bnuckols

Max Headroom or Donald Hairroom?

Seriously, have you ever seen them together? Or Trump in sunglasses?

Newbie Republican TRump

TRump is a very recently converted –well, mostly converted, except for big government, taxes and tariffs, government healthcare, and using government agencies to pick and choose winners and losers and courts to threaten others – Democrat.

It’s not as though he changed any donation habits more recently than the last two years. 

It’s not even as though he’s voted in a Republican primary since 1988.

He believes money and lawsuits are weapons and he is a bully.

He can not or will not give more than anecdotal evidence for any of his other conversion experiences.

He lied as recently as the steak incident – an entirely unnecessary lie, easily discovered.

He has no conservative credentials and does not pretend to apologize for it, even to God.

But he says that a simple majority is “a random number” and demands that the Republicans ignore our Convention rules and let him  make up his own.

TRump still lies, redefines words, ignores the rules and history and makes threats when he doesn’t get his way.

Newbie Republican still acts like a Dem.

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Right Wing Dystopia 2016 – Update with quotes

Conservatives/small(l)and Big(L)ibertarians /”Tea Party” activists and candidates have “Progressed” to the point that they can out-cuss, out-victim and out-mob any Progressive.

The course, vulgar language in public speeches, not just public speech, by supposed “Conservatives” has a history that goes back at least to the elections of 2004, when “Republicans” could be heard repeating Code Pink talking points. Our protests and counter-protests were once known for good behavior and leaving the site cleaner than we found it. But no more.

Who is surprised that the (later) slogan, “Shut ‘Er Down!” was taken literally to the point of the anarchy we now see at campaign events?

An interesting commentary by John Hart, comparing two division(s) within the Tea Party as “The French Revolution,” is worth your time and attention. Mr. Hart has worked with both former Senators Coburn and DeMint. (If you don’t know the significance of this part of his resume, you are who I’m writing for and you especially need to read the article.)

The loudest discourse in Conservative venues first became critical, then condemning, of anything other than obstruction and taking hold of power. At one time, Conservatives spoke of the emotional, illogical campaigning on the Left, which angrily demanded instant gratification.

How could Ann Coulter forget her own words in “Demonic?”

“The French Revolution was spontaneous, impulsive, passionate, emotional, romantic, utopian, resentful, angry, dreamy—anything but rule-bound and reasoned. No one knew, from one year to the next, where the Revolution was heading. That’s why, at the end of it all, they enthusiastically threw themselves into the arms of the dictator Napoleon.”

Or Mark Levin his opening lines in “Liberty and Tyranny?”

“For the Conservative, the civil society has as its highest purpose its preservation and improvement.”

Or his admonition in Chapter 2:

“The Conservative believes, as Burke and the Founders did, that prudence must be exercised in assessing change. Prudence is the highest virtue for it is judgment drawn on wisdom. The proposed change should be informed by the experience, knowledge, and traditions of society, tailored for a specific purpose, and accomplished through a constitutional construct that ensures thoughtful deliberation by the community. Change unconstrained by prudence produces unpredictable consequences, threatening ordered liberty with chaos and ultimately despotism, and placing at risk the very principles the Conservative holds dear.”

Historically, anarchy is soon followed by a plea for any relief, even if it means a dictator. Tearing down without a firm foundation of principles based on the furtherance of civil society is not necessarily a desirable Revolution, and certainly not sustainable Reformation.

Texas’ Women’s Health, UT Study: Other than that*, the story was true.

*The authors of a study published in the New England Journal of Medicine admit to a narrow focus that ignored the multiple methods of funding Family Planning in Texas,  looking instead at a single type of “provider” – Title X clinics like Planned Parenthood (“PP”) – and a single source of funding for a specific set of services: long-acting reversible contraceptives such as the IUD and implants and injectables.

Yet, in typical fashion, the reports about the study claim much more. For example, the Texas Tribune has an article out, “Texas disavows Controversial Women’s Health Study,”  about the political fallout due to the skewed conclusions of the authors and the even more skewed editorializing in the media.

While the NEJM article (free article!) states in the “Methods” section that,

“After the exclusion, the provision of injectable contraceptives fell sharply in counties with Planned Parenthood affiliates but not in counties without such affiliates; subsequently, the numbers of claims in both groups of counties remained relatively stable during the next 2 years. In contrast, the provision of short-acting hormonal methods changed little in the two groups of counties in the quarter after the exclusion and declined steadily thereafter.” (Emphasis mine. )

the Tribune article reports that in answer to criticism,

Joseph Potter, one of the UT researchers who co-authored the study, said in an email that the paper addressed the “specific question” of how the exclusion of Planned Parenthood from the Texas Women’s Health Program affected women. Nothing raised in Traylor’s letter, he said, contradicted the researchers’ conclusions.

“We made no claims about access to reproductive health care as a whole in Texas,” he said, and he stood by the finding that claims for long-acting contraceptives fell after Planned Parenthood was excluded from the women’s health program.

The law in question, SB7, was passed with bipartisan support in 2011, a year when Texas, along with State budgets all over the Nation were tight. Although family planning was cut, no specific vendor was “excluded” and PP was not even mentioned in the legislation. Only because PP did not offer continuing, comprehensive care, that business would effectively be cut out.

The Obama Administration took great offense at our State’s attempt to take care of the whole woman and refused all Family Planning Title X money for Texas Medicaid.

Instead, Obama intervened to specifically direct $13 Million of Title X funds to a private organization,the Women’s Health and Family Planning Association of Texas (“WHFP”) which funds only Title X clinics, almost all of which are now Planned Parenthood businesses), so no money was lost even at PP.

The State Health Services no longer managed those Medicaid matching dollars once allowed by a special Medicaid waiver. Instead, State funding for the Family Planning programs and the Texas Women’s Health Program, was replaced by State dollars and directed toward programs and doctors that offer continuing, comprehensive care, such as Federally Qualified Health Centers (FQHC), State, County and local clinics and hospitals, and fee for service doctors that participate with Medicaid. Women could be diagnosed and treated for a much broader spectrum of health problems and their families were welcome at the same clinics.

Senator Jane Nelson, Chair of the Senate Finance Committee and sponsor of the Bill, objects to the implication by the NEJM that the authors were writing on behalf of the State. In her letter to the Executive Commissioner of Texas’ Department of Health and Human Services, Chris Traynor, Senator Nelson noted,

“This study samples a narrow population within the Texas Women’s Health Program (TWHP) — which represented only 33 percent of the overall number of women enrolled in our women’s health programs in Fiscal Year (FY) 2014. This ignores hundreds of thousands of women being served through the Expanded Primary Health Care Program; the Family Planning Program; and the 628,000 women of child-bearing age receiving full Medicaid benefits, 75 percent of which received contraceptive services in FY 14. Women often rotate in and out of our state programs, so we must look across our entire system to determine whether we are truly meeting their needs. Just because a claim for service was not submitted to TWHP does not mean a woman went without that service.
The study also creates an impression that fewer Texas women are accessing long-acting reversible contraceptives (LARCs). That’s simply not true. Across our state programs, there were more claims for LARCs in FY 2014 than there were in FY 2012 when Planned Parenthood was still a provider.”

In other words, women with private insurance and women who never had access to PP had similar numbers.

And another thing: Potter, a sociologist at UTAustin and the co-author quoted above, was the one who told the LA Times that,  “It’s not like there is a large, over-capacity of highly qualified providers of effective contraception out there just waiting for people to show up.”

On behalf of Texas’ Family Physicians, OB/Gyns, Pediatricians and Internists who accept traditional Medicaid and who had been unable to access the money in those competitive Title X grants awarded to PP, I’d like to inform him that yes, we have been waiting – for a chance to offer our patients this care.

But other than that ….

March 9, 2016 Republican Delegate Count – UPDATE

Hawaii is in. Look here – or here – for updates.Further breakdown of allotments is available at the Washington Post website.  (UPDATE) The New York Times also has clear graphics (and faster) here:

NYT Delegate Tracker

.

Washington Post Delegate Tracker

Delegate tally so far

https://www.washingtonpost.com/graphics/politics/2016-election/primaries/delegate-tracker/republican/

Counting win before chicks are hatched.

If Ted Cruz wins Presidency, it leaves a huge blank if Cruz resigns before Obama is out.

A special election will be called for the next uniform election day or 32 days after election is called.

We’ll need Cruz to resign as soon as elected or wait until inauguration to prevent aggression by the “Office of the Lame Duck President.”

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Human rights for this class of persons?

How human is human enough for human rights?

Justice Taney on slavery, in the ruling on the Dred Scott case:
“”

The question before us is, whether the class of persons described in the plea in abatement [people of Aftican ancestry] compose a portion of this people, and are constituent members of this sovereignty? We think they are not, and that they are not included, and were not intended to be included, under the word “citizens” in the Constitution, and can therefore claim none of the rights and privileges which that instrument provides for and secures to citizens of the United States. On the contrary, they were at that time considered as a subordinate and inferior class of beings, who had been subjugated by the dominant race, and, whether emancipated or not, yet remained subject to their authority, and had no rights or privileges but such as those who held the power and the Government might choose to grant them. “

Nevertheless,  today’s Supreme Court hearing didn’t deal with the question of whether the zygote/embryo /fetus is human enough. It dealt with the regulations for abortion businesses and the doctors who work for them. These are essentially the same rules imposed on Federally Qualified Healthcare Centers.

Doctors must offer continuing care and the buildings should allow safe egress and sanitary standards of care.  The challenge is against State protections for the women who have chosen abortion.

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I’m quoted in Houston Chronicle about Supreme Court hearing

By 7 PM, there was a line of people setting up to spend the night in front of the Supreme Court of the United States building. They hope to be able to watch the Court proceedings on Wednesday when the Texas abortion law, HB2.

Here’s the coverage from Brian Rosenthal of the Houston Chronicle, about Texans, like me, who travelled to DC for the hearing. I’m quoted as ‘helpful about the future of the law in the last few paragraphs.

Beverly Nuckols, 60, a New Braunfels family doctor who flew in for the arguments, said she was happy that a long and just process finally could be coming to an end.

Nuckols said was hopeful about the ruling because she was confident in the law.

“I believe we will get a tie,” she said.

No “capitulation,” from Senator Cornyn

Watch out for political blogs pretending to be news sites.

As an example, you may have seen the tired attempt by “The Conservative Review,” (to get clicks by) “reporting” the exact opposite of reality and “prove” that the Republican leadership is not effective or Conservative.

Here’s  Cornyn’s statement as paraphrased:

“And although Sen. John Cornyn (R-TX), the Majority Whip, reiterated his desire that the next president fill the vacancy, he said that holding hearings is entirely up to the Judiciary Committee Chairman and scheduling a floor vote is entirely up to McConnell.”

That “although” is pure spin.

Here’s what he actually said ( from a link in the blog post):

“”It’s *entirely* up to the chairman of the Judiciary Committee whether *even* to schedule a hearing on the president’s nomination,” Cornyn said on “The Mark Davis Show,” a talk show on Dallas-area radio station KSKY. “And *were the nomination to get out* of the Judiciary Committee, it’s *entirely* within the control and discretion of the Senate majority leader, Sen. Mitch McConnell, whether to schedule it for a vote. **Which does demonstrate that majorities do matter**.”” (Emphasis mine)

A bit less supportive, don’t you think?

Isn’t this what we’ve all said in support of waiting to confirm a candidate nominated by the next President? Now, read on down for an emphatically different meaning:

“Cornyn said the presidential election should be a referendum “on who makes that appointment because I think many people simply feel like they don’t recognize their country anymore.””
He added, “It’s entirely up to the Senate whether to confirm that nomination, and I think we should not, and we should defer that to the next president.”

(Again, emphasis mine)

“The Conservative Review,” like Wingright.org, is a blog, not “reporting” by a valid news source. 

Texas Governor Greg Abbott endorses Cruz for President

Huge endorsement from Texas’ Governor Greg Abbott. This is one I had been wondering about.

In a video announcing the endorsement, Abbott said,

“Unlike far too many in Washington, the Ted Cruz we’ve seen in the Senate is the same Ted Cruz we elected and he’s the same Ted Cruz I served with when I was attorney general,” Abbott said.

I was very impressed and very proud of Ted Cruz back in 2009, on the day when Kay Bailey Hutchison announced that she would run one more time as Texas’ Senator. Within minutes, Cruz withdrew his bid for Attorney General, rather than run against General Abbott. Although later I became opposed to his campaign tactics, that moment showed integrity.

( I’m just barely cynical enough to think it also showed good political sense. In fact, that only just occurred to me. Doggone it! I want to believe it was character, not simply savvy politics.)

Cruz needs mentoring – to *accept mentoring* – from both Governor Perry, who has also endorsed Cruz,  and from Governor Abbott. I hope that he will.

Gardisil vaccine works in young women

The article contains a (free!) link to the study report in “Pediatrics.”

“”For young women aged 14–19, the presence of those four strains of HPV (and some others) were found to drop by an incredible 64 percent overall, and by 34 percent in women aged 20–24.””

There’s also a link to a study that indicates that there is no increase in sexual activity or early sexual activity after the vaccination, “as measured by pregnancy, sexually transmitted disease infections and/or contraceptive counseling for up to three years after vaccination.”

I do strongly disagree with the author about abstinence -based sex-ed:  Abstinence works 100% of the time it is use correctly and consistently.

21st Century Conservative Movement

Death Politics

Texas: Don’t Vote Early

I’ve never done this before,  but  …
I hope Texas – and especially Comal County – voters will wait to vote.  The State elections and the Presidential race are full of dirty tricks and deceptive ads and flyers.

People I once trusted are so fearful of a couple of powerful Lobbyist groups in Texas, and at least one lying campaign management firm, that they are making ill-advised endorsements. Those people most likely will not benefit the way they think they will.

Wait. Watch. Election day is March 1st.

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“Inaccurate and misleading” (Cruz attacks on Rubio)

At the Faith and Family conference, Senator Ted Cruz claimed that Senator Marco Rubio had not supported the defunding of Planned Parenthood by not voting against the annual budget vote in September, 2015.

I don’t know if most of my readers can understand what a big step it is for a group like National Right to Life to enter into this political debate between pro-life candidates. However, this accusation was enough to cause this statement to go out, as reported by Andrew Bair, @ProLifePolitics :

https://mobile.twitter.com/ProLifePolitics/status/698321269687775232/photo/1

“The following may be attributed to Carol Tobias, president of National Right to Life:

“Marco Rubio voted to defund Planned Parenthood before Ted Cruz ever got to the U.S. Senate (see roll call on H. Con. Res. 36, April 14, 2011). Since Ted Cruz joined the U.S. Senate, both he and Sen. Rubio have voted the same on every roll call that National Right to Life regards as pertinent to defunding Planned Parenthood. To suggest that Rubio voted wrong or missed meaningful votes on the Planned Parenthood issue is inaccurate and misleading. National Right to Life is pleased that all of the major Republican candidates for president, Sens. Rubio and Cruz included, have stated that, if elected, they would work to derail Planned Parenthood’s government gravy train. “

Government shut down would NOT defund Planned Parenthood

For every one who still claims that Republicans should have shut down the government last year rather than pass any budget that included funds for Planned Parenthood,  read what National Right to Life had to say at the time.  Even if the government had shut down over the budget,  PP would have continued to receive funds!

“Additionally, as LifeNews.com reported recently, a study by the Congressional Research Service found that the majority of federal funds flowing to Planned Parenthood would not even be temporarily interrupted if the government shut down over this issue, because the funds flow through “entitlement” programs such as Medicaid – and those entitlement programs do not do not depend on enactment of the annual funding bills.

“It is also important to understand that federal spending bills do not include any “line items” that specifically designate money for Planned Parenthood. Rather, Planned Parenthood affiliates tap into funds from big programs like Medicaid and Title X. In order to deny Planned Parenthood such funds, a new law must be enacted to specifically prevent such funding. But for Congress to approve such a law will require 60 votes in the U.S. Senate, to overcome the filibuster.”

(Emphasis mine)

 

Remember this the next time you read or hear that nothing has come from a Republican majority in the House and Senate because Congress passed a budget September, 2015.

Then, ask the writer or speaker what kind of budget we would have had if Pelosi and Reid had been in charge.

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Edited for formatting -BBN

When is autopsy mandatory?

For those wondering about autopsies today, here’s the Texas statute.

Art. 49.04. DEATHS REQUIRING AN INQUEST. (a) A justice of the peace shall conduct an inquest into the death of a person who dies in the county served by the justice if:

(1) the person dies in prison under circumstances other than those described by Section 501.055(b), Government Code, or in jail;

(2) the person dies an unnatural death from a cause other than a legal execution;

(3) the body or a body part of a person is found, the cause or circumstances of death are unknown, and:

(A) the person is identified; or

(B) the person is unidentified;

(4) the circumstances of the death indicate that the death may have been caused by unlawful means;

(5) the person commits suicide or the circumstances of the death indicate that the death may have been caused by suicide;

(6) the person dies without having been attended by a physician;

(7) the person dies while attended by a physician who is unable to certify the cause of death and who requests the justice of the peace to conduct an inquest; or

(8) the person is a child younger than six years of age and an inquest is required by Chapter 264, Family Code.

(b) Except as provided by Subsection (c) of this section, a physician who attends the death of a person and who is unable to certify the cause of death shall report the death to the justice of the peace of the precinct where the death occurred and request that the justice conduct an inquest.

(c) If a person dies in a hospital or other institution and an attending physician is unable to certify the cause of death, the superintendent or general manager of the hospital or institution shall report the death to the justice of the peace of the precinct where the hospital or institution is located.

(d) A justice of the peace investigating a death described by Subsection (a)(3)(B) shall report the death to the missing children and missing persons information clearinghouse of the Department of Public Safety and the national crime information center not later than the 10th working day after the date the investigation began.

Posted from WordPress for Android. Typos will be corrected!

THIS is “Establishment” (DNC superdelegates)

Unpledged delegates exist really to make sure that party leaders and elected officials don’t have to be in a position where they are running against grass-roots activists. (Democratic National Committee Chair Debbie Wasserman-Schultz, February 11, 2016)

The Washington Post reports on an interview with Wasserman-Schultz in which she is asked by CNN’s Jake Tapper to explain why Hillary Clinton received as many delegates in the New Hampshire Democratic (NOT) Primary as Bernie Sanders, who beat her by 22 percentage points.

For all those who declare other Republicans “establishment,” the Dem’s superdelegates are the true establishment of power by the Powers-That-Be of the Party. You only have to win your delegates, not 2/3 of the vote and then, again, 1/3 of Party officials. (Or lobbyists and donors.)

More on “Friendly Fire” (“Establishment”)

I’m “Establishment” if you believe what others say about me.  The “friendly fire” isn’t accurate in this case, if the goal is to defeat the Democrats in not only the Presidential race, but to keep our majority in the House and Senate.

I remember when conservatives were against “liberals” and liberals called us the establishment. Liberals and conservatives were clearly divided into Democrats and Republicans.  Today, Republicans are just as likely to deride other Republicans as being “establishment” as they are to use the equally variably defined “RINO” name-calling. At least with “RINO,” there was once an attempt to point out where the Republican-In-Name-Only differed from our core values. There’s no similar definition or list somewhere about what it is to be, or even as why it’s bad to be “establishment.”

The “establishment” designation is reminiscent of the tactic from the ’60’s: “Don’t trust anyone over 30.” It’s also classic Alinsky:  “Pick the target, freeze it, personalize it, and polarize it.”

Besides being a distraction (time spent denying or defending that ephemeral “establishment”), it attacks the person addressed, rather than the issue at hand.  By assigning the other as “other,” the name-caller can assume he is free to entirely skip any consideration about the other person’s thought process.

It takes more time to discuss issues and facts than to declare someone with differing views as a part of a mindless group, rather than as individuals who think and reason. It was much easier for President Obama to accuse Conservatives of being led by Fox News and Rush Limbaugh or for Hillary Clinton to assign us all to the “Right-Wing Conspiracy” than to confront us as individuals with reasons to oppose government-run and -owned medicine or higher taxes.

The Republican Party is a very diverse group of individuals, who generally agree that individual liberty is better achieved  under a small constitutional government with a strong national defense. Individuals within the Party can disagree on priorities and tactics and we can definitely disagree on personalities. We should not simply shut out fellow Republicans with name-calling.

Murphy’s Laws, War, Plans, and “Friendly Fire.”

Donald Trump @therealdonald made a comment during the February 13th #GOPDebate about making a great battle plan, etc., which reminded me of the saying, “No battle plan survives first contact with the enemy.” Looking up the origin, I found that it’s a shortened version of the observation by Field Marshal Helmuth Karl Bernhard Graf von Moltke, a 19th Century German.

More recently, the quote has been incorporated in “Murphy’s Laws of War” as, “No OPLAN ever survives initial contact.”

There’s at least one more Law that seemed to fit the debate last night: “The only thing more accurate than incoming enemy fire is incoming friendly fire.”

Representative Debbie Riddle on HB 416

PRESS RELEASE
February 3, 2016

Rep. Riddle on Enforcement of House Bill 416

SPRING, TEXAS – Representative Riddle passed legislation during the most recent legislative session in Austin to require health care facilities that provide abortions to train their staff and volunteers to identify victims of human trafficking when victims enter one of these facilities. Her legislation was House Bill 416. It passed the Texas House and Senate and was signed into law by Governor Abbott on June 19, 2015.

Rep. Riddle had this to say about her legislative effort, “When I first contemplated filing legislation to require health care facilities that provide abortions to train their staff and volunteers to identify human trafficking victims, I realized we might just be saving two lives instead of one. When an expectant mother is trapped in a life of involuntary servitude how many opportunities does she have to cry out for freedom? My work on the issue of human trafficking has taught me she has very few.”  

She went on to say, “House Bill 416 will allow a victim of human trafficking to reach out and find help. It will require all abortion facilities to train their staff and volunteers to I.D. trafficking victims.”

The Department of State Health Services (DSHS) stated how they plan to enforce HB 416.

”

The department’s rules will allow for enforcement action which will require that facility enter into a corrective action plan to describe how and when the facility will come into compliance and also reference the range of enforcement actions that can be taken in response to the facility’s non-compliance and/or its failure to come into compliance.  The range of enforcement actions includes administrative penalties, suspension or revocation.”

“It is clear,” Rep. Riddle said, “the department has the tools and the power to enforce my legislation. This bill will save lives and rescue women trapped in a living hell.”

News: “U.K. Scientists Given Green Light To Edit Human Embryos” | IFLScience

http://www.iflscience.com/health-and-medicine/uk-scientists-given-green-light-edit-human-embryos

Cute. We’re assured that it’s still illegal to implant these “edited,” engineered embryos – but until now, it wasn’t legal to edit them! See the pattern?

The experiments are only supposed to only  use “surplus” embryos conceived by in vitro fertilization. Next will come the argument that embryos should by designed “from scratch” as a couple’s right (or group marriage partner’s rights.

The only embryos that will be helped as a result of this line of experimentation wold be extracorporeal embryos that are to be edited, themselves! Job security for the experimenters, perhaps.

We can be sure implantation will happen, moving closer to “designer babies.” Lots of science fiction has often dealt with the good and bad, the intended and unintended consequences of “editing” the humans or transhumans we conceive.

The unintended consequences can’t be known, but we can know that they will occur. And yet, that child of tomorrow can’t consent, his or her contemporaries can’t consent and their off spring certainly can’t consent.

The nascent  human once again unquestionably becomes the means to another’s end, rather than an end in himself.

Yes, someone will point out that  many or even most parents may have children for their own purposes other than to truly become one with their spouse or to reproduce and pass on their genes. The mere fact that anyone can contemplate “spare” or “excess” human beings is proof of that. (And don’t forget the “unwanted” child the abortion advocates constantly remind us of.)

Will there be a money-back guarantee for the “failed” comodified child?  Will those future generations think better of us than we regard past efforts at breeding a better human? Let’s hope that if we live among them, they tolerate us!

No Indictment for Hillary?

Cue, “I got friends I’m low places?”
But, no, this is the President of the United States!  The latest news is that  the “White House” says Hillary Clinton will not be indicted for mishandling above-top  secret, classified documents!

Cronyism in line with any banana state you could namel

Jury Indicts Two Antiabortion Activists Linked to Planned Parenthood Videos – WSJ

Ethics 101: The man and woman who were indicted for their actions exposing the harvesting of baby parts by Planned Parenthood were doing our duty to protect the right to life.

Rights impose duties on third parties, privileges do not.

Abortion, especially elective abortion of healthy babies in healthy mothers, is not a right. It is an illicit privilege granted by an act of law. No one has a duty to enable or act to cause an elective abortion at the request of a woman.

It is an “illicit” privilege, since the right not to be killed is an inalienable right. Each of us in society has a duty imposed by that right to prevent its infringement.

http://www.wsj.com/articles/grand-jury-indicts-2-anti-abortion-activists-linked-to-planned-parenthood-videos-1453761641

Edited 1/27/16 to clean up grammar and add links. BBN

Perry endorses Cruz for 2016

I still haven’t made up my mind and I’m waiting to see how those objections and lawsuits concerning whether Cruz qualifies as a “Natural Born Citizen.” However, the endorsement from Governor Perry is a strong mark in Senator Ted Cruz’ favor:

“I wanted to talk about him, who he was, see if I could get a handle on Ted Cruz the man, not Cruz the caricature I’d seen through the political lens. What I found was a very different person than what I had been led to believe.”

******

Conservatives Against Trump

The National Review has a page online of non-endorsements for @therealdonald. They are worth reading. Here’s a few excerpts:

From Erick Erickson, radio talk show host and formerly of RedState.com, this reminder:

“Nonetheless, I will not be voting for Donald Trump in the primary. I take my conservatism seriously, and I also take Saint Paul seriously. In setting out the qualifications for overseers, or bishops, Saint Paul admonished Timothy, ‘If anyone aspires to the office of overseer . . . he must not be a recent convert, or he may become puffed up with conceit and fall into the condemnation of the devil’ (1 Timothy 3:1,6).”

From Yuval Levin, editor of National Affairs and author (I stole his line about Pope Benedict for my email signature, “I have a mustard seed and I’m not afraid to use it.”), observes:

American conservatism is an inherently skeptical political outlook. It assumes that no one can be fully trusted with public power and that self-government in a free society demands that we reject the siren song of politics-as-management. A shortage of such skepticism is how we ended up with the problems Trump so bluntly laments. Repeating that mistake is no way to solve these problems. To address them, we need to begin by rejecting what Trump stands for, as much as what he stands against.

“Why is there a double standard when it comes to evaluating Donald Trump? Why are other politicians excoriated when they change their minds — as, for example, Rick Perry did on the question of whether HPV vaccinations in Texas should be compulsory — but when Trump suddenly says he’s pro-life, the claim is accepted uncritically? Why is it unconscionable for Ted Cruz to take and repay a loan from Goldman Sachs to help win a tough Senate race but acceptable for Donald Trump to take money from George Soros? Why is vetting Trump, as we do any other candidate, considered “bashing”? Aren’t these fair questions?”

Read more at: http://www.nationalreview.com/article/430126/donald-trump-conservatives-oppose-nomination

Death, lies and video

Death, lies and video

Supported only by his imagination, what he saw in videos produced by Texas Right to Life lawyers, and a news article,Dr. Phillip Hawley, Jr., M.D., wrote “A Tragic Case of Modern Bioethics; Denying Life-Sustaining Treatment to a Patient Who Wanted to Live” about the truly tragic, but inevitable death of Chris Dunn. Hawley erred by pretending to read the minds of doctors and hospital representatives and calling complete strangers “utilitarian” “murderers.” Before discussing the ethics of his accusations, it’s necessary to explain the meaning of the documented facts, available in news sources, blog posts and court records:

1. Dunn was not “alert and cognizant” as he had documented delirium secondary to hepatic encephalopathy and over a month on the ventilator with sedation and pain meds
2.  The hospital voluntarily, without a court judgement, promised to continue life-sustaining treatments in place until the legal guardianship question was settled.
3.  Food and water, legally termed as “Artificially Administered Nutrition and Hydration” or AANH and including total parenteral nutrition, cannot be removed against the objection of patients or surrogates, under Texas law.
4. The doctors stated that they believed the “life-sustaining treatments,” were causing suffering.
5. The hospital never sought guardianship for themselves, only for “a qualified family member,” and listed their names and locations in the original petition.

It is very unlikely that Chris understood his condition, the questions the lawyers were asking or the consequences of his “prayer.” That he was unable to make medical decisions is supported by the fact that his parents had been making his medical decisions. The Harris County judge agreed with the hospital’s request that a single legal guardian be named by a separate court.
“Life-sustaining treatment,” “medically inappropriate” and “Artificially Administered Nutrition and Hydration” are legal terms defined in the Texas Advance Directive Act (TADA), which outlines the exact procedure and language for communications between doctors, the hospital committee, and patients or their surrogates. The use, monitoring and adjustment of a mechanical ventilator is in the definition of “life-sustaining treatments.” TADA specifically excludes “Artificially Administered Nutrition and Hydration” (AANH) in the definition of “life sustaining treatments,” which would argue against the accusation that his doctors planned to withdraw “food and water.”
The only legal reason under TADA to remove any “life-sustaining treatment” is that it is deemed “medically inappropriate” by the attending physician and then only if the hospital medical or ethics committee “affirms” that decision. If and when they are withheld, the Act specifically prohibits “mercy killing” or otherwise intentionally intervening with the intent to cause death by artificial means.
Additional demands by Chris’ mother, Mrs. Kelly, and the lawyers in blogs and news articles would have also fallen under the legal definition of “life-sustaining treatment.” These demands included a biopsy in order to determine a definitive tissue diagnosis for the clinically apparent pancreatic cancer and liver lesions, a surgical tracheostomy and the removal of the ventilator (to be fair, I believe they meant the tube through the vocal chords), less sedation, searches for and trials of treatment of the cancer, and the non-standard use of an indwelling drain for the ascites (large exudates in the abdomen due to high pressures in the liver and the failure of the liver to make necessary proteins). These are invasive, potentially painful and, based on the reported size and effects of the mass, the extent of liver damage visibly evident in the videos as temporal wasting and copper-colored skin, ascites and the GI bleeding – they were very unlikely to lengthen his life, much less cure his cancer. In fact they could be very likely to hasten – or be the immediate cause of – his death.
Chris died in the ICU on full life-sustaining treatments, including the ventilator and intravenous AANH.
The doctors are on record as basing their decision on the suffering caused by the treatments to their patient, Chris. This is consistent with the known side-effects of the ventilator and even reports from Chris’ mother, who told reporters that Chris suffered from the treatments and fluid building up in his lungs despite the ventilator. And yet, Dr. Hawley made sensational statements such as:

“For patients with terminal illnesses, this standard often leads to the utilitarian question: Is the patient’s life still worth living?
“In Chris Dunn’s case, the committee’s answer was “no.” Relative strangers with little or no knowledge of his values and beliefs weighed his “quality of life” and decided that he no longer deserved to live.”
And,
“. . . How did these committee members who had only recently met the patient—if they ever met him at all—know that it was in his best interest for them to end his life?”
And,
“. . . But, somehow, we are to believe that these committee members were able to deduce existential truths about what was in Chris Dunn’s best interest?”

The physicians who cared for Mr. Dunn for over a month had certainly met him and members of the Methodist Hospital Biomedical Ethics Committee met with the family several times. Court documents are clear that the doctors believed the life-sustaining treatments were causing suffering and that the committee agreed that the treatments were medically inappropriate. There certainly is no evidence that the doctors or the committee members sought to intentionally “end” Chris’ life. “Medically inappropriate treatment” is not an “existential truth” and never in the patient’s best interest.
(Some may remind us that suffering can have benefits. However, Mr. Dunn couldn’t consent to suffering, much less benefit from the suffering, whether as a medical treatment or a willing religious self-sacrifice.)

Robert P. George is one of my heroes a conservative tenured professor of law and ethics at Princeton and one of the founders of the Witherspoon Institute, an organization known for its defense of Judeo-Christian ethics based on natural law, and the parent organization of Public Discourse. He has helpfully outlined a “key” to evaluate the withholding or withdrawing of life-sustaining care:

“[T]he key is the distinction between what traditionally has been called “direct killing,” where death (one’s own or someone else’s) is sought either as an end in itself or as a means to some other end, and accepting death or the shortening of life as a foreseen side effect of an action or omission whose object is something other than death—either some good that cannot be achieved or some evil that cannot be avoided without resulting in death or the shortening of life.”

George and Hawley each point to a value in medicine that is higher than autonomy or even preserving life at all costs: the duty of physicians to care for the patient. “Cure when possible, but first, do no harm.”
The lawyers didn’t just sue to maintain “life-sustaining treatments,” or even Mrs. Kelly’s right to force the doctors to treat Chris the way she wanted them to. The lawsuit, blog posts and public statements document the ultimate goal to have TADA declared unconstitutional and to force all doctors to give patients and surrogates the right to demand any and all desired treatment indefinitely. The power of State courts, law enforcement and licensing would be used to force Texas doctors to carry out acts against our medical judgment, education, experience and conscience.
What justification can the lawyers and Dr. Hawley give for not believing the physicians who care for patients daily and hourly when those caretakers document that the patient is suffering?

What kind of physicians will we end up with if the State can force us to act without judgement or conscience?

What kind of State would we have?

Based on a video and his imagined conversations between “malevolent” and “utilitarian” doctors and hospitals, Hawley declares Texas a “morally impoverished society.” Ignoring sworn statements from the physicians and misrepresenting TADA, he distorts the purpose of the Texas Advance Directive Act, which is to address the problems encountered when patients and surrogates disagree., Only by assuming evil intent is he able to force doctors to prove a negative and distract from any possibility of a conflict between the equal and inalienable rights of the patient and the doctor.

While the video of Chris apparently praying to be allowed to live wrenched at our emotions, it was used to tell a false story upon which Dr. Hawley built his harmful assumptions. We would all do well to remember my Mama’s advice: Don’t believe anything you hear and only half of what you see.”

Edited for grammar and decrease wordiness and formatting (1-15-16). BBN

The Ethics of Texas’ Advance Directive Act

Laws relating to medical ethics debates are generally behind medical advances.

Unfortunately, those debates often become emotional and heated, and the individuals who are affected often face the “hard questions” of ethical dilemmas while reacting to life and death emergencies. When law-making is controversial, it’s best to go back to the basics of ethics for guidance: the inalienable rights to “Life, Liberty and the Pursuit of Happiness,” the Declaration of Independence, and Constitution.
All laws limit our rights, but good laws are based on the fact that these inalienable rights are negative rights: they are meant to prevent one person – or the government – from infringing the rights of another. Ethical laws strike a balance between seemingly conflicting rights. They prohibit or punish harmful actions, but they don’t compel a desired action against the will.
However, since there is a hierarchy of rights (the right to life trumps the right to liberty and property, liberty trumps property, etc.), there are very rare circumstances when it is appropriate for laws to compel individuals to act for the benefit of another. These laws should only go so far as to protect the life and freedom of the vulnerable patient or client, for a limited time with the goal of allowing safe transfer of the obligation to someone else.

For instance, parents are required to care for and protect their minor children since they are helpless and unable to legally consent or make contracts. And State laws require that doctors and lawyers be licensed, obtain certain levels of education, and follow specific, positive actions when they wish to withdraw from a professional relationship with or refuse the request of a patient or client.
That brings us to the controversy over the Texas Advance Directive Act of 1999 (“TADA” or “the Act”). In addition to describing “Advance Directives to Physicians” (also known as a “Living Will), TADA also attempts to outline the procedure for resolving any disagreement between a doctor and patients or their surrogates regarding medical treatments, especially concerning end of life care.
When I first read the Act, I (naively) thought it was malpractice protection for doctors who did not want to withdraw or withhold care. There have actually been a few “wrongful prolongation of life” lawsuits against doctors who – knowingly or not – used CPR when the patient had a Living Will.
Most of the time, however, TADA is invoked when the attending physician “refuses” a request to actively administer medical treatment that he or she believes is medically inappropriate. The steps laid out in the law involve the doctor’s notification of his refusal to the patient or the surrogate, the rules for assisting with transfer of care to another doctor who believes the treatment request is appropriate, and asking for a medical or ethics committee to be convened at the hospital. If no other willing doctor can be found and the committee agrees with the doctor, the treatment can be withheld or withdrawn (after 10 days). During that time, full life-sustaining treatment must continue and the hospital is required to provide medical records and to actively assist in looking for another doctor and/or hospital.

The law does never allow patients to be killed by intentionally stopping breathing. The law does prohibit withholding of pain medicine or comfort care and the removal of “artificially administered nutrition and hydration.”
Medical judgment is how doctors utilize our education, experience, and consciences as we plan and anticipate the effect of each medical intervention or treatment. “Life sustaining treatments are not “basic” or “usual care.” Nor are they one-time events without consequences. The interventions require a physician to administer and maintain. They must be monitored by observation and tests, and adjustments need to be made intermittently so that the treatment is effective and not harmful. They may lead to further more invasive and aggressive interventions and the need for the skills of other doctors in other specialties.

In some cases, patients and their advocates report trouble finding other doctors willing to provide the treatment that the first doctor thought was inappropriate. In my opinion, that difficulty is due to physicians’ common education and shared experiences – to medical reality, not ill intent.

Texas law is clear that only doctors may practice medicine by diagnosing and treating patients directly or “ordering” other medical personnel. Although TADA outlines specific duties for hospitals and hospital medical or ethics committees who determine whether or not the care is medically inappropriate, the process can only be invoked by the “attending physician” who is being asked to act against his medical judgment. The committee acts as a safeguard, to uphold medical ethics and the standard of medical care. In a formal meeting, the committee members review the case and either agree or disagree with the doctor as to whether he or she is correct about what is “medically inappropriate” treatment, for the patient.

Unfortunately, the Act has become known as the “Texas Futile Care Law,” and divides even the pro-life community. One side claims that doctors, hospitals and hospital committees are biased and should not be allowed to determine medically inappropriate care, and that doctors are obligated to give any and all desired treatment “until transfer.” Others want each case to go to court, where lawyers, judges and juries would settle every difference of opinion about “medically appropriate treatment.”

Ultimately, even the lawyers would need to consult doctors, unless the judges start writing orders for doctors, nurses, and medical professionals.

Our laws normally prohibit actions and only very rarely compel people to act. Under the conditions laid out in TADA, it is possible that the doctor can be forced to act against his medical judgment, but only for a limited, stated period of time. TADA is an attempt to balance conflicting rights: the patient’s wishes for medical intervention with liberty of the physician to practice medicine to the best of his judgment and conscience.

(Edited 03/11/18 to add a missing quotation mark. BBN)

Texas Advance Directive Act: What the lawyers really want

I’ll admit that I’m not a lawyer and have to do my homework to even attempt to understand lawyer-speak. (For example, see this definition of “Abatement”) How I wish more lawyers would admit they aren’t doctors, especially when they accuse doctors and entire hospital committees of killing patients.

Earlier this week, I reviewed the latest sensationalized case involving lawyers and lawyer-lobbyists playing doctor in the media and courts to overturn Section 166.046 of the Texas Advance Directive Act (“TADA”).

TADA outlines the process to settle disputes between an attending physician and the patient (or the family of a patient) when the medical judgment of the doctor about what is medically appropriate for the patient conflicts with the demands for treatment that the patient or family wants *that* particular doctor to perform.

Texas law prohibits the removal of “artificially administered nutrition and hydration” and pain medications unless the doctors determine they will cause further harm. However, a ventilator, intubation tubes in the throat, cardio-version (CPR), surgery and invasive procedures or tests are not ordinary or comfort care and are considered “life-sustaining” treatment that may be removed or withheld from a patient with a terminal disease if the patient’s doctor determines that are not medically appropriate. There is certainly no provision in Texas law to intentionally stop a patient’s breathing or to otherwise cause certain death.

The lawyers lobbying and suing against TADA admit in both public statements and legal complaints that they will settle for nothing less than “Due Process,” lawyer-speak reference to the Fourteenth Amendment clause, “due process of law.” They demand that every dispute about medically appropriate care between doctors and patients be argued – by lawyers – in court, preferably with a risk of “liability” for the doctor, any committee member who reviews the case under TADA, and the hospital where the patient is under care. Judges, and possibly juries, would determine the local medical standard of care, which medical procedures are appropriate for which patients, and liability. Lawyers and judges would essentially practice medicine instead of doctors.

To summarize this latest case, court records document** the affidavit from the attending physician of a 46 year old Pasadena, Texas man, Chris Dunn. Mr. Dunn was admitted to the ICU at Houston’s Methodist hospital unresponsive after a major gastrointestinal bleed due to metastatic pancreatic cancer led to his emergency transfer from a hospital in his hometown. Mr. Dunn was on a ventilator and suffering from liver, kidney, and respiratory failure. He had fluid in his lungs, necessitating higher and higher pressures on the ventilator. He had fluid leaking into the abdominal cavity due to the liver failure, ascites, that required intermittent draining. He also suffered from hepatic encephalopathy, a form of variable dementia and delirium.  His doctors and his father agreed that the repetitive, invasive treatments necessary to maintain the ventilator and treat the multi-organ failure should be stopped because they were causing Mr. Dunn harm, while comfort care would continue.

In their lawsuit against the hospital, a group of lawyers brought in by Mr. Dunn’s mother and Texas Right to Life sued the hospital in Mr. Dunn’s name, although there was a question about both Mr. Dunn’s ability to legally consent and the legal status of either parent alone to make medical decisions on Mr. Dunn’s behalf. In fact, the court ruled an “Abatement” or suspension of the lawsuit on December 4, 2015, until the legal guardianship for Mr. Dunn could be settled in another court. And, sadly, in spite of continued treatment in the Intensive Care Unit, on a ventilator, with IV and tube feedings, and all the repetitive blood tests, suctioning, and invasive procedures these treatments required, Mr. Dunn succumbed to his disease before that other court could meet to name a guardian.

In their lawsuit against the hospital, the lawyers even accuse “the facility” (not the attending doctor) of planning to actively euthanize Mr. Dunn by the deliberate use of injections intended to cause his death, rather than to relieve his pain:

“Defendant scheduling . . . and Defendant administering, via injection, a combination of drugs which will end his life almost immediately, thus warranting immediate intervention by this court.” (**p.2)

The lawyers further declared that the doctors and the Methodist Biomedical Ethics Committee – and every doctor or hospital committee – would be corrupted by their affiliation with the hospital:

“The statute does not provide adequate safeguards to protect against the conflict of interest inherently present when the treating physician’s decision is reviewed by the hospital “ethics committee” to whom the physician has direct financial ties.
“Texas Health and Saftey [sic] Code violates Plaintiff’s right to procedural due process by failing to provide an adequate venue for Plaintiff and those similarly situated to be heard in this critical life-ending decision. The law also fails to impose adequate evidentiary safeguards against hospitals and doctors by allowing them to make the decision to terminate life-sustaining treatment in their own unfettered discretion.” (**pp. 5,6)

And,

“Under Tex. Health and Safety Code 166.046, a fair and impartial tribunal did not and could not hear Dunn’s case. “Ethics committee” members from the treating hospital cannot be fair and impartial, when the propriety of giving Dunn’s expensive life-sustaining treatment must be weighed against a potential economic loss to the very entity which provides those members of the “ethics committee” with privileges and a source of income.” (**p. 7)

 

Lawyer-speak notwithstanding, I can’t figure out – and the lawyers don’t tell us – how to ensure that “unfettered” pancreatic cancer presenting with multi-organ failure followed “due process” in Mr. Dunn’s case. Other than lawyers from each side hiring and paying even more doctors to re-examine the patient and re-view the existing medical records, repeated clinical exams and nurses’ notes, lab work and non-invasive scans of the liver and abdomen, what would a judge or jury consider “evidentiary safeguards against doctors and hospitals?”

But in news article after blog post, lawyers (but no doctors) claimed that “the hospital wanted to kill” Mr. Dunn.  Lawyers (but no doctors) claimed there were un-named additional tests and treatments which could have changed the diagnosis, treatment or prognosis. Lawyers (but no doctors) disputed the medical judgment of the very doctors from whom the lawsuit demanded continued intensive care.

In their lawsuit, the lawyers also declared that, “Members of a fair and impartial tribunal should not only avoid a conflict of interest, they should avoid even the appearance of a conflict of interest, especially when a patient’s life is at stake.” (*p. 7) But that didn’t stop them from including an ironic and self-serving demand that Methodist hospital pay their “Attorney fees and costs.” (p. 12)

**(Protected “.pdf” “Images” of the original legal documents quoted below can be found online, here.  The document images aren’t link-able and can’t be copied or printed, so I will have to type up and share quotes. See Family case number 2015-69681. The quotes above are from document number 6796448.pdf, “Plaintiff’s Original Verified Petition and Application for Temporary Restraining Order and Injunctive Relief.”)