Saturday, March 13, 2010

Why We Let Catholic Health Care Discriminate.

The Moderate Voice has a great discussion going about the benefits and detriments of Catholic health care in the US. If you read here often, you know that the Catholic Church controls the services provided at the 624 hospitals - and hundreds of long-term care, hospice care and other institutions - in the US.

The post is a little long and emotional, as well as full of disinformation. But the comments area is fascinating and gives a good look at the high emotions that surround this issue.

For decades the Catholic church has worked to perpetuate the belief that they are too big a part of health care to be forced to operate without discrimination. What would the country do if the church pulled out of hospital operation?? In fact, they have worked in this field for centuries as part of their mission to care for the poor and sick. While I believe that the purpose is sincere, nonetheless, they discriminate against patients by not providing the full spectrum of legal, medically sound services. And they refuse to provide proper informed consent or referrals. In essence, they use the reverence that society has given the moral goodness of the church to discriminate against women, gays, elders and the poor by deciding what "conscience" those patients should have.

Here's my comment on the site:

Fantastic discussion. A couple of corrections: Catholic hospitals get 50% of their funding from the government, just like every other non-profit hospital. Less than 3% of their income is from donation so they are clearly not providing Catholic health care with Catholic donations. And Catholic hospitals - all 624 of them - statistically do no more "charity" work than other non-profits. In fact, all hospitals are required by federal law to treat the uninsured.

The best analogy is a company town. The company provides the jobs, the housing, the schools, even owns the grocery story. They are "too big to fail" in that town. One can say, oh thank god for the company, without it we would have no jobs or schools or groceries. But the truth is that the company then dictates all aspects of the town's life. And if the company says women should not be able to plan how many children they have or that a terminal patient can't be removed from artificial nutrition and hydration when they wish, the company is exercising it's size and monopoly to the detriment of employees rights.

When a pluralistic society finds itself subject to the doctrine of a religious health care institution, patients' rights are violated. Those who suffer the most are the poor and minorities in society. But we are bashful about calling out this issue because we give reverence to the "good intentions" of the Catholic church and those of us with voices have the resources to go elsewhere.

Reproductive services clinics have risen over the past 38 years to provide what Catholic and other denominational hospitals have not. They serve the poor and provide services unobtainable elsewhere.

I do believe that denominational healthcare is a discriminatory practice in the US but I also accept that the dictates of the Catholic hierarchy are not necessarily what's practiced in Catholic hospitals. Yet, that dissent cannot erase the fact that Catholic Ethical and Religious Directives discriminate against the poor, women, elders, gays and others by not informing patients' of all legal and medically-sound treatments and providing meaningful referrals. If we continue to privilege provider (and institutional) conscience over patients' conscience, we perpetuate this discrimination. Denying this is dishonest and a disservice to equality and individual conscience in this country - as well as a violation of equal rights.

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Faith Doesn't Necessarily Determine Political Affiliation.

From Politics Daily, an article about what people believe and how they vote, by Jeffrey Weiss. Check out a couple of interesting points regarding abortion, self-identification, and a new study published at SSRC.

Here's a clip but I recommend you read the whole thing:

Wouldn't you figure that a rainmaker who believes in his power would want to create rain when it's dry? But what people believe, what they say they believe, and how they act are often only loosely linked. As Chaves points out:
"Among respondents to the General Social Survey, conservative Protestants are no less likely than other Protestants to have been divorced, to have seen an X-rated movie in the last year, or to be sexually active even if they aren't married."
When it comes to religion and politics, he offers an example that is too often forgotten: Blacks and whites in America who espouse similar theological positions tend to take very different political positions. So how does their faith explain their behaviors?

Tiptoe carefully into any such speculation, Chaves says. The ways that people behave don't make nearly as much sense as we'd like to think they do. He says:
"Almost every claim of the form, 'People act in a certain way because they are in a particular religion or because they attend religious services or because they hold this or that religious belief,' commits the religious congruence fallacy."
Careful scholar that he is, Chaves offers a counterbalance:
"I want to be clear about something I am not saying. I am not saying that religious congruence is impossible. I am saying that it is rare, and much conventional practice does not appreciate how rare it is."
And yet, scholars and pundits chew up lots of electrons using the tenets and dogmas of religion to explain how people behave. People who go to church a lot tend to vote GOP. Theology driven? Terrorists in the name of Islam attack a town. The Quran tells them so? Pastors fail to live up to the moral code that they preach. Shocking hypocrisy?

Experts and regular folks seem to expect that people will tend to act consistently with the religion they belong to or claim to believe in. Not so much, Chaves told me this week.

"This is the single most important misunderstanding of religion out there in the popular culture," he said. "Religion is fundamentally situational rather than characterological."

Translation: Where you are and who you're with generally has a lot more to do with how you act than where you pray or what you pray. And correlation is not causation.

So sure, there's a statistical link between church attendance and GOP voting. But what's the cause of that link? Don't assume, Chaves said.

"Always and everywhere, religious congruence is rare rather than common," he said.

There are examples where people act consistently with their religious teachings, Chaves said. But they are generally found in a culture where it's difficult to separate the secular from the sacred. Orthodox Jewish communities, or Amish communities, for instance. But even in those situations, plenty of members act in contradiction to their highly reinforced religious moral codes.

One example in modern political culture that Chaves said could show cause and effect: How moral or religious opposition to abortion seems to drive some voting patterns. The long, hard process of internalization has taken place so that people can draw upon that view even in the voting booth, he said.

By coincidence, another paper in this month's SSSR journal examined a phenomenon of the sort that Chaves is talking about. The paper is titled "Belonging Without Belonging: Utilizing Evangelical Self-Identification to Analyze Political Attitudes and Preferences, " by Andrew Lewis of American University and Dana Huyser de Bernardo of the University of Massachusetts.

The paper looks at polling data where Christians were asked what denomination they belonged to, whether they considered themselves to be evangelical, and where they stood on several points of theology. And then they were asked for their positions on abortion policy, same-sex marriage laws, and party identification.

The quick bottom line: "Religious tradition is a good predictor of political attitudes while self-identification is a good predictor of party identification."

Translation: People who belong to denominations that scholars consider evangelical tend to take conservative political positions more than people who self-identify as evangelical but don't belong to those denominations. But people who self-identify as evangelical but don't belong to evangelical denominations are more likely to be Republicans than people who say they belong to evangelical denominations but don't self-identify as evangelical.

Which is a modestly interesting result. The paper is filled with the sorts of symbols that only a statistician can love. When I asked Chaves about it, he said that the basic analysis and results looked pretty good to him.

But he raised an eyebrow at some of the explanations that the researchers used to explain their results. Here's one paragraph Chaves noted:
"Our models also show the importance of including evangelical self-identification into analyses seeking to explain the impact of religious affiliation on political preferences. In particular, the results show that different types of evangelical belonging influence political outcomes in different ways."
Which is to say that religion and religious identification create political outcomes and preferences. That, Chaves told me, is farther than he'd be willing to go.

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Racial Disparity in Hospice Enrollment.

From HFA's Hospice and Caregiving Blog, a look at the racial disparities in hospice enrollment. The fact is that minorities including blacks and hispanics enroll in hospice much less often than whites, even though they suffer some illnesses at a higher rate.

Most of the reports I've seen coming out about this simply note the facts and statistics but make little speculation as to why. It is the why that is most important if we wish to ensure that all Americans have a chance to die the way they want to.

I can guess at a two primary reasons: fear of the medical community after decades of what these groups may rightly call discrimination against the value of minority lives; and a higher prevalence of devout faith which studies have shown compels individuals to agree to aggressive care until the end of life.

Layer these two factors over the impression in larger society that enrolling in hospice is "giving up," and the chaos of last summer that, whether we like to admit it or not, has changed the way the media and society view hospice, advance directives, end of life planning. For minorities who already have less resources for caring for the dying in their homes and a lower rate of participation in their own caregiving (because they tend to use clinics where a relationship with a doctor is not fostered) and you have a perfect storm of challenge for dying minorities and their families.

As in ever other sector of society, the poor and minorities suffer the worst outcomes because of marginalization, lack of access and information and poverty. Health care is no exception. In fact, it is one of the primary failures of our society.

The March 8 issue of the Archives of Internal Medicine reports that among patients with advanced heart failure, blacks and Hispanics are less likely to enroll in hospice care. Researchers from the Institute for Aging Research of Hebrew SeniorLife and Boston University School of Medicine adjusted for sociodemographic, clinical, and geographic factors and found that blacks were 41% less likely to use hospice care than whites, and Hispanics were 51% less likely.

Researchers looked at 98,258 beneficiaries who were not enrolled in 2000, and whether or not they entered hospice in 2001.

From the
Ivanhoe Newswire:
Concerning experts is the fact that blacks develop heart failure at a significantly higher rate than Hispanics and whites, mostly because of their increased rates of diabetes and high blood pressure. A recent study revealed young and middle-aged blacks suffer heart failure 20 times more than white individuals in the same age group.

"Our findings document significant racial differences in hospice use and show that overall increases in the availability of hospice services in the 1990s have not erased racial differences in hospice utilization," Jane L. Givens, M.D., M.S.C.E., lead author and a scientist at the Institute for Aging Research in Boston, was quoted as saying.

Earlier studies show cultural belief and values play an important role in hospice use, but Dr. Givens says hospice care must be culturally sensitive to work.
Read the Cardiology Today and MedPage Today reports of this study.

HFA's 2009 initiative focused on
Diversity and End-of-Life Care, and also included this special report on African Americans and End-of-Life Care. The report offers explanations as to why hospice, historically, has not been a choice for many African Americans, looks at grief and the African American community, and suggests ways to reach out to African Americans who are making end-of-life decisions.

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A Look At Disability Rights In North America.

Journalist Douglas Todd writes for The Vancouver Sun today about the changing landscape of disability rights in North America. The article has a great little history on the disability rights movement and notes the challenges that the disabled still have in asserting their equal rights in society. Here's a clip:

Even though Stainton said Canada has lost its place as a world leader in disability rights, the movement has challenged all of us on a number of charged philosophical and political fronts.

With differing degrees of success, disability-rights advocates have urged Canadians and others to:

- Change the way we talk about and understand disabled people.

- Stop stigmatizing people with disabilities.

- Spend tax dollars on including the disabled in all facets of life.

- Force employers to accommodate people with disabilities.

- Oppose voluntary assisted suicide for those with severe disabilities.

- Respond to the connection between disability and poverty.

- Not forget the disabled in developing countries.


A more crucial emphasis for disabled-rights proponents, perhaps, has been on the need to make a firm distinction between the "medical" and "social" models of disability.

The "medical" model, said campaigners, came out of science in the early 20th century. It was individualistic. The medical model acts as if a person's disability, whether a missing limb or paraplegia, is medical "damage," which places the disabled person outside human normalcy.

In response, advocates of the "social model" of disability have been arguing since the 1970s that the problem for people with disabilities is not that they're in a wheelchair, without a limb or blind.

It is that society doesn't accommodate them, whether with disabled-only parking or books in braille.

With the discussion thus shifting to communal rights for the disabled, people in Canada and much of the Western world began to put their emphasis on reducing social barriers to access and inclusion.

The complex debate over disability models continues to boil, as governments, businesses and employers in the industrialized world are increasingly compelled to do everything they can to accommodate disabled men and women.

Given that the Canadian Charter of Rights forbids any form of "discrimination" on the basis of "physical disability," is there any limit to how far an organization must go to include a person who is visually impaired, in a wheelchair or without a limb?

Even while governments and businesses are being pressed by legislation to include disabled people in every aspect of life, Stainton said courts have been ruling there are financial limits to consider in providing "reasonable accommodation."


The battle for disabled rights has had other unpredicted twists and turns.

One of them is over the so-called "right to die." As advocates for the disabled have continued battling for recognition, they have clashed with people who want laws in Canada and the U.S. permitting assisted suicide for those with severe disabilities and terminal conditions.

Even though polls show the majority of Canadians support regulated euthanasia, disability rights activists have strongly lobbied politicians to make sure no one, regardless of the severity of their disability, should be able to choose an assisted suicide.

In this increasingly bitter debate, disabled activists claim legalizing assisted suicide would be an ethical "slippery slope" that would lead to all disabled people, no matter the degree of their impairment, being devalued as human beings.

In turn, advocates for assisted suicide maintain the arguments of disabled-rights activists are a misplaced over-reaction to their proposals.

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