Friday, January 22, 2010
Implications of Citizens United Ruling for Roe.
Thinking About How We Talk About Health 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?
RIP Ruth Proskauer-Smith.
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.
Primer on the Establishment Clause.
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.
Bobby Schindler Wants Your Complete Vulnerability.
"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."
Your "Pro-Life" Avatar.
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.