Sunday, January 17, 2010

"Pro-Life" Groups Focus on Aid in Dying.

It was predictable: state-level "pro-life" groups are working to focus their awareness efforts on end of life issues. The ubiquitous Wesley J. Smith was in Vermont for the annual National Right to Life rally this week to help attendees focus their efforts on aid in dying.

From the Times Argus; the article is a look at how these groups are approaching patients' rights and end of life care without any knowledge of the dying process and an un-nuanced approach to that ill-defined term "life." And the article is so fawning, it hardly counts as reporting.

Allowing doctors or other medical professionals to legally end the lives of patients is a radical, "culture-changing" shift in American society that, once begun, can lead to unintended and horrible actions.

A nationally known speaker, Wesley J. Smith, issued that warning in Montpelier on Saturday to the roughly 400 people who packed the Statehouse during the annual Vermont Right to Life rally.

"When we're talking about assisted suicide, we're talking about something that is really a culture-changing agenda," Smith told the crowd. "I mean, think about the potential impact on how we view each other as human beings."

Smith, who is a lawyer, bioethicist and writer whose articles frequently appear in well-established conservative journals such as National Review and The Weekly Standard, gave an impassioned speech to the rally-goers, who ranged from young children to senior citizens.

Smith sprinkled his speech with stories from Oregon and the Netherlands, places that already have approved assisted suicide. His message was that even though most legislation allowing the practice limits it to the terminally ill, it quickly – and logically – begins to include people in all types of pain.

"Once you accept the premise that ending life intentionally through artificial means is an acceptable answer to a problem of human suffering, how do you leave it to the terminally ill?" Smith asked.

The answer is that once legal, it's not limited to the terminally ill, Smith said.

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More On the Coakley-Brown Emergency Contraception Issue.

A new post from Sargent at the Plum Line makes it sound like he's missed the entire hoopla over the "devout Catholic" comments Coakley made on radio recently. Sargent reports thatshe's got a flier out attacking Brown on the issue, below.

But just to be perfectly clear: Catholic hospitals have been fighting this law since it came down. Because they are governed by the USCCBs Ethical and Religious Directives, they say they should not be forced to provide rape victims with emergency contraception because they believe contraception causes an abortion. In many Catholic hospitals across the country, women will only be given the EC after a pregnancy test has proven the victim is not pregnant. In other words, Catholic hierarchy is demanding that its care facilities not be subject to state laws and in many cases are non-compliant. If a provider or institution refuses to administer EC, it should be required to inform victims of the pill and give them a meaningful referral.

And an aside: these hospitals are tax exempt, receive 50% of their funding from the federal government, and serve pluralistic societies. If that's not federally funded discrimination, I don't know what is.

This is absolutely brutal: Massachusetts Dems have dropped a mail piece accusing GOP Senate candidate Scott Brown of wanting hospitals to turn away “all” rape victims.

The mail piece — sent over by the Brown campaign — shows pictures of women who are supposed to have been raped, one of them in a wheelchair bent over with her head in her hands. It says: “1,736 WOMEN WERE RAPED IN MASSACHUSETTS IN 2008. SCOTT BROWN WANTS HOSPITALS TO TURN THEM ALL AWAY.”

Click to enlarge:



The mailer — paid for by the Massachusetts Democratic Party — says the claim is based on “a law to let emergency hospitals turn away rape victims in need of emergency contraception.” That appears to be a reference to a Brown-sponsored 2005 amendment that would have exempted hospital personnel, on religious grounds, to inform victims of the availability of the morning after pill.

As Coakley’s own Web site says, after Brown’s amendment was rejected, he voted in favor of the bill to require emergency rooms to provide rape victims with emergency contraceptives, and the whole debate seems to be more nuanced than the mailer suggests.

The mailer could be related to the fact that internal Dem polling reportedly shows Coakley under-performing with less-affluent women.


Update: Scott Brown and Republicans attack the Coakley campaign over the mailer.

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Religious Freedom Day.

Howard Friedman at Religion Clause notes Obama's marking of Religious Freedom Day. Please click through to read the comments and to make your own. (Now if only this administration would address faith-based initiatives accordingly!)

Today is Religious Freedom Day marking the anniversary of Virginia’s 1786 Statute for Religious Freedom. Yesterday President Obama issued a Proclamation (full text) officially designating the observance. It said in part:

The Virginia Statute was more than a law. It was a statement of principle, declaring freedom of religion as the natural right of all humanity -- not a privilege for any government to give or take away. Penned by Thomas Jefferson and championed in the Virginia legislature by James Madison, it barred compulsory support of any church and ensured the freedom of all people to profess their faith openly, without fear of persecution. Five years later, the First Amendment of our Bill of Rights followed the Virginia Statute's model, stating, "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof . . .".

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More Proof that Medicine is Neglecting EOL Planning.

Yet another study shows that patients are dissatisfied with their end of life care information:

Patients with advanced chronic kidney disease (CKD) often do not receive adequate end-of-life care and are unhappy with the medical decisions made as their conditions worsen, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The findings indicate that end-of-life care should be improved to meet the needs of CKD patients.

Although many CKD patients die prematurely, surprisingly little research has been done to study CKD patients preferences for end-of-life care and how those preferences align with the care they receive. Sara Davison, MD, FRCP(C) (University of Alberta, Canada) surveyed 584 late stage CKD patients as they came to dialysis, transplant, or pre-dialysis clinics in a Canadian, university-based kidney program between January and April 2008.

Patients reported that they would like their kidney care team to help them plan for the future in case they become incompetent to make decisions. If seriously ill, patients indicated interest in receiving help with managing pain and other symptoms and psychosocial and spiritual support. These services were not routinely integrated into their kidney-related care. Patients were often unaware of palliative care options and of the status and progression of their illness. Of the patients studied, 61% regretted starting dialysis, noting that the decision to start the treatment reflected physicians and family members preferences rather than their own personal choice.

While the vast majority of dialysis patients die in hospitals, more patients in this survey wanted to die at home (36.1%) or in a hospice facility (28.8%) than in a hospital (27.4%). Less than 10% of patients reported having discussed end-of-life care issues with their kidney specialists in the past year.

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Organ Donation and Death's Timing.

Dr. Michael Kirsch posted a comment on this site this morning that is reiterated in his column at MDwhistleblower. That column in part reads:

I think we should provide more incentives to donate, although I do not advocate buying and selling organs on the free market. This would lead directly to economic and physician exploitation of our most vulnerable people. I also vigorously oppose bending the definition of death for the purpose of saving others. One life is not worth more than another. Of course, it’s easier to make principled and categorical statements as a blogger. But, don’t ask me for my high and mighty opinion if my child is on the transplant list. I’d pay the ransom.

If it were up to me, health care - period - would not be monetized or profit-driven. So of course I agree that buying and selling organs should be out of the question. Forever. Always.

I don't think anyone posits that one life is worth more than another's - to justify any type of organ donation. Such a statement is insensitive to the difficult decisions that face both families of the dying and families of those in need of organs. Demonization of any faction of society is so unnecessary - and plays into the overblown fears of a "culture of death" that in actuality doesn't exist. So let's just leave that strawman to those who want to have irrelevant, emotional conversation.

The challenge to organ donation in the US is that fewer people donate than organs are needed. And as Sanghavi noted in his NYT article, when organs are harvested is vital. That schedule is contingent on a medical and legal question that does not have a clear answer: when does death start?

The very best answer is to do what we already do: leave decisions regarding organ donation up to patients and/or their medical proxies. Technology constantly evolves and allows us greater understanding of the dying process. So until someone can tell us definitively what death's schedule is, I think we'll be left to discuss this issue for a while.

Another thing we can do - as Dr. Kirsch suggests - is promote organ donation. I add that this should be done with a sensitivity to the fears that minorities and the disabled have historically had about donation.

I'm thinking I'll change my living will to say something like, "In lieu of flowers, mourners are asked to ensure that they have marked their driver's licenses for organ donation."

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MLK's Economics

Mark Engler has a great piece up at The Nation that looks at the last campaign Martin Luther King, Jr. embarked on before his assassination: The Poor People's Campaign. Here's an excerpt:

Martin Luther King Jr. was working hard to get people to Washington, DC. But when he told an audience, "We are going to bring the tired, the poor, the huddled masses. We are going to bring those who have known long years of hurt and neglect.... We are coming to ask America to be true to the huge promissory note that it signed years ago," the year was not 1963, and his issue was not segregation. Instead, it was 1968, five years after his "I Have a Dream" speech, and now the issue was joblessness and economic deprivation. King was publicizing a new mass mobilization led by the Southern Christian Leadership Conference, a drive known as the Poor People's Campaign.

In King's vision of the campaign, thousands of Americans who had been abandoned by the economy would create a tent city on the National Mall, demand action from Congress, and engage in nonviolent civil disobedience until their voices were heard. King argued in one of his last sermons, "If a man doesn't have a job or an income, he has neither life nor liberty nor the possibility for the pursuit of happiness. He merely exists."

The solution, he believed, was to "confront the power structure massively."

Four decades later, as our country struggles with disappearing jobs and growing desperation, much of the critique of the U.S. economy offered in the Poor People's Campaign is newly resonant. As the country celebrates Dr. King's life and legacy, it is an opportune time to ask: How did the reverend approach issues like poverty, unemployment, and economic hardship? And--given that he offered his criticisms amid one of the greatest periods of economic expansion in our country's history--how might he respond to today's crises of foreclosure and recession?

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The Courts and Patients' Rights.

All morning, in my admittedly naive way, I've been thinking about the courts' approach to the Establishment clause. This train starts in my formation - nee, dream - of a patients' rights coalition that encompasses disability, elder, women's and LGBT rights and fellow-travelers, all focused on ridding medical delivery of the ideologically-motivated discrimination that now exists in our care delivery culture.

From contrived "ethical," pseudoscience, "secular" arguments against abortion to discrimination of "others" like the poor, the gay, the disabled, I see the legislature entertaining the powerful "pro-life" lobby with laws that blatantly discriminate against minority groups.

The recent court decision in Montana to legalize aid in dying only went half way toward guaranteeing patients' a choice in how they die - all but inviting the legislature to step in and create the laws the court found to not exist.

And yet, the third branch of government has at times stepped up to it's challenge of interpreting the constitution without pressure from religious groups, the legislature, media bias, the executive branch, or "traditional" mores.

I've got google alerts set on a host of topics. Each morning my inbox is loaded down with news items that pertain to "euthanasia," "separation of church and state," "Establishment clause," and other key phrases. I just received a heartening link to a story on "terri schiavo," the Florida woman who was removed from artificial nutrition and hydration according to her husband's wishes and the ruling of one Florida judge - despite massive, exhausting, distorting pressure from the Bush administration, the media, "pro-life" groups, the Catholic Church, and state legislature.

David Hancock wrote for CBS News on March 31, 2005, the day Terri Schiavo died:

Forget Michael Schiavo and Bob Schindler. Forget the earnest protestors and the solemn hospice workers. Forget the dopey politicians and the greasy media consultants. Forget the angry preachers and the smug doctors. In the end, in my opinion, the only true unvarnished hero in the recent "legal" phase of the Terri Schiavo saga is 11th U.S. Circuit Court of Appeals Judge Stanley F. Birch, Jr. He is truly a profile in courage.

After his "special concurrence" in the Schiavo case Wednesday, Judge Birch is a hero to all of us who believe that the courts can rise and stay above cheap politics - and that the hypocrisy and demagoguery and self-interest that fuels the other two branches of government still can be neutralized when it comes into our courts of law.

He is a hero to all of us who hoped during the past fortnight of argument and appeals that the federal courts would determine this case in a nonpartisan, non-ideological way. He is a hero to all of us who wanted the courts to beat back this brazen power-grab by the other two branches.

I'm not naive enough to think that court judges are outside society; of course their appointments and efficacy are dependent on their political affiliation, their religious stance, public opinion, who appoints them, and the direct pressures of the "other two branches." As a society, we often fool ourselves into thinking that judges and justices have more objectivity than they really do - as if we need to believe in an uninfluenced, higher authority that can mediate the differing demands of various segments of society.

Hancock calls Judge Birch a hero, but really, he was doing his job: applying existing laws, legal precedent, and the strictures of the constitution to an emotional case that often got lost in the fabrications and exaggerations of various groups in society. Hancock reminds us of how uncommon it is that judges are unhampered in their decisions by outside forces:

"In resolving the Schiavo controversy," Judge Birch wrote, "it is my judgment that, despite sincere and altruistic motivation, the legislative and executive branches of our government have acted in a manner demonstrably at odds with our Founding Fathers' blueprint for the governance of a free people - our Constitution."

Because the special legislation passed by Congress and signed by President Bush "constitutes legislative dictation of how a federal court should exercise its judicial functions (known as a 'rule of decision') the Act invades the province of the judiciary and violates the seperation of powers principle." To hold otherwise, Judge Birch concluded, would be to act in a manner consistent with the label "activist judge." Touché.

Judge Birch was appointed in 1990 by the first President Bush. Because he is a Republican appointee, and a judge who is generally viewed as a solid conservative jurist, his voice carries with greater force in this debate. It carries the word that what happened here in this case was so beyond the pale, so extralegal, that even political and jurisprudential opposites on the bench could agree that it was terribly wrong and had to be blocked.

A Clinton appointee could not have spoken with such legal and political and moral force in this case. It would have come off as too obvious; too predictable. It took a brave judge appointed by the current president's father to call the current president to task for trying to pull a fast one on the overarching concept we have in this country known as the separation of governmental power.

So Judge Birch is a hero and he is now a symbol. Of all of the federal judges who were forced - literally forced - by Congress and President Bush to give special treatment to the Schindlers, only Judge Birch spoke up and called it like he saw it.
Without overwhelming public support for his decision (CBS and ABC polls at the time showed that a majority of Americans - from 70 to 82% - opposed executive and legislative "meddling" in the case, 8 in 10 said they would not want to be kept alive), I wonder if Birch would have had the heroism to stand up to these outside forces.

Which brings me back to my coalition for patients' rights: if the case for non-demoninational, non-discriminatory, un-biased health care were made by such a broad coalition, would the public be motivated to support judges who stood up to "pro-life," Catholic, executive branch, legislative branch, and media forces?

Would the medical industry be forced to drop it's staunch opposition to government regulation? Would "pro-life" groups be forced to end their "mission" of ideological health care for all? Would the powerful Catholic health care behemoth, the second largest provider of health care in the country, relinquish it's overzealous use of federal funds to discriminate against marginalized patients?

Hyde, Church, Coats, Weldon, the Bush "conscience clause" all exist not because they are constitutional but because they have not yet been proven unconstitutional, despite their discriminatory favoring of ideology in medicine. As our health care system continues to implode, one can only hope the public and more judges like Birch start to take notice.

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