Archives

Medical ethics

This category contains 49 posts

Arguing Abortion on YouTube

I usually agree with this doctor. But not about abortion. ZDoggMD, Zubin Damania, has a sense of humor and a sense of balance. But today, he demands that we to “come to the center” because 1 in 4 women in the US have an abortion by age 45. “It happens.”

Well, according to the 1860 US Census, approximately 25% of families owned slaves. “It happen(ed).” Common ground was hard to find there, too.

The question is whether or not abortion ends the life of a human that is human-enough to possess the Human Right not to be killed. Are they one of us and can we kill them if they don’t threaten our lives?

The first question has been definitively answered, at least scientifically. Louise Brown was born 5 years after Roe v Wade. Serial ultrasounds showing the progression of the egg to embryonic organism to fetus were possible soon after. (I’m tempted to echo the ZDogg, “Grow up and get into the 21st Century.” But of course, I won’t.)

Answering these questions according to ethics and law can’t be addressed by science and requires a bit more discussion. Nevertheless, the trend in Western societies has been toward including all humans as rights bearers endowed with at least the right not to be killed or treated as the property of another and preventing legally sanctioned killing and enslavement, regardless of characteristics, abilities, or background.

Beyond the life of the mother, the rest of ZDogg’s arguments are the usual justification for what I call, “I want” ethics, including arguments for the “control of the woman’s body,” the health of the woman, and exceptions for rape and incest.

Nik Hoot, a 20 year old young man from Indiana, lost his feet and part of his legs and fingers to an attempted abortion, but survived to be adopted, eventually a State Semi Finals high school wrestler, and a productive member of society. His mother’s body didn’t lose limbs; his did. As he says, he has to “live with someone else’s choice.”

As to the health of the mother, how could anyone know at 12 weeks that there will be sequelae at or after delivery?

The safety of abortion is most often reported using short term data. There’s support for increased mortality and morbidity in the long term, however.

Late discovery of fetal abnormalities isn’t a good argument in favor of induced abortion, either. After 15 weeks and definitely after 20, it’s statically safer for the mother to carry to term.

I won’t even entertain arguments that crime is down because the unwanted are killed. “Minority Report” has a double meaning, here.

Here’s an article from The Atlantic – not an “anti-choice” publication, by any standard – focusing on the rape exception.

Let’s face it: the wrong human is killed by abortion justified by reason of rape or incest. If you cringe at that statement, you might want to consider why.

Edit: Comments are closed. Please comment on my Facebook page.

Beverly B Nuckols, MD

Updated information on TRTL, end of life, and money

One Texas Right to Life (TRTL) lawyer has posted an update on Facebook about the “rescue” of Mrs Carolyn Jones. I’m afraid that, as with the declaration that another patient was “slain,” TRTL is gaming the Medicare funding and Texas medical systems for political purposes.

Emily Cook, General Council for TRTL, wrote that she worried that “funny business clinically would happen as we moved her” from the hospital where Mrs. Jones has been admitted for over 6 months, where the docs had weaned her off the ventilator and wanted her to transfer to a more appropriate level of care facility over 2 months ago.

Emily says TRTL spent their own money (*see my last paragraph) to put her in a private ambulance and take Mrs. Jones to another hospital ER. That hospital couldn’t provide dialysis, so they in turn transferred her via ambulance somewhere else, to yet another hospital until admission can be arranged at the nursing home.

Even Lawyer Cook admits that the first move wasn’t “legit.”

Cook-ing the system

There were comments on various sites that the original hospital had refused transfer. However, from what I’ve read, it’s likely the hospital was refusing to be complicit with “patient dumping.” For a hospital to knowingly discharge a patient for the purpose of transferring to the ER of another hospital without (or even with) the acceptance of the transfer from the docs at the other facility is highly irregular, and likely goes against Medicare regulations.

Mrs. Jones’ Medicare funding for the original hospitalization is bound to have run out some time ago. Normally, Medicare will allow 90 days per admission, with an extra 60 “reserve” days, once per person, per lifetime. The patient is responsible for part of the bill from the first day of admission, and for the total hospital costs after the eligible days.

But there are still Medicare regulations to deal with in the case of “Medicare eligible” patients, even when they aren’t paying.

As to the refusal of the original hospital to accept private payment for in-hospital dialysis, there were 2 issues: Medicare funding about privately payment for covered services and the probability that the physician-patiebt relationship would be reset, along with the 10 days in the statute.

Medicare makes it very difficult and risky for everyone to navigate the private pay process. When I had a question in my private medical office about whether Medicare would cover something, we had the patient sign an informed consent agreement and an acknowledgement that the patient might have to eventually pay if Medicare denied the service. Then we performed the service, filed the charge with Medicare, waited to be denied, and then tried to Bill the patient. I gave away a lot tetanus vaccines and removed a lot of moles and warts for free to avoid the risk of “fraud and abuse” from the likes of Janet Reno.

The same risk would have applied if the hospital had privately charged Mrs. Jones’ Dialysis.

I don’t believe the first new hospital is at risk for a charge of “dumping” if they documented a legitimate reason. However, both new hospitals will be able to charge the Jones copays and co-insurance. They may also find Medicare coverage limited because of the way Mrs. Jones left the original.

Another, discussion has concerned the delay in funding from Medicaid:

“Medicaid limits 2019” (a .PDF)

I certainly don’t know the Jones’ financial circumstances, and I may have over estimated the maximum income in early speculation. However, there are strict maximum Medicaid income and asset levels. These vary according to age, disability, and marital status. (Even the government bureaucratic Leviathan doesn’t want the spouse if a nursing home patient to end up indigent.)

In my experience, the social workers and benefits experts at hospitals and nursing homes are experts at negotiating and translating the bureaucracy. In addition, the disabled Medicare eligible person will have access to a benefits specialist. I’ve never had a hospital discharge and nursing home admission blocked by this “paperwork.” Certainly not for months at a time.

*TRTL hasn’t updated their Carolyn Jones fundraising numbers since last week. That “Family Assistance Fund,” part of their 403(c) PAC, (AKA the Educational fund”), has been posted as a little over $33,000, since last Friday.

I hope TRTL assists the Jones family with what is certain to be several enormous hospital bills. As long as they pay the bills directly, the funds won’t be counted as income to Mrs. Jones.

Why does TRTL lie? (UPDATE)

I can’t tell you why, but it’s true: Well below their “Donate Now” banner, Texas Right to Life (TRTL) is shamefully spinning another one of their false stories.
Just as they lied on their website that Chris Dunn was “slain by his doctors,

they now post that a woman, Mrs. Carolyn Jones, had to be “rescued” from hers, “racing” to another facility “in the middle of the night.”

Okay, it’s night in that picture. That and the proper names are the only things they got right.
Mrs. Jones wasn’t “rescued” from the hospital that has been giving her excellent care for over 6 months. Nor were her doctors and nurses “surprised.” that she was able to breathe on her own. After all, they were the ones who weaned her from the ventilator over a month ago.
What was expected was that Mrs. Jones would be transferred out if the hospital where she’s been admitted since November, 2018 to a more appropriate, lower level of nursing care two months ago.
On April 10, Mr. Jones testified to the Texas Senate Health and Human Services Committee that, thanks to the hospital doctors, his wife now needed the ventilator only “occasionally at night.”

The family were given notice that they needed to transfer Mrs. Jones in March. They’ve had another doctor and three facilities capable of providing the treatments she needs waiting to accept Mrs. Jones.

When the family of a hospitalised patient refuses to allow her to be transferred to a more appropriate treatment facility, the attending doctor has no legal means other than the 166.046 process laid out in the Texas Advance Directives Act (TADA). This is the legislation that has been called the “Futile Care Law” in the past, but TRTL likes to call it the” 10 Day Rule,” now, in spite of their rejection of effort after effort, etc., to expand the time frame and increase transparency and assistance. This is the issue that led to the rebuke (.PDF) of TRTL by the Texas Conference of Catholic Bishops and gleefully reported by the liberal press in Texas
The Jones family are real people, scared and hurting. Mr. Jones somehow was misled to believe the lie that “food and water” would be removed. I would have thought that at least one of the many, many lawyers at TRTL would have assured him that that is not legal under Texas law.
Instead, the Jones family’s fears – and your compassion – are being used as a means to TRTL’s political – and fundraising – ends.

And now, TRTL – in direct competition with – and with absolutely no mention of – Mrs. Jones’ family’s GoFundMe campaign – has been raising money in Mrs. Jones’ name. They state that the funds will be used for (TRTL) lawyer’s fees in addition to Mrs. Jones’ healthcare needs and that “excess” funds will go to help (TRTL’S) efforts for other patients.

I hope that TRTL’s money will also be used to pay for the very large hospital and doctor’s bills that the Jones family will receive. While there’s a chance that Texas Medicaid will pay for three months of medical bills, retroactively, Medicare doesn’t pay for hospitalizations over 90 days and has a 20% co-insurance (co-pay).

That’s bound to have added up in over 6 months.

We’ll just have to trust that TRTL won’t lie again.

Beverly B Nuckols, MD

Edit, Updated information:

One of the bloggers has told us more about that “rescue.” (Or today’s story, anyway.)

TRTL put her in a private ambulance and took her to *another ER,* one that couldn’t provide dialysis, so they then transferred her somewhere else.

There were comments about the first Hospital refusing transfer — no, refusing to be complicit with “dumping” a patient. Discharging to without ( or even with) acceptance of the transfer from the docs at the other facility is highly irregular and likely illegal.
Much has been said about funding. Yes. It appears that Medicare funding ran out, so no longer paying. 90 days per admission, with an extra 60 days over, under certain conditions.

About that Medicaid funding: I don’t know the limits of the mandatory asset tests, but the yearly income level is $60,000. One way to adapt is to spend money on medical costs.

Medicare makes it difficult to navigate the private pay process. When we had some question, we got informed consent, promise to pay, then performed the service, filed with Medicare, waited to be denied, then tried to Bill the patient. The risk is always a charge of “fraud and abuse.”

The same thing would have happened if the hospital had privately charged for Dialysis.

(5/20/19, BBN)

False story about Texas Advance Directives Act (TADA)

I’m a subscriber to the new reader-supported online news site, The Texan which is the project of former State Senator, Konni Burton, having recently paid for the annual subscription. (A heads up: if you click through on all my links, you’ll risk using up all your free views this month.)
But I’m disappointed to see a definite spin in today’s news story about the Texas Advance Directives Act (TADA), even though one of my WingRight blog posts is quoted.

TADA isn’t just for disagreements over whether CPR and ventilator support are “medically inappropriate treatment” It covers any dispute between the doctor and the hospitalized patient when “the attending physician refuses to honor a patient’s advance directive or a health care or treatment decision made by or on behalf of a patient.” (emphasis mine) This could be demand for inappropriate surgery or medications or if the patient refuses to leave the hospital or be transferred after 6 months, for instance.
From all the previous news reports and blog posts, her husband’s testimony to the Senate Health and Human Services Committee, and a few of my blogs, Mrs. Carolyn Jones’ case seems to be a disagreement over whether to transfer her from the hospital, where she’s been admitted and improving for about six months.

Mrs. Jones is not dependent on the ventilator.

In fact, it sounds like Mrs. Jones has had excellent treatment at the hospital,

even after the Committee meeting on March 8.

Mr. Jones told the Texas Senate Health and Human Services Committee that the doctors at the hospital successfully weaned Mrs. Jones from the ventilator.

He also said that three other facilities are ready for her admission.

Drew White, Senior Editor of The Texan, and I communicated by email over the weekend, after I wrote to explain some errors in the news coverage.

I’m happy to see that today’s article by reporter Tony Guajardo quotes both opponents and supporters of TADA and corrected the impression that Mrs Jones is dependent on the ventilator: “She requires dialysis, occasionally needs a ventilator for breathing assistance, and uses a feeding tube.

All of these treatments are routinely provided at lower level of care facilities, other than tertiary hospitals.

And yet, today’s The Texan article still misrepresents this case: “UPDATE: Recovering Beaumont Woman’s Life-Sustaining Treatment to End Due to 10-Day Rule.”

There’s also a quote from Mrs. Jones’ daughter, repeated from the earlier article: “My mom is going to die on Monday because of a law that saves hospitals money.”

It turns out that money and Medicaid paperwork is actually what is keeping the family from allowing Mrs. Jones to be transferred to another doctor and facility. The family is concerned that they (rather than the hospital) will be responsible for the costs of Mrs. Jones’ care.

This is in spite of the fact that when a patient first goes on dialysis, she becomes immediately and automatically eligible to apply for Medicare and Social Security Disability.

Depending on assets and income, patients unable to work on dialysis also qualify for Medicaid and other State benefits in Texas. Medicaid will even pay bills retroactively for three months.

Even more than usual, I double checked all of my information to ensure that I’m right that Mrs. Jones isn’t dependent on hospital treatments – since it was reported in the article that the hospital would withdraw “life-sustaining treatments” at 2 PM, today, May 13, 2013.

The good news is that she isn’t dependent on the ventilator, dialysis is not constant but only 2-3 times per week and paid by Medicare, food and water by the feeding tube can’t be withheld under TADA.

Hopefully, the Jones family will finally agree to transfer her, even if costs them more than her Medicare & Social Security Disability will pay.

Have they no decency?

Now, Texas Right to Life is blatantly lying, posting an article on their website entitled “American hero slain two days before Christmas …”

“slain?”

Far down in the piece, there’s this:

“Chris passed away naturally on December 23, 2015 – two days before Christmas.”

Mr. Dunn died from his metastatic pancreas cancer, on full medical treatments. His mother, Mrs. Kelly actually thanked those who cared for him at the hospital.

Every article on TRTL’s website has a “Donate” button at the top, prioritizing money over the people whose stories they use to raise money and influence the Texas Legislature. Now, we see this completely dishonest caption.

Just what is their mission and how can we trust them?

Hurting patients and families

Facing the life-threatening illness of a loved one is hard enough, without misunderstandings. It’s cruel when people who claim to be helping don’t correct those misunderstandings.
I can’t comment on on Texas Right to Life’s (TRTL’s) recent Facebook post, where the organization is, frankly, spreading falsehoods and perpetuating misunderstandings that are bound to make a difficult process even harder.
The story about the family of Mrs. Carolyn Jones is one I’ve covered before.
I believe that the Jones family could be – should be – reassured about the care and treatment that Mrs Jones is receiving. In my post, today, I would like to further clear up some of the problems in TRTL’s reporting.
Significantly, on April 10, 2019, Mr. Jones testified to the Senate Health and Human Services Committee ( at 52 minutes into the video, near the end) that, on March 8 of this year, after 4 months’ admission, the hospital held what he says was the second ethics committee meeting. After the meeting, the family believes that the hospital informed them that Mrs. Jones needed to be transferred by March 18, or her oxygen, food and water, and dialysis would be stopped.
Why hasn’t anyone told Mr. Jones that withholding or withdrawal of even IV Artificial Administered Hydration and Nutrition (AAHN) is prohibited by the very law he believes should be repealed?
Mr. Jones testified that over the last month, his wife has since been weaned from the ventilator, only needing assistance “sometimes at night.”

I don’t understand why TRTL repeats that a ventilator tube prevents Mrs. Jones from speaking or eating. Mrs. Jones has a tracheostomy in place (the tube we see in the pictures is a feeding tube). The tracheostomy, even when a ventilator is attached, would not interfere with her ability to speak and swallow, with training.

Breathing assistance, AAHN, and dialysis can all be provided by the 3 facilities – and at least one doctor – that have agreed to accept Mrs. Jones as a patient.
TRTL is using the grief of the Jones family to solicit donations and to lobby for a Bill I’ve also written about, SB 2089, that would require “treatment until transfer.”
In this case, the treatment that is disputed is transfer from in-hospital treatment after 5 months to a lower level facility that is able and willing to provide what Mrs. Jones needs.
Comments are closed here. (I just can’t keep up with all the sites.) Please comment on my Facebook page.

End of life or end of hospital stay?

What a tragic story!

While I only know what I’ve seen online, in my experience, it appears that the dispute about Mrs. Carolyn Jones is over continued hospitalization at this hospital, versus transfer to care at another facility.

(See this television news report.)

I’m the first to say that hospitals are scary places and to sympathize with families struggling to cope with the bureaucracy and protocols. However the current news, press releases, and pro-life blogs are reporting several errors and omissions about Texas’s law and legislation up for consideration in Austin.

The obvious errors in this report include:
1. First. It’s not correct that Mrs Jones will die on Monday, even if the ventilator is turned off at the hospital. She’s not intubated through the mouth or nose. Instead, there’s a tracheostomy and a feeding tube in place. Supplemental oxygen could be provided many different ways, at home or in a nursing home.
2. Mr. Jones has testified at the Texas Senate Health and Human Services Committee meeting (EDIT: the video is here, at 52 minutes in) on 4/10/19 and elsewhere that Mrs Jones had been weaned off the ventilator, needing it only occasionally, at night.
2. She should be able to speak and swallow with training.
3. Texas Advance Directives Act doesn’t require that the doctor declare the treatment be “futile.” Instead, the doctor must declare that he refuses to follow a certain treatment decision that the patient or family demands .
4. Kidney dialysis is paid for by the Federal government, so the problem isn’t only funding.

In my admittedly limited knowledge about this particular case – it appears that Mr. Jones disagrees that it’s time to move from the hospital to home or nursing home, even after 5 months (not 10 days).

At least since 2005, legislation has been introduced at the State to increase the timeframe to as long as a month. Texas Right to Life refuses to agree to anything other than indefinite treatment, with the doctor forced to act against his will, violating his conscience and ignoring his medical judgement.

TRTL has even clashed with other pro-life organizations and Texas’s Catholic Bishops and “primaried” several conservative Legislators, although they are the only Texas pro-life group that opposes the law.

It would be good to add more time – I don’t know of anyone who disagrees. But there needs to be a limit to how long a doctor is forced to act against his conscience. One Bill that was rumored this year would change the “10 days” to 21 days and add a week to the notification period before the Ethics committee meets. Unfortunately, it never got past the Powers That Be.

For more on the ethics of the Texas Advance Directives Act, see this WingRight post.

The most urgent need is communication with families, correcting misunderstandings like those outlined here.

(Edited May 10, 2019 at 12:22 AST, to correct the Link to the testimony of Mr. Jones. BBN)

Emergency: Liberty Right Infringement

Texas Right to Life General Counsel Emily Cook is attacking Texas Medical Association on Facebook, even though virtually every other pro-life, medical, nursing, hospital, and disability group in Texas oppose SB 2089 by Hughes, that would change the “Texas Advance Directive Act, “TADA” will harm patients and attack the right of doctors to refuse to act against our conscience.

Here’s a partial list of organizations opposing SB 2089: Texas Medical Association, Texas Baptist Christian Life Commission Ethics, Texas Catholic Bishops, Texas Nurses Association, Texas Society for Anethesiology, Texas Osteopathic Association, Catholic Health Association, Texas Hospital Association, Baylor Scott and White, Texas Teaching Hospitals, Texas Alliance for Life, Coalition of Texans With Disabilities.
The central question isn’t “10 days” or the actions of a “Committee.” Doctors start the process, and under the law, the Committee can only affirm that his decision is medically appropriate or not.
The question is whether a patient can demand that a doctor be forced against her conscience to indefinitely write orders and provide treatment she believes is not in the best interest of the patient because the patient or family wants it?
The patient is near death and in the hospital, so the doctor can’t morally just “fire” him if there’s a disagreement. We all agree that 10 days isn’t enough time for families, and have tried since 2005 to add days to the process – we had a Bill that would expand the time to a month in 2007. (CSSB 439)
But Texas Right to Life would/will accept nothing but indefinite “treatment until transfer.” They keep demanding lawyers, courts and trials for medical decisions.
This is the issue that caused the break between TRTL and the Catholic Bishops.
It would force Drs to violate our conscience, without compromising with a set, limited time frame.

We’ve worked to fix other problems: Artificially administered food and water, even full IV feedings, can‘t be removed. Texas law didn’t even mention DNRs, but last session, we passed an amendment with explicit procedures and informed consent language.

SB 2089 ends the ability for a doctor to “refuse” medically inappropriate treatment, only allows “recommending,” (while being legally required to act against her conscience, harming the patient, prolonging death and increasing side effects, requiring more treatments.)

There’s no leeway, at all, in the new Bill.

SB 2089 specifically says anyone can file a lawsuit in any Court in the County, the Court can’t charge the patient (or surrogates) any fees, and the judge is required to rule in 5 days.

More doctors will limit the number of older or sicker patients to keep from falling under the dispute process and the Court battle.
Even tertiary hospitals – teaching hospitals and big City referral hospitals – will find that their doctors don’t want to accept patients from outlying hospitals.
It will kill tort reform, because it’s designed to get all these cases into Court.
It’s like the Masterpiece Cakeshop case, only bigger, in my opinion, because if doctors lose here, we lose the right to conscience in everything.

If you believe that even doctors have the right of Conscience, and that infringement of the right not to be forced to act against your will is wrong, please contact your Texas Senator and Lieutenant Governor Dan Patrick and respectfully ask that SB2089 not be brought up.

You can let me know if you disagree on my Facebook page.

Another kind of lawyer joke

“[T]he doctor/bioethics committee thinks the patient should die.” Wesley J. Smith, Esq., Texas Senate Health and Human Services Committee, 4/10/2019 LifeNews.com

Wesley Smith is a rarity among the many lawyers who chased bioethics to the bedside late in the last century: he actually believes in the sanctity of human life and in the right of conscience. I’ve attended and reported on his debates and encounters with proponents of intentional euthanasia. And even happily defended him.

Unfortunately, Lawyer Smith was not above spinning the truth this month when he came from California to once again misrepresent the Texas Advance Directive Act (“TADA,” “the Act,” or “166.___”), an attempt to balance conflicting rights when doctors disagree with a patient or his surrogates about actual medical procedures and treatments that the doctor believes harms the patient.

On April 10, 2019 Mr. Smith gave invited testimony to the Senate Health and Human Services Committee in favor of SB 2089 (Hughes) and
SB 2129 (Creighton). LifeNews.com published part of his testimony online, under the title, “Texas Rule Allows Hospitals to Essentially Euthananize Patients After a 10-Day Notification.”

Mr. Smith doesn’t just contradict multiple Supreme Court rulings since Cruzan (1990) affirming that withholding or withdrawing treatment is not equivalent to euthanasia. Paradoxically, he echoes arguments that anti-conscience activists use to justify abortion on demand, Physician Assisted Suicide and intentional euthanasia by a third party by claiming that the principle of autonomy supercedes “First, do no harm,” or non-malevelence, and the right to conscience.

(You can watch all of Part I and Part II of the April 10, 2019 Health and Human Services Committee meeting addressing SB 2089 by Senator Bryan Hughes and SB 2129 by Senator Brandon Creighton online. Part I includes Mr. Smith’s testimony beginning at 33:00/1:01:10.)

We’ll skip Mr. Smith’s assertion that there is a right to force others to provide everyone medical care in general, not just in emergencies or at the end of life. I’ve covered these assertions and his attacks on the Texas Conference of Catholic Bishops I’m, back in 2007.

Today, let’s just look at his spin on the current version of TADA.

Lawyer Smith uses emotionally weighted terms that aren’t in TADA, such as, “life-extending,” “futile care,” “permitting the institution to force its will on patients and families,” “invidious discrimination,” and “inappropriate care.” He contrasts patient’s “rights” with doctor’s “values,” and is the first that day to raise the specter of doctors willing to kill when patients are “expensive.” And, reflected in the LifeNews.com headline, Mr. Smith flatly says that TADA allows euthanasia – intentional acts to kill patients – equivalent to the administration of injections or medications that he wrote about this week.

As I’ve stated so many times in past WingRight.org and LifeEthics.org posts, TADA doesn’t allow us to remove or withhold care for patients, only treatments that are “medically inappropriate.” There are no futile patients, only futile treatments that cause harm to the patient over and over, without any expectation of reversing organ failure after organ failure.

Mr. Smith also ignores the multiple attempts by the medical and pro-life community and Legislature to improve the law’s timeframe and communication, much as Senator Creighton’s Bill. One example from 2007, SB 439 by Senator Bob Deuell, would have required written notice and an offer of a private ethics consult to take place at least seven days before the hospital committee meeting. That Bill had a schedule for giving the patient or surrogates written information about the dispute process, copies of medical records, and lists of resources. The family would have been given access to the committee meeting, with their own advocates. When the committee agreed that the treatment requested was inappropriate, the family would have receive assistance in searching for7⅞ another doctor or facility for at least another 21 days. I believe that the Bill bogged down in the House because of opposition from Texas Right to Life to any Bill that did not include liability for doctors and the indefinite “treatment until transfer” in this year’s SB 2089.

In the last five minutes of the Part I video, another lawyer, Texas Right to Life General Council Emily Cook, gave us the best clue about the ultimate goal of her organization: “judicial review.

Ms. Cook and Mr. Smith would have every one of these disputes settled by a Court. This is the Texas trial lawyers’ dream: a huge weapon against our State’s tort reform.

Today, the law specifically allows an appeal to a County probate judge when the Committee agrees with the doctor’s decision. SB 2129 allows a request for an injunction in any Court in the County, enabling “judge shopping.” Since it also prohibits the County from charging the patient or his surrogates any fees, the costs would fall solely on the County.

Ultimately, SB 2129 would make it much, much easier to sue the doctor and the hospital, moving Medical decision-making into the courtroom.

Most of the “stakeholders” for patient rights in Texas (including Texas Alliance for Life, Texas Baptist Christian Life Commission, Coalition of Texans With Disabilities, Texas Medical Association, Texas Hospital Association, Catholic Hospital Association, Texas Nurses Association, and the Texas Conference of Catholic Bishops and many others) oppose both of the Bills that Mr. Smith favored. Since SB 2129 would mandate that the County pick up any Court costs and that the judge make his ruling within five days, don’t be surprised if we hear objections from representatives of these parties, too.

So what’s the “joke?”

It could be the ridiculous notion that Lawyer Smith is a mind reader, able to discern the “invidious” motives for the “discrimination” he feels doctors and hospitals routinely practice:

“To fully comprehend the unjust nature of Texas law in this regard, realize that these “futile care” or “inappropriate care” decisions do not terminate treatment because it won’t work, but because it does. It is keeping the patient alive when the doctor/bioethics committee thinks the patient should die.” (Emphasis from LifeNews.com’s transcript.)

He repeatedly comments that physician’s decisions about medically appropriate treatment are subjective and that they (we) might “project their fears and their desires onto the patient” based on our “values,” rather than medical judgement based on repeated, at least once a day examination of the patient, reports by the nurses and staff and our education and experience.

The joke might be that Lawyer Smith volunteered that the indefinite, repeated evaluation and medical decision-making against the medical judgement of doctors would not be “slavery.” I would like to know what Lawyer Smith calls the legal requirement to use one’s body and brain to carry out actions, including writing orders for nurses and other medical staff, against your will.

It might be tragically funny to watch “judicial review” end up with the two sides hiring expert witnesses – doctors – to give the judge opposing views. There’s dark humor in the realization that ultimately the judge would order the original doctor to use her medical judgement to provide treatment – against her best medical judgement.

But the real joke is that “judicial review” risks the unintended consequence of decisions made by judges like the late t Judge George Greer, who Mr. Smith wrote about in this article.

Comments are closed. Please comment on my Facebook page.

Texas Advance Directive Act 2019 Legislature

The Texas Advance Directive Act is being attacked in the State Legislature, again, as it has just about every Session for the last 10+ years. In my opinion, one group is doing the bidding of the trial lawyers to destroy Texas’s tort reform by attempting to force every end of life treatment disagreement into the Courts.
Here’s my explanation of the Act, written in 2016, as an “effort to balance” patients’ rights and the rights of doctors to practice Medicine according to their consciences, using our best medical judgement. And here is an example of a previous attempt to truly improve the Act.
The opponents of TADA would force doctors to ignore their consciences to continue performing procedures and writing orders – for nurses and staff to carry out – against our best medical judgement, while faced with the moral distress of continuing acts that hurt our patient, as organ system after organ system fails, faster than we can compensate, prolonging and increasing his suffering and death.
For example, yesterday, the House passed a useless Amendment to a useless amendment to HB 1504, the Sunset review and reauthorization of the Texas Medical Board.
(22) in complying with the procedures outlined in Sections 166.045iand 166.046, Health and Safety Code, fails to make a reasonable effort to transfer a patient to a physician who is willing to comply with a directive.
Amendment No. 5
Representative Toth offered the following amendment to Amendment No. 4:
Amend Amendment No.4 by Toth to CSHB 1504 on page 3, line 25, between “Code,” and “fails”, insert “willfully”.””
The amendment is useless because doctors don’t handle or arrange transfers between facilities; the hospital social services staff and nurses do. The only possible exceptions might be ER docs in outlying areas, transferring to a larger medical center or a rare phone discussion between doctors about the patient’s course after the two separate staffs have worked out the logistics. Neither of these would apply in the TADA cases.
Importantly, how would the accusation of “willfully fails to make a reasonable effort” be made? Could there be more vague terms in that sentence than “willfully” or “reasonable?” (Especially in light of TRTL’s claim that 60 attempts weren’t reasonable in the tragic case recently ruled moot and dismissed by Texas 1st Court of Appeals, covered here and here.) Is this an attempt to criminalize the actions of doctors, an excuse to sue in a Court of law?
After the amendment passed, one of the lawyer lobbyists paid by Texas Right to Life tweeted a mean little remark:
The lawyer said that doctors who begin the process in TADA “set the 10 day count and sit on their hands.”
I understand that he never had to ask (to order) a nurse to cause pain to a dying patient, but he should understand that doctors don’t “sit on their hands” during the waiting period. We still perform those life sustaining procedures, write orders, and interact with the patient and family.
In order to push their view point they oppose not only other pro-life organizations, but the Texas Catholic Bishops, the Texas Baptists, and Texas Medical Association. Bills such as SB 2129 or SB 2089 would destroy TADA and undermine Texas’ tort reform.
Of course, once in the Courts, the lawyers would have to hire doctors to testify and the judges would decide between the two sides and order doctors to act against their consciences.
That, or lawyers and judges would be placed in the position of practicing medicine: writing medical orders for nurses and staff to carry out.
In the long run, the risk of civil and even criminal liability of caring for patients at the end of life would drive most doctors away from not only intensive end of life care, but increase the risk for any of us who care for trauma, oncology or geriatric patients.

Edit 19 April 2019 BBN: Comments are disabled here. Please comment at my Facebook page, “Beverly Nuckols.” https://m.facebook.com/story.php?story_fbid=10218835564657861&id=1163711361&refid=52&_ft_=mf_story_key.10218835564657861%3Atop_level_post_id.10218835564657861%3Atl_objid.10218835564657861%3Acontent_owner_id_new.1163711361%3Aoriginal_content_id.2226941544065344%3Aoriginal_content_owner_id.110756395683880%3Athrowback_story_fbid.10218835564657861%3Apage_id.110756395683880%3Astory_location.4%3Astory_attachment_style.share%3Apage_insights.%7B%22110756395683880%22%3A%7B%22role%22%3A1%2C%22page_id%22%3A110756395683880%2C%22post_context%22%3A%7B%22story_fbid%22%3A2226941550732010%2C%22publish_time%22%3A1555527649%2C%22object_fbtype%22%3A32%7D%2C%22actor_id%22%3A1163711361%2C%22psn%22%3A%22EntStatusCreationStory%22%2C%22sl%22%3A4%2C%22dm%22%3A%7B%22isShare%22%3A0%2C%22originalPostOwnerID%22%3A0%7D%2C%22targets%22%3A%5B%7B%22page_id%22%3A110756395683880%2C%22actor_id%22%3A1163711361%2C%22role%22%3A1%2C%22post_id%22%3A2226941550732010%2C%22share_id%22%3A0%7D%5D%7D%7D%3Athid.1163711361&__tn__=-R

Prenatal manslaughter?

Something to consider, from a question on Facebook about abolishing abortion and my discussionof the human rights of prenatal human beings:

I read the article. It seems filled with potholes to extend personhood to an embryo. Would then a mother who, through negligence, caused death or damage to the embryo, say [by] falling down the stairs or drinking alcohol, be guilty of manslaughter?

My answer:

The prenatal human is undoubtedly a member of our species, correct?

The risk of abusive prosecuters doesn’t negate the human right not to be killed or justify two classes of human beings, some with human rights, some not human-enough. It certainly doesn’t justify the current abortion on demand: New York’s abortion until birth or Vermont’s proposedconstitutional amendment that prenatal humans “shall not have independent rights under law.”

This is where there is a clear physiologic and philosophic difference between negligence after birth and before. There is no other human relationship equivalent to pregnancy and gestation. Before birth, she’s harming herself first, the child secondarily.

Just as some people had to learn to accept the full humanity of emancipated slaves, there will be a learning curve for the full humanity of the prenatal human. We can do better than Reconstruction and much better than Jim Crow.

There’s previous experience taking the unique relationship into consideration. We already deal with children harmed by alcohol abuse or born addicted to illegal drugs every day.

While there have been abuses, like the drug testing of mothers in South Carolina, it has been more productive to treat addiction than to prosecute as crimes.

*********

Please comment at my Beverly Nuckols Facebook page.

HB 896 Abolish abortion in Texas

#HB896 @TxLeg

The Texas Legislature only meets for 4 months, every other year. Every session, several Bills are introduced that would regulate abortion in our State. Monday night, April 8,the House Committee on Judiciary and Civil Jurisprudence, chaired by Representative Jeff Leach, heard testimony on HB 896, authored by Representative Tony Tinderholt. HB 896 would change Texas law to treat elective abortion for what it is: the intervention intended to kill a member of the human species. The law would require that abortion be treated the same as a felony murder is treated by Texas law: “entitled to the same rights, powers, and privileges as are secured or granted by the laws of this state to any other human child.”

You can watch the testimony in the House Broadcast Archives.

Those of us who believe in human rights must decide whether laws can legitimately divide humans into two classes: those members if our species who are and those who are not human-enough to possess legal, protected (“inalienable”) human rights.

Yes, the law would create complications in a world that’s become accustomed to the act of elective abortion, “spare” human embryos, fetal research on aborted children, and arbitrary “choice” as to which babies live and which are susceptible (in New York State, for instance) to killing on the day before they become citizens by being born.

However, we know how to deal with those complications, because of lessons we learned in our Nation’s history of slavery and the abolishment of slavery. The lives and livelihoods of slave brokers, slave breeders, and slaveholders were disrupted by declaring slavery illegal in the United States, with penalties.

The (dreadful) Supreme Court Dred Scott decision about the status – the “inferior” humanity – of Black slaves has never been overturned by the Courts. In that 1850 ruling, Chief Justice Roger Taney stated that the Constitution affirmed that black slaves were not only property, but “beings of an inferior order” and that they and their descendents could never be citizens of the United States.

Ultimately, a Civil War and Constitutional Amendments 13, 14, and 15 were necessary to outlaw slavery and allow black persons, including former slaves and their children, to become citizens. The 14th Amendment also protected non-citizens, prohibiting laws which “deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

A Constitutional Amendment may be necessary in this case, too, but I don’t think so, because of the way Roe v. Wade was decided.

Roe v. Wade is the Supreme Court decision that declared that there was a “right” to abortion under the Constitution. Justice Blackmun refused to

“. . . resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man’s knowledge, is not in a position to speculate as to the answer.

“Man’s knowledge” has developed since 1973. Philosophers and theologians may still argue (as they do about the civil rights and personhood of neonates, the disabled, and the elderly) but the science is clear. Ultrasounds, MRI’s, and in vitro fertilization have all demonstrated when the life of human beings begins. Just ask the newest technician in the in vitro lab.

As a doctor, I deny that elective abortion is healthcare. I certainly deny that the baby in utero is a part of the body of the mother. It’s not logical to say that the embryo, then the fetus, is not the same organism that we call a baby as soon as he or she is born.

If nothing else, we now have evidence in the form of serial ultrasounds (US) and in vivo MRI’s that demonstrate that human life is a continuum that begins at fertilization.

Even 30+ years ago in training, I saw US used to follow an oocyte from just before ovulation, to the developing embryo in the uterus a few days later. We’ve all seen the US of children as they develop.

Just this month, a research article in the journal Developmental Cognitive Neuroscience reported on sex differences in functional connectivity of neural pathways in the brain, demonstrated by functional MRI of babies in utero.

Questions were raised by the Committee members and citizens alike about a possible death penalty for the felony murder of the unborn child, about women who are coerced into having abortions and whether or not the mother would be charged and subject to penalties.

Well, what penalty does the State impose for procurement of a contract to kill? What charges are brought against the mother who smothers her baby at birth?

It’s true that laws in Texas have never punished the mother who has an abortion. Part of that is out of compassion for the mother who is seen as a victim of circumstances. However, the main reason is that most laws regulating abortion have been passed under the legislation regulating medical practioners and technology, rather than as a civil or human rights issue.

In fact, abortion performed by the mother has always been treated as self-harm, like attempted suicide. But that custom was established before modern information about human embryology. It was long before medical abortion utilizing Mifepristone ( RU486) or methotrexate. We all know now that the mother is not killing a part of her body in an abortion and certainly not when she pays a third party to do it.

I believe that invoking the threat of the death penalty is a red herring. Our homicide laws recognize the right to kill in self defense (for the life of the mother) and mitigating circumstances such as mental illness and in cases of force and abuse by a third party, allowing for different degrees of homicide.

We don’t, however, allow euthanasia or eugenics in the case of born disabled children or give the mother the “choice” to kill by poisoning or distruction of the body of a child who becomes unwanted after birth.

Texas declared the child an individual before birth back in 2003, creating a penalty for third parties who cause the death of a child, except in the case of intentional abortion by a doctor or when the mother herself acts. There have been several convictions under the Texas Prenatal Protection Act.

In light of our expanded knowledge about human biology, it’s time for the Supreme Court to overturn Roe v. Wade and declare what Justice Blackmun deferred: life begins at fertilization and all humans possess human rights that should be protected by the State.

Maybe I’m tilting at windmills, but I would like to see Texas defy Roe v Wade and pass HB 896.

I’ve disabled comments on the blog. Please leave your comments on my Facebook page, “Beverly Nuckols.”

Immunologist denies Imunology (Vaccines)

Here’s a review and critique (with live links, by Skeptical Raptor) on one of the anti-vaxx advocates, an “immunologist” who exaggerated her credentials, makes her money through the big-money scam “Vaxxed,” and who wrote this ridiculous lie:

“”Immunology does not attempt to study and therefore cannot provide understanding of natural diseases and immunity that follows them.””

No, doctors don’t kill 200,000 a year

Not even in 20+ years.

The numbers are much lower than you’ve heard: more like 5000 a year die due to “Adverse Events.” And the rate has decreased by about 21% since 1990.

The number of deaths due to “Adverse Effects of Medical Treatment” are higher than 20 years ago, but much lower than previously reported. They are higher, but not because the number or severity of Adverse Events have increased. Instead, it’s because the population has aged and the elderly have more medical interventions and are more susceptible to morbidity and mortality after those Adverse Events.

This essay reviews the data, the statics, and the methods of selecting both. The article, “Association of Adverse Effects of Medical Treatment With Mortality in the United States: A Secondary Analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study” was published in JAMA and can be read for free.

“KITTENS,” before humans

I didn’t believe the opinion article by Tony Perkins of the Family Research Council, that claimed that a Democrat who voted against last month’s S311, the “Born-Alive Abortion Survivors Protection Act,” had then submitted a Bill to prevent the euthanasia of kittens used in scientific research. I assumed it was a spoof or hyperbole.

KITTENS before babies

But no, a simple search proved that Oregon’s Dem Senator Merkley absolutely opposed the Act, even posting a press release and giving his reason in Twitter, @SenJeffMerkley

The Act would not have criminalized anyone. It would only reinforce and clarify the 2002 “Born Alive Infant Protection Act,” by requiring the doctor performing an abortion to provide the same care for a born infant who is unexpectantly delivered alive during a late term abortion that would be provided to any other child in the same circumstances.

The CDC estimates that about 150 babies are born alive during abortions, each year, while acknowledging that the estimate may be low.

Merkley came up with a cute name for his Bill: “Kittens in Traumatic Testing Ends Now.” It’s a shame he didn’t give as much thought to human babies.

“KITTENS,” before humans

I didn’t believe the opinion article by Tony Perkins of the Family Research Council, that claimed that a Democrat who voted against last month’s S311, the “Born-Alive Abortion Survivors Protection Act,” had then submitted a Bill to prevent the euthanasia of kittens used in scientific research. I assumed it was a spoof or hyperbole.

KITTENS before babies

But no, a simple search proved that Oregon’s Dem Senator Merkley absolutely opposed the Act, even posting a press release and giving his reason in Twitter, @SenJeffMerkley

The Act would not have criminalized anyone. It would only reinforce and clarify the 2002 “Born Alive Infant Protection Act,” by requiring the doctor performing an abortion to provide the same care for a born infant who is unexpectantly delivered alive during a late term abortion that would be provided to any other child in the same circumstances.

The CDC estimates that about 150 babies are born alive during abortions, each year, while acknowledging that the estimate may be low.

Merkley came up with a cute name for his Bill: “Kittens in Traumatic Testing Ends Now.” It’s a shame he didn’t give as much thought to human babies.

“KITTENS,” before humans

I didn’t believe the opinion article by Tony Perkins of the Family Research Council, that claimed that a Democrat who voted against last month’s S311, the “Born-Alive Abortion Survivors Protection Act,” had then submitted a Bill to prevent the euthanasia of kittens used in scientific research. I assumed it was a spoof or hyperbole.

KITTENS before babies

But no, a simple search proved that Oregon’s Dem Senator Merkley absolutely opposed the Act, even posting a press release and giving his reason in Twitter, @SenJeffMerkley

The Act would not have criminalized anyone. It would only reinforce and clarify the 2002 “Born Alive Infant Protection Act,” by requiring the doctor performing an abortion to provide the same care for a born infant who is unexpectantly delivered alive during a late term abortion that would be provided to any other child in the same circumstances.

The CDC estimates that about 150 babies are born alive during abortions, each year, while acknowledging that the estimate may be low.

Merkley came up with a cute name for his Bill: “Kittens in Traumatic Testing Ends Now.” It’s a shame he didn’t give as much thought to human babies.

Please comment on my “Beverly Nuckols” Facebook page.

Transgender First Principles

This weekend, the debate concerning the ethics of medical and surgical intervention for transgendered men and women, more properly called “gender dysphoria,” heated up again. The New York Times published an essay by a man who wishes to become a woman so much that he is about to undergo a 6 hour surgical procedure to fashion an artificial vagina, although the author admits that the surgery may not produce happiness and, indeed, will most certainly cause lifelong pain and the necessity of further intermittent, painful procedures.

In answer to my assertion (in an online private group) that transgender ideation is a pathology, a pediatrician said that I might as well claim that being black is a pathology.
While I’ve never heard of a black person seeking medical or psychological treatment to make his body more or less in concert with his race or body image ( or maybe I have..), there has to be some perception of a problem on the part of the transgendered person who seeks intervention.
Back in the’90’s, when I was in medical school, the definition included a lack of pleasure from the “wrong” genitalia. While it appears that this requirement for intervention has gone by the wayside, at the least, gender dysphoria makes leading their lives difficult. This seems to be a fair, if simplified, definition for “disorder.”

In addition, one of the early leaders in the development of surgical procedures for trans persons, Dr. Phil McHugh, agrees that transgender ideation is a “Pathogenic meme.”

The fact is that the treatments sought or offered are based on biologic sex and are essentially bimorphic: MtF (Male to Female), FtM (Female to Male). The treatments themselves are described as “feminizing” or ” masculinizing” – one or the other.
The incidence of transgender ideation in the US is less than 1% (probably about 0.5%), with as many as 80% of those who claim to be transgendered in childhood “desisted,” changing their minds at a later date, usually around puberty.
The known association with autism
and schizophrenia, along with the “clusters” of peer-group rapid and late onset, as well as the rate of reversals, suggest caution when it comes to treatment that might later be considered disfiguring and permanent.
The author of the NYT piece states that the traditional “First Principle” of medical ethics, “First, do no harm,” is only a way for doctors to be “little kings” who deny what patients “want,”
“”Nonmaleficence is a principle violated in its very observation. Its true purpose is not to shield patients from injury but to install the medical professional as a little kings of someone else’s body.””

If doctors truly forget the First Principle, what’s to stop us from “First, doing harm?” Who decides the “harm” in that case? Better hope we don’t give up our consciences.

Certainly, in this case, I would be one of those “little king” doctors who would not carry through on surgery, based on what appears to be atypical reaction to the cross-sex hormones.
Just as it’s malpractice to affirm the anorexic girl’s body image as correct and help her avoid food, it’s unethical to pretend that transgender ideation is normal or even something we can “affirm.”

Please comment on my Facebook page, Beverly Nuckols.

Federal vs. State (FGM) Updated

Update from the Detroit News:
“[T]he judge left intact conspiracy and obstruction charges that could send Nagarwala and three others to federal prison for decades.”

This story has me thinking about the powers of the State vs. the Federal government.

I am a firm believer that the individual States should regulate and enforce both criminal law and the practice of medicine.

States may make what I might consider errors in their specific codes and punishments. However, the 50 States act as individual laboratories for laws and law enforcement. As long as the States rather than the Federal government regulate these areas, citizens have a better access to the Legislators who make the laws and the bureaucracy that implement and enforce them. The voters can speak directly to their legislators in person and at the ballot box and, if truly unhappy or unwilling to wait for often slow legal changes, they can move to a State with laws they like.

These cases involve two doctors and multiple accomplices who conspired to bring girls across State lines in order to carry out Female Genital Mutilation (FGM).

The procedure is described in words and pictures at the link above and at the World Health Organization report(in .pdf), but here’s the short, least-horrifying-I-could-come-up-with version:

Pre-pubertal girls (two of the girls in this case were 7 years old at the time) are subjected to some degree of cutting in their genital area. The procedure may be anywhere between a minor cutting sufficient to cause bleeding without permanent structural or functional change, to removal of the entire labia majora and minora, along with the entire clitoris, with the vaginal opening sewn almost completely closed, only to be opened (obviously, traumatically) at marriage to allow vaginal intercourse and at childbirth.

The clitoris is a sensitive organ and very much an important part of the sexual function of the female body. The cutting site, the scarring, and the consequences of obstructed urine and menstrual flow can be life long. The actual reported goal is to make the girl chaste and impair her ability to engage in illicit sex and blunt her sexual pleasure.

FGM is a criminal act and should most certainly be malpractice under State’s medical codes. These sorts of cases would normally best be brought before the State courts.

The reason that these particular cases should be prosecuted (also prosecuted?) in Federal Court is that the girls were transported across State lines. In addition, they were irreversibly mutilated solely because they are females. If this latter doesn’t come under the 14th Amendment Equal Protection clause, I need a lawyer to explain that protection. In slow, simple language, please.

Now, I know some people will ask how I can oppose what is most likely a religious act and one that seems to come under both parental rights protection and the penumbra of “right to privacy.” And what about male circumcision?

The right to freedom of religion. Parental rights, and privacy do not have precedence over the rights not to be permanently harmed. Unlike male circumcision, there’s no medical reason to perform FGM, FGM directly impairs multiple bodily functions, and carries a significant risk of life long pain, repetitive infections, and even death.

It’s the legitimate function of government under our US Constitution and supported by the Declaration of Independence to protect the rights of individuals from being placed in harm’s way. These cases of mutilation are nothing but harmful for life, were performed on minors who are too young to consent, and were accomplished by conspiracy, using federally regulated telecommunications to make appointments, taking the girls across State lines, and utilized State licensed personnel, equipment, and medications.

I hope the Federal appeals overturn this ruling. Quickly!

Time for your flu shot!

I admit to being an advocate for ethically produced vaccines. I’m also against involuntary vaccination and very much an advocate for parental rights. However, I believe in education and (strong) encouragement to take advantage of vaccines, which are a fantastic tool to prevent disease.

I’m often confronted with objections about the actual seriousness of flu, the lack of effectiveness of the vaccines and fears about the side effects of the shots. So, in my geeky way, I spent some time doing research.
Here’s the CDC data for influenza infection rates and effects in the US over the last year, including deaths. And here’s a review of actual historic vaccine effectiveness.

Even with the variation in effectiveness of vaccines, prevention is always better than any treatment, since treatment effectiveness will also vary according to the health and risks of individual patients. Vaccines are the best prevention we can offer.

Hospitals and medical facilities work to prevent – and to detect – iatrogenic infections: handwashing, gloves, masks, isolation, active infectious disease department surveillance, etc. The trouble with so many diseases, including influenza, is that they are contagious before the symptoms are obvious.
This week, friends are sharing an article about objections from nurses who are required to either be vaccinated or wear a mask during flu season. (I won’t share that article because it’s nearly a year old, points to out dated information from as far back as 1990, and is full of false accusations and inaccuracies.)

The most recent data that I found shows that a requirement for health care workers (HCW) to choose to either wear a mask or be vaccinated reduces infection in those workers by 74%-88%.

However, the studies on effectiveness for prevention of patient infection weren’t as conclusive. The problem is that the studies available were conducted in nursing homes (not in hospitals) where patients were exposed to many more people than simply HCW and only about 12% of the HCW actually got vaccinated.
One thing to remember about reports on side effects: all of them are present in the general population. The important data is whether there’s a higher incidence in the vaccinated population than in the controls.

Here is a study on flu vaccine safety last year, as reported by over 70,000 Australian patients. There were no serious events, and only about 1% sought “Medical Attendance” (saw a doctor) for events, usually fevers.

Thanksgiving is next week, with its travel and visiting – and spreading of germs. Expect cases to increase in time for Christmas and New Year, as usual. Please think about getting your vaccine, this week.

Happy Birth Parent Day

screenshot_20180616-075345_chrome5005037694364168408-e1529155414475.jpg
Google Images for “Baby Daddy” card

That lawsuit I wrote about yesterday would not only would put an end to Texas’ Medical and legal regulations on abortion – including informed consent, waiting periods, and sonograms – the plaintiffs go out of their way to redefine mother and father, too.

From Footnote 1, page 2:
“”1 Most people with the capacity to become pregnant identify as women. Historically, both jurisprudence and public health data have focused on women when addressing reproductive rights and health. But there is an emerging recognition in the law and society more generally that not all people who may become pregnant identify as women. See generally Glenn v. Brumby, 663 F.3d 1312, 1316-19 (11th Cir. 2011)
(holding, consistent with the weight of authority, that the Equal Protection Clause prohibits discrimination on the basis of “gender nonconformity”) (collecting cases); Robin Marantz Henig, How Science Is Helping Us Understand Gender, National Geographic (2017), https://www.nationalgeographic.com/
of all individuals to end an unwanted pregnancy, regardless of gender identity.”
 (I’m sorry, but can’t find a link to the lawsuit on line. It’s “Whole Woman’s Health Alliance et al v Paxton et al, U.S. District Court, Western District of Texas, No. 18-00500.)

From the UK, we see the inevitable results in a time of identity and personal choice :

Lawyers have told a judge that he had been biologically able to become pregnant but had legally become a man when the child was born.

“They say the transgender man wants to be identified as the child’s “father” or “parent” on a birth certificate.”

And, in Ohio:

“Explaining their unusual parenting arrangements, Amy said: “We went through a lot of fertility treatments, until we finally reached a point where we needed to make a decision as to whether we were going to do more medical intervention or if we were going to switch bodies. (emphasis mine)

“We were fortunate enough to have two uteruses. So, after a lot of thought and emotion and difficulties we switched to Chris.

“And while Chris lived as a man and didn’t feel female, he was willing to use his womb for the good of their family.”

Of course, neither Chris nor Amy could donate sperm. So, who is really — is there even — a father?

Or a parent, of either gender or any identity, who sees the child as his own person, human-enough to possess inalienable rights, rather than a political statement and a means to an end?

Safe, legal, and unrestricted?

If the law deems some of our offspring not human-enough to have the right not to be killed, what’s the use of restrictions on the licensed killers?

From the San Antonio Express News, we learn about a new lawsuit filed by the State’s ” largest abortion provider.”

“The lawsuits (sic) challenges numerous requirements including only allowing doctors to perform abortions, rather than clinic staff. It also challenges licensing standards, 24-hour waiting periods and a requirement that an ultrasound be shown to the patient.””

I suppose “Whole Women’s Health” owner, Amy Miller may have a point. Perhaps the ruling against HB2 made whole new conditions for abortion laws. See the timeline of litigation on HB2, here.

Do we even need to license the killers in the first place? Why should only doctors wield a vacuum wand or curette or dispense abortifacients without an ultrasound?

The question is whether this case is unique and sweeping enough to move the Supreme Court to hear another Texas abortion case? And will the Court remain divided as it was on HB2, which was decided 5-3 in the absence of the late Justice Antonin Scalia?

Could this pressure Justices Anthony Kennedy (81 years old) or Stephen Bryer (80 yo in August) to put off retirement a while longer? And will Justice Ruth Ginsberg (85 yo) still be on the Court?

But we don’t have to question where the money to pay the abortionists’ lawyers. Unfortunately, the taxpayer’s of Texas are required to pay the lawyers that represented the plaintiffs $4.5 Million.

06/15/18 12;50 PM Edited to clean grammar, BBN

06/16/18 7:30 AM Edited formatting, BBN

Human-chicken hybrids in the lab

Nature reports on the creation of human-chicken hybrids using “embryo-like structures” in order to study human embryonic “organizer cells.”

The ethical line is at destroying the embryo to harvest the stem cells. Could these “structures” have been created with ethical induced non-destructive stem cells?
I’m not sure that the “embryo-like” structures are or ever had the capacity to become human organisms, but it is worrying that the implication is that they were. It doesn’t appear that there was ever a placenta or the possibility of one. However, the “structures” developed a primitive streak and notochord – the earliest neural and skeletal structures – and other apparently human cell lines

, in an organized manner.

How significant are the primitive streak and notochord? Are these deliberately created stunted human organisms or simply cell lines and isolated organ systems grown in the lab? What are the ethical limits for creating huma-animal hybrids?
Scientists must respect the dignity of every human being, at every stage of life and development. That is not possible if beginning by destroying a human embryo.

Response to criticism about Texas Advance Directive Act

I’ve been having a long Facebook discussion with representatives of organizations, people who claim that I support coercion and killing patients because I defend the Texas Advance Directives Act, 166.0046. (TADA).

I want to respond as fully as I can. ( I’m bandwidth deprived today and will gradually add more links when I reach better signals. See here, here, and here for more explanations from earlier WingRight posts. Links to the law, the press, and previous blog posts by others can be found in those articles.)

First, no one withdraws or withholds *care* of the patient. The patient still receives food and hydration, pain medicine, oxygen by tube or mask, if needed, and other medical treatment.
The 10 day period is the only recourse allowed under Texas law when a doctor refuses a treatment requested by the patient. All legislative attempts to increase the times have been blocked.
For hospitalized patients, the Act is the only way for a doctor to refuse a patient’s request for medically inappropriate treatment without risk of abandoning him. If the doctor doesn’t follow the law, he becomes liable. Although no reason is required by law, in every case I know of the doctor has made it clear that the requested treatment is causing suffering and/or actual harm and violates the First Principle: “Cure when possible, but first, do no harm.”
I have asked who/where are the doctors willing to accept transfer. There must be some doctor willing to accept the patient in order for there to be a transfer. “Facilities” or hospitals can’t accept a patient without an accepting physician. For the most part, doctors in Texas don’t work for a hospital and can’t be ordered to admit or treat by the facility. That no other doctor can be found is actually evidence that the first doctor’s medical judgment is based on good medicine.
Transfer has happened in a couple of examples (that I know of because they have made the press or gone to court), where a doctor disagrees with the original attending physician. I’m sure this has happened in many others that we never heard about because of the transfer.
I didn’t want to cover a specific case, preferring to stick with the issues of ethics. However, my accusers repeatedly brought up Mr. Chris Dunn. His case is very typical of both my experience with patients dying of end-stage hepato-renal failure and the course of other patients I’ve been able to follow through public documents.

It was easy to follow this case. There was a video published by Texas Right to Life (TRTL), a lot of press, statements to reporters by family, lawyers, and TRTL staffers, as well as a couple of lawsuits. I spent the better part of two days once again reviewing the public records.

Virtually all of the hospital medical reports were made public record in the latest appeal by Mrs. Kelly’s lawyers, Joe Nixon and Trey Trainor, BTW. (Another BTW: Senator Nixon, please follow the gown rules for isolation rules in the future. There’s a reason for them.)
There have been many misleading statements and errors about the case in news articles, blogs, and press releases, including both condemnation and praise for the doctors and the hospital by the family members, TRTL, and repesentatives of Empower Texans (ET), (making this review pertinent as the conversation began on Facebook in response to another ET article). The affidavits of the attending doctor, the chairman of the Methodist Biomedical Ethics Committee, the social worker, and legal documents from Mrs. Kelly’s and Methodist’s lawyers have been public records at the Harris County court website and elsewhere online.
Mr. Dunn was transferred from another hospital to Methodist hospital after having a gastrointestinal bleeding episode that resulted in his becoming unresponsive and being placed on a ventilator. He had severe liver failure, kidney failure, and the build up of fluid in his lungs which his mother told a reporter about. His clinical diagnosis was obvious, and supported by records from an earlier hospitalization when he was diagnosed as having a metastic pancreatic mass. He had checked himself out of that hospital against medical advice after refusing a biopsy of his pancreatic mass or further treatment.
On admission, Mr. Dunn wasn’t able to make decisions, as he was suffering from hepatic encephalopathy (which causes delirium) and sedated due to pain and the ventilator. (Note the restraints on his wrists, his jaundice and swollen belly, and his sleepiness and confusion are evident in that video we’ve all seen.)
He didn’t have an Advance Directive or a Durable Power of Attorney for Medical Care. (TRTL’s lawyer John Seago claimed the mother had one.) The doctors turned to his divorced parents to make decisions as co-equal surrogates under Texas law.
Unfortunately, as his sister told one reporter, his dad agreed with the doctor, but his mother disagreed. According to court documents, the elder Mr. Dunn said that he believed that Chris didn’t want to die in the hospital and insisted on removal of the ventilator and transition to comfort care (not the administration of a deadly “serum” as the lawyers claimed in the lawsuit and media). Mrs. Kelly kept asking for more time to talk to family members before making a decision. in their affidavits, a hospital social worker and the Ethics Committe chair, each described the parents’ interaction with one another as a “firestorm.”

It

was obvious that Mr. Dunn needed a legal guardian. That he was unable to make medical decisions is supported by the affidavits of the attending doctor and a later court examiner, as well as the fact that his parents were agreeable to making those decisions.
The Ethics Committee chair and other members documented meetings with the parents and family at least five times over the month after admission, and given copies of the hospital policy on disputes. When the doctor invoked TADA, the Ethics chair met with them again and they were given 3 day’s notice of the committee meeting. (Dispelling the lawsuit and blogging claim that the family wasn’t informed and was surprised by the sudden notice.)
Mrs. Kelly attended the meeting and spoke with the Committee. Both parents were given information about the hospital policy on the TADA and told that the doctor would be allowed to remove the ventilator 11 days later. While Mr Dunn’s father agreed, his mother did not and filed her first lawsuit.
The hospital social workers contacted over 60 different facilities in attempt to transfer. They were able to find a hospice (and presumably a hospice doctor) willing to care for Mr. Dunn on the ventilator at home, but Mrs. Kelly declined that transfer.
The MICU intensivist doctors and hospital voluntarily agreed, without a court order or hearing, to continue the ventilator until a single legal guardian could be named. There was never a restraining order after the initial Agreed TRO. There was never any move to deny the Total Parenteral Nutrition or any other treatment. The doctors, the hospital and the court where Mrs. Kelly filed suit against the hospital requested that the probate court determine a legal guardian to settle the dispute between the parents. The hospital specifically asked for a family member to be named guardian. There never was a move to remove Mrs. Kelly as guardian since she never was the guardian. The probate court hadn’t named a legal guardian at the time of death.
At autopsy, the pancreatic adenocarcinoma was found in the pancreas, liver, lungs, and lymph nodes. There were 20 liters (5 gallons) of ascites fluid in the abdomen due to the liver failure which prevented the production of protein and blood clotting factors. The lungs showed evidence of fluid congestion, aspiration of stomach fluids and pneumonia. The kidneys had failed and were infected. There was wasting of fat and muscle tissue.
The clinical diagnosis was confirmed. Mr. Dunn died of his disease with 40 pounds of fluid in his abdomen, congested lungs, pneumonia and kidney infections, and on a ventilator with total food and hydration by IV. This is not “natural death.”
The court has dismissed the lawsuit(s) in favor of the hospital. The only coercion in this case was against the doctors who evidently gave extraordinarily good care in order to keep him alive while waiting for the surrogates’ decision, then waiting for the probate court to act. And yet, Mrs. Kelly’s lawyers have amended her lawsuit, since dismissed, and filed an appeal which demands a “fair trial” whenever disputes like this occur.
The demands we’ve heard about TADA, to mandate that individual doctors “treat until transfer” or face new civil and criminal liability – even jail time – for doctors who use their consciences and refuse to act against their medical judgment would not only infringe against a doctor’s right not to be enslaved by positively forcing his hand against his will. It would be a moving target, with advances in intensive care technology and the ability to keep a patient’s body functioning with increasing technology.
As to the “Doctors aren’t God” refrain by others: I agree. And I’ve agreed each time someone shouts (or writes) it at me when I won’t refer for an abortion or write that opiate perscription that they are certain is their right.
Inalienable rights are negative rights: the right not to be killed, the right not to be enslaved.
Doctors are human beings with inalienable rights, including the right to conscience and to not have their hand forced to cause harm to a confused and delirious patient who cannot consent to suffer.
As shown by the first month of the Chris Dunn case, we recognize that some times we must stretch our limits. However, not indefinitely and not all our limits.

(Edited 03/11/18 for typos, to add a link, and to clarify points originally made on Facebook in a long debate. BBN)

Personhood “TBD” 

“To Be Determined,” or the Schrodingder’s cat* version of human rights.

Does the possession of inalienable human rights depend on unknown future facts? Can the moral worth of a human being be determined by the actions of another human being – or by fate, the available and utilized medical technology?

Sherif Girgis discusses the theory of Princeton philosopher, Elizabeth Harman, in today’s Public Discourse. The professor’s view that abortion is – or may be – a neutral act has been the subject of discussion since she appeared in the YouTube video, Philosophy Time, produced by actor James Franco and Eliot Michaelson.

Besides the obvious problems pointed out by Girgis of defining “consciousness” and the TBD “kind” of a human fetus, there are other problems.

First, any concept of “inalienable” human rights would need to be discarded. There goes the Declaration of Independence and the basis of the United States Constitution.

In addition, Professor Harman’s theory would presumably allow the use of bodies of the human species for the benefit of humans with “moral worth,” as long as those bodies are never allowed to become conscious. This is the current practice of researchers using embryos, including those created for the purpose of manipulation and destruction.

But there’s nothing in this philosophy to prevent the intentional manipulation of a human body for research or to benefit others, as long as the body is never allowed to develop consciousness. Continual sedation or mutilation of the brain from the beginning – before consciousness – would prevent the development or acquisition of moral worth and rights.

In the process, “human” rights would cease to exist. The actions of others, laws and location and the potential use of technology would finally determine who is human enough to possess the right not to be killed. (Forget the right not to be “enslaved.”

What happens if (as Girgis proposes) the abortion itself is aborted or fails? Or if the brain isn’t damaged sufficiently to prevent consciousness?

Forget about opening the box: don’t put humans in there in the first place.

*I saw this analogy on a Facebook thread, but thought the same thought before I stole it.

Edited to correct my misspelling of Dr. Harman’s name.

Health Insurance Choice Is Bad?

Health insurance choice is bad?

The San Antonio Express News picked up a Washington Post op ed on those big, bad Republican plans to repeal Obamacare. Originally titled, “The reason Republican Republican health-care plans are doomed to fail,” by the editorial board that declared, “There’s no way to replace Planned Parenthood.”

And it’s bunk, even as prudently renamed and appropriately filed in the Opinion section.

What we are *actually *seeing *today is that costs are rising and insurers are withdrawing from States. Choices are certainly limited if there’s only one insurance company on the exchange and routine screening costs are “free” — But the care for treatment discovered at screenings is subject to high deductibles.

Limited coverage plans with major medical for extraordinary costs – rather than a wish list covered with other people’s money from first dollar – encourages personal responsibility and will cut costs. It would also allow people to own their insurance, rather than have it controlled and limited by current employers.

Science vs. Philosophy

R(obin) Alta Charo has once again been given a platform in the New England Journal of Medicine.

Poor Robin. She conflates ethics and philosophy with science. Although observing what “is” can lead to insight about which actions and manipulation lead to harm and which improve individual and group well-being, Science cannot prove or disprove philosophy, or determine what we “ought” to do.

Ms. Charo continues her career-long advocacy for elective, interventional abortion and against the inalienable human right not to be killed – all in spite of her assertion that she has no conflicts of interest in this essay. By declaring that Trump Administration appointees “embrace alternative science,” Robin makes her own gross scientific error. In addition to confusing “science” and philosophy, she bases much of her objection on an emphasis on “established pregnancies” and ignores the existence of the human embryo after fertilization but before implantation.

The very odd complaint about definitions of gestational age assumes that time varies according to when we start counting days.

Some state legislatures have tried to redefine pregnancy dating, shifting from the standard measure of time since last menses to time since probable fertilization. Such a definition falsely enhances the viability statistics for lower gestational ages and helps to bolster arguments for 20-week limits on abortion rights.

Again: Science is about what 《is,》 while ethics ought to be, not about true  《oughts.》

Modern opposition to germ theory???

Why is it that a CPA is trusted to tell the “truth” about vaccines, but doctors aren’t? Perhaps, because doctors understand the science behind the germ theory, learn to read and evaluate the medical literature, and aren’t willing to give credence to doctors who have their licenses restricted or stripped for fraud, much less herbalists who teach that the earth is flat.

In discussions about vaccines with people who oppose them, I’ve been told that vaccines haven’t been subjected to large, “properly,” controlled tests. Even when I pointed to large, controlled, blinded, and randomized studies the answer was that these weren’t the “properly” controlled tests.

This is what they’ve been taught by people like Ty Bollinger, a CPA who has made his living blaming sinister global government chemtrails and, of course, doctors and vaccines for cancer, autism, allergies, and all sorts of other health problems.

The latest Bollinger video series, “The Truth About Vaccines” was evidently promoted on Facebook in April, but I missed it.  I won’t link to the video, but if you want, you can Google it and find episode 1 for free on YouTube. Don’t pay for it!  I’ve watched all 1 hour, 57 minutes, and have been doing research on the “experts.”

In this episode, Bollinger interviews parents, doctors, lawyers, lawmakers, activists and some of the most notorious contemporary doctors: Andrew Wakefield, who had his license revoked for real, intentional fraud in the United Kingdom, and Rashid Buttar, DO, from North Carolina, who is no longer allowed to treat children or cancer patients. And then, there’s the blurb from David “Avocado” Wolfe, an herbalist who denies that the Earth is round or revolves on its axis around the sun!

Pediatrician Laurence Pavlesky, MD,who is prominently featured in the video, doesn’t define the characteristics of a “proper” study in the video, he does in another interview,

“What’s missing in these data is a population of healthy people who have not had any flu symptoms – to actually see if their noses contained H1N1 – because if someone is sick and has the presence of an H1N1 virus in the nose, it doesn’t mean that the H1N1 is causing the illness.

“You really have to take an appropriate control group to see if people are colonized with that virus even when they’re not sick. “

http://articles.mercola.com/sites/articles/archive/2009/11/14/Expert-Pediatrician-Exposes-Vaccine-Myths.aspx

So do docs have to match stroke or heart attack victims with healthy controls, to prove that the controls have no lesions in order to prove that occluded vessels caused the lack of brain function or heart function? 

It’s well-documented that some people are chronic carriers of strep, but not sick. Typhoid Mary was colonized, able to expose others who got sick, but not sick, herself. We also know that the incubation period varies.

Okay, maybe we could get over the difference of opinion about “proper” controls. Or whether the earth is flat. Or even why a CPA and lay people are capable of learning the truth about scientific knowledge, but doctors aren’t. However, another theme often repeated by Pavlesky and other “experts” prominent in Bollinger’s video is the denial of the germ theory.

Fom Pavlesky’s “General Guidance”:

“The expression of these symptoms may not always be caused by infections from bacteria and viruses. Instead, these symptoms and illnesses may develop as a sign that our children are healthy; that their bodies are strong, and working to bring to the surface, and cleanse, any accumulation of wastes that are deep inside them, having accumulated due to their exposure to varying stressors in their lives. In many instances, the process of bringing these wastes to the surface of the body is aided by the bacteria and viruses already living inside of them, and is a necessary step for them to become well.”

Sheri Tenpenny, DO  is another doctor in the video. On her blog, she also promotes infections as a good way to get rid of  “toxins,” adding,

As contrary as it seems, germs are attracted to the diseased tissues; they are not the primary cause of it.”

Here’s a little statement from me:

*The diseases we call infections are caused by infectious agents: bacteria, viruses or parasites​.* 

If we can’t agree on this (and that the earth is not flat), we have no common ground for a logical discussion about Western medicine.

More to come in later posts about the “experts” in the video.

Law makers to doctors: “Keep the patient alive” 

If only we doctors – or legislators, lawyers and probate judges – really had the power to “keep the patient alive” as this article claims two new Bills  (  HB 4090 & SB 1213) in front of the Texas Legislature will (force doctors to) do. 

The article is misleading in its claim that a committee or a hospital decides whether or not a therapy is given: Texas doctors practice medicine in Texas. Even the Bills make it clear that the “attending physician” makes the decision whether or not to follow the patient’s (or more likely, the surrogates’) medical request.

We – Texas doctors, hospitals, and legislators – have tried repeatedly over the last decade to amend the law, Texas’ Advance Directive Act,   to increase the time frame. Last Session, we helped to ensure that food and water can’t be withheld. The lawyers and those who would have Estate (probate) judges involved in every dispute – even at the bedside of the dying – have blocked effort after effort because the Bills did not include liability for the doctor. 
These Bills are just the camel’s nose under the tent of Texas’s tort reform. Worse yet, we’d end up with medical expert testifying against medical expert in court, with the judge eventually telling the doctor how to practice medicine. It would also severe the “ethicists” who actively seek to undermine conscience protections for health care professionals.
If you’ll notice, the Bills also remove the requirement for the patient to pay for any transfer, too. I don’t suppose that the tort lawyers ​will pay for the ambulance or plane ride.

Do you want Texas law to force doctors to practice against our consciences​? 

How long and how far should any man or woman be forced by law to act against his or her will?

Texas “Bathroom Bill”

(Photo of the men’s bathhouse at Pompeii, in contradiction to the claim that gender-segregated facilities are a modern concept.)

The Texas Senate State Affairs has another long day ahead, as testimony will be heard today on SB6, the so-called “Bathroom Bill.”

Here’s a rebuttal that I wrote in response to a facetious op-ed that appeared in the Austin American Statesman last month. The Opinion editor told me a shorter version would be published, but I haven’t seen it. 

Obviously, John Kelso isn’t a survivor of male on female sexual abuse or harassment. 

Many survivors (like me, at 3 years old) have strong reactions to the idea – the threat – of a man in the enclosed space of even a “public” bathroom. Just as as I worry about the safety of children, I also want a “safe space,” where I am not likely to be confronted by a male. 

If the transgendered individual doesn’t trigger that fear – and I have no doubt that I’ve shared bathrooms with some who didn’t –  then no problem. However, their ability to do so is no justification to engage in sweeping social experiments.

Representative Schaefer and Lieutenant Governor Patrick didn’t start this controversy. Individuals making policy decisions  in cities, school districts and the Federal government did, sometimes with the weight, fines, and penalties of law.

The fact is that at least 1 in 5 women have been sexually abused before the age of 18. (In my experience as a Family Physician, I would have expected the percentages to be higher.) More than 90% of those assaults are committed by males who prey on females. While “only” 20% or so are perpetrated by strangers, isn’t that enough?

And yes, some of us do consider innocence a value to be protected and wish to protect girls from involuntary exposure to the physical characteristics of anatomical males. Thus, our objection to co-ed bathrooms and the Obama Administration’s Department of Education guide lines that included locker rooms and overnight accommodations on school trips.

Significantly, Kelso claims to be ignorant of multiple abuses of by straight males, dressed as females or otherwise, who take advantage of the opportunity to exploit newly accessible, formerly same-sex, hygiene facilities. I suggest at least a bit of online research.

How dare commenters mock women’s “worry” and “FEAR(sic)?” Isn’t fear of assault the reason most often given to justify “gender neutral” policies?

@bnuckols tweets

Click here to get your “Choose Life” license plate

Rick Perry RickPAC

Yes, I'm still for Governor Perry!

RickPAC

What to read around here

Archives

SiteMeter