Monday, January 11, 2010

Aid in Dying in Connecticut.

On the heels of the Montana Supreme Court's decision on New Year's eve that nothing in the state laws prevent the use of aid in dying comes a court case in Connecticut which challenges an aged statute that prohibits "assisted suicide."

The plaintiffs will argue that the right for a terminal, mentally sound patient to receive a lethal prescription from their doctor which they may choose to take is not "assisted suicide" but aid in dying.

The Connecticut Law Tribune writes a good summary of the case, although I wish they had distinguished the difference being made between the two terms and that aid in dying is a choice elected by the patient and self-administered:

Aid In Dying

Dennis C. is 72 and suffering from terminal lung cancer. Chemotherapy and radiation have had little effect. When not inundated with morphine or other drugs, he is in great pain.

Dennis’s doctor is a highly regarded Connecticut internist. He has watched this disease take over Dennis’s life. Yesterday, Dennis asked his doctor if he could give him something to help him die. What can his doctor legally do?

A law passed some 40 years ago states that any person who “intentionally causes or aids another person, other than by force, duress or deception, to commit suicide” is guilty of second-degree manslaughter. There is no exception for doctors.

End of story? Maybe not. Two doctors are asking a Connecticut court to rule that this statute does not necessarily prohibit “aid in dying...a recognized term of medical art,” which “may, in the professional judgment of a physician, be a medically and ethically appropriate course of treatment.”

Despite the “assisted suicide” prohibition in the Connecticut law, it is today generally accepted that a “living will” may direct a physician to withhold procedures “that would serve only to artificially prolong the dying process” and may provide that the patient “be permitted to die naturally” with only those medicines or procedures that provide comfort or alleviate pain.

Connecticut law permits doctors to follow these directives for patients in a “terminal condition.” It defines that as “an incurable or irreversible medical condition” which, in the opinion of the attending physician, “will result in death within a relatively short time period.”

Using such a definition, how different, ethically, would it be to allow a patient to further direct the use of affirmative medical procedures that would, in fact, hasten the dying process?

Whether a Connecticut court feels free to recognize an exception for “aid in dying” or simply concludes that it must follow the literal language of the assisted suicide statute remains to be seen. Should it make a difference to the court that the legislature has, in fact, confronted the issue before and refused to amend the statute? Would it be appropriate for the court to approve an exception by reasoning that if the legislature strongly objected to the judicial gloss, it could easily amend the current statute to specifically deny such an exemption or further define its permissible use?

In the event the court believes it cannot recognize a physician’s “aid to dying” as not covered by the assisted suicide statute, the legislature should itself re-examine the restrictions imposed by this statute. How might it be useful to do so?

Here is a short list of some of the many issues that the court and the legislature should consider, and some possible responses:

• What category of doctors should be allowed to decide whether to carry out a patient’s aid-in-dying request?

The doctor making the decision should be one of the treating physicians. If there are any circumstances that might compromise the decision of a treating physician, then another physician in the same specialty should be so authorized.

• When and how should the patient’s aid-in-dying request be legally recognized?

If legally competent, the patient should be able to make such a request either in a living will or through a health care representative at a later time if duly witnessed. In the absence of either the spouse or other relatives should only be allowed to request an aid-in-dying treatment under very controlled circumstances. This topic warrants another editorial.

• What other safeguards need to be provided?

A “terminally ill” patient needs to be defined, probably in terms of the current language used for living wills.

Today, doctors regularly make medical decisions based on reasonable probability. Physicians treating very ill patients are perfectly capable of determining whether patients knowingly seeking an aid to dying are “terminally ill.” Physicians having doubts can always seek a second opinion. The point is that it is in the patient’s interests, and in society’s interests, to provide trained doctors with a legally permissible means of helping terminally ill patients die with dignity, whether through affirmative or passive means. •

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Religious Tolerance and the Health Care Mandate.

Anabaptists have long eschewed public insurance policies for their own collective address of medical emergencies. Home owner's insurance and other plans designed to prevent catastrophic loss are seen by the more conservative members of the Anabaptist sect as intrusions. While car insurance was never much of a problem - if you own a car the chances are you're "worldly" enough to buy into insurance needs.

In fact, family story has it that my Mennonite grandparents left a more traditional church in Lancaster County when the pastor there criticized my grandmother's short bonnet strings (long ones were oh so much more pious) and my grandfather's insurance policies.

While the Amish and conservative Mennonite communities are now forced to provide their employees with workmen's compensation, they have stayed far away from health insurance, coming together to care for a broken arm or a dire prognosis like they would to build a barn.

The health care bill has many wary critics among these conservative Anabaptist sects, most hoping they will be able to receive exemption from the new mandated fees. David Mekeel writes:

UNLIKE MOST Americans, James B. Weaver has never really given much thought to health insurance.

An Old Order Mennonite living in Maxatawny Township, Weaver, 56, doesn’t subscribe to the idea of buying insurance of any kind.

He opts to rely on his community when it comes to handling the bur den of sickness.

“We sort of like to try to pull our own weight, and we’re very staunch believers that there is no free lunch, Weaver said of the Plain communi ties in Berks and elsewhere. “We take care of our own sick and infi rm.”

The same is true for the few Amish households in Berks County, which are mostly in the far western part of the county.

But the debate about a new na tional health care bill has forced the insurance topic to the forefront for many Amish and Old Order Men nonites.

Both the U.S. House and the Sen ate have passed health care reform bills, and the lawmakers are expect ed to work out the details of a fi nal bill early this year.

Each bill includes requirements that would force nearly every Amer ican to carry health insurance and make businesses provide it for employees.

Those who don’t have insurance would face fi nes.

Weaver suspects most members of Plain communities would balk at the idea of buying health insurance. But he said some younger members may not be as steadfastly against the idea.

“I think there’s going to be a lot of talk, a lot of dialogue in our circles about how we are going to deal with this,” Weaver said. “Unfortunately, I think quite a lot of our younger people might not be opposed to some form of it.

“The older generation, though, will probably try to work something out where they get exemptions.”

An unwelcome intrusion

In Plain communities, health insurance requirements are viewed as an unwelcome government intrusion.

“It’s basically a religious reason,” said Don Kraybill, professor of Anabaptist studies at Elizabethtown College in Lancaster County. “They feel the members of the church are responsible by their Christian faith to help each other and take care of people.

“They feel they shouldn’t be paying outside commercial entities to be taking care of them. That’s the responsibility of members inside the community.”

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One Doctor's Fight Against Homophobia in Uganda.

From the Independent, an article about the "whisper campaign" against a Ugandan doctor who is treating HIV infection:

A whispering campaign is under way in Uganda's capital, Kampala, accusing Paul Semugoma, a doctor, of being a predatory homosexual, actively recruiting younger men into his "vice" with the help of foreign conspirators. His home and business addresses have been published online and he has received a string of death threats. "They are saying that I'm the 'gay tycoon', spreading the infectious disease of homosexuality in Uganda," he says with a bitter laugh. "It's such nonsense."

In reality, he is a respected doctor who has volunteered his time to help with HIV and safe sex education programmes and writes a weekly medical advice column for a popular newspaper. But in the last month he has been publicly outed as a homosexual four times with government officials offering money to anyone willing to inform on his private life.

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Montana's New Aid in Dying Law: Legal Does Not Mean Accessible.

On New Year's Eve, Montana's Supreme Court ruled in the Baxter v. Montana appeal case that aid in dying is not prevented by the state's laws or constitution. The decision wasn't exactly what patients' rights activists were hoping for because now the legislature, decidedly reticent to take up the issue and notoriously more conservative, is invited to address the issue.

But as women's rights advocates know well, legal does not mean accessible. Montana doctors are not jumping to use the new aid in dying ruling because, many say, the law does not have guidelines regarding use. Other's have noted that opponents to aid in dying, primarily "pro-life" groups who have become expert at blocking access to abortion, a legal medical procedure in the US, will use their access-limiting expertise to prevent dying patients from using aid in dying.

From provider refusal laws ("conscience clauses") that allow pharmacists to refuse to fill lethal prescriptions for terminal patients, to restrictions on Medicare and Medicaid coverage of aid in dying, to pressure from Christian doctors' associations, to "shaming" campaigns that confuse the public's understanding of what aid in dying is, "pro-life" groups are already working in Montana to, if not change the laws, make receiving aid in dying assistance there very difficult.

From Billings Gazette today:

It could be a while before Montana doctors are willing to help terminally ill patients die, despite the recent state Supreme Court decision that nothing in state law prevents physician-assisted suicide.

The court decision made Montana the third state where it is legal, but the state has no specific laws outlining guidelines for doctors like they do in Oregon and Washington. That will leave Montana doctors on their own to determine how to proceed if they choose to help a dying patient commit suicide.

The Supreme Court said nothing in the law prevents a doctor from prescribing death-inducing drugs to terminally ill, mentally competent patients. And the court said doing so would be a defense against homicide charges.

But doctors, just because they could have a defense to charges of murder, aren't likely to rush into the process. They are hoping the Legislature — until now hesitant to wade into the debate — will craft a legal framework for assisted suicide.

"I think legally they could proceed, but I think they would need to do so with an extreme mount of caution and substantial guidelines on whether that was a proper thing to do," Missoula doctor Stephen Speckart said.

The Montana Legislature has been closely divided in recent years along partisan lines, making it very difficult for controversial legislation of any type. If that continues into 2011, there are no guarantees that lawmakers will provide any guidance at all.

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The Texas Board Of Education and Efforts to Rewrite History.

From The Austin-American Statesman, another story on the struggle taking place on the Texas Board of Education to shape history text books. This is a national story because as Texas school books go, so go those in the rest of the nation. Publishers tend to honor Texas requirements because the state is the second largest buyer of school books after California, though the latter is not buying books this year.

The contention by some board members is that the US is a Christian nation and that the bible and Christian ideology should receiver greater emphasis in the teaching of our history. While most agree that Christianity has indeed played a great role in shaping society - and should be addressed - several board members wish the inclusion to be promotion of Christian values rather than critical approaches to religion.

From the story:

Barton and Marshall were among six reviewers chosen by the board to make suggestions for changing the curriculum. Their key recommendations for revision include more emphasis on documents from early America like the Mayflower Compact of 1620, written by Christian pilgrims who wanted religious freedom, or adding the Bible to sources that influenced the creation of significant documents when America was founded. If their changes are accepted, students who now receive a more generic overview of religious freedom and its importance in the country's founding would be taught that the nation's founders wanted to shape America based on biblical principles.

Those ideas resonate with many Christians, history and religion professors say, but they concern many others.

"I'm an evangelical Christian, and I think David Barton and Peter Marshall are completely out to lunch," said John Fea, a history professor at Messiah College in Pennsylvania, a Christian institution. "They are not experts on social studies and history. Neither of them are trained in history. They are preachers who use the past and history as a means of promoting a political agenda in the present."

Barton, a Texas-based GOP activist and nationally known speaker, and Marshall, a traveling evangelist whose father was a U.S. Senate chaplain in the 1940s, are aligned with American University law and history professor Daniel Dreisbach — one of four academics on the review panel — in the belief that America was intended to be a "Christian nation" with no separation between church and state.

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