes in the estate tax, or the politically termed "death" tax, which go into effect at the end of this year, will cause wealthy elders at the urging of their soon-to-be-cheated-of-millions heirs, to commit suicide using the Death with Dignity laws in Washington and Oregon.

Some writers are with-it enough to have noticed that Montana just legalized aid in dying but some, like Kay Helbling with the Oregon Business Report, quoted below, miss Montana altogether.

It's a contrived story, for a number of reasons I'll get to in a minute, but perfectly indicative of how the media irresponsibly get aid in dying wrong again and again, to the benefit of "pro-life" activists who oppose aid in dying, by illogically and unfactually slapping together cause and effect.

Helbling writes with perfect, false alarm:

In insurance it’s called a “moral hazard”. A moral hazard is the result of maximizing behavior. A person weighs the costs and benefits of an action and when benefits exceed costs, he takes the action. For example, if an accident costs the person $1000, but pays $2000, the person not only has no incentive to avoid the accident but may have an incentive to seek it out.

What has this got to do with assisted suicide? There could be “millions” in estate tax reasons why they relate. Estate taxes have long been referred to as the “death tax”, but 2010 may shine a whole new meaning on that term. Presently the estate tax is 45%. The estate tax will drop to 0% for just one year, 2010, and then return to the pre-Bush administration rate of 55% in 2011.

Opponents to the physician-assisted suicide laws have long felt there is a moral hazard to granting a person the right to chose when to die. Will the person make that choice merely because of their personal suffering, or are they going to feel obligated to do so to relieve their children of the need to care for them or because they are a financial burden. Add to the mix the possibility that by dying in 2010 they could become a financial “windfall” for their heirs and the risk of a “moral” hazard to the law rises.

Firstly, Helbling completely misses the way aid in dying works in the three states where it is legal. A patient in Washington, Oregon, or Montana must be terminal, meaning near death, to request a lethal dose from their doctor. Then they must administer the medicine themselves. Instead, she paints the laws as state-legalized suicide that allows a patient to end their life whenever convenient.

The story only exists because ignorant or politically motivated parties continue to conflate suicide - an untimely taking of ones life - with aid in dying, the ending of the suffering of a terminal patient, already sentenced to death by old age or a terminal illness. The continued popular use of "assisted suicide" doesn't help much and is perpetuated by those opposed to aid in dying.

The story that the changes to the estate tax will cause more suicides is a cloudy crystal ball - and who am I to predict the future? Certainly someone should be able to scrape up statistics about how many patients extended their lives (at the urging of relatives, on life support, a comatose vegetable until the calendar changed) until the lax Bush laws came into effect.

But murder is illegal and so too is suicide in some states, the former prevents the actor from inheriting, the latter from receiving lucrative life insurance pay outs. That aid in dying provides nefarious, evil family members with an easy way to snuff a parent is silly. Aid in dying has caused greater oversight and regulation of the end of life period than is given it in other states.

Murder and suicide have nothing to do with aid in dying, though opponents try to convince the public that they do. Assumed coercion by greedy family members is less likely in states where aid in dying is closely watched, regulated and reported on. And assuming coercion will occur is a grave injustice to the elderly and terminally ill, a discrimination against their autonomy and ability to make good decisions.

So few people die at home these days, less than 20%, that no family members, particularly those of the wealthy, are required to care for the dying at home. The assertion that the terminal elder will kill themselves or will be coerced to kill themselves by greedy heirs is a trumped up concern that has no proof - it is simply a supposition that business and "pro-life" groups have clasped onto - but certainly has nothing to do with the Death with Dignity laws.

There's an enormous difference between a dying patient requesting a lethal dose of medicine to end their last days or weeks of suffering - with the strictly government regulated oversight of their doctor - and committing a crime.

Now if only the media would leave sensationalism out of it and report according to facts.

Labels: , , ,

Response to NYT Palliative Sedation Article.

The responses are coming in on Anemona Hartocollis palliative sedation article for the New York Times on December 27, including one response from the ubiquitous - and uncharacteristically normal sounding - Wesley J. Smith.

But even here, Smith knows the fight against aid in dying will only work so long as the dying have palliative sedation to alleviate their suffering. He's working according to Catholic teaching which allows for the "double effect," or full sedation of patients if the effort is to end suffering, not life. In Montana, part of the case dealt with the fact that there is little difference between palliative sedation and aid in dying but the doctor's statement of purpose. It's an ideological distinction, not necessarily a practical one.

Labels: , ,

Montana Mythologizing.

The "pro-life" groups are starting to spin the decision in Montana now that they've had a few days to digest the odd decision. It's no surprise that the hyperbolic Steven Ertelt at LifeNews would exaggerate the ruling in order to continue the miseducation and scare-mongering opponents of aid in dying use to keep their followers in the snow and in check. He knows that once someone experiences the death of a loved one or faces their own death, they are more likely to be open to aid in dying as they contemplate end of life suffering. The more patients know about the dying process, the more open they are to hastening death when the patient is in accute pain.

Note a couple of things:

*the scary needle image;
*the lack of information about Robert Baxter (because he was on the other side he ceases to be a person; compare the absence of Baxter to the ever-presence of Terri Schiavo as a martyr for the "pro-life" cause);
*"Unlimited" assisted suicide is a complete fabrication, the law applies to terminal, suffering patients;
* the steadfast use of "suicide" and "kill himself" despite the court's use of aid in dying;
*the law only prevents doctors from being prosecuted for giving a dying person a lethal prescription, not from "almost any prosecution for engaging in them";
*then he sticks the landing with a solid "slippery slope" argument that all old folks should be scared as hell that they will be coerced into killing themselves because the law has "little or no oversight." Removal from life-sustaining machines is now legal in the US if a patient or their medical proxy ask for it.

Conflating aid in dying with unchecked killing of the elderly or ill is just irresponsible. Aid in dying must be requested by the patient. But who cares about facts when you have an ideology of redemptive suffering to protect, compassion be damned, patients' wishes be damned. The misinformation, scare tactics and lying continue to the detriment of patients' rights and compassionate end of life care.

From the LifeNews newsletter via email:

Montana Supreme Court Makes State Third to Allow Unlimited Assisted Suicide
Helena, MT ( -- The Montana Supreme Court has officially paved the way for the state to become the third to allow the practice of assisted suicide. The high court considered a case from a now-deceased terminally ill patient who wanted the right to kill himself with assistance from a physician.

The high court did not determine if the Montana constitution guarantees a right to assisted suicide but said nothing in state law or the precedent of the court prevented assisted suicide.

“We find nothing in Montana Supreme Court precedent or Montana statutes indicating that physician aid in dying is against public policy,” the high court said in its opinion.

The decision essentially has Montana joining Oregon and Washington as the only three states in the nation to allow assisted suicides. It declared assisted suicide as legal and could prevent doctors from almost any prosecution for engaging in them.

Montana law “explicitly shields physicians from liability for acting in accordance with a patient’s end-of life wishes, even if the physician must actively pull the plug on a patient’s ventilator or withhold treatment that will keep him alive," the court said. However, assisted suicides in Montana will likely go further as the state doesn't have even basic limitations, restrictions or guidelines in place and the ruling could pave the way for the practice of euthanasia with little or no state oversight. Full story at

Labels: , , , ,