Friday, January 8, 2010
Rom Houben and the Evolution of Uplift.
Disability and Health Journal Special Issue on Assisted Suicide.
All of the articles published in this special issue emerged during the 2 years the APHA struggled to adopt a policy on assisted suicide. During that time, I personally went from seeing this issue as a personal right to understanding that assisted suicide is at the heart of the disability movement. The broadly used definition of “disability” includes individuals who have limitations in their functional status and/or use assistive devices to maintain function. Almost all people at the end of life can be included in the definition of “disability.” Thus, the practice of assisted suicide results in death for people with disabilities. People with disabilities have been recognized as a health disparity group (included in Healthy People 2010); they experience substantial discrimination in society, and yet they can live extremely high-quality lives. The ADA is civil rights legislation that guarantees equal treatment under the law. From the perspective of the ADA, the assisted suicide debates raise the question: Should we have laws that give physicians the ability to prescribe lethal doses of medicine to people, who are told they have less than 6 months to live, OR should we provide the supports, services, and pain management they need to continue living?
First, the very existence of legalised assisted suicide threatens disabled people. It will lead to an expectation that the disabled, elderly and infirm should shuffle off their mortal coil a bit early to relieve the burden on their carers. This fear has been ridiculed by supporters, who contend that all they want is choice at the end of life. Dream on, says Diane Coleman, of the lobby group Not Dead Yet. "Proponents of legalized assisted suicide are willing to treat lives ended through abuses of the practice as 'acceptable losses' when balanced against their wish for a pleasant way out and their unwillingness to accept disability, or responsibility for their own suicide. We disagree."
Second, the danger is not mandated euthanasia, as in Nazi Germany. Rather, it is a subtle and widespread expectation that death is better than disability. "If the legalization of assisted suicide continues, I believe the rank and file will some day see nothing wrong with hastening the deaths of many people," writes Dr Carol J. Gill. "They will stand by and do nothing to stop it and will endorse the policies and institutions that advance it-not because they are evil people but because it will no longer be evil in our culture to do so. It will be compassionate, respectful, routine."
Third, several authors argue forcefully that Oregon's Death with Dignity Act, which is the model for assisted suicide in the US, is deeply flawed. After about 15 years, several intractable problems have emerged. The authors claim that there is very little patient control; that statistics are incomplete; that oversight is minimal and secretive; that safeguards are easily circumvented; and that negligent doctors cannot be prosecuted. Allegations that in Oregon and in the neighbouring state of Washington, which has also legalised assisted suicide, the circumstances of deaths are routinely falsified are especially disturbing. In fact, Washington actually requires that doctors falsify the death certificate by listing the terminal disease as the cause of death rather than the lethal dose of barbiturates. ~ Disability and Health Journal, January
Who's Rationing Now, Mayo Clinic?
Mayo is probably a leading indicator of where other hospitals and doctors are headed. Physicians on average earn 20% to 30% less from Medicare than they do from private patients, and many are dropping out of the program. While about 92% of family physicians participate in Medicare, only about 73% of those are now accepting new patients. In some specialties—neurology, oncology, gynecology—in places like Manhattan and Washington, patients can struggle to find any doctor who'll accept Medicare.
The $500 billion in Medicare cuts planned as part of ObamaCare won't help this trend. The hospital industry agreed earlier this year to chip in $100 billion over the next decade in lower annual payment increases for Medicare. The chief Medicare actuary estimates that up to 20% of hospitals could become unprofitable as a result of the scheme.
The irony is that the Obama Administration has repeatedly praised Mayo as an example of the efficiency and lower cost that will spread everywhere if ObamaCare passes. And it's true that Mayo is a sterling example of the kind of health reform that many economists—notably White House budget chief Peter Orszag—extol.
Sharlet on Maddow.
The Legacy of Mental Health Misdiagnoses.
Race-based misdiagnosis emerged in the context of the civil rights era of the 1960s and 1970s, when activism became equated with mental illness, says Jonathan Metzl, an associate professor of psychiatry and women's studies.
Metzl examined archives of Ionia State Hospital for the Criminally Insane and learned that black men, mainly from Detroit during the civil rights era, were taken there and often misdiagnosed with schizophrenia.
"Some patients became schizophrenic because of changes in their diagnosis rather than their clinical symptoms," said Metzl, a 2008 Guggenheim award recipient.
Events at Ionia, located in a mostly white northern Michigan community, mirrored national conversations that linked the disease with blackness, madness and civil rights, he said. Many black men came to the hospital during the Detroit riots, dramatically increasing the facility's black population.
How the psychiatric profession defined schizophrenia also changed during this period. In the 1920s-1940s, doctors considered the illness as affecting non-violent white individuals (mainly women), but later changed the language to violent, hostile, angry and aggressive as a way to label black men, he added.
"It's an easy thing to say this was racism, but it's a much more complicated story -- that's still playing out in present day," said Metzl, director of U-M's Culture, Health and Medicine Program.
He noted that the criminalization of mental illness and misdiagnosis of schizophrenia meant many black men have been placed in prisons rather than psychiatric hospitals. The Ionia facility, for instance, became a prison in 1977.
Despite increased efforts for cultural competency training, over-diagnosis of schizophrenia in black men has remained.
"Multicultural training is important, but it often does little to address how assumptions about race are structurally embedded into health care delivery systems," said Metzl, whose findings appear in the new book, "The Protest Psychosis: How Schizophrenia Became a Black Disease."
What is "Traditional Christianity?"
Don't miss Mark Jordan's fantastic article at ReligionDispatches today on the political assumptions made about the "traditional" and "liberal" divide.
I'm as guilty as the next "liberal" of railing against the imposition of "traditional values" in medicine and social services. Jordan gives us the necessary reminder that "traditional values" as proclaimed by the Religious Right (Catholic and Fundamental/Evangelical) are not representative of the whole or even traditional religious teaching. This frame has greatly helped opponents of equality and individual rights. And the media, reticent or unable to report the nuances of religion, have used the frame to perpetuate inaccurate assumptions about religious teaching and adherents.
Of course the Religious Right plays a heavy hand in enforcing the dominance and theological rightness of it's positions. Saying that church theology supports, for instance, gay equality, falls outside the understood, reported, polarized frame. Jordan writes:
You wouldn’t know this reading Steinfels’ description of our recent debates. To be fair, he is hardly alone. Most reporting of religious debates over sexuality, whether in the Times or on the wire services, assumes the same division—or performs the same sleights-of-hand. When self-proclaimed “traditional” voices are quoted against same-sex marriage, they are allowed to claim scriptural evidence, church history, and even the name “Christian.” When other Christian clergy or believers are quoted in support of same-sex marriage, they become “activists” who are allowed only to speak about civil rights or fairness or—sometimes—wispy Christian principles, but not about scripture or church history or faith itself.
I used to think that this was the fault of progressives—that we reverted too often to the bland language of fairness, toleration, or rights. So I tried always to give reporters scriptural and historical arguments. They rarely found their way into print. I wondered whether the forced simplification of religious journalism had a built-in bias for obvious, “literal” readings of scripture. Or whether the need to tell a story—to sell a story—drove reporters back to the familiar plot: venerable belief versus modern liberalism. So I began to experiment with saying very traditional religious things in interviews.
“I support ordaining openly lesbian and gay candidates because that’s where I’m led when I study scripture and pray.”
“My belief in incarnation pushes me toward the blessing of same-sex unions.”
The reaction was mostly an awkward silence. I could hear the typing stop at the other end of the line.