Sunday, January 29, 2012

Quick Links

This just in from a friend of mine who is watching the activities of the very powerful Ohio-based "pro-life" group (which recently endorsed Rick Santorum) FAMiLY LEADER, headed by Bob Vander Plaats:

End of Life Decisions
House Study Bill 511 under the direction of Representative Joel Fry advanced out of the Human Resources committee on Wednesday. The legislation supports what are known as Physician Orders for Scope of Treatment (POST). Intended for terminally ill patients, these orders specify the desires of the individual patient regarding life support. Safeguards are established to protect against unwarranted termination of care. The FAMiLY LEADER cautioned against the tendency to “drift” in the direction of physician-assisted suicide. We trust and respect Representative Fry, and encourage our readers to pray for him to have wisdom as he prepares for House debate on the bill. As a cautionary signal, The FAMiLY LEADER is registered as “Undecided” on the bill.

BioEdge reminds us that the "dead donor rule," the medical standard that is used to determine when life ends for the purpose of organ removal, is in need of a revisit.

The prison population across the nation is getting old and prison administrators are grappling with how to best handle health and aging concerns, Fox reports. A new report by Human Rights Watch report on the aging prisoner population is here.

Catholic Health Care West has changed it's name to Dignity Healthcare, to varied reactions. Here's "pro-life" advocate Wesley J. Smith's.

Hawaiians support aid in dying, a new poll finds. While support is slightly higher there, the poll is consistent with attitudes across the rest of the nation.

While I'm all for advancement of medicine--who isn't?--the recent push to "kill" or redefine the persistent vegetative state diagnosis is fascinating and a little worrisome. Ever since the death of Terri Schiavo, activists have been working to undermine the diagnosis and qualify it as a severe disability. Studies like the recent one that shows "some" PVS patients wake up when given a sleeping pill or that EEGs can help find "locked in" patients have caused huge amounts of attention but are strangely politically motivated and seemingly statistically unviable. Furthering understanding of PVS and brain dead patients (both, admittedly, are nebulous terms that offer no hard answers) is necessary. But the irresponsibility of some of the articles these recent studies is hard to stomach. Truth, they say, is truth. With issues as profound as the definition of life, truths look a lot more like wishes, on which beggars and activists can ride.

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Sunday, September 11, 2011

Contraception, VSED, POLST, PVS, Oh my!

In "Fear of a Catholic Ghetto" at Religion Dispatches Sarah Morice-Brubaker points out the language being used by Catholic leadership to influence the new mandatory coverage of contraception. Rightly, she emphasizes the size of the Catholic Church's participation in our health care. And she links to a piece of mine at my other home where I'm editor, The Revealer. Here's a clip from the USCCB's statement against coverage of contraception:

As to the exemption, the comments detail how it “is narrower than any conscience clause ever enacted in federal law, and narrower than the vast majority of religious exemptions from state contraceptive mandates,” wrote Picarello and Moses. “By failing to protect insurers, individuals, most employers, or any other stakeholders with a religious objection to such items and procedures, the HHS exemption, like the mandate itself, violates” the U.S. Constitution and various federal statutes.

Here's a clip from the post at First Things where she gets her article's title:

This definition is so narrow that it excludes almost all Catholic institutions as they now operate. The conjunction, “and” before the fourth article ensures that almost no religious organization satisfies the criteria; “or” would have been limiting, but “and” is crippling. Catholic hospitals, schools, and charities do not serve primarily Catholics, they serve everyone; there is no baptismal requirement to receive services from Catholics. We do not serve people because they are Catholic; we serve people because we are Catholic. And the same goes for members of other religious groups.
Elsewhere I've written about Catholic hospitals and health providers as part of the church's mission to spread the Catholic faith. Which is fine by me unless it involves coercion, lack of informed consent, or lack of meaningful referrals. We are not all Catholic. We never will be. The law should protect the right of conscience of those who aren't from those who provide services, with federal dollars, and think they should be. That's not persecution of Catholics.

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A new article at Solitary Watch traces the predecessors to The War on Terror, The War on Crime and The War on Drugs. Here's a clip:

Many historians trace the birth of the War in Crime to the mid-1960s–specifically, to Barry Goldwater’s 1964 presidential campaign, with and his rhetoric of “crime in the streets” and the need for “law and order.” Since that time, politicians have increasingly exploited the fear of violent crime and its perpetrators to institute ever more draconian laws and policies. The War on Crime was soon joined by its partner the War on Drugs, which was launched by Richard Nixon and gained traction during the Reagan Administration. One crime bill after another was passed with broad bipartisan support, and more and more federal and state monies were poured into expanding law enforcement and building and maintaining prisons. Between 1970 and 2005, the U.S. prison population grew by 700 percent.

The thread for me, from my work on denominational health care and end of life care to systematic penalization of segments of society, is how the US legislates who should die, who deserves dignity (and what that means), and how we can/should/get to die. If you are put outside society by governmental systems and laws (think conscience clauses that deem Catholic hospitals outside regulation or "three strikes" drug offenders in prison in California), you are exempt from what the rest of society typically deems as appropriate and fair. Clearly religious exemptions privilege Catholic conscience while penal laws take that privilege away. Still, the law works to provide "special" circumstances to these groups or segments of society.

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Studies continue to break down the persistent vegetative state diagnosis. At The Guardian Mo Costandi interviews Adrien Owen who's conducted studies that test the consciousness of PVS patients since the mid 2000s. While I think it's an unrevealing article--most of this has been hashed elsewhere and with more, shall we say, purpose--it begs the question: what does determining "minimal consciousness" within these patients really mean to them (if that's an appropriate question) but also to their families, their doctors, and to society at large?

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Last month Compassion & Choices launched a campaign to educate elders on how to end their lives by voluntarily stopping eating and drinking (VSED). The issue of elders refusing food and water was nationally highlighted recently when a couple was evicted from their nursing home for choosing VSED. The Catholic Church and its conservative supporters have, as I predicted they would, come out strongly against patients' rights at the end of life, even, as this article attests, going after living wills and do not resuscitate orders. The author, Christian Brugger, Fellow at The Culture of Life Foundation, writes here about a new law in several states that requires medical personnel to abide by a patient's wishes as noted on the new form, POLST. His concern is that a terminal condition is no longer necessary for patients to refuse treatment:

The POLST-type legislation removes the condition that a patient is terminally ill or diagnosed in a PVS before a refusal order is actionable. In other words, the new law permits any adult patient to refuse any treatment at any time for any reason in the event they lack decisional capacity; and health care professionals, directed by a doctor's medical order, ordinarily would be (and are) required to carry out the order. Although the law for strategic purposes is rhetorically formulated as bearing upon end-of-lifemedical decisions, it sets forth no requirement that a patient's refusal of life-support must be limited to end-of-life conditions.

Note the italics (his, not mine). Shouldn't you be able to refuse treatments you don't want? Only if your body and your life are your own. The position of church leadership, however, is that your body is not your own but rather belongs to their interpretation of god. In a society that is comprised of endless varieties of faith, an organization that does not believe your body belongs to you--and is managing 1/5th of all hospital beds--is on a serious mission.

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Sunday, April 25, 2010

POLST and End of Life Conversation.

Eric Widera at GeriPal asks how the new POLST forms work at compared to advance directives and wonders if they are replacing end of life care conversations or complimenting them:

Over the last 30 years we have tried to standardize patient communication about end-of-life issues though the utilization of statutory advance health care directive forms. While this approach has not been a complete failure, the results have been less than stunning given the amount of resources allocated to this endeavor. Is there a better way? At the Coalition for Compassionate Care of California (CCCC) Annual Meeting, Charles Sabatino, JD, talked about one possibility – the POLST paradigm.

Mr. Sabatino is the Assistant Director of the American Bar Association’s Commission on Law and Aging, as well as a professor at Georgetown University Law Center. At today’s
CCCC meeting, Mr. Sabatino gave a presentation on the inadequacy of a legal transactional approach that has dominated advance care planning, best exemplified by the Advance Directive document. He describes how the transactional approach is beginning to give way to “communication approach” to advance care planning, where shared decisions are made between patients, families, and healthcare providers on a ongoing basis. The communication approach requires healthcare providers to learn about the goals and values held by their patients, which is then converted into a portable plan of care: the POLST.

The POLST paradigm does not attempt to standardize patient communication about preferences at the end-of-life. The Advance Directive still attempts to accomplish this, although as it is a complex and highly individualized process, standardization becomes difficult. Rather, as Mr. Sabatino points out, POLST attempts to standardize physician end-of-life orders for patients with serious illnesses. The goal is to translate the complex discussions around the values of patients into specific medical orders. The standardized forms include orders addressing:
  • Cardiopulmonary resuscitation
  • Administration of antibiotics and IV fluids
  • Use of intubation and mechanical ventilation
  • Use of artificial nutrition

Twelve states have adopted the POLST paradigm into law (CA, HI, ID, MD, NY, NC, OR, TN, UT, WA, WV), and
many more are developing programs. My state (California) has signed the POLST into law, although implementation in San Francisco is spotty at best.

I’m interested in hearing from the GeriPal community what they think about the POLST. Have you used it? What are your concerns with it? What do you think are the strengths and weaknesses? Please comment and discuss!

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