Tuesday, February 9, 2010

Finally, Legacy Media Picks Up On New Catholic Directive.

While the US Conference of Catholic Bishops changed their Ethical and Religious Directives in November to now consider artificial nutrition and hydration "obligatory" care, few major media outlets have picked up the story. Yesterday, the Chicago Tribune finally ran a long article covering the issue.

They do the usual two-sides-to-every-story bit, primarily citing Catholic "experts" but slip in a quote from Barbara Coombs Lee of Compassion & Choices. My concerns with the story are many, including: the down-play of who ultimately gets to make decisions (the good-intentioned doctors at your friendly local Catholic hospital); little is made of why Catholic hospitals are allowed to make these decisions for patients; and the writer make no mention of how large the Catholic health care system is in the US - second only to Veterans' Affairs and serving 1 in 5 patients annually.

The comments from readers are resoundingly opposed to this imposition. We can only hope that this article and others like it will begin to spread. The more light shed on this draconian, paternalistic, authoritative new directive the better. And the more people aware of the Catholic Church's heavy grasp of health care delivery in this country - via provider refusal laws - the better a chance that elders and the public at large will fight it.

Here's a clip on PVS patients:

People in a persistent vegetative state, the bishops say, must be given food and water indefinitely by natural or artificial means as long as they are otherwise healthy. The new directive, which is more definitive than previous church teachings, also appears to apply broadly to any patient with a chronic illness who has lost the ability to eat or drink, including victims of strokes and people with advanced dementia.

Catholic medical institutions — including 46 hospitals and 49 nursing homes in Illinois — are bound to honor the bishops' directive, issued late last year, as they do church teachings on abortion and birth control. Officials are weighing how to interpret the guideline in various circumstances.

What happens, for example, if a patient's advance directive, which expresses that individual's end-of-life wishes, conflicts with a Catholic medical center's religious obligations?

Gaetjens, 65, said she did not know of the bishops' position until recently and finds it difficult to accept.

"It seems very authoritarian," said the Evanston resident. "I believe people's autonomy to make decisions about their own health care should be respected."

The guideline addresses the cases of people like Terri Schiavo, a Catholic woman who lived in a persistent vegetative state for 15 years, without consciousness of her surroundings. In a case that inspired a national uproar, Schiavo died five years ago, after her husband won a court battle to have her feeding tube removed, over the objections of her parents.

The directive's goal is to respect human life, but some bioethicists are skeptical.

"I think many (people) will have difficulty understanding how prolonging the life of someone in a persistent or permanent vegetative state respects the patient's dignity," said Dr. Joel Frader, head of academic pediatrics at Children's Memorial Hospital in Chicago and professor of medical humanities at
Northwestern University's Feinberg School of Medicine.

On the various interpretations of the new directive:

There are several important exceptions. For one, if a person is actively dying of an underlying medical condition, such as advanced diabetes or cancer, inserting a feeding tube is not required.

"When a patient is drawing close to death from an underlying progressive and fatal condition, sometimes measures that provide artificial nutrition and hydration become excessively burdensome," said Erica Laethem, a director of clinical ethics at Resurrection Health Care, Chicago's largest Catholic health care system.

Some ethicists are interpreting that exception strictly. The Rev. William Grogan, a key health care adviser to
Cardinal Francis George and an ethicist at Provena Health, based in Mokena, said death must be expected in no more than two weeks — about the time it would take someone deprived of food and water to die.

But Joseph Piccione, senior vice president of mission and ethics at OSF Health Care in Peoria, said that if a patient knows she is dying of, say, incurable metastasized ovarian cancer but is several months from death, she can decline to have a feeding tube inserted if she anticipates significant physical or emotional distress from doing so.

Of course the Catholic media have done their job in spreading the over-dramatized Rom Houben story and the new study of PVS patients that suggests few are able to hear and experience brain waves that respond to questions from researchers. Both cases have been repeated and spread in an effort to promote the Church's - and Fundamentalist and Evangelical fellow-travelers' - "pro-life" stance. A commenter brings up Houben's case as justification for the new policy.

And a clip of the questions that follow the article:

Q. What inspired the change?

A. Church leaders oppose assisted suicide and euthanasia and wanted to affirm strongly that the lives of severely disabled people have value.

Q. Does it apply to Catholics only?

A. The guideline affects all patients who seek care at Catholic medical centers, regardless of their religion, said Stan Kedzior, director of mission integration at Alexian Brothers Health System.

Q. Who decides if a feeding tube is "excessively burdensome" and therefore not warranted?

A. That's up to the patient, but it isn't as simple as, "I don't like it and I don't want it." There have to be discernible physical, emotional or financial hardships for the patient, according to Joseph Piccione of OSF Health Care. Those hardships must outweigh the potential benefits.

For the record: the decision is now not up to the patient. That should scare the hell out of us all.

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The Atlantic Profiles Ludwig Minelli, Dignitas President.

An excerpt from Bruce Falconer's profile of Switzerland's controversial Ludwig Minelli, president of Dignitas, a "suicide clinic," in the March 2010 The Atlantic:

Assisted suicide did not always carry the stigma it does today. It was an accepted practice in the ancient world. Athenian magistrates stockpiled poisons for their citizens, with the admonition “If your life is hateful to you, die; if you are overwhelmed by fate, drink the hemlock.” The Hippocratic Oath, written sometime between the fifth and third centuries B.C., pledged doctors to refrain from hastening the deaths of their patients and specifically prohibited the prescription of fatal drugs. The oath was a seminal development in the ethics of medicine, but was ignored by most ancient physicians. Only hundreds of years later, with the rise of Christianity and its belief in the sanctity of human life, did attitudes toward euthanasia swing decisively in the other direction. By the 12th century, mercy killing was opposed throughout the Western world. Thomas More’s Utopia, published in 1516, reinvigorated debate with its vision of a society in which “the magistrates and priests do not hesitate to prescribe euthanasia,” and where the sick “end their lives willingly, either by starvation or drugs.” Later, during the Enlightenment, thinkers like Francis Bacon, David Hume, and Montesquieu, among others, also defended the practice, though their writings did little to alter the prevailing wisdom.

The modern argument over euthanasia began only in the 19th century with the advent of medical anesthetics like ether and morphine. In 1870, a schoolteacher named Samuel D. Williams delivered a speech to the Birmingham Speculative Club in England. He argued that, for patients suffering from terminal illness, physicians should use chloroform not only to relieve pain, but to “destroy consciousness at once, and put the sufferer to a quick and painless death.” His comments were later collected into a book that received favorable attention from prestigious political and scientific journals and inaugurated a period of spirited discussion, in both Europe and the United States, over euthanasia’s potential to cure certain social ills. Scientific rationality was the byword of the age. Darwin’s theory of evolution had itself evolved into the sociological notion of “survival of the fittest.” Euthanasia promised the possibility of a healthier and more productive society, free from the burden of caring for its weakest members—the sick, the old, and the mentally ill. In 1906, two bills introduced in the Ohio legislature called for the legalization of euthanasia for terminally ill adults and for “hideously deformed and idiotic children.” They were voted down.

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Lancaster, CA, A Good Christian Community.

You heard the news last week about the California Mayor who declared his community Christian?

From Paliban Daily, a report on what God's plans are for Lancaster, CA:

The mayor of the sixth-largest city in Los Angeles County turned his state-of-the-city speech into a call to Christian repentance and growth as a “Christian community” as he supports a ballot measure to permit Christian prayer at City Council meetings.

Lancaster, CA is the sixth-largest city in Los Angeles County. Its population is about 150,000; not a bustling metropolis, but not a backwater burg, either. NBC Los Angeles reports that Mayor R. Rex Parris, presently up for re-election, veered from the expected subjects of his January 28 State of the City speech to urge citizens to support a local ballot measure.

Mayor R. Rex Parris

The measure? It’s available online here.

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Dementia and Futile Feeding Tubes.

Update: The GeriPal post on this subject is well worth reading.

From EurekAlert, a new study to be published in tomorrow's Journal of the American Medical Association shows that many patients suffering demential are given futile feeding tubes at end of life.

This study, conducted over 8 years by Brown University and Harvard Medical School, will hopefully draw attention to the Catholic Church's new Ethical and Religious Directive - used to govern more than 624 hospitals in the US - that considers artificial nutrition and hydration to be "obligatory" care, thus defying patients' advance directives (living wills) regarding end of life choices and enforcing futile care.

From EurekAlert:

Their position follows an eight-year study, which found that the use of feeding tubes varies widely. Among their major findings: At 25 percent of the nation's acute-care hospitals, this vulnerable population had a one in 10 chance of having a feeding tube inserted. Twelve percent of acute-care hospitals did not insert a feeding tube at all.

Medical evidence has long suggested that feeding tubes do not improve survival or overall outcomes in patients with dementia, a terminal illness that affect a patient's mind and eventually the ability to eat.

Details of the study are outlined in the Feb. 10, 2010, issue of JAMA, the Journal of the American Medical Association.

"Our results suggest that decisions to insert a feeding tube in persons with advanced dementia are more about which hospital you are admitted to than a decision-making process that elicits and supports patient choice," said Dr. Joan M. Teno, lead author and professor of community health and medicine at the Warren Alpert Medical School of Brown University.

The range of feeding tube use varies widely. Researchers found the rate of feeding tube insertions per 100 hospital admissions varied from 0 to 39, depending on the hospital. On average, 6.5 out of every 100 admissions resulted in a feeding tube insertion.

Teno and the other researchers conducted their study by looking at nearly 2,800 acute-care hospitals. They sifted through Medicare claim files involving more than 280,000 admissions from 2000 to 2007 to determine the rate of feeding tube insertions among hospitalized nursing home residents over age 66 with advanced dementia. They looked at hospitals with at least 30 admissions involving nursing home residents with advanced dementia during that period.

Hospitals with a culture of aggressive care at the end of life were nearly three times more likely to insert a feeding tube, according to the study. Larger or for-profit hospitals tended to use them more. Smaller, rural hospitals not affiliated with medical schools used them far less frequently.

Second author Dr. Susan Mitchell, associate professor of medicine at Harvard Medical school, said the data points to a clear need to examine how treatment decisions are made for patients with advanced dementia.

"Our results call for acute-care hospitals to examine how decisions are made for nursing home residents with advanced dementia, to ensure the decisions reflect patient wishes and values," Mitchell said.

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Legal Right "Experts" and Religious Tolerance in California.

There it is again, that "leading scholar" title, bestowed on yet another Religious Right figure who has established their credibility not among peers but among like-minded religious constituents - in other words, in an unquestioning and politically motivated vacuum.

This time the subject is one David Barton, cited as an expert source by a Religious Right organization called Wallbuilders, in a California case that will examine the legality of denying a Wiccan priest employment in a local prison because of his faith. Texas Freedom Network describes Barton:

WallBuilder’s argument is nonsense, of course, but Barton should know something about “revisionist history” — it’s something he regularly promotes. The WallBuilders brief touts Barton as “a recognized authority” and “leading scholar” in American history and government because of his “vast collection of rare, primary documents.” But simply collecting artifacts doesn’t make someone a “historian” and certainly not a “leading scholar.” Barton, in fact, has no degree or formal training in either American history or government. His bachelor’s degree is in Christian education from Oral Roberts University. He doesn’t publish peer-reviewed research in social science journals, and his books are largely self-published political tracts. Rather than a “leading scholar,” Barton is a smooth-talking propagandist who distorts history in pursuit of a radical political agenda.

Legitimate expertise is getting flimsier by the decade! But the rise of the "Legal Right," a shadow field of law, often funded and created by Religious Right organizations such as Focus on the Family, mirrors exactly the rise over the past few decades of the Medical Right. In a recent article for the Journal of Legal Medicine on opposition to end of life care and patients' rights, lawyer Kathryn Tucker describes the Medical Right thusly:

Medical Right organizations promote medical opinion reflecting fundamentalist beliefs. Whether offshoots of professional associations, single-issue groups, multi-issue family values organizations, advocacy groups, or bioethics policy organizations, the various parts of the Medical Right are linked. They intersect with the Religious Right policy organizations and, in many cases, the same Religious Right funders.

As a result, scientific, health, and medical issues are increasingly being blurred and distorted by conservative religious views in the area of end-of-life care. The Medical Right relies upon a limited number of experts to give the impression that it has a legitimate body of medical fact behind its opinions. Through the repetition of its views, the Medical Right has established an alternative body of supposed medical fact that provides the larger Religious Right community with the arguments it needs to pass laws approved by the Religious Right, oppose laws with which it disapproves, and otherwise enact its positions into public policy.

Substitute "Legal Right" for "Medical Right" and you've got a description of the very organizations - in some cases, organizations that work on health care and legal issues simultaneously - that are responsible for the recent rise of "separation of church and state" deniers, "family values" fanatics, and the likes of David Barton: The Alliance Defense Fund (ADF); Americans United for Life (AUL); National Right to Life Committee; The American Center for Law and Justice, Family Research Council. The list goes on and on.

Back to the California case, Texas Freedom Network concludes:

...the WallBuilders brief uses Barton’s trumped-up credentials to justify wading into the case. After that, it’s all about promoting a particular ideological agenda, not real history. In short, the brief is a long-winded justification for allowing — in fact, encouraging — government to engage in religious discrimination.

“(T)he Founders did not intend the Religion Clauses [of the Constitution] to protect paganism and witchcraft,” the brief argues. In fact, the brief says the two can’t even be considered religions under the Constitution. Then WallBuilders goes even further, arguing that the Founders really intended only to protect freedom for monotheistic religions (such as, of course, Christianity). In Barton’s America, the Constitution affords no such protections to followers of polytheistic religions.

WallBuilders also argues that atheists shouldn’t be equal under the Constitution either:

“It is one thing to allow freedom of conscience to all. It is another to trust atheists to testify at trial or hold office. This is so because, if one does not believe in God and in an eternal state of punishment or reward, one has no reason to fear that punishment and thus, the theory goes, will be more likely to engage in immoral or unethical behavior, to the determent of one’s fellow citizens and of society.”

Got that? The guy the Texas State Board of Education put on a panel of “experts” helping revise social studies curriculum standards for public schools runs an organization that argues the Constitution essentially creates two kinds of American citizens: those who believe in approved religions and those who don’t. And government may then discriminate against the latter.

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Kentucky Mennonites Targeted By Robbers.

From Nicole Ferguson at NewsChannel 5, Kentucky:

TODD & CHRISTIAN COUNTIES, Ky. – Kentucky State Police are investigating ten separate armed robberies and break-ins in Mennonite communities over the weekend.

Officials said they were investigators the attacks against Todd and Christian County Mennonites as hate crimes.

"He was almost in tears when he called me," said Shane Hessey, a friend of one of the victims. "He answered the phone and he said 'Shane, I'm in bad trouble.'"

Most of the weekend accounts are the same. The Mennonites describe their homes broken into in the middle of the night, with anywhere from two to five suspects holding their families at gunpoint and robbing them.

"They are a frugal people," said Todd County Sheriff Billy Stokes. "I know that in one of the home invasions [the suspects] only got $15."

Mennonites are Christian Anabaptists, known for their plain lifestyles.

"This would definitely fall under hate crime or targeted group for sure," said Stokes.

Stokes said he has been investigating reports of harassment in the Mennonite community over the past several months. He believes many of the incidents have gone unreported, perhaps because of the Mennonites stance for peace.

"Unless it's something major or repetitive, the [Mennonite] people are reluctant to report anything – they don't want any trouble," said Stokes. "They're very good neighbors to everyone. Anytime there's a crisis, there always first on the scene."

Hessey said patrols have been beefed up in the southern part of the county, but manpower presents difficulty in protecting the Mennonite community. They count on state police to assist them.

"I wish I could provide more protection for them, but that's solely based upon what our fiscal court is able or willing to do for our sheriff's department," said Stokes.

Kentucky State Police officials said the suspects have been described as having dark complexions, ranging in height from 5'7" to 6 feet tall. They were wearing bandanas and ski masks at the time of the attacks. Victims reported the theft of money and one firearm.

Meanwhile Hessey and Stokes fear worse consequences if the suspects are not caught.

"Certainly the fear is that somebody dies in this process of robbing," said Hessey. "It's unfortunate that they're targeting these Mennonite families because they're God-fearing, law abiding, very private families that work very hard for what they have."

"One of two things are eventually going to happen," said Stokes. "Either the perpetrators are going to go into the wrong house thinking it's a (Mennonite) house – we're a real community and most of the people here have weapons. Or the perpetrators are going wind up getting spooked and kill somebody innocent. Either which way it spells out disaster."

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