Medical ethics

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.

Happy Birth Parent Day

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.

“”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/

magazine/2017/01/how-science-helps-us-understand-gender-identity/. The Constitution protects the right

of all individuals to end an unwanted pregnancy, regardless of gender identity.”

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.

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?

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.”

, in an organized manner.

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.)

It

(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?

​Would you like to refuse?

Shocking Bill from Texas’ Jason Villaba, Republican State Representative from Dallas’ District 114 :  HB 1938 would make organ donation after death “opt out” for anyone applying for a driver’s license in Texas.

Texas would be the first State to pass such a law.

Organ donation is a public good for those who wish to do so. However, there is no ethical or legal precedent for treating human bodies – living or dead – as public property or commodities.

From the Bill as introduced:

(2)  for an applicant who is 18 years of age or older:
	(A)  specifically ask each applicant the
	question, “Would you like to refuse to join the organ donor
	registry?” and state, “If you answer ‘no’ to the previous question
	or do not answer the previous question, you consent to join the
	organ donor registry by performing either of those actions.”; and
	(B)  if the applicant does not affirmatively
	refuse to be included in the registry under Paragraph (A), provide
	the person’s name, date of birth, driver’s license number, most
	recent address, and other information needed for identification
	purposes at the time of donation to the nonprofit organization
	contracted to maintain the statewide donor registry under Section
	692A.020, Health and Safety Code, for inclusion in the registry.

http://www.legis.state.tx.us/tlodocs/85R/billtext/html/HB01938I.htm

Autonomy and aiding self-harm

​It’s very rarely good medicine to encourage a symptom of disease, especially one that leads to harm. I don’t help raise a patient’s temperature when they have a fever. I treat the infection and to keep the temperature from going up to dangerous levels.
In every case of cutting and self harm that I saw in my practice, the several girls and one boy had already been the victim of sexual abuse and were also abusing alcohol or drugs. The cutting was a symptom of depression, post-traumatic stress and the victimization that started the cascade.

And yet, the Journal of Medical Ethics has published an article arguing that since cutters are going to cut, doctors should aide them by providing sterile knives or razors. 

The Journal  is actually a forum for public arguments on controversial topics in bioethics, rather than a policy manual or review of facts and best practices. However, far too often the subjects are treated with respect and support those same controversial ideas. 

The online bioethics newsletter, Mercatornet, disputes this normalization of pathology and outlines the history of support and opposition to the concept of “safe” self harm.

Indeed, the argument for limiting harm is often given as the reason for elective abortion, physician assisted death and other forms of euthanasia.

Please, apply the suicide or cutting to illegal drug use. Does the rationale follow through? If a person is only happy after heroin, should we assist him by allowing and providing a cleaner, more pure product – as well as the needles so many State laws have made possible?

Cook sarcastically sums up with an imaginary Tweet:

“Bioethics is broken. Doctors respecting patients who make really BAD decisions. All because of AUTONOMY. DUMB!!! Back to human dignity!!!” 

I have long described Bioethics as “the formal study of who we can kill.” Now, we can add, “and aid in harming.”

Trust me, I don’t have a conscience (yes, THAT again)

Speaking of CS Lewis’ “conditioners” in my last post, a small group of “philosophers and bioethicists” got together in Geneva, Switzerland last June and came up with a “Consensus Statement on Conscientious Objection in Healthcare.”

On the “consensus” from less than 20 self-selected individuals, we’re supposed to advocate the move from shaming doctors for objecting (to acts that have been considered shameful by Western society since Hippocrates) to some sort of judgment by tribunals.

From the BioEdge.org blog:

“After a special workshop held at the Brocher Foundation in Geneva, Switzerland, over a dozen bioethicists signed a ten-point“Consensus Statement on Conscientious Objection in Healthcare.” The group stated that “healthcare practitioners’ primary obligations are towards their patients, not towards their own personal conscience”. As a consequence, “healthcare practitioners who are exempted from performing certain medical procedures on conscientious grounds should be required to compensate society and the health system for their failure to fulfil their professional obligations by providing public-benefitting services.” They also stated that “Medical students should not be exempted from learning how to perform basic medical procedures they consider to be morally wrong.”

What’s to enforce those guidelines if the physician has no conscience? What place does “should” or “ought” – words that are flung about in the “Consensus” – have if the conscience is to be dismissed?

As Wesley Smith points out  at his blog on National Review, any objectors would be re-“conditioned.” The “Consensus” demands that  doctors not only be forced to explain their rationale, perform “public-benefitting services” (in addition to their jobs as doctors), and teach medical students those morally controversial procedures, they would be sent to re-education classes.

Oh, and they might not be able to get a job in the first place if they aren’t morally pure – excuse me – able to “fulfil (sic) their professional obligations,” according to this little club:

“This implies that regional authorities, in order to be able to provide medical services in a timely manner, should be allowed to make hiring decisions on the basis of whether possible employees are willing to perform medical procedures to which other healthcare practitioners have a conscientious objection.”

I sincerely doubt that any representatives were invited – or allowed – to attend. (At least, that’s my experience.)

More on “conscience” by searching the “Categories” on this page.

Human cloning fable doesn’t justify abortion.

Sigh . . . There are still people out there trying to justify elective abortion of healthy babies in healthy mothers by claiming that the embryo is nothing special, since liver tissue is alive when it is harvested for transplantation and ” . . . a skin cell contains DNA that could be implanted into a human egg and be developed into a baby.”
​That hypotheticals is, at this time, just that. No one has yet been able to clone humans beyond a very early blastocyst. In some way, these embryos don’t function well enough to maintain organized cell division, development and growth.
However, even if cloning a human were possible, that new human life would not begin at the harvesting of either the skin cell, the liver tissue or the oocyte destined to be enucleated. Just as with gametes in vivo, those cells are end-stage specialized cells that do *not* actually have the potential to be other types of cells – much less a new human – without fertilization or the manipulation that scientists might someday be able to discover.
The natural, in vitro, or someday-maybe cloned human life begins at fertilization or not-yet-achieved generation of functional clones. Each are – or would be, in the case of the hypothetical – verifiable by observing the organized cell function, development and division in the embryo, driven by the nucleus of the new organism.  Intentional, interventional abortion ends that organized development and growth, causing the death of the organism.

I’m sure my explanation won’t stop those who really,  really, reeeally want to abort unwanted humans from  using junk science to justify killing humans. Most likely, they will just go back to those long essays discriminating between which humans are human-enough.

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.

Posted from WordPress for Android. Typos will be corrected!

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.

Death Politics

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

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)