Saturday, January 30, 2010

Bible Instruction in Tennessee Public Schools.

How can you teach America's history, politics, culture, foreign policy, or economics without addressing the profound influence of religion? You can't. But it's what you teach about religion that matters - not just to the creation of historical record but to the future of the democracy.

What the continuing contest over the meaning of the Establishment Clause and "separation of church and state" proves is that religious tolerance means many things to many people depending on their objective. (Note the Supreme Court's notorious unpredictability when ruling Establishment Clause cases - or even their avoidance of it when addressing, for instance, patients' rights.)

If the objective of religious education is to promote a particular theological viewpoint - to win souls to one's own conception of God - you're infringing on the separation of church and state. If you're looking at the influence of religion with a critical eye, you're representing the appropriate forces that have shaped the nation. The hinge then on properly approaching religion in public schools - and in society - is not far from the concept of informed consent that patients' rights advocates discuss.

Individual autonomy is incumbent on the choices of an informed conscience. So the new news coming out of Tennessee isn't, in and of itself, alarming to me. Yes, religion, the bible as literature, should be taught in schools. Indeed is necessary for a full educational experience. But how religion is approached is a difficult thing to legislate. Only citizens' constant scrutiny protects the very essential provision of religious tolerance.

I say it again and again: those who work to legislate their particular ideological beliefs are essentially undermining their own right to do so. Tolerance doesn't work one way. The citizens of Tennessee are left to assert that tolerance means both for and from.

From the Examiner:

Tennessee has joined several other states and determined how biblical principles can be incorporated into public school curriculum.

According to the National Council on Bible Curriculum in Public Schools, Chief Justice, Warren Berger, notes, “the Constitution does not require complete separation of church and state. It mandates accommodation, not merely tolerance of all religions and forbids hostility toward any.” Although many individuals are under the assumption that permitting Bible teachings in public school environments breaks a law and goes against Constitutional rights, a complete severance of religious studies in public classrooms is not required.

Each school can elect how the new curriculum fits into its programs and teachings accordingly; however, theTennessee Board of Education has an approved curriculum it will provide to schools to act as a guideline for how instructors are to teach the information. Prior to the Board’s decision, each school district in Tennessee was permitted to institute its own Bible courses. The new guidelines indicate that schools must use the pre-approved curriculum.

The new guidelines include which translations of the Bible can be taught as well as the instruction of religious history and literature of the text. The curriculum also covers the continued religious and social implications of the Bible’s messages and morals.

Labels: , , , , ,

Op-Ed on CBS "Pro-Life" Superbowl Ad.

Catch the Op-Ed in tomorrow's Washington Post by Frances Kissling and Kate Michelman about the CBS decision to break with corporate policy to run a "pro-life" commercial, paid for by Focus on the Family, during the Superbowl.

Kissling and Michelman, without drama, address issues of free speech, religious tolerance, and individual conscience:

Those opposed to legal abortions have learned a lot about reaching out to the many Americans who can't make up their minds about the issue. Many of these people don't want abortion to be illegal but believe that too many such procedures take place in this country. Conservative groups, such as Focus on the Family, have gotten that message. They know to save the fire and brimstone for their hardcore base; for Super Bowl Sunday, you appeal to people's hearts with a smiling baby -- or Tim Tebow and his mom. Presenting Americans with a challenge of personal sacrifice, especially if the person who has to sacrifice is a woman, is a convincing sell.

Women's and choice groups responding to the Tebow ad should take a page from the Focus on the Family playbook. Erin Matson, the National Organization for Women's new vice president, called the Tebow spot "hate masquerading as love." That kind of comment may play well in the choice choir, but to others, it makes no sense, at best; at worst, it's seen as the kind of stridency that reinforces the view that pro-choice simply means pro-abortion.

We have seen a dramatic shift in attitudes toward "pro-life" and "pro-choice." In 1995 Gallup asked respondents for the first time whether they considered themselves "to be pro-choice or pro-life." Only 33 percent took on the pro-life label. In 2009, 51 percent considered themselves pro-life, and pro-choice had dropped from a high of 56 percent to 44 percent.

Labels: , ,

Demential and Mammograms: Addressing Futile Care in the Elderly.

Ken Covinsky at GeriPal wrote a few days ago about the harm of mammograms for dementia patients. It references a new study and subsequent commentary that address issues of compassionate end of life care, rationing, futile care, and informed consent:

In order to help our patients avoid care that is more likely to hurt them than help them, it is important all of us be able to explain to our colleagues why mammograms are not a good idea in women with dementia. Here is a brief outline of that explanation:
  • Mammography frequently finds abnormalities that are not cancer and need further evaluation. The fear caused by these findings, and the stress from the evaluation can be debilitating for healthy women. For women with dementia, the anxiety and stress can be debilitating. And with dementia, this stress is also felt by overworked caregivers.
  • However, contrary to common perceptions, the most serious harm from mammography in women with dementia is not false positives, but actually finding a clinically insignificant cancer. The concept of clinically insignificant cancer is not understood by the public. A clinically insignificant cancer is a tumor that if undiagnosed would never cause symptoms in the patient's lifetime. The type of tumors for which mammograms are beneficial will generally be clinically insignificant in women with dementia. Without mammography they will go undetected and not cause problems. But if found, these women will often be given surgery and other invasive therapy. To subject someone with dementia to invasive therapy that has little chance of benefiting them is very unfortunate. Dr. Walter has previously shown that in some cases, this treatment leads to devastating complications, including one case report of a non healing wound infection, and another case of a post-operative stroke.
Perhaps the most fundamental problems with ordering screening mammograms in women with dementia is that it suggests check box medicine is being provided, and therefore the real needs of the patient and her caregiver are not being attended to.

Our health system fails frail elders with dementia. There is so much more that needs to be done for them. Contrary to those who raise the Rationing charge when it is suggested that women with dementia not get mammograms, this is actually about doing more for these patients, not less. We can start by not doing tests that are more likely to hurt our patients than help, and focusing on what these patients and their caregivers really need.

Labels: , , , , ,

GeriPal: What a Nursing Assistant Will Tell Us If We Ask.

From fantastic GeriPal, a note of the changing culture of health care deliver and the increase of home health care. This is a must read for those of us who are paying attention to how patients' rights and needs will have to be met in the coming new reorganization of health care for the terminal and elderly.

It is projected that there will be a 50% growth in home health aide positions in the next ten years because of the expansion of home care for our geriatric population (US Bureau of Labor Statistics). How will we work with home health aides to increase retention? How can we argue for better compensation for such a demanding (physically and emotionally) position? And for those of us involved ingeriatric palliative care, how can we ensure that palliative care education is offered and encouraged for home health aides?

In the larger picture, offering continuing education and acknowledging specialized training is a start. I know that programs such as
ELNEC-Geriatric include specific content and attention to nursing assistants (self disclosure - I’m part of the team offering this course in Philadelphia in March-link above is for this, but see * below for more details). And in recognition of additional education and experience in palliative care, HPNA (through NBCHPN) offers certification for nursing assistants. These are a start—as was the public attention given to the role in the Washington Post articles. In my own practice, the same as with most of you I assume, I often elicit opinions and thoughts from the home health aides caring for an individual. But in the smaller, every day picture is this enough? How we can better include nursing assistants in palliative care teams? I don’t have the answer, but I do think that as we continue to consider how geriatric palliative care is delivered, we all need to advocate for nursing assistants as valued members of the interdisciplinary team.

Labels: , , ,

How Saintly Was Mother Teresa and Does She Deserve a Stamp?

Whatever you think about Mother Teresa's (torturous) adherence to Catholic concepts of redemptive suffering and subsequent sainthood, that a Mother Teresa stamp violates separation of church and state seems a small issue considering the other Establishment Clause violations in the country: our health care delivery system is doctrinal and discriminatory; our schools continue to depart from science-based education, and in our political process is bullied by reverence for one particular Fundamental faith.

And yet it's a debate that's being had, thanks to a challenge by the Freedom from Religion Foundation. Here's a clip from Deceiver:

Forget about the Presidential Medal of Freedom and that little thing called the Nobel Peace Prize. (Okay, bad example…) But it’s obvious, at least to the folks at theFreedom From Religion Foundation, that the Postal Service has no business putting super-humanitarian and all around do-gooder Mother Teresa of Calcutta on a stamp.

Why? It’s the nun thing.

Freedom from Religion Foundation spokeswoman Annie Laurie Gaylor told Fox News that issuing the stamp runs against Postal Service regulations because, quite simply,

Mother Teresa is principally known as a religious figure who ran a religious institution. You can’t really separate her being a nun and being a Roman Catholic from everything she did.

…There’s this knee jerk response that everything she did was humanitarian, and I think many people would differ that what she was doing was to promote religion, and what she wanted to do was baptize people before they die, and that doesn’t have a secular purpose for a stamp.

The Postal Service, of course, disagrees. As far as they’re concerned, the Mother Teresa commemorative stamp has nothing to do with her religion. As Postal Service spokesman explained:

Mother Teresa is not being honored because of her religion, she’s being honored for her work with the poor and her acts of humanitarian relief,” Betts told

“Her contribution to the world as a humanitarian speaks for itself and is unprecedented,” he added.

Labels: , ,

Growing Catholic Church Schism, The Call for Remonstrance.

Talk 2 Action's Frank Cocozzelli writes an important post about the need for remonstrance by mainstream Catholics of the extremism in the church and describes a growing schism between these two factions:

I recently wrote about the need for mainstream and liberal Catholics to offer remonstrance -- an earnest presentation of reasons for opposition or grievance against the reactionaries now fomentingschism within the Church. I'd now like to further explain the need for such action.

Why is Catholic remonstrance necessary? Here are a few compelling reasons.

First, remonstrance is a form of dissent. Any institution, whether it be a national government or a religious hierarchy, needs to hear about potential problems before they become major problems. Listening and hearing such dissent is essential to institutional health. Arguably: No dissent, no health.

Dissent also draws attention to vital new ideas even if they were treated with scorn upon arrival. For example, a reconsideration of natural law principles in light of knowledge acquired since St. Thomas Aquinas in the thirteenth century offers strong arguments in support of artificial birth control and embryonic stem cell research while establishing homosexuality is not the aberration Church fathers believe it to be. Even the great Aristotelian thinker, St. Thomas Aquinas was treated as a heretic and excommunicated shortly after his death. And yet his ideas came to greatly influence Catholic theology.

Remonstrance also allows more the esoteric economic agendas of the Catholic Right to be exposed.

Reactionaries now control much of the structure of Church governance. For example, Archbishop Raymond Burke is now the current Perfect of Supreme Tribunal of the Apostolic Signatura, roughly the equivalent of a Vatican Supreme Court. Additionally, Pope Benedict XVI is expanding the ranks of conservatism in the Church by reaching out to the anti-modernist, anti-SemiticSociety of Saint Pius X (SSPX) and attempting bring socially conservative Anglicans into the fold.

Although he also recently issued the economically progressive encyclical Caritas in Veritate, he is appointing and elevating economically regressive bishops and cardinals -- especially in the United States. The very anti-health care reform Kansas City, Kansas Archbishop Joseph F. Naumann, as well as Kansas City - St. Joseph Bishop Robert W. Finn, Cardinal Justin Rigali of Philadelphia and Bishop R. Walker Nickless, of the Diocese of Sioux City, Iowa immediately come to mind. Many of these church princes cavort with Catholic neocons whose political agenda for the church has more to do with comforting the wealthy and extending empire than with Jesus's concern for the oppressed, the marginalized, the vulnerable, and the despised.

Finally, Catholicism risks transformation as an appendage not only of neconic oligarchy but opposition to pluralism as espoused by traditionalists. Some such as Tradition, Family, Property, are downright scornful of modern democracy. To that end, these folks often abuse the Catholic notion of obedience. In their hands it is transformed from the idea of living a life in compliance with God's will to one of blind obedience to those who abuse their hierarchical authority to violate other key components of natural law such as distributive justice. To people like these, dissent is a dangerous thing.

It is not difficult to see where this goes. If the faithful can be bullied into religious compliance by dint of damnation anxiety, then they can be an effective tool for oligarchs who join with traditionalists in equating dissent with disobedience to God.

That is why mainstream Catholics must now offer remonstrance; and refute the substitution of Caesar for God; both in the pew and in the public square.


British Nurses Tackle End of Life Care.

At Nursing Times, Joan Morgan reports on a new study designed to improve end of life care in Britain, based on the Liverpool Care Pathway.

Being responsible for planning and implementing change in practice/behaviour involves bringing about a major cultural shift. As end of life care in critical care is possibly more varied and complex than other areas of the hospital, this will take time, from both a personal and professional perspective.

It is imperative to have a thorough understanding of the legal and ethical issues involved. In the UK, the legal practice of withholding and withdrawing treatment is determined by doctors, although usually carried out after a consensual decision making process involving other professionals and family members. Moreover, we now live and work in a multicultural and ethnically diverse society, which requires greater understanding and sensitivity.

It was therefore necessary to conduct a literature review to understand current practice surrounding end of life care in critical care. This review reinforced the notion that deep seated beliefs affect care of dying people (Morgan, 2008).

Labels: ,