Gary Coleman, Terri Schiavo and the Definition of Death.

Jill Stanek's apparently an immortal doctor.

Protesting a 94 Year Old's DNR.

Oy. Should we really point out the differences between a 94 year old unconscious alzheimer's patient with a DNR order and Terri Schiavo? Or should we just let this reporter slip in a divisive name in order to get the story some eyeballs? How can this be written as anything other than absurd -- all under the guise of fair reporting by representation of "both sides"? And at what point is the media irresponsibly sensationalizing death?

I find this to be some of the most irresponsible reporting -- and a frighteningly sad case. Does the niece expect her aunt to live to be 100? 110? Can death really be cheated? What kind of pain is the patient in? And what is the niece willing to do to prolong her aunt's death? How misguided is this "local right-to-life" group to take up this case with protests -- and to what end? And what good is a medical proxy when any family member or hospital administrator (as seen in other cases) can over-ride decisions? Isn't grieving and decision-making enough effort without protests? And why is the reporter irresponsible enough to allow the commenter to equate sedation with euthanasia?? Absolutely outrageous.

We can only hope that cases like this show the absurd belief we have fostered over the past few decades that humans can live forever; that doctors can perform miracles; that a DNR equals removal from life support or that it signifies anything other than compassion; that life, no matter how pained, frail, aged or afflicted, is worth "saving." And yeah, thanks for listing the address of the elder home.

Family members of an elderly women under a court-ordered "do not resuscitate order" in an Orland Park assisted living center joined members of a local right-to-life group Saturday to protest the court decision, saying their "beloved aunt" should be kept alive by all means necessary.

"This is the dark side of probate court," said Jay Drabik, a nephew of 94-year-old Lydia Tyler, who remained heavily medicated and unresponsive in a room at the Brighton Gardens Assisted Living Center at 16051 S. LaGrange Road.

The case has echoes of the prolonged court battle over Terri Schiavo, in which family members feuded for seven years over whether Schiavo's feeding tubes should be removed as per the wishes of her husband.

In Tyler's case, her brother, James Drabik, and two other relatives authorized a court-appointed guardian to convene an "end-of-life" meeting for Tyler late last month, leading to the "do not resuscitate order," said Lynn Drabik, a niece who joined other protesters Saturday.

Relatives who want to keep Tyler alive dispute a doctor's finding that she is in a state of advanced Alzheimer's and not capable of living independently. Only a month ago, they say, Tyler held a birthday party and posed for pictures with family members.

Attempts to reach Tyler's brother, or an attorney representing him, were unsuccessful Saturday.

Meanwhile, protesters fear Tyler could die at any moment under the influence of strong narcotics meant to ease her into death without pain.

"Nobody wants her to be in pain, but you euthanize pets and animals, not people," said Jay Drabik.

The Opposite of Love is Fear?

Don't miss this fantastic post at GeriPal that makes us think about why we are so unprepared for end of life decisions. Here's a clip but please go read the whole thing:

Talking with patients about their impending death is never simple. However, it’s easier if it’s done with a certain kind of love. This love is related to compassion, the willingness to suffer along with another human being in pain. A quiet joy can emerge when people suffer together like this. Medical training seems to have little to say about death, and even less to say about this kind of love.

Common wisdom tells us that the opposite of love is hate. But that’s only true on the surface. Love and hate are two sides of the same coin, the coin of attachment. Humans are just as attached to the people they hate as to the people they love. Either way, they just can’t stop thinking and talking about each other. Look at the world of politics.

In reality, the opposite of love is fear. Whereas love connects us, fear cuts us off from each other. Fear fosters abandonment, which can take many forms. Some are more obvious than others, but all are damaging.

At times we abandon our patients by ignoring or rejecting them. More often, paradoxically, we abandon them to further treatment, treatment that may or may not extend their lives, never thinking to ask them how they feel about it. High costs can accrue from this thoughtlessness. These costs are not just economic, but emotional and spiritual as well.

Death Panels, A Timeline.

Seethruit at DailyKos diagrams the "death panel" meme for us (with rather astounding precision), below. I wonder, where in all of this did we as a country lose the chance to discuss end of life care like adults?

It sure looked like a flash fire but it actually smoldered for nearly a year. In early '09, the Washington Times, George Neumayr, and Cal Thomas linked HCR to euthanasia while "Dr" Betsy McCaughey PhD, the same "expert" who helped torpedo ClintonCare) hoisted repeated bogus incendiaries about health rationing. But it wasn't until McCaughey hit on compulsory end-of-life counseling that she really got things going. Then, with a boost from Michelle Bachmann (R-MN)'s assertion that "Ezekiel Emanual" HCR would cut off health care for the disabled, Palin was primed for full ignition:

EUTHANASIA + RATIONING + BUREAUCRATS = DEATH PANEL

And the blast was AWESOME. The MSM couldn't get enough:

...the Washington Post mentioned the phrase 18 times, the New York Times 16 times, and network and cable news at least 154 times...

In just 2 weeks 86% of Americans to hear about 'Death Panels'. Overheated townhallers screamed and shouted and HCR was nearly collared for failure.

• seethruit's diary :: ::

Brendan Nyhan (U of Mich political scientist) traces the "Death Panel" rollout from Betsy McCaughey's end-of-life counseling assertion, through rightwing bloviators (Hannity, Ingraham, Limbaugh), Michele Bachmann's boost, to Sarah Palin's FB explosion, and beyond. Dividing the timeline into Phases, I have also added the euthanasia prep work (see credit below) that preceded the explosion and assorted additional players(in italics):

PHASE I - SMOLDERING
11/23/08 Washington Times op-ed
1/27/09 George Neumayr American Spectator
2/9/09 Betsy McCaughey Bloomberg.com
2/11/09 Washington Times op-ed
2/18/09 Cal Thomas Commentary Washington Times
PHASE II - HEATING UP
7/16/09 Betsy McCaughey Fred Thomspon Show
7/17/09 Betsy McCaughey New York Post op-ed
7/17/09 Sean Hannity Sean Hannity Show
7/17/09 Laura Ingraham Laura Ingraham Show
7/21/09 Rush Limbaugh Rush Limbaugh Show
7/23/09 Betsy McCaughey Wall Street Journel op-ed
7/23/09 Rep. Boehner (R-OH) Press release
7/27/09 Rep. Bachmann (R-MN) House of Representatives speech
7/27/09 Peter Johnson Jr. Fox News Channel
7/28/09 Rep. Foxx (R-NC) House of Representatives speech
7/29/09 Washington Times Editorial
PHASE III - IGNITION
8/7/09 Sarah Palin Facebook Posting
PHASE IV - BLASTOFF
8/8/09 Ann Althouse
8/9/09 Michelle Malkin
8/10/09 Glenn Beck Glenn Beck Program
8/10/09 Rush Limbaugh Rush Limbaugh Show
8/12/09 Sen. Grassley (R-IA) Town hall in Winterset, IA
8/13/09 Rush Limbaugh Rush Limbaugh Show
8/14/09 Rep. Broun (R-GA) Amer. Conservative Union letter

Concurrently, by late July, a viral email with a link to Betsy McCaughey's euthanasia counseling pitch on the Fred Thompson Show had already been intercepted by Snopes.com. So there it was - in just 4 weeks, a cabal of conservative elites, rightwing pundits, Fox News, GOPers, viral hoaxers, and MSM panderers had succeeded in reaching 86% of Americans with an utterly preposterous, and thoroughly reprehensible, claim. There's just one more thing. Wouldn't you like to take a look at Palin's incoming calls for early July? Luntz anyone?

Postscript: Frank Luntz asserted that Obama critics had "gone to far' with the 'death panels'. I believe this merits extending the timeline:

PHASE V - CLEAN UP
8/27/09 Frank Luntz Fox and Friends

Credit: Jim Rutenberg and Jackie Calmes' excellent NYT article provided citations for euthansia commentary in early '09.

Schiavo v Schindler

More noise from the destructive relationship between Michael Schiavo and the Schindler family: A new report out of Florida called the Terri Schindler Schiavo Foundation's finances into question last week; now Michael Schiavo is threatening to sue the Schindlers for using Terri Schiavo's name to raise money.

The news, first reported at conservative LifeNews by ridiculously prolific Steven Ertelt, immediately spread across the "pro-life" blogosphere causing all of the Schindler's tried-and-true supporters like Wesley J. Smith to weigh in. The article is rife with misconceptions regarding Schiavo's death; misconceptions that the Schindlers (and Smith and Ertelt) have worked tirelessly to maintain in their fight against patients' rights to removal from artificial nutrition and hydration. The renewed animosity should prove interesting to watch, particularly as it plays into state-level discussions regarding end of life care, health care reform, and patients' rights. The Schindler family, particularly Bobby Schindler, have worked in the past few months to fashion themselves as advocates for the disabled. Other disabled rights activists view this terminology creep as somewhat suspect.

From Alex Schadenberg at Euthanasia Prevention Coalition, a friend of the Schiavos.

Sponsor This Cremation Urn.

And from Gawker, one of the stranger news stories. A guy raises money to pay for his cremation so his wife won't go into debt. Really.

What About That Advance Directive?

The Center for Practical Bioethics has a podcast with doctors Michael Green and Benjamin Levi on the status of the advance directive. Their discussion includes how the advance directive works now, how difficult it is for healthy patients to imagine future situations, how directives should serve as tools to discuss end of life care with family and doctors, and should evolve over time. It's an incredibly helpful podcast. You can listen to it here.

April 13 Teleconference on Advance Directives.

Thaddeus Pope at Medical Futility Blog reports on a conference that will be held on April 13:

FIVE BIG MYTHS OF ADVANCE CARE PLANNING AND HOW TO STAY ANCHORED IN REALITY

Sponsored by the ABA Health Law Section, the Senior Lawyers Division and the ABA Commission on Law and Aging

Tuesday, April 13 at 2:00-3:30pm Central

This complementary teleconference (and podcast will be posted here afterwards) will address the five biggest myths that plague advance care planning and how to steer clear of them and make advance care planning more effective.

Myths:

1. People should use their state’s official advance directive form(s).
2. Your advance directive should include as specific instructions as possible.
3. Advance Directives are legally binding so doctors have to follow them.
4. Doing everything possible for dad means keeping dad alive at all costs.
5. A written advance directive is better than talk.

Since the mid-1970s, health care advance directives have become the central legal tool to make sure one’s health care wishes are known in a formal way and, it is hoped, followed. However, clinical realities and the medical-social sciences literature over the last 30 years cast doubt on the effectiveness of advance directives. The reality is that directives are just a part of a process of advance care planning that requires more than just a form and a signature. Sometimes forms get in the way.

Panelists:

• Richard Payne, MD, Professor of Medicine and Divinity, Esther Colliflower Director, Duke Institute on Care at the End of Life, Duke University Divinity School
• Charles P. Sabatino, J.D., Director of the American Bar Association’s Commission on Law and Aging

Just Covering for the Blue Dogs.

From St.MichaelSociety, a run down of Saturday night's Stupak events.

Apparently, there are many who feel Stupak is not strong enough. When your objective is ending abortion completely - repealing Roe v. Wade essentially - despite what statistics say about the effects on women's health, public opinion, and what we claim is a religiously diverse country that must accommodate all beliefs, nothing will satisfy you.

Bottomline is, there was always going to be a way, designed by the Democrat leadership, to allow pro-life leaning and blue dog Democrats to say they voted for an Amendment that prevented abortion funding. The abortion industry and its allies in the House were hoping to get by with a weaker Amendment, while still appeasing pro-life leaning blue dogs. Outside of the Hyde Amendment, Stupak-Pitts was the strongest language pro-lifers could come back with and win passage. The arguement over Stupak hurting the broader cause is silliness and a poor attempt at finger pointing. If it was not Stupak-Pitts, it would have been Capps, Ellsworth, or someother 11th hour phony insothat these blue dogs could go home and say they voted against abortion funding. Better to have an Amendment with teeth, than a phony.

We are still a long ways from this discussion being settled. In order to sustain Stupak-Pitts language in any final bill that goes to President Obama, the pro-life movement must keep the pressure up on Senators, then eventually on conference committee members, some of whom will try to remove Stupak-Pitts from the final House-Senate compromise . And, as we move forward, we must keep fighting to stop end of life counseling, i.e. assisted suicide, and work to ensure that there is a strong conscience clause protection for pro-life doctors and medical professionals as we have been covering here on the SMS site, pushing on our Facebook page and on Twitter. And, most importantly, the pro-life movement must stay as united as it has been — 240 votes is quite an accomplishment, but we are far from ultimate victory. The fight for life has only just begun.

The move to ban payment for Death with Dignity as legal in Oregon, Washington and Montana is still alive. According to lifenews:

HR 3926 also contains numerous end-of-life concerns.

The bill contains the controversial "death panels" panned in the previous legislation and it includes two clear end-of-life provisions -- including one that requires insurance companies to distribute advance directives and other planning tools to all who are insured on the new government-run exchange.

The other allows Medicare reimbursement for optional end-of-life planning consultation.

Both provisions appear to exclude assisted suicide from the consultations and advance directives, but those exclusions have no meaning in the Washington and Oregon (and possibly soon in Montana) where assisted suicides are legal.

There, state law says that "death with dignity," the legal terms in those states for assisted suicide, does not actually constitute assisted suicide.

In both states, state law says actions under the assisted suicide statute "shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law."

As a result, in Washington and Oregon, Medicare reimbursed consultations could involve assisted suicide planning and advance directives or other planning materials distributed by mandate. Thus, taxpayer-funded information provided under both provisions will include assisted suicide options in those states where it is legal.

To be clear (and I think, regarding misinformation on end of life provisions, I write that often), Death with Dignity acts, as law in Oregon and Washington, require the patient to bring up the issue with the doctor. Any literature that may state the laws exist - and these are laws, by the way - is fully legal. It is still within the patient-doctor relationship that Death with Dignity must be determined viable.

What could get interesting is the lack of such requirements in the Montana law. Because it comes through the courts - and is expected to be upheld by the Montana Supreme Court by the end of the year - it has no such provisions. I expect a lot of noise when the decision comes down.