Friday, January 22, 2010

The Medical Right.

A fantastic article about the medical right, by Kathryn Tucker (wicked smart legal counsel for Compassion & Choices, end of life rights group) at the Journal of Legal Medicine.

While her work is on religious imposition on patients' rights at the end of life, her logic and rationale apply directly to women's reproductive rights - indeed to all patients' rights. A quick clip:

Medical Right organizations are delving ever more deeply into activism, policy promotion, and politics. They are expanding the range of issues they work on, forming new organizations, and consciously taking front and center roles in media and legal debates. The RCRC Report points out that the Medical Right has created a virtual “shadow medical establishment.” [FN8] Unlike *498 professional societies that represent physicians and other health care providers, medical schools, and teaching hospitals, most of the Medical Right groups are relat- ively unknown because they act outside of the normal channels of medical policy and practice.

Evidence of the shadow medical establishment can be found in legislatures, the courts, and obscure profes- sional societies and journals. The goal is to establish an alternative body of medical fact to validate beliefs of the Christian Right and thereby advance its political agenda.

Want proof that she strikes a cord? Here's Wesley J. Smith, everyones favorite "pro-life" patriot and Discovery Institute fellow, going wacko over Tucker's article, conscience clauses, informed consent and referrals.

I know I've been banging the Establishment drum pretty hard lately but it is the drum that the Religious Right, the Medical Right - and if I may, the Legal Right - fear the most.

Labels: , , , , , , ,

Implications of Citizens United Ruling for Roe.

A scary report from Politico that asks whether the current Supreme Court, so ready to throw decades-old precedent out the window for corporations, will toss Roe v Wade next:

The Supreme Court’s ruling Thursday overturning a ban on corporate political spending that had been in place for more than a century has left abortion-rights supporters jittery that the justices could be similarly prepared to upend the landmark Roe v. Wade decision the court handed down 37 years ago this week.

“Yesterday’s Roberts court decision, which exhibited a stunning disregard for settled law of decades’ standing, is terrifying to those of us who care deeply about the Constitutional protections the court put in place for women’s access to abortion,” said Nancy Northup of the Center for Reproductive Rights. “We are deeply concerned….Yesterday’s decision shows the court will reach out to take an opportunity to wholesale reverse a precedent the hard right has never liked.”

“It is worrisome beyond the direct impact of yesterday’s ruling on election law,” said, Jessica Arons, the director of the Women’s Health and Rights Program at the Center for American Progress. “It’s certainly cause for concern.”

The court’s 5-4 ruling in the Citizens United case Thursday declared unconstitutional a law which has been in place since 1907 barring corporations from involvement in federal elections. Just six years ago, the Supreme Court called the longstanding ban “firmly embedded in our law.” Now, it’s gone.

Labels: , , ,

Thinking About How We Talk About Health Care.

Alex Smith at GeriPal asks us to consider the language we use about medical care.

Words have power. Language has power.

The words we use may comfort or shock, allay or provoke, sooth or batter. Words often imply layers of meaning that are not explicitly articulated, yet rest beneath the surface:

“I worry that time is short for you” (You are dying) (I care about you)

“I wish we could have done more” (Nothing would have changed her death) (I am on your side)

“I hope with you that you’ll get better, but I think we should prepare in case things don’t go as we hope” (You are not getting better) (I support your hope)

I can think of no situation in which there is greater variation in how our choice of words varies than how we explain cardiopulmonary resuscitation (CPR). Many people, including me, vary the language we use depending on our recommendation for treatment. Some use more drastic language than others. Here are some examples I have encountered, again with possible implied meanings in parentheses:

“Would you like us to restart your heart if it stopped beating?” (Please say yes) (I’m just asking as a formality)

“Would you like to allow us to let you to die naturally?” (Saying no goes against nature) (We have an unnatural power over life and death)

“Would you like us, in what would naturally be your final moments, to press on your chest and break your ribs, shove a tube down your throat and poke you with needles in lots of places in a chaotic attempt that has a very small chance of giving you more time to be technically alive but unlikely to ever return to meaningful communication with others?” (Please say no) (CPR is horrific) (I don’t want to have to do this to you)

“Do not punctuate the end of your life with a senseless act of brutality!” (You’re crazy if you say you want CPR)

Using persuasion to argue for something we believe is in a patient’s best interest is ethically permissible. Coercion - the use of force or threats – is not. Guy Micco, one of our contributors and a physician ethicist in the East Bay, talked with a philosopher who preferred the terms “influence” and “undue influence.” "Influence" is, of course, permissible - the line not to cross is the “undue” one.

Where do you see the line with these statements? What language do you use? Do you find yourself varying the language you use based on your recommendation for or against CPR? Does “unbiased” language exist?

Labels: ,

RIP Ruth Proskauer-Smith.

She co-founded NARAL. She worked tirelessly for end of life rights. She lived 102 years.

From Compassion & Choices president Barbara Coombs Lee:

Ruth Proskauer Smith, a friend and an activist for individual autonomy, died last night, closing her life in the manner she had wished for, planned for and devoted her life to securing as her right.

When I met Ruth in 1996, she was already an icon in the movement for freedom of choice at the end-of-life. She had a long list of accomplishments behind her. But she was not happy. At that time, only Oregon had succeeded in affirmatively legalizing aid in dying, and its Death With Dignity law languished in legal limbo. Ruth was determined to make a difference and joined the work of Compassion & Choices, serving as a dedicated ambassador of end-of-life choice.

Among the things I treasure from my 15-year friendship with Ruth is having had the opportunity to see her growing pleasure with advances we’ve achieved in end-of-life choice. Together Ruth and I witnessed the triumph of justice over repeated legal challenges to Oregon’s law, the passage and implementation of Death With Dignity in Washington, the passage in California of the Terminally Ill Patients’ Right to Know End-of-Life Options Act and a ruling by the Montana Supreme Court to recognize and affirm physician aid in dying.

Ruth was a generous, fierce and dedicated supporter of our movement, as she was forreproductive choice.

From HuffPo:

Ruth Proskauer Smith, a founding hero of the reproductive rights movement, died last night at 102 years of age.

As we celebrate today the anniversary of Roe v. Wade - an historic decision of which Ruth was part - we mourn the loss of this remarkable woman.

Ruth Proskauer Smith's history on behalf of reproductive freedom spans back to the 1940's, when she began advocating to give women access to birth control. In 1969, she co-founded NARAL with the goal of litigating against state abortion prohibitions, a life mission that led us directly to the steps of the United States Supreme Court and Roe v. Wade. For her work in reproductive rights, NARAL Pro-Choice New York honored her with a Lifetime Achievement Award at our 2009 Champions of Choice Luncheon.

While she lived to see the legalization of abortion and took pride in her role in ensuring safe healthcare, she also recognized the unrealized promise of full access and the challenges that remain.

We honor Ruth as a founder and are reminded of all the young women activists today who will be the next leaders of our movement. On this 37th anniversary of Roe v. Wade, we send out thanks to the women who came before and all those who will come after.

Labels: , ,

Primer on the Establishment Clause.

Thanks to Christian News Online, here's a nice, clean primer on the Establishment clause and the Supreme Courts undulating approach to it's interpretation. An excerpt:

Outside the realm of case law, much has been made of President George W. Bush's faith based initiative in 2001 that opened the door to government funding for pervasively Christian and other religious organizations. What gave him the opportunity was a provision of the 1996 Welfare Reform Act passed by President Bill Clinton called charitable choice.

Before charitable choice, the only Christian and other religious organizations to receive government funds disbursed social services via a separate nonprofit organization that they set up solely for that purpose. Since charitable choice, pervasively Christian and other religious organizations have had equal access to federal bids and grants that allow them to provide social services.

Some wondered if charitable choice was constitutional. A Court decision in 1997, Agostini v. Felton, cleared the air even though the case was not about charitable choice. Here Justice O'Connor partially rewrote the Lemon test so that the third prong supplements the second. She added two other qualifiers. Recipients of government funding still must ensure it serves a valid secular purpose and does not advance religion.

But to satisfy the "does not advance religion" prong, they must only ensure that the aid:

  • is not being used for religious indoctrination
  • defines the eligibility of participating organizations without regard to religion
  • does not create excessive government entanglement

From the time of Everson, the Court had demanded that government funding for Christian and other religious organizations be indirect. Agostini, however, suggested that direct aid could be okay.

When Congress passed and President Bill Clinton signed into law the 1996 Welfare Reform Act, the executive and legislative branches approved charitable choice and direct aid to Christian and other religious organizations.

President Barack Obama shows no signs of disapproval. The accomadationist tendencies in our government will continue into the foreseeable future -- at least until separationist justices replace accomadationist justices on the High Court. The period since Charitable Choice and the faith Based Initiative has now ingrained the accomadationist perspective into government grant funding programs.

Labels: ,

Bobby Schindler Wants Your Complete Vulnerability.

This post from Catholic News Service is making the rounds of the "god, guns, and country" blogs right now. In it, Bobby Schindler condemns the media for misrepresenting his sister's health at the time of her death.

A number of things are worth noting: the tone, Schindler's points, the fact that Schiavo died 5 years ago, coincidence with the Walk for Life and The Terri Schindler Schiavo Foundation's promotion of a new annual concert (featuring Randy Travis), and the way Schiavo denies that individual patients should have rights to their own health care choices.

The tone of the article is saccharine, full of talk about the gift that "these people" bring to our lives. But the conversation shouldn't be about the Schindler family's unnaturally long and unhealthy grief. It should be about law and patients' rights. Here's the totally creepy quote:

"They allow us to show our compassion, our love. I believe that they are blessings.

“And if you talk to families that are caring for people like my sister, they look at their loved one as a blessing – to be in this position of having to care for them – because they are completely vulnerable to us."

Complete vulnerability is point.

Loving someone who can't love you back is like loving a God you can't prove is there. You can project whatever attributes onto that being you want and you will never be told a lie, never given a harsh word, never doubt their love, never wonder what they are thinking, never, in other words, have a real relationship with them fraught with all the challenges of typical human interaction.

Loving and caring for the severely disabled, however, does not occur in a vacuum. The Schindler's would like you to believe that their "sacrifice" for their sister was redemptive (and it did give Bobby Schindler a new career). They fail to mention the details of such care, the fact that such care is in many cases not possible for families, and the fact that Terri Schiavo was only alive because she was placed on life support at the time of her initial collapse, her body maintained long after her coma and severe brain damage. They work hard to tell you how horrible her death from dehydration was but coroners have said she was unable to sense any pain.

I saw Bobby Schindler speak in Pennsylvania in October. His prolonged grief was otherworldly, an unhealthy extension of mourning and suffering, written in the lines on his face, in the drag of his voice, the slow pace of his steps. His profoundly sad "testimony" was about how his sister's death won him back to God.

Unconditional love is a beautiful thing. But what the Schindler family - and so many others deny - is that there's something unnatural and disturbing about their efforts to prolong Terri Schiavo's death - abetted by a patriarchal hierarchy, the Catholic Church, that for centuries has made its legacy out of the suffering of others and the conversions it brings them.

In November, the US Conference of Catholic Bishops, even as they worked to make the health care bill denominational, changed their Ethical and Religious Directives to qualify artificial nutrition and hydration as "obligatory" care. Now, at all Catholic hospitals - 1 out of 5 in the country - despite whatever a patient's proxy or advance directive or state laws say, will be given ANH if the hospital deems it necessary.

To be clear: The Schindler's fight is no fight for life. This is an all out battle by "pro-life" organizations and the Catholic Church to remove by whatever means necessary your right as a patient to decide what your medical treatments will be. While they are certainly sincere, it is their faith that they wish to legislate, not your rights as a patient.

And these powerful organizations have the ear of your legislator, your attorney general, your Catholic doctor, your emergency room, your hospice or long-term care facility, and your neighbor. They are better funded and organized than any patients' rights group out there. And their objective is to impose their religious ideology on your health care rights by law.

Labels: , , , , ,

Your "Pro-Life" Avatar.

Can't make it to Washington today for the annual March for Life? No worries, create your own avatar and march alongside Sarah Palin's avatar! Incredible. The virtual March for Life.

Tomorrow thousands are expected to rally along Constitution Avenue, stopping at the Hill and the Supreme Court during the 37th annual March for Life, held each year on the anniversary of Roe v. Wade. This year’s march has a digital twist: those who can’t make it to Washington can still join in – virtually.

There, you can create an avatar and march with the likes of Sarah Palin, Michael Steel and Jon Boehner. – see their avatars here.

The March For Life organizers will hold a rally outside of the White House tonight in Lafayette Park. No word on how many are expected to attend, though the group says they are permitted for 3,000. The group is hoping to catch the attention of President Barack Obama, who supports reproductive rights.

President George W. Bush was out of town every year the march took place and never attended the rally in person, but did call the marchers to voice his support. Presidents Ronald Regan and George H. W. Bush also addressed the marchers by telephone. President Reagan use his radio address in 1983 to affirm his opposition to abortion.

Labels: , , ,

Frenzy of Compassion: Medea and Britain's Mom Mercy Killers.

From, a summary of the two mercy killing cases in Britain.

Two mothers who have taken the lives of their severely disabled children are in this article oddly summarized as "separated from their husbands, with whom they were still on good terms, but they made the decision alone after working themselves into a frenzy of compassion."

I wonder if the implication of the last phrase is something like that common female derangement, hysteria? Why else would someone choose death if not crazy? Why else would one consider the "murder" of their loved one if not in a frenzy? I doubt "frenzy of compassion" and the marital status of the women would be so blatantly framed as "causes" of the deaths had the actors been men.

The article seems to reach to that other ancient "mercy killing" mother archetype, Medea, who killed her two beloved children to get back at Jason, her philandering husband, to save them from a life of shame and debasement. Like Medea they are described as in a frenzy, like Medea they look to that modern oracle, the internet, for answers, and like Media they are bound for banishment from society.

Here's the rest of the article, by Michael Cook:

Mrs Francis InglisAssisted suicide is never long out of the headlines in England, it seems. This week they featured two devoted mothers who killed their disabled children. In the first case, 57-year-old Frances Inglis was sentenced to life imprisonment for giving her brain-damaged 22-year-old son Thomas a lethal dose of heroin in November 2008. She will have to serve a minimum sentence of 9 years.

In 2007 Thomas was injured in a brawl and taken unwillingly to a hospital by ambulance. He jumped out while it was moving and ended up with severe brain damage. She believed that since then he had been living a life of "horror, pain and tragedy'' and she was determined to bring it to an end. In September 2007 she injected her son with heroin, but he was resuscitated. She denied her involvement after she was arrested. While on bail for attempted murder, she obtained 10 packets of heroin for £200, and injected him again.

Mrs Inglish told the court that she had no choice: "The definition of murder is to take someone's life with malice in your heart. I did it with love in my heart for Tom, so I don't see it as murder. I knew what I was doing was against the law." However, prosecuting lawyer Miranda Moore said in her closing statement: "It is a tragic case but it is not a defence to murder to end someone's life to put them out of their misery.''

In a similar case which is still being tried, 55-year-old Kay Gilderdale gave her 31-year-old daughter sleeping pills, anti-depresssants and morphine to help her to commit suicide. Her daughter Lynn had been mute and bed-ridden since she was 14 after contracting myalgic encephalomyelitis.

The two stories have common features. Both women were separated from their husbands, with whom they were still on good terms, but they made the decision alone after working themselves into a frenzy of compassion. And both relied upon the internet for finding information about their children's condition and how to kill them. Mrs Gilderdale was reading about euthanasia campaigner Dr Philip Nitschke as her daughter was dying. -- London Telegraph, Jan 20; BBC, Jan 20

Labels: ,

Scotland and the Work of "Life" Crusaders.

To the string of Westernized countries that have contemplated aid in dying over the past year, add Scotland. This week, Margo Macdonald introduced a bill that has been called more permitting than the Netherlands' - and according to opponents of aid in dying the latter country is not one to emulate. In every court case in the US, the Netherlands has been held up as the primary "culture of death" capital, only exceeding Switzerland in it's wickedness because the latter has made efforts to reign in "suicide culture" by considering changing it's "permissive" laws.

Of course Scotland's bill, the End of Life Assistance Bill, has caused an international "pro-life" ruckus. Here are some links from the usual noisy criers:

From Peter Saunders, Director of Britain's Care Not Killing
From Wesley J. Smith, of the junk science haven Discovery Institute, who paused to demonize Scotland before ranting his (premature?) joy at the defeat of the US health care bill.
From Alex Schadenberg at Euthanasia Prevention Coalition

Rather than dig into the bill to tell you the pros and cons of it's construction, or tell you the forces that are working on the ground to address it's passage, or the story of the MP who introduced it, I'd rather ask a question:

Why is there a rash of constituents in Westernized countries who are compelled to press their legislators and government leaders for aid in dying?

To those who work from the premise that society is bifurcated into good and evil, that "the culture of death" has risen from the "threat" of modernization and the decline of church power over personal lives - the Peter Saunders, Wesley J. Smiths and the Alex Schadenbergs - a great decline in human morality is what most threatens the "sanctity of life" around the globe.

This fear of change and the future is a powerful force or these men wouldn't make their living hating personal autonomy and patients' who fight for their right to control their medical destiny. These men think they are grappling against the new decline in personal and societal morals. However successful their strategies are at the moment, they are on the grand scale actually actors who, like the American teabaggers who are funded by corporations to promote government deregulation, aiding and abetting power structures by spreading fear of sound government representation of individual citizens.

To the rest of us who view the Westernized medical landscape without the fear or ideology, without the self-righteous desire to keep society governed by unchanging and draconian faithful strictures, the cause of aid in dying bills is more difficult to explain.

The patriarchal character of medicine has combined with new technology to remove patients' from their own medical decision-making. The church and the state have colluded to, with all their might, leave such rights in the hands of doctors dedicated to curing disease; doctors who now operate within a closed, corporatized and cost-driven delivery system that compels patients into futile care, over-treatment, and ignorance of how death occurs. Patients are rendered helpless in this new landscape and so they fight, country by country, to wrest their control over death back from these institutional forces.

The new dying culture has pitted helpless, resourceless patients against the church, the state and the medical profession, much more powerful and organized institutions.

The three men I cite consider themselves crusaders for society's morality. In truth, they are crusaders, throwbacks to the time when ideological views of the world were unchallenged by science and medicine. Their ways are dated because they appeal to a moral compass that no longer exists, and indeed was a state and church sanctioned imposition on personal beliefs and autonomy. These men are the enemies of patients' rights, of social services that work to end suffering, and of human advancement.

And their maniacal, antiquated work has allowed the state and the medical profession, forces that they otherwise despise when they counter the church, to dictate what rights individuals have in the world of new technology.

They are throw-backs to be sure. With self-righteousness and paternalism they claim to stand for the disabled, the poor, the ill, the "least of these." But their stand is on their own ideological premise, not on the rights of individuals in a pluralistic society. They demean the autonomy of every patient and yet claim compassion. They paint selected facts and statistics as proof of moral debasement. They monger fear among the elderly and disabled.

And most importantly, they fail to address the cause of these bills in a mature, real-world manner, preferring to work in their good vs. evil constructs, rather than seek non-judgmental approaches to the crisis in modern medicine of a good death.

Scotland is not the last country where citizens rise up and say they want to make their own health care decisions. Crusaders who work to keep individuals under the power of corporations, the state and the church will always exist. They will continue to frame the issue of patients rights as one of "moral decline". And they will continue to do the work of imposing power structures while patronizingly claiming that they indeed know what is best for a patient.

The task we have as a society is to recognize who they work for.

Labels: , , , , , , ,