Thursday, April 15, 2010

Newsweek Reviews "You Don't Know Jack"

A clip:

If someone says, "I want to call Dr. Kevorkian," we grasp exactly what that means. You Don't Know Jack, HBO's film starring Al Pacino as the man who made physician-assisted suicide a still-hot national debate, reveals how Jack Kevorkian came to be such a cultural force. His campaign to legalize assisted death gained traction in the 1990s thanks largely to his publicity-hound lawyer, Geoffrey Fieger (Danny Huston). And Kevorkian, who had hoped to get his case to the Supreme Court, managed something bigger: he appeared on 60 Minutes. This sophisticated film suggests that issues can become socially relevant not because their time has come but because they are dragged into the media spotlight.

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The Ethics of Palliative Sedation.

Dr. Jim deMaine writes thoughtfully about an experience with a terminal patient he calls Larry. An excerpt that I hope urges you to read the whole post:

On examining Larry, I can see the distended neck veins and the barrel shaped chest. It is apparent that the lungs were over expanded and the diaphragms flattened and moving poorly. There is a trace of swelling in his legs. The blood gases now show an elevation in his carbon dioxide. He can’t breathe sufficiently to either maintain oxygen or get rid of the CO2. Chronic respiratory failure due to chronic tobacco abuse is his long standing diagnosis. He finally kicked the habit 5 years earlier which helped some but not enough. He hates the oxygen tubes and prednisone side effects. He now has the “moon face”, bruising of the arms, muscle wasting, and weakness – all the scourge of chronic prednisone use.

A few weeks after his request I arrange to meet Larry at a restaurant nearby the hospital. After some pleasantries, Larry lets he know that he wants to talk about dying: “Look, I’ve lived a long time and what I’m doing now isn’t really living. These flare-ups are torture, I feel like a fish out of water and I don’t want to die that way. My biggest fear is suffocating to death.”

We talk about ventilators to support breathing, “No”; ICU care with aggressive support, “No”. Larry is clear; he wants to be in control. “Look Doc, all I want you to do is promise me that you’ll help me at the end”.

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Rita L. Marker, Lost Credibility.

In a recent article for the right-wing American Thinker, Rita L. Marker takes a very long time trashing health care for school students as provided by the new health care bill, to get to a simple and false point: students in Oregon and Washington will be instructed on and sent for "assisted suicide" when they should be in math class -- and all without parental notification.

If Marker, Executive Director of the increasingly wacky International Task Force on Assisted Suicide and Euthanasia and sometime-consort of ubiquitous, self-important Wesley J. Smith, had only read the Death with Dignity bills, which have been legal, and highly examined and reported since 1997 (Oregon) and 2008 (Washington) she would know that no one -- not a student, not a terminal patient - can get a prescription for lethal drugs in 2 weeks.

In addition to all the other regulations (two written requests, two doctor consultations, less than 6 months to live, etc.) there is a mandatory waiting period of 15 days.

Instead of making things up to imply that the government and Compassion & Choices and school doctors are all out to just kill your kids, she could have read the bills. But that's not how she makes her living.

Agree with the bills or not, there's no place for deceitful discussion regarding the care the way we care for all of our citizens.

The article, with so many other over-the-top insinuations, I'll leave you to find them:

Some years ago, I was speaking to a Nebraska state senator after testifying on a pending bill. I had explained that I wasn't saying that the billwould be interpreted in a certain way, only that it could be. Then he said something I've never forgotten. "Be assured that if a law can be interpreted in a certain way, it will be -- by someone. And it will all be perfectly legal."

In the week during which ObamaCare, euphemistically named the "Patient Protection and Affordable Care Act," was signed into law, I recalled that senator's words.

The catalyst was a story from a Seattle television station reporting a mother's outragethat a school-based health clinic (SBHC) had arranged for her 15-year-old daughter's abortion. The high school student was given a pass, put in a taxi, and sent for an abortion during school hours -- all without the parents' knowledge. To add insult to injury, the teen was told that there wouldn't be any charge for the abortion if she concealed it from her family.

Was this legal?


According to Seattle School District spokeswoman Teresa Wippel, "From a legal/procedural standpoint, it's a non-issue."

But this article isn't about abortion and ObamaCare. That topic has been and will continue to be widely discussed. Rather, it is about school-based health clinics, parental consent, and assisted suicide. That aspect of the new law has, until now, been under the radar even though it is part and parcel.

Under ObamaCare, there will be a massive expansion of SBHCs (Sec. 4101), creating full-service clinics across the country.

SBHCs are not new.

Over the years, health-related services in schools have expanded from a part-time nurse who checked to see if little Johnny has a fever to clinics offering such broad services that they have become the primary source of health care for many children, particularly teens. So rapidly did they become entrenched in school across the country that by the mid-'80s, health services on school premises were the subject of national conferences of school-based clinic administrators and personnel. Caseloads in a school-based clinic located in or near high schools and junior high schools ranged from about 500 to 5,000 students per year.

Currently, thousands of such clinics are members of the National Assembly on School-Based Health Care (NASBHC), which has the stated mission "to improve the health status of children and youth by advancing and advocating for school-based health care." But until now, they had been funded by state and private funds. With passage of ObamaCare, the federal government has entered into the fray. According to the NASBHC, passage of ObamaCare was "an unprecedented victory for school-based health centers" which will enable other communities to open school clinics.

Kevin Jennings, the Obama administration's controversial Assistant Deputy Secretary of the Office of Safe and Drug-Free Schools, is slated to keynote the organization's June convention with an address titled "Partnering Education and Health for a Safer School Environment."

Hundreds of millions of federal dollars will be directed to SBHCs.

Since the stated rationale for passing ObamaCare was to provide health care coverage for the uninsured, it would be logical to expect that school-based clinics would become obsolete. It is therefore curious that the very law that was intended to provide health coverage for all allocates millions of dollars to school-based health clinics that will "be integrated into the school environment" and will provide, "at a minimum, comprehensive primary health services." The expanded clinics will provide on-site access during the academic year and 24-hour coverage through backup health providers to ensure access to services on a year-round basis when school is not in session. All of this will proceed with little or no parental involvement.

From the time that clinics began to expand services, parental consent has been requested for clinic services. The new law also gives lip service to parental consent. However, such consent is obtained by means of a general consent form signed at the beginning of the school year. Parents -- knowing that their children can receive immunizations, sports physicals, etc. through the SBHC-- rarely refuse such authorization for their children. They sign the consent form, naïvely assuming that it is just an inexpensive way to insure convenient, free physicals and care for minor medical problems.

But that's not the way it works.

According to the NASBHC, access to any service (sports physicals, for example) requiresparents to sign written consent for their children to receive the full scope of services provided at the SBHC.

As the Seattle area mom found out, the Ballard High School consent form that she signed gave permission for any and all services available that the clinic provides, either directly or by referral. In addition, it makes it crystal clear that all information is kept confidential, with few exceptions. One such exception is that if a student under 18 years old has a life-threatening health problem, parents will be informed of a child's condition. But that all changes once a child reaches her 18thbirthday.

Consider the following.

A number of life-threatening (indeed, terminal) conditions can be diagnosed in a clinic or through a referral to a hospital on an outpatient basis. A student may be diagnosed through an SBHC's clinic with acute leukemia or melanoma -- all within school hours, when her parents believe she is in class or at band practice. And she could, under the state's law, be "qualified" for assisted suicide, since, in Washington (as well as in Oregon and Montana), the crime of assisted suicide has been transformed into a "medical treatment." That treatment is available to qualified patients who are at least 18 years old.

Within two weeks of her initial diagnosis, the student who had been looking forward to going to the prom could instead be referred to Compassion & Choices, the assisted suicide advocacy organization formerly called the Hemlock Society. (Compassion & Choices is the go-to group for assisted suicide services, responsible for facilitating most reported assisted suicide deaths in Washington and Oregon.)

Before her parents even knew she was ill, she could be given a prescription for a lethal drug overdose. She could take it. And die.

And her parents would be completely unaware of her condition -- until it's too late.

Will this happen? No one can know for sure.

Can it happen? Yes.

And if it does, the school district could say, "From a legal/procedural standpoint, it's a non-issue."

Welcome to full-service school-based health clinics -- ObamaCare style.

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