Thursday, May 31, 2007

National Hospice and Palliative Care Organization Reiterates Opposition to Assisted Suicide

The nation's leading hospice professional organization, the NHPCO, has reiterated its opposition to the legalization of assisted suicide. Good. Assisted suicide is directly contrary to the hospice philosophy. Indeed, as the statement notes, it constitutes (often unintentional) abandonment. For the full resolution, follow this link.


Poll:Euthanasia More Popular Than Assisted Suicide

A lot can be made of a new Gallop Poll about assisted suicide and euthanasia. When asked if assisted suicide is morally acceptable, 48% say yes and 44% say no. That is very close to the AP poll I posted about the other day.

Then Gallop asks a question which seems to me intended to heighten the "yes" response:

"When a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patient requests it?"
The response is 56-38%--much lower than the high 60% we often see in polls. But note the following: First, the poll uses the "sever pain" comment, a sure fire way to increase support. Second, it is almost always a false premise, since almost all pain can be at least alleviated to some degree. Third, no legislation in the United States requires that a suicidal patient be in severe pain to qualify for assisted suicide. Fourth, note that under the poll, the disease need not be terminal, but incurable, which means that diseases such as arthritis would qualify. I will bet the poll numbers would change with more accurate questions.

And here's an interesting note. The poll also asked, apparently about euthanasia:
"When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient's life by some painless means if the patient and his or her family request it?"
A whopping 71% say yes and 29% no. Assisted suicide advocates used to promote active euthanasia, but having lost two initiatives in Washington (1991) and California (1992), they took a step back to move the agenda forward by not permitting doctors to lethally inject, and carried the day in Oregon (1994). Since then, the entire advocacy in the USA has been for assisted suicide. (Belgium has since legalized active euthanasia.)

What can we make of this question? First, I think the authority of the doctor moves these numbers. Second, the question is vague about what it means to end a life--it could be interpreted as removing from life support. I daresay that had the term killing been used, the yes response would have plummeted. Third, note that this question wasn't about "choice" at all but killing as a response to human suffering, with families having the right to make the decision.

In summary: Support for assisted suicide generally is lower than it has been in the past. The poll is terribly written and seems designed to get a certain response, or is sufficiently vague that people can read into what is meant by the question. And it demonstrates the principle about how the slippery slope can really take off once the premises of euthanasia advocacy are accepted.

Bottom line: Assisted suicide is a priority issue for a small, energetic group of activists. If it were an important issue for people that drove voting patterns, politicians would be running on the promise to legalize it, and very few do. However, due to the partisan differences found in the poll, there is a danger that legalization could come to be seen as just another in a series of "progressive" agenda items--although in my view, it is just the opposite--and could one day be accepted by the Democratic Party in its plank. That is one place where disability rights activists, who are generally considered a Democratic Party constituency, have provided a profound public service by standing athwart the euthanasia/assisted suicide agenda.


Wednesday, May 30, 2007

"Dr. Death Rides Again"

As promised, here is the Weekly Standard article I co-authored with Rita Marker, which points up the similarities between Jack Kevorkian's illegal assisted suicide campaign and the legal assisted suicide regimen currently regent in Oregon. Here are a few excerpts:

In 1990, when Kevorkian began conducting post-mortem press conferences, he assured the nation his "patients" had to be terminally ill, and his attorney maintained that Kevorkian required proof of a terminal condition...Because assisted suicide is illegal in Michigan, however, authorities couldn't take Kevorkian's word for it, and had autopsies performed revealing that more than half of Kevorkian's 130 known victims were not terminally ill. Most were disabled with conditions such as multiple sclerosis. In fact, several had no serious physical illnesses that could be determined upon autopsy.

Under Oregon's assisted-suicide law, to qualify for assisted suicide, a patient is supposed to have a terminal condition, defined as a life expectancy of six months or less...And how many of those who died actually had a terminal condition? Nobody knows. Oregon does not require autopsies of people who die there by legalized assisted suicide, so we don't know their actual underlying conditions.

Yet the words of one Oregon physician who regularly assists suicides indicate a cavalier attitude towards the law. Dr. Peter Rasmussen, an advisory board member of the Oregon chapter of Compassion & Choices, acknowledges his involvement in deaths numbering in the double digits. He said that predicting life expectancy is rife with inaccuracy but dismissed that as unimportant. He explained, "W]e can easily be 100 percent off, but I do not think that is a problem. If we say a patient has six months to live and we are off by 100 percent and it is really three months or even twelve months, I do not think the patient is harmed in any way."...

Kevorkian also raised eyebrows in some quarters for having extremely brief relationships with his "patients" before helping them commit suicides. For example, Good Morning America noted that many of the people over whose deaths Kevorkian presided died within 24 hours of meeting him for the first Similar all-but-nonexistent doctor-patient relationships have been reported in Oregon. Although a patient's requests for assisted suicide purportedly must span a 15-day period, official Oregon reports indicate that, over the last seven years, some patients have died by suicide having known their assisting doctors for a week or less...

[W]hat about Kevorkian's lack of medical experience in examining and treating patients? Kevorkian was a pathologist who did not treat patients after his medical school and residency days in the 1950s... Kevorkian would have been within his rights under the law to act as an "attending physician" who could legally carry out assisted suicide. You see, in Oregon, any licensed physician--including any dermatologist, ophthalmologist, or pathologist--can write lethal prescriptions. It doesn't really take a lot of medical savvy to prescribe a deadly dose. To paraphrase the Geico commercial, "It's so easy even an unemployed pathologist can do it."
I will have more on Kevorkian soon. In the next installment, we will explore his ultimate goal in pursuing his nearly decade-long assisted suicide campaign. Hint: It had very little to do with compassion.


More on Dutch "Organ" Game Show

When I wrote the other day about the Dutch "reality" television show in which a terminally ill woman will interview "contestants" vying to receive her kidney for transplant, I assumed that the donation would be after she had died. Apparently not. According to this story, the dying woman wants her kidney taken before death.

Will doctors actually permit themselves to be part of such a scheme? And if a dying woman, why not a disabled person who is depressed and feels his or her organs would be better used by someone else? Or for that matter, whyt not any suicidal person? After all, choice is choice, and ratings are ratings.

By the way, please do not believe that such grizzly scenarios are unthinkable. In Culture of Death I quote two very prominent American organ transplant ethicists who argue that it could be acceptable to permit people to donate their organs as part of every planned death, including euthanasia. That is also Kevorkian's perspective.


Tuesday, May 29, 2007

Terri Schiavo: A Life of "Indelible Impact"

USA Today has named Terri Schiavo one of the top 25 people who "moved us" in the last 25 years. Hmmm. I know her family would rather she hadn't made such an impact, that instead, she were still alive and being cared for in the bosom of their love.

It is undeniable though that Terri did profoundly impact the world. As I travel nationally and internationally speaking, she remains very much on people's minds and in some of their hearts.

And that impact continues. Her brother Bobby Schindler, with whom she was very close in life, continues to hold her flame aloft throughout the world. Bobby has become a very good friend. I have watched, deeply moved, as he has harnessed his profound and continuing grief to grow from a somewhat shy individual into an eloquent advocate and speaker on behalf of disability rights and the sanctity/equality of all human life. I have often appeared with him, most recently last week at an anti-euthanasia conference in Edmonton, and his personal decency and abiding love for Terri never fails to deeply move his audiences. Both loved and loathed for their desperate fight to save Terri's life, Bobby and the entire Schindler family also, in my view, continue to make an important and indelible impact.

USA Today opines that Terri's contribution concerns living wills. I disagree. I think her most profound legacy is that after Terri, no one can now say they are unaware that we dehydrate people to death because they have profound cognitive disabilities.

In the end, I think, Terri is a mirror upon whom we project our own deepest feelings about life, death, disability, helplessness, personal control, and mortality. People who are capable of moving the world as she unquestionably did are few and far between. There was clearly something very special about Terri Schiavo that surpassed the bitter politics of her death. So, yes: USA Today got this one right. Her life had--and continues to have--a profound and indelible impact on us all.


Bursting the Myth of Assisted Suicide Inevitability

We often hear that more than 60% of Americans favor assisted suicide. I have never believed it because the polls that count--elections--mostly show narrow disapproval of legalization (except Michigan where an assisted suicide legalization bill lost 71-29% in 1998, hardly narrow, and Oregon, which approved legalization in 1994, 51-49%).

This most recent public opinion poll (AP) indicates that Americans are closely divided on the issue. A non-whopping 48% supported assisted suicide and 44% opposed. What makes me even more cheered by this poll is that the media tends to write stories that are distinctly sympathetic to assisted suicide, and most major newspapers editorialize in its favor. And still, Americans are justifiably wary. I credit the disability rights movement for much of this, because they have effectively punctured the myth that only religious conservatives oppose euthanasia.

So, the debate rages on. And if we don't tire, we can preserve ethics in American medicine.


I think A.B. 374 May Be In Some Trouble

Methinks A.B. 374, the bill to legalize assisted suicide in California, may be in some trouble. The authors have--sort of--amended the bill to require a three months left to live rather than a six months left to live standard, before a lethal prescription can be written in the "Safeguards" section. I say "sort of" because the bill still defines a terminal illness as six months left to live in the definitions section. Also, the application form still has the 6 month time. To me, this indicates a rushed effort to convince reluctant assembly persons to go along, as time to pass the bill out of the Assembly this year is running out.

The issue isn't the time, but the principle. Assisted suicide is bad medicine and worse public policy. I just hope resisting legislators don't get seduced by this newest gambit.


Swiss Worry About Their High Suicide Rates

The Swiss suicide rate is apparently quite high and a matter of great concern. The Swiss have vowed to fight it, but they have a problem: Opposing "suicide" while legally permitting assisted suicide sends a decidedly mixed message that would seem to make prevention advocacy less effective. Of course the Swiss don't see it that way: They blame the ready availability of guns because their ubiquitous use in self killing.

But its the end that is the societal problem, not the means. Moreover, how do you tell suffering, suicidal people that some suicides are fine and dandy--if you have a physical or mental illness or disability--and others aren't? And get this from the Reuters story:

The Swiss suicide rate stands at 19.1 suicides per 100,000 inhabitants, a 2005 study by the country's Federal Health Office said, well above the World Health Organization's global average of 14.5 and of 14.1 in the European Union. That figure may be inflated by assisted suicides-- about 10 percent of suicides are through the suicide-assistance groups for which the country has built up some fame.

Good grief: Assisted suicide is suicide. Including the data from those deaths does not inflate the suicide rate, it accurately reports it. (In Oregon, assisted suicides aren't "suicide" and so that state actually undereports its suicide statistics.)

Reuters' reporting is further proof that we have entered the world of 1984 Newspeak: If you use a gun it's suicide. If you use an overdose of drugs supplied by an assisted suicide group it's not suicide? Good grief.

HT: Alex Schadenberg


Dutch TV Contestants Vie for Kidney

The Dutch continue to stun with their fall off a vertical bioethical cliff: In this installment, a television show will soon air in which three ill contestants vie for the right to the kidney of a terminally ill woman. From the story in the UK's Guardian:

In the show, due to be broadcast on Friday, a woman identified only as Lisa, 37, will select a recipient based on their history, profile and conversations with their families and friends. Throughout the 80-minute show, viewers will be invited to send Lisa text messages to advise her.
This is voyeurism on a scale that boggles the mind. It turns the serious issue of the ethics of organ transplant into a game show. It denies intrinsic human dignity in that it pits desperate people against each other, clawing and kicking--metaphorically speaking--for life. What kind of a physician would be willing to be part of such a spectacle?

Hey! Here's an idea: Maybe in the next show they can tie the organ contest with a televised assisted suicide! That would garner the ratings.

But, why worry: It's just "choice," right?


Monday, May 28, 2007

Human Experimentation Without Consent

I find myself feeling ambivalent about this story: Permission has been granted to therapeutically experiment on trauma victims and people whose hearts suddenly stopped beating, toward the end of improving care in such medical emergencies. In the past, I have opposed using unconscious and dying patients in medical experiments not intended to benefit them because I perceived it as treating them as objects rather than subjects. But these proposed experiments are different, e.g., they are intended to help the person experimented upon as well as those who will later benefit from the knowledge thereby gained. From the story:

The studies are being conducted by the Resuscitation Outcomes Consortium, a network of medical centers that do research in Seattle, Portland, San Diego, Dallas, Birmingham, Pittsburgh, Milwaukee, Toronto and Ottawa, and in Iowa and British Columbia.

The first experiments, involving nearly 6,000 patients, involve patients who are in shock or have suffered head injuries from a car crash, a fall or some other trauma. About 40,000 such patients show up at hospitals each year, and the standard practice is to give them saline infusions to stabilize their blood pressure. For the study, emergency medical workers are randomly infusing some patients with "hypertonic" solutions containing much higher levels of sodium, with or without a drug called dextran. Animal research and small human studies have indicated that hypertonic solutions could save more lives and minimize brain damage.

The next experiment, which will involve about 15,000 patients, is designed to determine how best to revive patients whose hearts suddenly stop beating. About 180,000 Americans suffer these sudden cardiac arrests each year. Emergency medical workers often shock these patients immediately to try to get their hearts started again. But some do a few minutes of cardiopulmonary resuscitation first. Researchers want to determine which tactic works better by randomly trying one or the other -- both with and without a special valve attached to devices used to push air into the lungs during CPR. That study is expected to start next month.

"We will never know the best way to treat people unless we do this research. And the only way we can do this research, since the person is unconscious, is without consent," said Myron L. Weisfeldt of the Johns Hopkins University School of Medicine, who is overseeing the project. "Even if there are family members present, they know their loved one is dying. The ambulance is there. The sirens are going off. You can't possibly imagine gaining a meaningful informed consent from someone under those circumstances."

The methodology and oversight are to be taken by Institutional Review Boards (IRB). I am not one who necessarily trusts this system, but so long as none of the methods undertaken on these unconscious patients is known to be less efficacious than current methods, and so long as preliminary research indicates that the experimental methods are more beneficial than current methods, such experiments may be the only way to learn what these researchers seek. If consent can be readily obtained, of course, it should be. But if not, in a suitable emergency, it seems to me that such experimentation does not treat these patients instrumentally, but in fact, just the opposite.

I am willing to be convinced otherwise, however. And if abuses pop up, those responsible should be dealt with in the most strict fashion.


Humphry Applauds Release of Murderer Kevorkian

There are some who claim that there is little connection between Jack Kevorkian and most euthanasia/assisted suicide advocates. Don't you believe it. Kevorkian merely had the temerity to actually do what most believe should be allowed to be done.

As evidence, here are relevant excerpts from a press release issued by Big Daddy Assisted Suicide, Derek Humphry--founder of the Hemlock Society, renamed Compassion and Choices:

Dr Jack Kevorkian free at last (on 1 June 07): The Euthanasia Research and Guidance Organization (ERGO) heartily welcomes the release from prison on parole of Dr. Jack Kevorkian after serving eight years of a 10-25 years sentence in Michigan, USA. We hope that he can enjoy a well-deserved retirement--he is 79--amongst his friends and supporters. In a better environment we trust his health will improve. According to the existing letter of the law, Dr. Kevorkian was correctly convicted of murder. But for those who saw his helping a man dying in great pain and distress, and asking to die now, his action was justified and merciful. This case made clear that the laws governing homicide need modifying to allow a plea of mercy killing, allowing juries to decide...The one undoubted benefit of his ten-year solo euthanasia campaign in the 1990s was making the general public aware of the unrecognized suffering of many dying people, and that physician-assisted suicide was oftentimes their choice of dealing with it. Kevorkian's hugely popular voice could be influential in future attempts at law reform.
Of course, the majority of Kevorkian's "patients" were not terminally ill. Some were not even sick, based on their autopsies. Moreover, Kevorkian was an advocate of an almost unfettered death on demand, as I will outline in an upcoming piece. So too, is much of the euthanasia movement, either explicitly or implicitly, based on euthanasia ideology and advocacy. Kevorkian is just more candid than most.

Meanwhile, Compassion and Choices--less candid and more politically astute than Humphry--merely announced the parole and advocated that the supposedly seriously ill Kevorkian have access to assisted suicide.
Suffering from diabetes and active hepatitis C, the 78-year-old Kevorkian is not expected to live more than a year. Compassion & Choices believes he deserves the same chance for a peaceful, dignified death [euphemistic buzz term for poisoning by drug overdose] that is the right of all people.
But with Kevorkian reportedly to get $50,000 or more per speech, don't expect that "death with dignity" any time soon.


Saturday, May 26, 2007

EVERYTHING is NOT About Abortion

On my way home from a speaking gig in Edmonton, Canada, I came across this long article in the Globe and Mail, byline Carolyn Abraham, that just got my blood boiling. The story concerns families who suffer a miscarriage and choose to bury their babies rather than having them disposed as mere medical waste. Why is this a story? Because of the politics of abortion. From the story:

Yet across Canada and in other parts of the Western world, the modern miscarriage has birthed a new and potentially incendiary brand of perinatal bereavement. A growing number of women and their advocates, many of them staunchly pro-choice, are pushing for the formal recognition of the miscarried fetus as a symbol of their grief and loss. In some cases, they're seeking out these rites even when, for medical reasons, they have chosen to terminate the pregnancy.

But the fetal funeral could be a Pandora's Box. Some graveyards and funeral-home staff have been reluctant to bury remains for which no burial permit can be issued. Medical staff worry it may push patients to dwell on losses they would rather forget. More profoundly, holding funerals for fetuses raises implicit, uncomfortable questions about when life begins.

Those who oppose abortion have long fought for the respectful burial of human fetuses in acknowledgment of their personhood. Can society simultaneously agree to mourn the early fetus and still sanction its destruction? Could the desire to recognize formally the death of a fetus --which has no legal status as a life--reignite the abortion debate?...

"This trend of ritualizing grief...will be watched with enthusiasm and pleasure by those who want to restrict women's reproductive choices, and watched with concern by those interested in preserving women's reproductive liberty," predicted Arthur Schafer, director of Professional and Applied Ethics at the University of Manitoba."Anything that encourages us to view early-stage pregnancy as personhood could impact the law on the choice to terminate pregnancy and on embryonic stem-cell research."

Indeed, the Campaign Life Coalition, the political wing of Canada's anti-abortion movement, considers the trend a sign of "society's progression." Jim Hughes, Campaign Life's national president, recently attended two funerals for fetuses miscarried before 20 weeks. He applauds the trend, regardless of whether those involved consider themselves pro-choice. "This is their little shot at recognizing this was a human being that was a part of their family."

I have long believed that abortion is the new slavery issue in that it seems to underlie almost every political dispute today, just as slavery did in the 1850s. (This is the reason I generally avoid discussing it here at SHS.) But good grief! Everything is not about abortion. People should be allowed to grieve miscarriages in peace, including, if they desire, burying the remains of their dead babies without advocates and media turning their tragedies into a political parade. Color me disgusted.


Media Kevorkian Time Line Misses the People

Our media love the outlaw, as demonstrated in this "Kevorkian time line" that omits information about his victims. They are the truly forgotten ones in this travesty of egotism and sensationalism.

Along the Kevorkian front, Rita Marker and I have a piece comparing Kevorkianism and Oregon's assisted suicide regimen out in the current Weekly Standard. It isn't linkable at the moment. When it is, I will post it here. It's pretty good if I don't say so myself.

P.S. Rita is the executive director of the International Task Force on Euthanasia and Assisted Suicide. She knows more about euthanasia/assisted suicide than anyone I know. If I were asked to pick the one person in the world who has done the most to prevent euthanasia from sweeping the Western world, I would name Rita without hesitation. She is also my mentor on these issues who dragged me kicking and screaming into this line of work. If you don't like me, blame her.


Should Pigs Be Used to Teach Surgical Techniques?

There is a protest in Hartford about a teaching hospital educating their surgical students by having them work on live, anesthetized pigs, who have been injured to mimic gun shot and knife wounds, etc. Animal rights activists are in high dudgeon, calling it cruel and demanding that the students use human cadavers instead. But I don't think they are right. From the story:

Dr. Lenworth Jacobs, director of the trauma program at Hartford Hospital who created the course in 1998, outlined the benefits of the training last year during an interview for a story posted on the University of Connecticut website.

Few doctors outside urban areas see the devastating effects of violent trauma, "but when they see it, they have to be able to handle it," Jacobs is quoted as saying. "By working on a standardized mode in a standardized operating room, students get the same experience they would get in a real operating room with a real patient."
That makes eminent sense to me. Surgery isn't just about the the place of organs or learning how to properly excise tumors, but also the environment of a living patient who bleeds and breathes. This is part of the surgical milieu. I want a surgeons to have been exposed to this difficult aspect of operations before attempting human surgery.

If there is another way to obtain the same educational benefit for the students, by all means it should be used instead. But if not, and given that the pigs are fully anesthetized, then heeding the animal liberationists would be to interfere with proper learning.


Friday, May 25, 2007

Texas Futile Care Law Bill Fails

I am not happy: But my ire was raised before the ultimate failure of the bill to outlaw futile care theory in Texas. The "good" bill, which would have required hospitals to maintain treatment pending a transfer to another hospital would have breezed to passage, and in the process given a body blow to Futile Care Theory. Then, inexplicably, the Catholic Bishops (I believe at the behest of the organization representing Catholic hospitals) opposed the bill and threw its considerable heft behind a bill extending the 10-day cut off to 21-days. That sounds impressive, until you realize that the extra time would have been meaningless, since it appears that Texas hospitals are honoring each other's futile care determinations and refusing transfers! Remember, Andrea Clark's family desperately searched as far as Illinois to find a hospital to accept her. (I spoke to one person on the ground, who told me that advocates are now looking to Mexican hospitals to take these patients!) The one good provision in the alternative bill, declaring tube supplied food and fluids to be ordinary care, should be passed anyway.

So, now it will be up to the courts. And we have to get other states to pass laws requiring continued care pending transfer in futility disputes. Otherwise, we are on the road to explicit health care rationing and an implicit duty to die.

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Wednesday, May 23, 2007

The Exceptional Species Tries to Save Two Sick Whales

Interfering with the cold, pitiless, purposelessness of natural selection, the exceptional species continues to strive mightily to save two apparently sick whales lost in the Sacramento River, (who may have been hit by a boat propeller). The effort has made newspapers throughout the country and in the world. Exhibiting the profound empathy of which only human beings are capable of consistently exhibiting, we are spending significant resources and time attempting to help creatures who are indifferent to human cares and woes. Well, good for us. Indeed, we are unique in the known universe.

Oh, and for those who say we have a duty to the whales because human activity may have caused their plight--that too is a statement of human exceptionalism. We are the only species who have moral duties. Again, good for us.


Animal Cloning Not Progressing Very Fast

It has been more than ten years since Dolly was cloned. Yet, for all of the animal cloning that has gone on, apparently the science of somatic cell nuclear transfer has not progressed very far. An article in Science by Jose Cibelli, formerly of Advanced Cell Technology and now a professor in Michigan, details that scientists are having a dickens of a time understanding somatic cell nuclear transfer and making it more efficiently in animals. There is no link to the article, but here are a few quotes:

Ten years ago, Ian Wilmut, Keith Campbell, and their colleagues from the Roslin Institute in Scotland announced the first cloned adult mammal--a sheep named Dolly--using a technique called somatic cell nuclear transfer (1). Since then, the experiment has been independently replicated in 16 other mammalian species. Laboratories around the world launched efforts to identify the mechanism responsible for this phenomenon. Hundreds of peer-reviewed manuscripts later, we are left with many unanswered questions about the technique and are still unable to substantially increase its efficiency. For all species cloned by this method, less than 10% of embryos transferred into the uterus will produce a healthy clone. Why?...

Ten years have not been enough time, though; the long list of unanswered questions about animal cloning reflects how our understanding is stalled at a fundamental level....Are we closer today to finding the mechanism(s) responsible for somatic cell nuclear transfer? Yes, but not by much.

Finding the gene(s) responsible for reprogramming will mark a crucial turning point for this technique in the next decade of animal-cloning research...Unveiling the genes and pathways involved in the cloning procedure is the first step to creating reasonable approaches for generating human cells that can later be used in therapy. Only then will so-called (and still hypothetical) therapeutic cloning become obsolete.
So, what does this mean? Cibelli seems to be stating that successful human cloning for stem cells may be a very long way off because even in animals, which have been cloned for more than ten years, scientists still don't really understand how it works. He also seems to believe that cloning research may be best used for learning which genes control development, which could allow "reprogramming," e.g., reverting a normal cell into an embryonic state--which is one of the many exciting "alternatives" to ESCR. In any it certainly appears that regardless of the substantial ethical issues, SCNT in humans may prove a very impractical road to devising efficacious medical therapies--and this dawning understanding is beginning to appear in the scientific literature--although not in politicians' speeches or popular media reporting.


Tuesday, May 22, 2007

Jack Kevorkian to Clean Up on the Speakers Circuit

When Kevorkian wanted out of prison, his lawyer repeatedly pleaded for mercy because, he said, Kevorkian's was so ill with hepatitis and other ailments that he was on the verge of death's door. For example, in this Court TV report from 2004:

The state parole board declined to commute Jack Kevorkian's murder sentence or grant the assisted suicide advocate parole, saying his claims of ill health mirrored claims he had made just a year ago.
Or take this 2005 report about another Kevorkian release based on ill health:
Jack Kevorkian's attorney is asking Michigan's governor and parole board for a third time to pardon the 77-year-old assisted-suicide advocate or commute his sentence. Kevorkian is eligible for parole in 2007, but attorney Mayer Morganroth says he might not live that long..."The man is in dire shape," Morganroth said in a statement Saturday. "Prison has deteriorated him almost to the point of no return."
But now that he is actually getting out, Kevorkian seems to have had a "miraculous" recovery. How else explain how a dying man who had reached the "point of no return" in 2005 is now, suddenly, well enough to join the speakers circuit? His going rate will be between $50,000-$100,000. Who says that crime doesn't pay?


Monday, May 21, 2007

Gov. Booth Gardner Lets the Cat Out of the Assisted Suicide Bag

I have long maintained that assisted suicide legalization is not intended to be permanently limited to the "terminally ill for whom nothing else can be done to alleviate suffering," (which is, in itself, a false premise). After all, as we have seen in the Netherlands and Switzerland, when "choice" is coupled with killing as an acceptable answer to human suffering, the actual health status of the person who wants to die is ultimately of little concern. (See my testimony last year in front of the California State Senate Judiciary Committee.)

Former Washington Governor Booth Gardner has, perhaps inadvertently, validated my point in this article in the Seattle PI. Gardner is disabled by Parkinson's disease, which has motivated him to promote the legalization of assisted suicide in a planned voter referendum next year. This matter is discussed in the paper, along with Oregon and the famous and meaningless propaganda statistics that are published each year, which the reporter swallows with not a hint of skepticism.

Be that as it may, Gardner--like most assisted suicide advocates--does not really want to limit the "option" of assisted suicide to the terminally ill. But, for the sake of political expediency, he is willing to--for now. From the story:

There, 292 residents in the last 10 years have used Oregon's Death With Dignity Act to end their lives. Each had to be diagnosed as terminally ill by two physicians and evaluated to ensure that the wish to die was not merely manifestations of depression. Most importantly, all had to administer the lethal dose themselves.

Too many hurdles for Gardner's taste--not to mention the fact that the rules would disqualify him, since Parkinson's, while debilitating, is not considered fatal. In his ideal world, the patriarch would be able to gather his family--two children, eight grandchildren and his first ex-wife (there are two)--at the Vashon Island home where Gardners have lived since 1898, and announce, "OK, it's going to be Friday. I want to go on Friday." Then he would contact a doctor, request a barbiturate and die as he has tried to live--with purpose and intent.

At the moment, however, that is illegal, and Gardner is willing to moderate his vision in the interest of passing any law that would allow what he calls "death with dignity."

I will leave Gardner's cliche romanticizing of assisted suicide to another time. But it is clear from his attitude that he is following the assisted suicide game plan: Pass laws limiting legalized assisted suicide to the terminally ill. Once assisted suicide is deemed acceptable and becomes popularized, then expand the license--whether through further legislation, court action, lax enforcement, or all three--toward the ultimate goal of near death on demand.

Well, at least Gardner is candid about his ultimate goal. Can't say the same for some of his assisted suicide political bedfellows.


"Haunting Echos of Eugenics"

In this excellent column published in the Washington Post, disability rights activists Andrew J. Imparato and Anne C. Sommers warn of the emerging new eugenics. Some key quotes:

Though society may be inclined to regard [Oliver Wendel] Holmes's detestable opinion in Buck v. Bell ["Three generations of idiots is enough] as a relic of a time past, eerie similarities exist in contemporary remarks of the well-respected...Some 72 years later, renowned embryologist Bob Edwards said, "Soon it will be a sin for parents to have a child that carries the heavy burden of genetic disease. We are entering a world where we have to consider the quality of our children."...

In the past, eugenicists emphasized the "burden" of disability. Holmes wrote that individuals with disabilities "sap the strength of the State." In recent years, Peter Singer, a professor of bioethics at Princeton University, has said, "It does not seem quite wise to increase any further draining of limited resources by increasing the number of children with impairments."...

Last fall, Britain's Royal College of Obstetricians and Gynecologists argued for "active euthanasia" of significantly disabled newborns to spare parents emotional and financial burden. Two years earlier, the Groningen Protocol emerged in the Netherlands; it proposed selection criteria for euthanizing babies and children with disabilities. And across the United States, "futile care" policies have required that the most vulnerable give up their hospital beds -- and lives -- for those with more "potential."...

On this 80th anniversary of Buck, let's not foolishly believe that victims of eugenics are an artifact of history. So long as we speak in terms of good genes and bad genes, recognize a life with a disability as an injury, and allow health policies to value some lives over others, we continue to create human rights violations every day.

What is it they say about not learning the lessons of history?


Baby Emilio Dies

While I was in Europe, Baby Emilio Gonzales died. The case stimulated much discussion of Futile Care Theory, in which Texas law allows ethics committees to refuse wanted life-sustaining treatment--not because the treatment won't extend life but because it will. The Texas Legislature is in the process of amending the law, but as I will write later, it looks like it is going to punt rather than really prevent people from being forced to die for want of desired medical treatment.


Sunday, May 20, 2007

Evil is Real--But So Too, Is Goodness

Whilst in Poland, Debra and I felt duty bound to bear witness to the suffering of the victims of Auschwitz/Birkenau. These are a few of the photos I took.

These were not "just" death and slave labor camps: They were designed for the systemic torture of helpless people. Utter insanity.

I won't even attempt to describe the experience of seeing the bales human hair sheered from hundreds of thousands of murdered women before they were cremated, of the tens of thousands of shoes and toiletry items stolen from victims during the "sorting" process, or the horror of the starvation cells, the standing cells, the gibbets, the shooting wall, or of standing in a gas chamber where thousands of people perished, or the shock upon catching the first glimpse of the Arbeit Macht Frei gate at Auschwitz or that awful red brick building that stands astride the train tracks at Birkenau built to allow genocide bureaucrats to observe the sorting of human cargo.

Evil is real. Auschwitz proves it. And yet...even amidst the worst of which human beings are capable, even there, one still can find flickering evidence of true goodness. Suddenly, unexpectedly, there was the starvation cell in which Fr. Maximilian Kolbe volunteered to die in place of a man with a family, who we were told, survived the Holocaust as a result of Kolbe's sacrifice.

Seeing Auschwitz/Birkenau was one of the most harrowing and anguishing experiences of my life. It is inexpressibly painful, but if you are ever near Krakow, please go. You owe it to yourself and you owe it to them. Never again!


Wednesday, May 09, 2007

Hiatus Time

I have a speaking gig in Warsaw on Saturday, so Secondhand Smokette and I are taking the opportunity to see some of Eastern Europe. I have decided not to lug the old laptop around, and so chances are I will not post anything until around the 21st. However, one never knows. The last time I left the country, California defeated the assisted suicide bill requiring me to drop some some dollars at an Internet cafe. Let's hope for a rerun of that little scenario.

In any event, thanks to all for your readership and contributions to Secondhand Smoke. Let's get together again upon my return.

Tuesday, May 08, 2007

Ashley's Case: Court Order Should Have Been Obtained

Ashley is the little profoundly disabled girl who was subjected to non therapeutic interventions, including a hysterectomy and a mastectomy, in addition to hormone therapies to keep her "small." At the time, I wrote here at SHS that, at the very least, matters such as this should be brought to court for review before engaging in such serious interventions.

I hate to say it, but I think any such future cases should be decided beforehand in a court of law, with full arguments made on both sides of the question. I can't think of another way to protect the profoundly disabled from well meaning but potentially dangerous and unnecessary medical procedures.
I got a bit of flack for that. But now, even the Seattle Hospital agrees that the matter should have been brought to a court beforehand. From the story in the Seattle Times:
Children's Hospital & Regional Medical Center admits it was acting outside the law when its doctors performed a controversial hysterectomy on a severely disabled 6-year-old girl, even though her parents and doctors had concluded the operation was in her best interest.

In response to an investigation by a disability-rights organization, hospital officials now acknowledge they should first have sought court approval for the 2004 surgery on the girl, known publicly only as Ashley. The hospital says the error was the result of a "communication breakdown."

Uh huh. It's always a communication breakdown, isn't it? The entire investigative report by the Washington Protection and Advocacy System an be accessed here. A few excerpts:
- The sterilization portion of the "Ashley Treatment" was conducted in violation of Washington State law, resulting in violation of Ashley's constitutional and common law rights.
- The Washington Supreme Court has held that a court order is required when parents seek to sterilize their minor or adult children with developmental disabilities, and that the individual must be zealously represented by a disinterested third party in an adversarial
proceeding to determine whether the sterilization is in the individual's best interests.
- Courts have also limited parental authority to consent to other types of medical interventions that are highly invasive and/or irreversible, particularly when the interest of the parent may not be identical to the interest of the child. Thus, the other aspects of the "Ashley
Treatment"-- surgical breast bud removal and hormone treatments--should also require independent court evaluation and sanction before being performed on any person with a developmental disability.
- The implementation of the "Ashley Treatment" also raises discrimination issues because, if not for the individual's developmental disabilities, the interventions would not be sought. Such discrimination against individuals because of their disabilities is expressly forbidden by state and federal law.
In any event, good for the disability rights organization that wouldn't let this go, and as a result, have acted forcefully to protect the interests of children such as Ashley.


Monday, May 07, 2007

We Keep Growing

SHS just had one of its all time best weeks. More than 5000 people from all around the world came by to "set a spell." I am very gratified and will continue to strive to make the sight interesting and find stories for us to ponder that affect the human future. Thanks to all.


Future Squinter? No Right to be Born

Well, we have fallen along way off the moral cliff in a very short time; from tossing away embryos with genetic defects for serious illness in infancy, to tossing them away because they are the wrong sex, to destroying those with a genetic propensity to adult onset cancer. And now, with the inevitability of sun in summer, embryos in Brave New Britain are be selected out if the future child would have...squinted. From the story:

Embryos are to be screened for a cosmetic defect for the first time in a British clinic. Doctors have been given permission to create a baby free from a genetic disorder which would have caused the child to have a severe squint.

The Bridge Centre family clinic, in London, has been licensed to treat a businessman and his wife to create the baby. Both the businessman and his father suffer from the condition, which causes the eyes only to look downwards or sideways.

Critics have said that the permission is another step on the road to creating only perfect-looking babies in the laboratory. The licence was granted by the Human Fertilisation and Embryology Authority (HFEA) to Prof Gedis Grudzinskas, who believes the landmark ruling marks a shift away from granting licences only for life-threatening conditions.

He said: "We will increasingly see the use of embryo screening for severe cosmetic conditions." He added that he would seek to screen for any genetic factor at all that would cause a family severe distress.

Notice that it isn't even about the future born individual any more. But whether the family would feel stress. When asked if embryos with a propensity to a certain hair color would be selected out, the good brave new biotechnologist replied:
"[Hair colour] can be a cause of bullying which can lead to suicide. With the agreement of the HFEA, I would do it."
Children are the new puppies.


Advanced Cell Technology in the News Again with ESCR

"Embryonic Stem Cells Can Repair Eyes," is the headline. But the Reuters story, byline Maggie Fox, about an experiment announced by Advanced Cell Technology (ACT), doesn't actually demonstrate this. From the story:

Writing in the journal Nature Methods, [Robert]Lanza's team said they found a way to grow and differentiate human embryonic stem cells without using culture. They directed the stem cells into becoming what they believe are hemangioblasts, the blood vessel precursor cells, although other teams will have to replicate this for it to be accepted.

"When injected into the bloodstream, they homed to the other side of the body and repaired damaged vasculature within 24 to 48 hours," Lanza said. "For example, we injected the cells into mice with damaged retinas due to diabetes or other eye injury. The cells (labeled green) migrated to the injured eye, and incorporated and lit-up the entire damaged vasculature. The cells are really smart, and amazingly, knew not to do anything in uninjured eyes."

The researchers killed the mice to check the cells' progress, so they do not know the long-term effects."

Oh. So, they infer that vision would have improved, not that it actually did. Killing the animals early also means that there is no way to tell whether the mice would have developed tumors from the cells, a significant problem in embryonic stem cell research.

And here's the money part--literally--that always seem to find its way into stories about ACT's announced research successes:
William Caldwell, chairman and chief executive officer of Advanced Cell Technology, said the company wanted to test the cells in people and had asked the Food and Drug Administration for permission to do so by the end of next year. "We also have studies underway indicating that the cells can also considerably accelerate wound healing, repair lung damage, and can even generate unlimited amounts of red blood cells for transfusion," Lanza said.

ACT has a history of, shall we say, puffing its research successes. And a request for FDA approval is by no means a guarantee of a receiving FDA approval. Nor should what appears to be a proof of principle experiment be confused with actually accomplishing the deed--in this case restoring vision. People may wish to invest and hope it all works out, of course. Still, prospective investors would be well advised to exercise due diligence. Or as a famous man once said, trust but verify.


The Deep "Ecology" Threat to Human Exceptionalism

As readers of SHS know, I believe that human exceptionalism is under profound assault from many different directions, including utilitarian bioethics, animal liberation, and philosophical materialism. But also, some in the environmental movement have turned the conservation ideal on its head, threatening to transform environmental awareness into an explicitly anti-human quasi-religion, sometimes called deep ecology.

Deep ecologists attack human beings as a "vermin" species that threatens the living planet Gaia. Paul Watson, the founder of the Sea Shepherd Conservation Society has just issued such an explicitly anti-human screed. He contends we are in the midst of a mass extinction event--due to the horrible humans:

We are the ruthlessly territorial primates whose numbers have soared far beyond the level of global carrying capacity for the deadly behavioural characteristics that we display.

This did not happen yesterday because we suddenly became aware of the dangers of global warming. It began 50,000 years ago when a relatively hairless primate stumbled out of equatorial Africa and began wiping out the megafauna of the time. Wherever this creature (our ancestor) went, their arrival was followed by large die-outs of megafauna. Primitive hominids were well-organized, efficient, slaughter crews. As they advanced, the mammoth, sabre-toothed cats, cave bears, giant sloths, camels, horses, and wholly rhinos fell to their stone weapons and deliberately set fires. The extinction of all of these great mega-species is directly attributable to "primitive" human hunters. The hunting down of the mega-fauna was followed by the advent of agriculture and the domestication of selected animals. Domesticated cows, goats, sheep, and pigs grew in numbers and denuded large areas of grasslands. Irrigation systems began to toxify land. Then agriculture was followed by industrial activities, and finally, by the burning off of vast amounts of fossil fuels.

One would think this was just evolution in action, human beings acting to propigate the species and help it thrive. Indeed, elephants utterly destroy their habitiats without a peep of protest from the likes of Watson--but of course, that is because unlike elephants, we are exceptional and possessed of concepts of right and wrong. But I digress.

The answer to our malign presence, is a quasi-human extinction:

The planet's ecosystem is a collective living organism and operates very much like the human body...Humans are presently acting upon this body in the same manner as an invasive virus with the result that we are eroding the ecological immune system. A virus kills its host and that is exactly what we are doing with our planet's life support system. We are killing our host the planet Earth.

I was once severely criticized for describing human beings as being the "AIDS of the Earth." I make no apologies for that statement. Our viral like behaviour can be terminal both to the present biosphere and ourselves. We are both the pathogen and the vector. But we also have the capability of being the anti-virus if only we can recognize the symptoms and address the disease with effective measures of control.
Then he gets to the eugenics. Our population should be radically cut to under 1 billion. This would require mass killing, which he doesn't address. But he does promote that only the few be allowed to have children, people who would be "professional" parents, who would all home school. But here is the kicker, that reveals the viciousness to which anti-human exceptionalism leads:

Curing a body of cancer requires radical and invasive therapy, and therefore, curing the biosphere of the human virus will also require a radical and invasive approach.
Of course, only the "AIDS species" even cares about the extinction of other species. Be that as it may, such self-loathing and nature worshipful attitudes if acted upon, would not, in the end, "save the planet," but could instead unleash a genocidal utopian viciousness against the most weak and vulnerable humans. At the very least, you can bet that Mr. Watson does not perceive himself as one of the human vermin to be exterminated in defense of the earth's flora and fauna.

HT: Bob Hiltner


Sunday, May 06, 2007

Dr. David Prentice Receives Bioethics Award

The American Physiological Society, founded in 1887, which describes itself as "a nonprofit devoted to fostering education, scientific research, and dissemination of information in the physiological sciences," has awarded my friend David Prentice its 2007 Walter C. Randall Award in Biomedical Ethics. Excellent. Prentice has been unfairly pilloried by Big Biotech for his indomitable effort to keep the ongoing successes of adult stem cell research in the news. Good for you, David. I hope there is money attached!


Saturday, May 05, 2007

When Scientists Bully Anti-ESCR/Cloning Scientists

I have mentioned before that scientists with heterodox views in the areas of cloning/ESCR (as well as in other contentious areas beyond the subjects dealt with here at SHS) are bullied, attacked, ridiculed, threatened with loss of job, or if tenured, forced to teach "punishment" classes, and otherwise have their professional trajectories interfered with when they become viewed as, shall we say, heretics or apostates.

A small example of this phenomenon was recently on display, courtesy of the professional science journal Nature Neuroscience. A friend of mine, Dr. Maureen Condic, associate professor of neurobiology and anatomy at the University of Utah School of Medicine, wrote a column for First Things in which she criticized scientists for hyping the curative potential of embryonic stem cell research. It is a long article, which you can read for yourselves at the link above, but here is a good summarizing paragraph of Condic's perspective:

The hubris of scientists in the field of embryonic stem cell research who confidently asserted "Give us a few years of unrestricted funding and we will solve these serious scientific problems and deliver miraculous stem cell cures" was evident in 2002, and it is even more evident today. For the past five years, researchers have had completely unrestricted funding to conduct research on animal embryonic stem cells, and yet the serious scientific problems remain. They have had every conceivable tool of modern molecular research available to them for use in animal models, and yet the serious scientific problems remain. Millions of dollars have been consumed, and hundreds of scientific papers published, and yet the problems still remain. The promised miraculous cures have not materialized even for mice, much less for men.
This bit of accurate ego puncturing was too much for Nature Neuroscience, which editorialized against Condic (and the White House) in the April 2007 edition. While admitting that, as Condic reported, "there are formidable hurdles to overcome before HEScs might serve therapeutic purposes," the editorial argued that "these hurdles are no reason to abandon stem cell research for stem cell therapies."

The editorial's conclusion was fair enough, although I didn't read Condic as urging that ESCR be abandoned. But the personal attacks against Condic of "trying to spin science...for an anti-science purpose," and strongly implying a religious motive--merely because she dared to express the state of the science accurately, along with a heterodox opinion with which the journal disagreed--is a tiny sample of the intense pressures scientists are placed under to keep them from stepping outside the party line.

At the very least, Condic, having been personally attacked as somehow being an anti-science scientist, should have been given the right to defend herself. Indeed, she tried to do that, but the editor, Sandra Aamodt, Ph.D., refused to permit her the courtesy of a reply in the journal itself, sniffing that there wasn't enough space, and anyway, she could post a rebuttal on the journal's blog.

Not good enough. The stature of being in print matters, given that the attack was in print, and given that Condic would want the same people who read the editorial to also be able to see her defense. Moreover, the personal nature of the editorial seems designed to harm Condic in her professional life. One can imagine an academic symposium being organized and Condic's name coming up as a possible presenter. "Oh, no," the head organizer sniffs. "I heard she's anti-science based on religion. Can't have any of her kind here."

And they still laugh at the Catholic Church for stifling Galileo. But who are the stiflers now?


Friday, May 04, 2007

Genetic Test Can Warn of Risk for Heart Disease

This story demonstrates the great potential of biotechnology, but being a congenital party pooper, I am also compelled to use it as a nagging moment. From the story:

Scientists have discovered a strand of DNA that dramatically raises the risk of coronary heart disease and doubles the chances of younger people suffering a heart attack prematurely.

The high-risk stretch of genes is common among Caucasian populations, with up to a quarter carrying copies that boost the risk of heart disease by 40% and increase the lifetime risk of a heart attack by 60%.

Early-onset heart attacks, occurring in men under 50 and women under 60, were found to be twice as likely among those who inherited the high-risk gene sequence from both their mother and father.

That's great. If someone tests positive, as the story notes, preventative measures can be taken. Perhaps one day there will even be a way to fix the genetic problem. But based on experience so far, it seems highly likely that this knowledge could instead be used to "select out" embryos with the defect so that a child will not one day suffer a heart attack.

It seems to me that the dangers of our rapidly increasing knowledge and new technologies lie not in the science, but our ethics. If we embrace intrinsic worth, we don't go wrong. If instead, we embrace "quality of life" and obsess about hyper-control, then we move into the realm against which Huxley warned us. Humans are exceptional. We get to choose.


Thursday, May 03, 2007

The New Eugenics: Sex Testing of 6-Week Embryos

The new eugenics forges ahead with a new "home" test soon to be available to determine an embryo's gender at 6 weeks development. (Ultrasound permits gender identification at about 20 weeks.) Why the need to know the sex--this isn't about disease--so early? I can think of only one main reason: If you want a boy and it's a girl--or probably less frequently, the other way around--then there is plenty of time to have a eugenic abortion and start again. From the story:

But some health authorities have already stopped revealing that information for fear of "wrong-sex" terminations...Wrong-sex abortions are more common in some ethnic minorities--with boys being more highly prized than girls.
But now with the home test, people who don't want a little girl or boy can find out early enough to destroy their daughter or son--with no one the wiser. So much for loving the child we conceive unconditionally. We apparently are moving into an era in which we not only have a right to have a child, but to have the child we want. We should call this the solipsistic era. All that seems to matter any more is, "I want."


Where Utilitarian Bioethics Leads

The NHS in the UK uses a committee of bioethicists and others to advise it about ethical policies, known as the National Institute for Health and Clinical Excellence, a.k.a., NICE. Well NICE isn't. In my view, it is dominated by utilitarian ideology that denies the intrinsic value of human life, determining policies for the application or denial of medical interventions based on explicit "quality of life" criteria.

Such advise is often based, not on whether a patient could survive, but on measurements known as the "quality adjusted life year," or QALY. A QALY combines quality of life, life expectancy, and cost considerations into one figure, on the assumption that an individual may prefer a shorter but healthier life to a longer life with diminished health. Here is a good description of how the system works from an article in Clinical Ethics about NHS and Alzheimer's patients (subscription needed), demonstrating that its purpose is rationing based on quality of life determinations:

The calculation assigns a numerical value for quality of life to a condition on a scale of 0 (death) to 1 (perfect health) (negative being a state worse than death) using a matrix. Predicted change in quality of life is established from clinical evidence and converted to a numerical value using the matrix. A formula then combines the predicted change, duration of treatment effect and cost. The result is a figure expressed in Quality-Adjusted Life Years...

The QALY can be applied in two main contexts:

1. In comparing merits of one treatment to an identified patient (or which of several to give for a particular condition).
2. In deciding which treatments should be allocated at all, and to which patient groups.

NICE employs the QALY in the second context. This is significant as, where the choice is made between different patients, issues of bias or discrimination become important.
The problem is, under the NHS, the imposition of QALYs make people "prefer" that approach by limiting treatment options based on this explicitly discriminatory (against people with disabilities, the aged, etc.) approach, as noted by the article:
In March 2005 NICE released draft guidance on the treatment of Alzheimer's disease, proposing that drug treatments [drug names omitted] should no longer be recommended for NHS funding due to lack of cost-effectiveness [based on QALY analysis]. This followed 2001 guidance stating that the drugs were clinically effective, and was met with anger from various ethicists, charities and clinicians...It concluded that the benefits provided by the treatment were not sufficient to make the drugs cost effective for use in the NHS.
This is where Futile Care Theory leads. Once the principle is accepted that health can be rationed based on judgments of a patient's quality of life, it eventually expands into refusing efficacious treatments for whole categories of people. And those most likely to be deemed to have less right to care are going to be the ones with the least political power.

We have to get a handle on resource issues, to be sure. But discrimination based on quality of life is not the way to go. The NHS's use of NICE is a warning to us here in the USA. We walk down the quality of life path at the peril of our most weak and vulnerable patients.


Futile Care Theory State Honor Roll

My sources tell me that the following states require life-sustaining treatment to continue pending transfer if a hospital determines that the desired treatment is "futile" or "inappropriate," or "non-beneficial: Alabama, Florida, Kansas, Maryland, Massachusetts, Minnesota, New Hampshire, New York, Ohio, Oklahoma, and Wyoming. Time for concerned citizens in other states to work to help this list grow.


Wednesday, May 02, 2007

More on Texas Bishops' Embrace of Futile Care Theory

I consider the Texas fight over Futile Care Theory to be one of the most important bioethical matters of the year. This is why I was so profoundly disappointed when the Texas Catholic Bishops and the Texas Catholic Conference supported a modified version of futile care, and opposed the legislation to do away with the pernicious 10-day rule.

I write at some length about this in NRO, just out. Here is my conclusion:

What would drive administrators and ethicists at some Catholic hospitals to support Futile Care Theory? No doubt, partly a sincere desire to alleviate the suffering of the most ill and profoundly disabled patients. But social justice--the polite term for the money imperative-- also cannot be left out of the equation. The care provided to patients involved in futility disputes is the most expensive. Boiled down to its essence, Futile Care Theory is a form of ad hoc health-care rationing that is at least partly designed to address the problem of tight resources in an era of managed care and HMOs. As the Ethics Committee of the Society of Critical Care Medicine said in a Consensus Statement back in 1997 supporting medical futility, "Given finite resources, institutional providers should define what constitutes inadvisable treatment and determine when such treatment will not be sustained"--which is precisely what the Texas law permits, and is now supported explicitly by the Texas bishops.

Near the end of his testimony, Bishop Aymond quoted the 1995 encyclical
The Gospel of Life, in which John Paul II stated that in situations "when death is clearly imminent and inevitable, one can certainly in conscience refuse forms of treatment that would only secure precarious prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted." But surely, John Paul II was referring to the right under Catholic moral teaching of patients and families to choose to forgo treatment--not the right of hospital ethics committee to impose such decisions upon the unwilling.

If patient autonomy is to retain any real meaning; if we are to prevent subjective and invidious quality-of-life value judgments from being imposed upon the sickest and most vulnerable among us--it is crucial that the Texas legislature kill the futile-care law's 10-day rule once and for all. Unfortunately, the Texas bishops and Catholic Conference are impeding the success of this important work. In so doing, they are opening the door to the imposition of medical discrimination against those judged by strangers on ethics committees to have lives not worth living. Somehow, I don't think this is what John Paul II had in mind.
I consider the Texas Futile Care fight to be of profound import, not only to Texas, but to the nation, and indeed, the world since this is a matter of growing urgency. It is in this context that the (in my view) abdication by Texas Catholic Conference is particularly unconscionable. Let us hope that right prevails.


FDA Approves Adult Stem Cell Human Trial for Heart Disease

Adult stem cell research continues apace. This PR press release touts an Australian company's gaining FDA approval to conduct human experiments in treating heart disease with adult stem cells. It's a "Phase 2 Trial," meaning it tests efficacy as well as safety. From the release:

The Phase 2 clinical trial will be based at the Texas Heart Institute,and will follow a similar protocol to the one used by the same investigators in preclinical studies for the IND submission. These showed that implantation of the company's proprietary allogeneic stem cells by catheter into damaged heart muscle resulted in significant improvement inheart function and reduction in congestive heart failure.

This clinical trial will be the first to test an allogeneic stem cell product injected by catheter into heart muscle damaged by a recent heart attack.
Of course, most of the release is about the business aspect of all this. Life sciences: thy name is commerce.


Tuesday, May 01, 2007

Texas Catholic Bishops Support Futile Care Theory

This is pretty inexcusable: As readers of SHS know, Texas is in the midst of a political battle to amend the futile care law to prevent patients, such as Andrea Clark, from being denied wanted life-sustaining treatment. Currently the law permits hospital ethics committees--meeting behind closed doors with no open record, right to cross examination, or other due process legal procedures--to refuse wanted life sustaining treatment and cut off care 10 days later (other than comfort measures and palliation) if the family has been unable to arrange a transfer to another institution. This is often difficult because the patients are expensive to care for, and some suspect, because hospitals don't wish to stand against each other's futile care determinations.

HB439/SB 1094 would do away with the 10-day rule and require treatment to continue until a transfer can be effectuated. But now, Bishop Gregory Aymond, speaking for the Texas Bishops and the Texas Catholic Conference, has come out against this good approach and instead, supported maintaining a modified futile care permissiveness in Texas.

HB 3474, as currently amended in committee, would expand the waiting period from 10 to 21 days, but also permit hospitals to refuse new forms of treatment that might be needed by the patient during the waiting period. In his testimony in support of what would still permit hospital ethics committees and physicians to impose their values on patients/families, Bishop Aymond confuses a patient/family choosing to refuse life sustaining treatment with hospital ethics committees imposing their views that the patient should not receive it.

We believe, and the tradition of our Church has always taught, that a person should be allowed to die with dignity and have a peaceful death. We believe that that is in conformity to God's will and that God is the one who chooses life and death. It is the teaching of the Church that we should not interfere with that. We also realize that sometimes families, through no fault of their own, are really not able to make those decisions because of their involvement, because of the emotions.
This is little different than utilitarian bioethicists claiming that families shouldn't be able to make such decisions because of the guilt they feel or misplaced religious belief. But I guess we shouldn't be too surprised. Some Catholic hospitals have supported futile care theory all along. Indeed, Children's Hospital of Austin, where Baby Emilio is the center of a futile care controversy, is a Catholic institution.

There are reasons for this. Part of it, of course, is a sincere desire to do right by very sick patients, even if the patient does not agree. But I also think that "social justice"--a polite term in this instance for resource issues and money--is also part of the equation since we are talking about some of the most expensive patients for which to care.

I have spent most of today dealing with this development and will have more to say about it very soon.


Latest Brave New Bioethics Podcast

In this edition of Brave New Bioethics, I deconstruct the growing eugenic trend to cull embryos for gene defects, including those that could cause a propensity to adult onset disease. Check it out.