Saturday, January 16, 2010

Judge Says "Clean Needle" Program Like Palliative Care.

Via the Washington Post, a Canadian judge has compared the first-of-its-kind, threatened "clean needle" program in BC to palliative care. The pertinent quote is in the last paragraph of the excerpt below.

I'm a strong believer in clean needle programs that recognize and address addicts' suffering and vulnerability to disease - without shaming or blaming the victims. I also think palliative care shouldn't be a marginalized field of medical practice. Yet the specialty is demeaned as "rationed" medicine or only for those who have given up on life (much like hospice!)

Apt comparison? Inviting dispersions? What do you think?

British Columbia's top court on Friday rejected an attempt by the Canadian government to close North America's first safe injection site for drug users.

The site, where people can inject illegal drugs with clean needles under a nurse's supervision, has operated since 2003 under a temporary exemption. It was opened as part of a harm-reduction plan to tackle an epidemic of HIV-AIDS and drug overdose deaths.

The exemption was scheduled to end in 2008, but a trial court allowed it to remain open. The Conservative government appealed Justice Ian Pitfield's ruling last year that allowed Insite, as the site is known, a constitutional exemption from Canadian drug laws.

In the May 2008 ruling, Pitfield said Insite - operated by the Portland Hotel Society in conjunction with the Vancouver Coastal Health Authority - provided important health care resources to addicts.

The British Columbia Court of Appeal rejected the federal government's bid to overturn the lower court's ruling that said Insite provided a needed medical service.

The three-member appeals court panel, which was split in its ruling, said Insite is a health facility and falls under provincial and not federal Canadian jurisdiction.

"Like palliative care, it is a form of harm reduction with benefits for both the patient and the community," said Justice Carol Huddart in the split decision. "The lure of safe injection gets those addicts into Insite so health care may be delivered."

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Roundtable on Palliative Care and Awareness Raising.

Here's a bit of the press release about a recent roundtable on palliative care, held in New Rochelle, NY.

Its occasion causes me one particular observation: while the moderator was a woman, the panel was completely comprised of men.

If palliative care wishes to raise awareness of it's opportunities among society at large, it would best address the primary care-givers in society: women. Tapping into feminists who work for women's rights, the LGBT community that works for gay patients' rights, nursing associations, hospice volunteers, home care givers, and end of life advocates, palliative care workers and advocates will be able to cause a more positive and broad understanding of palliative care.

It is only under the larger, more-encompassing rubric of "patients' rights" that elder rights and palliative care services will be given the attention they greatly deserve - and the sad state of patients' rights in the US will be improved.

Roundtable Discussion Highlights Vital Role for Palliative Care in Health Care Reform

New Rochelle, NY—Opinion leaders in the field of palliative medicine explored the unparalleled opportunities that now exist for the palliative care community, which matches treatment to the desires of informed patients and their families, to help define evolving health care reform policy. The thought-provoking Roundtable discussion, “Palliative Medicine: Politics and Policy,” is published online ahead of print in
Journal of Palliative Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc. ( The Roundtable is available free online at

The moderator,
Diane E. Meier, MD, from the Center to Advance Palliative Care at Mount Sinai School of Medicine, in New York City, led a lively discussion focusing on the need to change public perception of palliative care and to educate the public and policymakers on how palliative medicine can contribute to improved quality and greater cost-effectiveness of health care, two of the cornerstones of current health care reform efforts. In October 2009, Dr. Meier began a health policy fellowship in Washington, D.C., with the goal of learning how process and politics influence health policy.

Participants in the Roundtable included David J. Casarett, MD, from the Philadelphia Veterans Administration Medical Center and the University of Pennsylvania, Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine, and Provost, Institute for Palliative Medicine at San Diego Hospice (California)
, Walter J. Smith, SJ, PhD, from HealthCare Chaplaincy (New York City), and C. Porter Storey Jr., MD, from the American Academy of Hospice and Palliative Medicine (Glenview, IL) and Colorado Permanente Medical Group (Denver).

The discussion explored the successful approach to end-of-life care in the Veteran’s Administration health system and how it could serve as a model for the nation. The participants urged the palliative care community to be more proactive in promoting education and awareness, initiating a public conversation and countering misinformation, and demonstrating to politicians and stakeholders how palliative medicine has an important role in policies aimed at improving outcomes and linking evidence-based quality measures to reimbursement.

“Health care reform in the U.S. has put palliative care issues at the forefront of policy and politics as never before. As with all change, there are both opportunities and challenges. This roundtable discussion by national experts illustrates some of the nuance that is missing from the media reports,” says Dr. von Gunten.

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Rational Distrust vs. Rational Fear.

From Smile Politely (Champaign-Urbana's online magazine) comes an article by Dan Schreiber on what capitalism can do and what government can do - and warns us not to confuse the two.

I understand distrust of government. I really do. Government does things like start dumb wars in Iraq. Government killed hundreds of thousands of people during Communist purges. Government sometimes allows lazy bureaucrats to ignore your well-being.

But I also don't trust capitalism to automatically provide for the common good. The purpose of a company is to make a profit, after all. In countries with weak governments and strong capitalism, the only choices most people have are to work for long hours in substandard working conditions for a pittance. In our country, if it is unprofitable to insure people who are likely to get sick, capitalism's answer is to not insure those people and let them die. Companies choose profit over the public good because that is what they are designed to do.

It should be evident at this point that capitalism without government becomes economic slavery and government without a free market (of ideas and goods) becomes tyranny. The problem isn't the existence of one or the other, but that either will encroach on our freedom if it is allowed to become too powerful. We need both to balance each other out, because too much power in one place is inevitably corrupting.

So who is more powerful in America in the 21st century? An unwieldy but democratically elected government or multi-national corporations in search of the next quarter's profits? One way to answer this is to ask who is controlling whom. Government can tax corporations and put people in jail who don't follow laws. On the other hand, corporations can buy members of congress in order to enact favorable laws and gut enforcement of the laws that do exist. In the end, unjust laws can be changed with enough effort. But corporations are under no obligation to enact just labor practices or economic conditions unless government forces them to.

It is true that many liberals distrust capitalism. But it is not true that liberals naturally trust government. Liberals just recognize government as the only thing powerful enough to curb the excesses of capitalism. I suppose the important thing is to be able to differentiate between rational distrust and irrational fear, whether we are talking about government or capit


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GRITtv Segment on the Anniversary of Roe v Wade

The segment perfectly addresses the challenges faced by women now, 37 years after the passage of Roe v Wade.

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Hyde, Church, Coats, Weldon, "Conscience Clauses" All Unconstitutional?

Many have been critical since 1973 of the grounds of the Supreme Court's decision on Roe v. Wade.

The battles over abortion language in the health care bill have reawakened criticism of the courts for neglecting to determine that opposition to abortion - and other women's reproductive services - is religious in nature.

(I would extend the court's neglect to other patients' rights issues including end of life rights, and LGBT rights as violated by Catholic health care's protection by provider refusal laws (so-called conscience clauses) that allow doctrinal medicine to be delivered to the general public despite public funding of such facilities.)

A new paper by Justin S. Murray, a Georgetown University law professor, looks at the court's avoidance of direct Establishment Clause grounds for such decisions but works to prove that a secular case can still be made for opposition to abortion. He writes, "...I aim to prove the more modest proposition that a strong enough case can be made for restricting abortion, based solely on secular reasons, to satisfy the demands of the Establishment Clause."

This is the gold mine for opponents to abortion! Prove abortion should not be legal on secular grounds and - wallah! - the court's long-established and questionable skirting of the Establishment clause is excused. He even establishes what he calls the "underground Establishment Clause," noted with it's own acronym, UEC. It's a slight of hand: prove that Roe v Wade and other rulings are based on Establishment Clause principles and you remove any defense of subsequent laws that address women's rights to secular health care. It's almost equivalent to saying that you're not racist because you have black friends.

This is no new hat trick by opponents of abortion, and gets at one of my great concerns: the cultivation of religious legal, medical and political intellectuals by the Religious Right to oppose liberal or progressive intellectuals, all the while denying legitimacy to intellectual thought. The growing prevalence of religious education, both primary and university level, the increase of religious legal and medical associations, the dominance of religious think tanks and foundations all work to undermine secular "intellectual" society by claiming "common man" status. The perfect example is Wesley J. Smith, a senior fellow at the Discovery Institute - an organization which promotes intelligent design and "pro-life" principles while keeping "God talk" on the down-low. Same-sex marriage is refuted as "untraditional" or "unnatural." Legal abortion is not a violation of a woman's bodily autonomy and right to conscience but the state's "ethical" protection of an unborn citizen.

The slow secularization of society has not prevented these quietly religious organizations from influencing public policy on a grand and destructive level: witness the "faith-based" initiatives neatly woven in to the delivery of social services by the federal government by Bush - and maintained by Obama.

The Hyde Amendment, the Church Amendment, the Coats Amendment, the Weldon Amendment, and the Bush "conscience clause" are all reliant on contrived use or avoidance of the Establishment Clause. Yet, clearly the motivation/justification for them is religious in nature. In other words, the Establishment clause "protection" of religious actors - nurses, doctors, pharmacists and entire institutions like Catholic health care- is one-sided. Provider refusal of common secular medical services has been established according to the Establishment clause with no concern for patient's rights, conscience, or needs. One conscience and ideology protected to the detriment of another's. And to the detriment of a society that is still left to fight poverty, unplanned pregnancies, class segregation, and discrimination. The power over one's body has been, for religious reasons, put into the hands of those with authority and religious motivations. This empowerment of religious forces corrupts social justice on a grand scale because it favors one ideology over all others - and denies patients the right to their own health decisions.

As feminists now focus, in the wake of health care bill battles, on the overturning of Hyde, they would be wise to push for a reexamination of such amendments on Establishment clause grounds, as opponents of Proposition 8 in California are doing. How the courts respond is another issue that will only remain in question so long as society buys into these covert efforts to secularize or mask religious ideologies in law and ethics.

Constitutional lawyers like Marci Hamilton have made a strong case for the unconstitutionality of the Stupak Amendment and as Frances Kissling, former president of Catholics for Choices, has noted, Hyde has been unjustly accepted by feminists as a compromise on "common ground" in the abortion fight despite it's systematic discrimination against poor, minority women. This renewed focus on the quality and grounds of such rulings could signal a new move toward non-discriminatory health care laws. But it requires that patients' rights advocates reframe stealth religiosity out of the issue.

Until the courts - both state and federal - are forced to address the issue of religiously influenced medicine for women, gays, and elders, we will be left with laws that blatantly discriminate against minorities in direct violation of the Constitution.

The abstract from Family Law Prof Blog:

Murray: "Exposing the Underground Establishment Clause in the Supreme Court’s Abortion Cases"

Justin S. Murray (Georgetown University Law Center) has posted Exposing the Underground Establishment Clause in the Supreme Court’s Abortion Cases on SSRN. Here is the abstract:

In Roe v. Wade, the Supreme Court held that women have a constitutional right to abortion based on the Due Process Clause. To arrive at this conclusion, the Court implicitly relied on concepts that properly belong to the Establishment Clause - in particular, the Establishment Clause requirement that all laws must be supported by secular purposes, not religious ones. This Article is the first attempt to describe and critically evaluate the Court’s use of Establishment Clause ideas in Roe and later abortion cases.

Some brief background is essential in order to grasp the structure and significance of the underlying Establishment Clause dynamic of Roe. The Due Process Clause allows the government to restrict fundamental constitutional liberties (such as abortion) if it has a compelling reason for doing so. States have defended their abortion laws by arguing that protecting unborn human life against homicide is a compelling reason to restrict abortion. This argument, advanced in Roe, directly presented the Supreme Court with the question of whether fetuses are human beings entitled to protection against homicide.

The Court, however, refused to answer the question and provided a convoluted, ambiguous explanation for its refusal. Careful interpretation of these ambiguous passages reveals the Court’s underlying concern that neither the judiciary nor the legislature may decide the question of fetal humanity because it is a controversial religious question. When the Court’s rationale is clarified and plainly stated in this way, it becomes clear that Roe’s method of analysis - rejecting the state’s interest not because it is false or unimportant, but because it is religious and therefore an inappropriate basis for political judgment - is identical to the Establishment Clause requirement that legislation must be based on a secular purpose.

However, the Court’s analysis is problematic, because Establishment Clause principles are consistent with governmental protection of fetal life. The humanity of the fetus can be plausibly supported, not only on religious grounds, but also on the secular grounds of philosophical, historical, and experiential reasoning. To be clear, I do not argue that these secular grounds prove beyond dispute that fetuses are human beings. Instead, I defend the more modest proposition that a debatable secular case can be made for viewing fetuses as human beings. This conclusion is not strong enough to justify criminalization or restriction of abortion (which is beyond the scope of this Article), but it does prove that such criminalization or restriction would not violate the Establishment Clause. Thus, the Court should revisit the fundamental question that it evaded in Roe and later cases: is the fetus a human being, such that legislatures have a compelling interest in protecting fetal life against abortion?

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Top 50 Hospice, Elder Care Blogs.

The Health Herald blog has done us a favor by listing their pick of the top 50 hospice and elder care blogs:

General Hospice Care Blogs

1714014071_9a879f4c93Get a general idea of what hospice care is all about, and learn more about your options and the possibilities.

  1. Hospice Blog: This offers information on hospice care, and the fight for quality care.
  2. Hospice Physician’s Blog: Learn about hospice and how it works from a doctor working in the field.
  3. Hospice and Nursing Homes Blog: Hospice practices, insights, research, news and issues.
  4. Hospice and Caregiving Blog: News, information and more surrounding hospice care, as well as information for caregivers.
  5. Home Care Law Blog: This blog focuses on legal issues surrounding home hospice care.
  6. Alive Hospice Blog: Learn more about hospice care and end of life issues from a hospice provider.
  7. Hospice: Learn more about hospice care, and what goes into it, as well as what to expect.
  8. Life as a Hospice Patient: This is an interesting firsthand account of a hospice patient, and what hospice care means to her.
  9. Compton Hospice: Get a view of hospice care from a British perspective.

Elder Care Blogs

Find out about senior living, and how hospice care can fit into the picture. These blogs also include information about finding hospice care and making the most of it.

  1. AARP: Read the blog from the AARP, including coverage of issues related to health care, hospice care and end of life.
  2. Eldercare ABC Blog: Learn about the essentials of elder care, and find valuable resources and support.
  3. Elder Care Diary: Keep up with the day to day activities of a family involved in elder care.
  4. ElderCare Expert: Get useful insights and helpful hints from someone who has been involved in senior care for a long time.
  5. The New Old Age: A look at the way we age in these modern times. An interesting look at hospice, assisted living and other related issues.
  6. Senior Care Blog: Learn about issues associated with aging, as well as elder health, and information on long term home care.
  7. Choosing Elder Care: A review of different options in elder care, and helpful information and resources.
  8. Elder Care Blog: Learn about issues that come up in elder care, as well as issues relating to end of life.

Death Care Blogs

Get insight into the end of life process, and learn about how hospice care can fit into this.

  1. Death Care Law Blog: Keep up with what your rights are in end of life, and find information about pre-need issues.
  2. Death Care Law: Another interesting legal blog focusing on death issues.
  3. How We Die: An interesting look at stories from people regarding death, and how we view death as a society.
  4. Medical Futility Blog: Get a tongue in cheek look at the issues — judicial, legislative and political — surrounding the end of life.
  5. The Good Death: Bringing about death with dignity, and a look at how society deals with death.
  6. Death Care: Looks at issues surrounding death, as well as provides resources to help you make more informed decisions.

Pain Management Blogs

One of the important functions of hospice care is to provide pain management. Read about different options and treatments, as well as additional information on palliative care.

  1. Palliative Care: This blog focuses on pain management, as well as easing some of the other symptoms often associated with the approach of life’s end.
  2. GeriPal: This blog focuses on palliative care and pain management in the elderly. Offers helpful posts and insight into different medicinal options.
  3. Pallimed: A look at the role palliative care plays in the way hospice care handles end of life.
  4. Palliative Care Success: Explores the successes seen in pain management and symptom control as part of hospice care.
  5. Pain Management Blog: Focuses on different advances in pain management.
  6. Chronic Pain Management: Learn how to deal with chronic pain, and help others deal with it.
  7. St. Christopher’s Blog: Malcolm Payne: This blog is offered up by St. Christopher’s Hospice in London, and provides insight into palliative care and social care for end of life.
  8. Palliative Care Bulletin: Get the latest news alerts about end of life care.

Nursing Home Blogs

While not exactly hospice care, nursing homes can provide many of the same services. Learn about different nursing home options and possibilities, as well as preparation for long-term care.

  1. My Better Nursing Home: Get an idea of what better nursing home care could look like, and how we might be able to get there.
  2. My Elder Advocate: This blog deals mostly with issues related to nursing homes, and your rights with regard to them.
  3. The Nursing Home Administrator: Get an insider’s view of how a nursing home is run from a nursing home administrator in Indiana.
  4. Jonathon Rosenfeld’s Nursing Homes Abuse Blog: This blog focuses on nursing home abuses, and shows you how you can get better care from your nursing home.
  5. South Carolina Nursing Home Blog: News and information related to nursing homes, especially those in South Carolina.

Caregiver Blogs

Being a caregiver for someone approaching their end of life can be difficult. Learn about others’ experiences and find sources of strength and support.

  1. Caregiver List: Helpful information on where to find information about different facilities, training and other items.
  2. Inside Elder Care: Get a firsthand look at caring for others. This blog is written by someone who is caring for his aging mother.
  3. Lasting Tribute: This isn’t just about the elderly. You can leave stories and messages about anyone who has died. But the blog includes plenty of interesting stories from caregivers and others.
  4. Risa’s Pieces: Learn about what it’s like to be a hospice caregiver from this compassionate professional.
  5. Caring for Aging Parents: Learn about how you can cope with caring for aging parents, and find support as well as answers to your questions.
  6. Caregiver Support Blog: Find support in your position as caregiver, and read about others.
  7. The Caregiver’s Blog: Learn about being a caregiver and find support from others in a similar position.
  8. Caregiving: Tips and hints for caregivers, especially those who are caring for people with Alzheimer’s.

Nurse Blogs

Get professional insight from health care professionals who have some experience with end of life.

  1. Dethmama Chronicles: Follow the adventures of this end of life nurse. Includes some funny insights and more.
  2. Midwife for the End-of-Life: Get accounts of what it’s like to be a nurse caring for those who are near death.
  3. code blog: This nurse shares her experience as an ICU nurse, as well as insights on end of life.
  4. River of Life: Notes of a Hospice Nurse: This video offers a look into life as a hospice nurse.
  5. A Hospice Nurse’s Story: This post on from the Center to Champion Nursing in America offers a poignant look at what it’s like to care for others in a hospice setting.
  6. Minnesota HomeCare Association’s Nurse Consultant BLOG: Get an idea of what is going on in the world of home care nursing.

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