Wednesday, January 13, 2010

Evil Petition to Obama Saying Haitians Need to Help Themselves.

Find it here. h/T @harrislacewell. The small print at the bottom reads:

The U.S. Should Not Help Haiti Earthquake Victims Petition to U.S. Congress, President Obama was created by National Alliance for Liberty and Freedom, a coalition of national libertarian, tea party, objectivist, and Ayn Rand groups and written by Glenn Adamson ( This petition is hosted here at as a public service. There is no endorsement of this petition, express or implied, by Artifice, Inc. or our sponsors. For technical support please use our simple Petition Help form.

To: U.S. Congress, President Obama

The recent earthquake in Haiti is a tragic situation that has touched America's heart. However, America must be careful to avoid losing its head and making a bad situation even worse.

The National Alliance for Liberty and Freedom, a coalition of national libertarian, tea party, objectivist, and Ayn Rand groups hereby demands that no public funds should be spent on any disaster relief.

Certainly, if private citizens want to donate money that is an individual decision that they will freely make, and we cannot - nor would we seek to - prevent those citizens from deciding where to spend their money.

However, public funds are entirely different and should not be spent in this matter.

The main reason is simple: those funds are not the U.S. government's to begin with. Any money that the U.S. government would give would have been stolen - under threat of force - from U.S. citizens.

Further, any donations to Haiti will only serve as a "moral hazard", in effect underwriting their bad choices. Haiti had some of the highest tax rates in the Western Hemisphere, hampering the natural innovation of its citizens and making it difficult for corporations - today's engine of prosperity - to operate in that country. Their rules and regulations were among the most onerous as well, preventing true innovation to occur. Without such onerous rules and high taxation, Haiti could have been a thriving commercial center able to better withstand the earthquake and its aftermath.

By giving money, we will prevent Haitian citizens from rising up in their own Tea Party Revolution and taking their country back from the Marxists.

Once again, if private citizens want to donate their own money, that is their choice. However, the U.S. government should not give one dime: it isn't their money to give and it will only reward failed choices.


The Undersigned

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Uganda and Homosexuality.

Two new stories about Uganda and the anti-homosexuality bill there that originally proposed killing gays but now favors, after US pressure, lifetime imprisonment and "curative" procedures.

At RHRealityCheck, Edwin Ocong'o asks why Ugandans have so willingly accepted the Religious Right's anti-homosexuality ideas.

At The Nation, Peter Rothberg asks Americans to raise their voices against the discriminatory and draconian proposals in Uganda.

And a new article from Voice of America on how Ugandan officials are reacting to the increasing pressure form non-religious American voices.

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Margaret Somerville on Patient Dignity and Suffering.

Margaret Somerville, an opponent of aid in dying, writes for today's Globe and Mail some great things about how to help dying patients in pain feel as though they still control their lives.

While I agree with much of what she writes, her disingenuous digs at "euthanasia" ring hollow and unjustified in the context of the article. Patient dignity and control is not negated by aid in dying, when provided in the context of strict laws, but in particular terminal cases enabled by it. But the Canadians have their own culture war over "euthanasia" waging. Somerville has an ideology to enforce; unfortunately that's made an interesting and beneficial story into a piece of advocacy work, undermined by a position that she espouses but doesn't back up with fact.

Euthanasia is proposed by its advocates as an appropriate response to pain and suffering, precisely because, they argue, it gives patients ultimate control over what happens to them. But if, for ethical and practical reasons, we believe (as I do) that legalizing euthanasia is a very bad idea, what else can we do to reduce the suffering of seriously ill and dying people?

First, everyone has a right to all necessary pain-relief treatment: We must kill the pain, not the person with the pain. To unreasonably leave someone in pain is a breach of a fundamental human right and a breach of trust.

Trust in one's caregivers is very important in reducing suffering. In the past 30 or so years, we have changed from blind trust – “trust me because I know what's best for you” – to earned trust – “I will show you can trust me and will earn your trust.”

Earned trust requires honesty, and shared information and decision-making, all of which increase the patient's sense of control, thereby reducing suffering. When it's not possible for the patient to be in control, honouring the patient's trust becomes even more important.

We have medicalized, depersonalized, dehumanized and technologized death – and, as a result, dying people suffer intense premortem loneliness. We need to recognize and address that loneliness. Euthanasia is a medical technological response to suffering and death. But in a caring, ethical society, the answer to loneliness and abandonment is not a lethal injection.

We need to understand what seriously ill or dying people require to feel respected. Harvey Chochinov, a Manitoba psychiatrist who specializes in the care of terminally ill people, and his colleagues have developed a treatment they call “dignity therapy.” They identified the elements that contribute to dying people's suffering and designed interventions to counteract these elements. Hope, for instance, is very important in reducing suffering. It requires having a sense of connection to the future. We can give people “mini-hopes” – things to look forward to – even when a long-term future is not possible.

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Texas Board of Education (Re)Writes History.

It's a long hard battle. The Washington Post weight in. You can read other sources at my prior post here and here. And don't miss the new joint statement from religious leaders and public policy experts on religion and public life here.

Early quibbles over how much prominence to give civil rights leaders such as Cesar Chavez and Thurgood Marshall, and the inclusion of Christmas seem to have been smoothed over in the draft now being considered. But board members are crafting dozens of amendments to be raised for consideration before the tentative vote, expected Thursday. The 15-member board won't adopt final standards until March.

The curriculum it chooses will be the guideposts for teaching history and social studies to some 4.8 million K-12 students for 10 years. The standards will be used to develop state tests and by textbook publishers who develop material for the nation based on Texas, one of the largest markets.

Much of the conversation ahead of the hearing has turned to how much emphasis will be given to the religious beliefs of the nation's founding fathers, with some activists lobbying to promote and highlight their Christianity. Others who promote the separation of church and state are prepared for battle.

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Far Religious Right Attacks Coakley for Supporting Emergency Contraception for Rape Victims.

The Massachussetts senate race, in the wake of Kennedy's death, is bringing the issue of emergency contraception and Catholic hospitals back into the news - and it's a good thing.

While Drudge and others are criticizing Martha Coakley, who's running against the creepy "pro-life" candidate Scott Brown, for supporting laws that require Catholic hospitals to administer emergency contraception to rape victims, the straight-forward issue of Catholic doctrinal treatment of a pluralistic society is again getting a necessary spotlight.

The Catholic church is the second largest provider of health care in the US, after Veteran's Affairs. If you stop by here often, you know that the 624 Catholic hospitals in the country, hundreds of long-term care and hospice facilities, and 60 health care networks all operate according to doctrine approved by the USCCB. These directives stipulate that religious ideology be used to refuse common and accepted medical procedures to the millions of patients who pass through Catholic health care institutions each year. Fifty Catholic hospitals in the US are sole providers, the only hospital serving a community, and the difficult economy is forcing Catholic and secular hospitals to merge at an ever-increasing pace which results in further limitation of services such as tubal ligations, fertilization procedures, counseling on STD and AIDS prevention, contraception, and compliance with patients' advance directives at end of life.

Patients go into Catholic institutions expecting to receive modern medical care and find that they are subject to Catholic doctrine. What allows this draconian application of religious ideology to a mixed society, despite tax exempt status and 50% of funding from the federal government, is a series of laws that protect not only individual provider refusal of service - so-called conscience clauses - but those of an institution. And Catholic hospitals are currently able to deny informed consent by not notifying patients of common medical services available, but to not even refer patients to other care facilities for such services.

The Catholic church and allied "pro-life" groups consider some forms of contraception to be abortion and therefore resist state and federal laws regarding distribution of emergency contraception to rape victims. Massachussetts is one of the US states that requires rape victims be informed of and offered EC when they enter a hospital.

Yet multiple studies have found that Catholic hospitals across the country have worked around such a requirement, offering EC only after it is proven (via yet more tests) that the woman is not pregnant. In other words, the Catholic church is not complying with the law. Coakley has brought this up as an important issue and opponents are using it to discredit her campaign.

Studies have shown that even Catholics strongly oppose the USCCBs teachings. A full 97% of Catholic women will use some form of birth control in their lifetimes.

By continuing to treat women with discrimination, Catholic hospitals are applying restrictions that are not supported by their church members nor society. Coakley is right to bring this issue to the light. Women traumatized by rape should not be shamed nor denied modern medical treatment simply because they've wandered into a Catholic hospital.

We have laws that prevent discrimination against women. They should be enforced.

UPDATE: Don't miss this new research paper at SSRN on conscience and emergency contraception.

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Organ Donation and Determining When Death Starts.

Yesterday's New York Times article is titled with the loaded question, "When does death start?" and tells the sad story of a parent whose daughter is hit by a truck. The grief-stricken mother realizes that her daughter has lost all but a few basic physical reflexes and requires life support to survive. And she knows that her daughter would have agreed to organ donation.

Organ transplantation must abide by the so-called dead-donor rule: a person has to be declared dead before any vital organs can be removed. Yet organs have to be alive if there is any hope of successful transfer to a recipient. Medical professionals have handled this paradoxical situation — finding a dead body with live organs — by fashioning a category of people with beating hearts who are said to be brain-dead, usually after a traumatichead injury, and who are considered just as dead as if they had rigor mortis.

To diagnose brain death, doctors typically go through a checklist of about a dozen items, including assessing reflexes like blinking, coughing and breathing, which are all controlled by the brainstem. The criteria are extremely strict, and only a tiny fraction of severely brain-injured people meet them. Kleinman realized that Amanda, despite her severe brain damage, was not one of them. There was, Kleinman told Beaulieu, another option — one that was still controversial and had never been pursued successfully at Children’s Hospital. The procedure was called donation after cardiac death, or D.C.D., and it would exploit the other way the law defines death: as the “irreversible cessation” of the heartbeat.

D.C.D. requires doctors to confront the shadowy question of exactly when somebody dies after the heart stops. To authorize D.C.D., doctors must follow a strict procedure. Amanda would be taken, technically alive, to an operating room, where her breathing tube would be removed. If her breathing ceased naturally and her heart stopped quickly (within an hour), she would be moved to an adjacent operating room and Kleinman would count off precisely five minutes, during which time Amanda would be prepped for surgery with antiseptics and surgical drapes, while Kleinman carefully watched for signs of a returning heartbeat. If there were none, Amanda would be declared legally dead; the stoppage would then be considered “irreversible.” Before her organs were seriously damaged by the lack of oxygen (every minute counts), the surgeons would rapidly open Amanda’s torso and remove them for transplant.

The article tangentially takes up the "pro-life" accusations that determining death "arbitrarily" - in this case, 5 minutes after the heart stops - is really a contrived criteria motivated by the desperate need for organs. In many segments of society, particularly among the black community, failure to agree to organ donation, say on driver's licenses, is fueled by the fear that doctors will see the person as less than human, not worth saving, and rush them off for organ harvesting.

It's a fear that "pro-life" advocates have manipulated in recent years to fight everything from removal of artificial nutrition and hydration (the US Conference of Catholic Bishops has just changed their hospital policies to include ANH as "obligatory") to removal from respiratory machines. All life - unconscious, unrecoverable, slated for a life of machines and vegetative state - is sacred in God's eyes, they say. Doctors are playing God by deciding when a patients is dead. Never mind that doctors are playing God by keeping the patient artificially alive.

Disability rights activists too are concerned that, disability as defined as everything from blindness to frailty at end of life or vegetative state, as they advocate in order to bring more attention and normalcy to disabled states, then brings great concern to qualifications like "quality of life" and "dignity." Particularly concerning aid in dying, disabled groups fear that the medical profession and society have consistently failed to value disabled lives as worthy of advanced medicine.

The Times article give a little history of attempts to define death:

The paradox of needing a dead donor with a live body was first addressed in 1968. Henry Beecher, a Harvard anesthesiologist and medical ethicist, convened a 13-member committee to write a definition of “irreversible coma,” or brain death, for The Journal of the American Medical Association. Not everyone accepted the four-page report’s conclusions. After Norman Shumway, a Stanford University surgeon, performed the first American heart transplant from a brain-dead donor, he was threatened with prosecution by the Santa Clara County coroner. As a result of the widespread disagreement over the meaning of “brain death,” President Jimmy Carter asked a blue-ribbon commission to examine the issue. The commission culminated in the Uniform Determination of Death Act in 1981, which defined death as “irreversible cessation of all functions of the entire brain, including the brainstem.” The procedure to diagnose brain death, however, was never codified into law, and as a result, it varies from hospital to hospital. In 1987, the nation’s pediatrics authorities tried to standardize the diagnosis, listing 14 different criteria to confirm brain death, like the absence of reflexes, and requiring, under certain conditions, additional X-rays and tests for brain-wave activity. Last year, in the journal Pediatrics, researchers from Loma Linda University reported that of 277 brain-dead children in California who were referred to the regional organ bank over many years, only a single child received the full set of diagnostic tests.

The writer of the story, Darshak Sanghavi, a pediatric cardiologist at University of Massachussetts Medical School, gets at the controversy surrounding the determination of death and the harvesting of organs by citing a recent case:

As Gary Greenberg wrote in The New Yorker, donating organs in such a manner, deliberately and with anesthesia, could simply be “a particular way to finish our dying, at the hands of a surgeon, after some uncertain border has been crossed.” But Francis Delmonico, a professor of surgery at Harvard Medical School and a national leader in organ transplantation, fervently defends the need to establish death before removing organs. “I understand a family’s anguish and inability to have consolation when a child doesn’t die after removal of life support,” he explains, “but I don’t see this as a patients’-rights issue. It’s a matter of public trust in the system.”

Donation after cardiac death already arouses suspicion. Just as transplant surgeons like Norman Shumway were once harassed for procuring organs from brain-dead donors, a California-based surgeon, Hootan Roozrokh, was tried for dependent-adult abuse, a felony, after participating in an attempted D.C.D. A nurse who objected to the proceedings later registered a complaint about how painkillers were administered to the patient. Prosecutors charged him with trying to hasten the patient’s death. Though none of this held up in court — Roozrokh was acquitted last year — the trial left many transplant surgeons shaken. Just think of the outcry, Delmonico cautions, if families and doctors also decided it was acceptable to euthanize patients to procure their organs. “You would destroy organ donation in this country,” he said.

It's an important issue and a well-written article. Though I include excerpts, I recommend you read the entire article at the link above.

UPDATE: from the conservative lifenews, an article on this NYTimes article by Judie Brown that does nothing to understand the challenges faced by parents, like those described by Sanghavi, and everything to bash parents or medical proxies in difficult positions over the head with an ideological position that has little science or medical foundation.

This is not dialogue that Brown invites, this is a law, given to her by doctrinal authority and some hefty self-righteousness, which she demands be enforced, regardless of the patient's rights, faith, particular diagnosis, or a parent's wishes. Sanghavi produced a searching article that examined the challenges medicine and patients face as technology allows here-to-fore life-saving procedures. Inability of the Right to engage in conversation regarding these very nuanced and difficult decisions and ethics will not further advance science or humane response, it will continue to mire the Right in rigid and unchanging, draconian, impossible positions that label them deniers of science and modernity. As a community, we are here to solve emerging problems together. Brown shows that the "pro-life" position may have clout, resources, soldiers, and media outlets but it still lacks compassion for human suffering. Hers is a sad and telling position-piece on obsolescence.

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