I’ll admit that I’m not a lawyer and have to do my homework to even attempt to understand lawyer-speak. (For example, see this definition of “Abatement”) How I wish more lawyers would admit they aren’t doctors, especially when they accuse doctors and entire hospital committees of killing patients.
Earlier this week, I reviewed the latest sensationalized case involving lawyers and lawyer-lobbyists playing doctor in the media and courts to overturn Section 166.046 of the Texas Advance Directive Act (“TADA”).
TADA outlines the process to settle disputes between an attending physician and the patient (or the family of a patient) when the medical judgment of the doctor about what is medically appropriate for the patient conflicts with the demands for treatment that the patient or family wants *that* particular doctor to perform.
Texas law prohibits the removal of “artificially administered nutrition and hydration” and pain medications unless the doctors determine they will cause further harm. However, a ventilator, intubation tubes in the throat, cardio-version (CPR), surgery and invasive procedures or tests are not ordinary or comfort care and are considered “life-sustaining” treatment that may be removed or withheld from a patient with a terminal disease if the patient’s doctor determines that are not medically appropriate. There is certainly no provision in Texas law to intentionally stop a patient’s breathing or to otherwise cause certain death.
The lawyers lobbying and suing against TADA admit in both public statements and legal complaints that they will settle for nothing less than “Due Process,” lawyer-speak reference to the Fourteenth Amendment clause, “due process of law.” They demand that every dispute about medically appropriate care between doctors and patients be argued – by lawyers – in court, preferably with a risk of “liability” for the doctor, any committee member who reviews the case under TADA, and the hospital where the patient is under care. Judges, and possibly juries, would determine the local medical standard of care, which medical procedures are appropriate for which patients, and liability. Lawyers and judges would essentially practice medicine instead of doctors.
To summarize this latest case, court records document** the affidavit from the attending physician of a 46 year old Pasadena, Texas man, Chris Dunn. Mr. Dunn was admitted to the ICU at Houston’s Methodist hospital unresponsive after a major gastrointestinal bleed due to metastatic pancreatic cancer led to his emergency transfer from a hospital in his hometown. Mr. Dunn was on a ventilator and suffering from liver, kidney, and respiratory failure. He had fluid in his lungs, necessitating higher and higher pressures on the ventilator. He had fluid leaking into the abdominal cavity due to the liver failure, ascites, that required intermittent draining. He also suffered from hepatic encephalopathy, a form of variable dementia and delirium. His doctors and his father agreed that the repetitive, invasive treatments necessary to maintain the ventilator and treat the multi-organ failure should be stopped because they were causing Mr. Dunn harm, while comfort care would continue.
In their lawsuit against the hospital, a group of lawyers brought in by Mr. Dunn’s mother and Texas Right to Life sued the hospital in Mr. Dunn’s name, although there was a question about both Mr. Dunn’s ability to legally consent and the legal status of either parent alone to make medical decisions on Mr. Dunn’s behalf. In fact, the court ruled an “Abatement” or suspension of the lawsuit on December 4, 2015, until the legal guardianship for Mr. Dunn could be settled in another court. And, sadly, in spite of continued treatment in the Intensive Care Unit, on a ventilator, with IV and tube feedings, and all the repetitive blood tests, suctioning, and invasive procedures these treatments required, Mr. Dunn succumbed to his disease before that other court could meet to name a guardian.
In their lawsuit against the hospital, the lawyers even accuse “the facility” (not the attending doctor) of planning to actively euthanize Mr. Dunn by the deliberate use of injections intended to cause his death, rather than to relieve his pain:
“Defendant scheduling . . . and Defendant administering, via injection, a combination of drugs which will end his life almost immediately, thus warranting immediate intervention by this court.” (**p.2)
The lawyers further declared that the doctors and the Methodist Biomedical Ethics Committee – and every doctor or hospital committee – would be corrupted by their affiliation with the hospital:
“The statute does not provide adequate safeguards to protect against the conflict of interest inherently present when the treating physician’s decision is reviewed by the hospital “ethics committee” to whom the physician has direct financial ties.
“Texas Health and Saftey [sic] Code violates Plaintiff’s right to procedural due process by failing to provide an adequate venue for Plaintiff and those similarly situated to be heard in this critical life-ending decision. The law also fails to impose adequate evidentiary safeguards against hospitals and doctors by allowing them to make the decision to terminate life-sustaining treatment in their own unfettered discretion.” (**pp. 5,6)
“Under Tex. Health and Safety Code 166.046, a fair and impartial tribunal did not and could not hear Dunn’s case. “Ethics committee” members from the treating hospital cannot be fair and impartial, when the propriety of giving Dunn’s expensive life-sustaining treatment must be weighed against a potential economic loss to the very entity which provides those members of the “ethics committee” with privileges and a source of income.” (**p. 7)
Lawyer-speak notwithstanding, I can’t figure out – and the lawyers don’t tell us – how to ensure that “unfettered” pancreatic cancer presenting with multi-organ failure followed “due process” in Mr. Dunn’s case. Other than lawyers from each side hiring and paying even more doctors to re-examine the patient and re-view the existing medical records, repeated clinical exams and nurses’ notes, lab work and non-invasive scans of the liver and abdomen, what would a judge or jury consider “evidentiary safeguards against doctors and hospitals?”
But in news article after blog post, lawyers (but no doctors) claimed that “the hospital wanted to kill” Mr. Dunn. Lawyers (but no doctors) claimed there were un-named additional tests and treatments which could have changed the diagnosis, treatment or prognosis. Lawyers (but no doctors) disputed the medical judgment of the very doctors from whom the lawsuit demanded continued intensive care.
In their lawsuit, the lawyers also declared that, “Members of a fair and impartial tribunal should not only avoid a conflict of interest, they should avoid even the appearance of a conflict of interest, especially when a patient’s life is at stake.” (*p. 7) But that didn’t stop them from including an ironic and self-serving demand that Methodist hospital pay their “Attorney fees and costs.” (p. 12)
**(Protected “.pdf” “Images” of the original legal documents quoted below can be found online, here. The document images aren’t link-able and can’t be copied or printed, so I will have to type up and share quotes. See Family case number 2015-69681. The quotes above are from document number 6796448.pdf, “Plaintiff’s Original Verified Petition and Application for Temporary Restraining Order and Injunctive Relief.”)
Here’s Section 166.046 of the Texas Advance Directive Act, the part of Texas Law that is in the news, these days. This part only applies when there is a disagreement between the doctor (whom the patient wants to continue treatment) and the patient or his surrogate about treatment decisions.
Sec. 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR TREATMENT DECISION. (a) If an 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, the physician’s refusal shall be reviewed by an ethics or medical committee. The attending physician may not be a member of that committee. The patient shall be given life-sustaining treatment during the review.
(b) The patient or the person responsible for the health care decisions of the individual who has made the decision regarding the directive or treatment decision:
(1) may be given a written description of the ethics or medical committee review process and any other policies and procedures related to this section adopted by the health care facility;
(2) shall be informed of the committee review process not less than 48 hours before the meeting called to discuss the patient’s directive, unless the time period is waived by mutual agreement;
(3) at the time of being so informed, shall be provided:
(A) a copy of the appropriate statement set forth in Section 166.052; and
(B) a copy of the registry list of health care providers and referral groups that have volunteered their readiness to consider accepting transfer or to assist in locating a provider willing to accept transfer that is posted on the website maintained by the department under Section 166.053; and
(4) is entitled to:
(A) attend the meeting;
(B) receive a written explanation of the decision reached during the review process;
(C) receive a copy of the portion of the patient’s medical record related to the treatment received by the patient in the facility for the lesser of:
(i) the period of the patient’s current admission to the facility; or
(ii) the preceding 30 calendar days; and
(D) receive a copy of all of the patient’s reasonably available diagnostic results and reports related to the medical record provided under Paragraph (C).
(c) The written explanation required by Subsection (b)(4)(B) must be included in the patient’s medical record.
(d) If the attending physician, the patient, or the person responsible for the health care decisions of the individual does not agree with the decision reached during the review process under Subsection (b), the physician shall make a reasonable effort to transfer the patient to a physician who is willing to comply with the directive. If the patient is a patient in a health care facility, the facility’s personnel shall assist the physician in arranging the patient’s transfer to:
(1) another physician;
(2) an alternative care setting within that facility; or
(3) another facility.
(e) If the patient or the person responsible for the health care decisions of the patient is requesting life-sustaining treatment that the attending physician has decided and the ethics or medical committee has affirmed is medically inappropriate treatment, the patient shall be given available life-sustaining treatment pending transfer under Subsection (d). This subsection does not authorize withholding or withdrawing pain management medication, medical procedures necessary to provide comfort, or any other health care provided to alleviate a patient’s pain. The patient is responsible for any costs incurred in transferring the patient to another facility. The attending physician, any other physician responsible for the care of the patient, and the health care facility are not obligated to provide life-sustaining treatment after the 10th day after both the written decision and the patient’s medical record required under Subsection (b) are provided to the patient or the person responsible for the health care decisions of the patient unless ordered to do so under Subsection (g), except that artificially administered nutrition and hydration must be provided unless, based on reasonable medical judgment, providing artificially administered nutrition and hydration would:
(1) hasten the patient’s death;
(2) be medically contraindicated such that the provision of the treatment seriously exacerbates life-threatening medical problems not outweighed by the benefit of the provision of the treatment;
(3) result in substantial irremediable physical pain not outweighed by the benefit of the provision of the treatment;
(4) be medically ineffective in prolonging life; or
(5) be contrary to the patient’s or surrogate’s clearly documented desire not to receive artificially administered nutrition or hydration.
(e-1) If during a previous admission to a facility a patient’s attending physician and the review process under Subsection (b) have determined that life-sustaining treatment is inappropriate, and the patient is readmitted to the same facility within six months from the date of the decision reached during the review process conducted upon the previous admission, Subsections (b) through (e) need not be followed if the patient’s attending physician and a consulting physician who is a member of the ethics or medical committee of the facility document on the patient’s readmission that the patient’s condition either has not improved or has deteriorated since the review process was conducted.
(f) Life-sustaining treatment under this section may not be entered in the patient’s medical record as medically unnecessary treatment until the time period provided under Subsection (e) has expired.
(g) At the request of the patient or the person responsible for the health care decisions of the patient, the appropriate district or county court shall extend the time period provided under Subsection (e) only if the court finds, by a preponderance of the evidence, that there is a reasonable expectation that a physician or health care facility that will honor the patient’s directive will be found if the time extension is granted.
(h) This section may not be construed to impose an obligation on a facility or a home and community support services agency licensed under Chapter 142 or similar organization that is beyond the scope of the services or resources of the facility or agency. This section does not apply to hospice services provided by a home and community support services agency licensed under Chapter 142.
Added by Acts 1999, 76th Leg., ch. 450, Sec. 1.03, eff. Sept. 1, 1999. Amended by Acts 2003, 78th Leg., ch. 1228, Sec. 3, 4, eff. June 20, 2003.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0503, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 435 (H.B. 3074), Sec. 5, eff. September 1, 2015.
I am glad that the rules are explicit about the duty to report sexual or physical abuse.
Here’s a statement from Texas Alliance for Life, with links to the ruling:
Austin, TX — Today the Texas Supreme Court released rules for how courts handle judicial bypass proceedings regarding secret abortions on minors girls without parental notification or consent. The rules were created in response to HB 3994, authored by Rep. Geanie Morrison (R-Victoria) and sponsored by Sen. Charles Perry (R-Lubbock) and strongly supported by Texas Alliance for Life.
The following statement is attributed to Joe Pojman, Ph.D., executive director of Texas Alliance for Life:
We are pleased with the Supreme Court’s strong rules regarding the judicial bypass process for abortions on minor girls. These bring to fruition a 10-year effort by Texas Alliance for Life and a coalition of pro-life organizations to protect minor girls in Texas from abortion. In 2005, the Texas Legislature passed a bill requiring doctors to obtain the consent of a parent before performing abortions on minor girls. In 2015, the Legislature passed, and Gov. Abbott signed into law, HB 3994 to reform the judicial bypass process by which a judge can allow abortions on minors without parental consent. The reforms closed loopholes and increased protections for the minors from abuse. The Texas Supreme Court has faithfully implemented House Bill 3994 in a way that will best protect the well being of minor girls.
Here is a link to the Texas Supreme Court’s order issuing the rules: http://www.txcourts.gov/media/1225647/159246.pdf.
HB 3994 was one of five major pro-life bills and numerous other pro-life provisions passed in 2015. Here is a summary.
Texas Right to Life turned Mr. Dunn’s imminent death from metastatic pancreatic cancer into a crusade against the Texas Advance Directive Act (TADA or the Act). The Act is invoked by the attending doctor – not the hospital or ethics committee – when family members demand that he or she perform acts that go against the conscience because they are medically inappropriate, causing the patient to suffer without changing his course.
In this case, the mother and father disagreed with one another about the care plan and the patient was unable to make legally binding decisions. The father agreed with Mr. Dunn’s doctors that the treatment was causing suffering, objected to surgery to place a tracheostomy, and wanted hospice and comfort care. The mother wanted dangerous, painful procedures performed that would not change the medical outlook except to possibly hasten death.
And, unless you read the court records, you wouldn’t know that the judge ruled that Chris was not mentally competent to make his own medical decisions, that the hospital never wanted guardianship and had voluntarily promised to continue care until the guardianship could be settled. In fact all the lawyers, including the Texas Right to Life representatives, signed off on an agreement acknowledging this promise on December 4th. ( The official court records are available to view free of charge online at the Harris County District Clerk’s website as protected pdf images. See Family case number 2015- 69681.)
Inflammatory headlines falsely claimed that “the hospital” had imposed a “death sentence,” and was actively trying to kill Mr. Dunn by refusing to diagnose, treat or even give a prognosis. That same blog post mentioned non-standard treatments that some in the family were demanding.
First of all, of course there was a diagnosis. Several, in fact. From the signed affidavit of Mr. Dunn’s attending physician, filed December 2, 2015 in response to the law suit:
“Based on my education, training, experience, as well as my care of Mr. Dunn, I, and members of my team, have advised his family members that Mr. Dunn suffers from end stage liver disease, the presence of a pancreatic mass suspected to be malignant with metastasis to the liver and complications of gastric outlet obstruction secondary to his pancreatic mass. Further, he suffers from hepatic encephalopathy, acute renal failure, sepsis, acute respiratory failure, multi-organ failure, and gastrointestestinal bleed. I have advised members of Mr. Dunn’s family that it is my clinical opinion that Mr. Dunn’s present condition is irreversible and progressively terminal.”
The primary diagnosis was metastatic pancreatic cancer. The cancer was a mass that blocked the ducts and blood vessels coming from the liver as well as the normal function of the intestines. As liver excretions backed up into the liver and the blood pressure in the liver increased, Mr. Dunn suffered a life-threatening gastrointestinal bleed, fluid buildup in the abdomen and lungs, and sepsis (an overwhelming infection). All of these would aggravate respiratory failure, the necessity of a ventilator and lead to the kidney damage. Liver failure often results in hepatic encephalopathy and variable delirium.
There was definitely treatment given, including tube and IV feedings, antibiotics, the ventilator, and periodic removal of the abdominal fluid. Again, this was all publicly documented in Court documents, in the media and even on the Texas Right to Life blog that claimed that “Houston Methodist has invested no time or effort in Chris’s health, instead exerting their energies into trying to kill him instead.” [sic]
The Intensive Care doctors as well as the Biomedical Ethics Committee, met with the parents to explain Mr. Dunn’s condition and his prognosis. The family was given notice before the Committee hearing and met with the (not at all “nameless” or “faceless”) Committee to discuss their (differing) wants. Thirty days’ worth of medical records, a hospital case worker and assistance in finding alternative care were made available to the family.
Then, there’s the complaint about the limits on visitors and videotaping. It is not unusual to limit Intensive Care Unit visits to specific times and to allow only close family, especially when the patient can’t consent and there is contention among family members. It is certainly standard to prohibit filming in the Unit, since patients are visible from one area to the next, in various states of undress and undergoing constant or frequent *intensive* treatments.
(BTW, one of the lawyers in the TRTL ICU video proves the basis for the rules: he is not compliant with the usual isolation procedures. Former Senator Joe Nixon didn’t wear the protective gown at all correctly, risking the introduction of infectious contamination into the room and/or taking germs home with him.)
It’s very unusual for patients on a ventilator to be conscious because of the severe discomfort associated with the foreign body – the breathing tube – that is necessary in the airways. It’s difficult to believe that anyone would complain about sedating Mr. Dunn in order to bypass his gag reflex.
Finally, the standard of care in advanced metastatic pancreatic cancer is pain relief and palliative support. The surgery to remove a pancreas is extremely dangerous for even healthier patients. As Mr. Dunn had already had an episode of bleeding and both liver and kidney failure, it’s likely that even a biopsy of the pancreatic mass or liver, much less surgery, would have caused more life-threatening bleeding. With liver and kidney damage, he wouldn’t have been able to tolerate trials of radiation or chemotherapy, either.
In fact, the doctors and nurses gave excellent treatment all along, as shown by his survival beyond the average for patients who presented in such a precarious state and acknowledged by Mrs. Kelly in her statement after Chris’ death.
The truth is that Methodist never made plans to “kill” Mr. Dunn. Mr. Dunn was never in danger of the hospital “pulling the plug.” The real problem was a disagreement between Mr. Dunn’s divorced parents over who would legally make medical decisions. That rift is bound to have been made worse by TRTL and the lawyers turning Chris’ illness into a public political battle. The accusations about euthanasia, killing and murder may cause other future patients harm, if they are reluctant to seek care because of these stories.
We should at least have as much care for the donation of tissue from aborted human fetuses and embryos as we do for the donation of organs from those killed by capital punishment. Both scenarios involve purposeful intervention to cause death and the collection of tissues, at least, must be carried out by licensed and regulated medical personnel.
Robin Alta Charo (a law and ethics professor at the University of Wisconsin) has an opinion piece in this week’s New England Journal of Medicine, “Fetal Tissue Fallout.” in which she claims that society has a “duty” to use tissues harvested after elective, intentional abortions.
I object to the idea that society has a “duty” to make use of the end products of either procedure. Both scenarios involve purposeful intervention to cause death by licensed and regulated medical personnel, making those of us who vote for the legislators who write laws complicit in the actions, at least remotely. Under a strict philosophy of ethics based on the protection of inalienable rights, each act should be weighed individually and should only be carried out when the one killed is a proven danger to the life or lives of others.
Robin justifies her elevation of the use of fetal tissues after elective abortion to that of a “duty” by citing past benefits of research using fetal tissues. She is more political and names past Republican supporters in an earlier op-ed, published in the Washington Post on August 4th.
Yes, society has benefited from these tissues. However, that picture at the side of this post depicts Dr. Frederick Robbins, one of the scientists who utilized fetal tissue in the 1950’s development of the Salk polio vaccine. Dr. Robbins is depicted smoking at work in the laboratory, while handling test tubes without gloves. We know better than that, now. Isn’t it time that science and medicine researchers catch up with our knowledge that the human fetus is a human being from the moment of fertilization?
Where are the Ethics Review Boards that monitor for the unethical behavior we’re hearing about in the videos from the Center for Medical Progress?
In 2013, the science journal, Nature, published an article covering the history and evolution of informed consent and compensation for donors of human tissues, including the fetal tissue culture, WI-28. Ms. Charo was quoted as supporting monetary compensation:
But, says Charo, “if we continue to debate it entirely in legal terms, it feels like we’re missing the emotional centre of the story”. It could be argued, she says, “that if somebody else is making a fortune off of this, they ought to share the wealth. It’s not a legal judgment. It’s a judgement about morality.”
Yes, “It’s not a legal judgment. It’s a judgement about morality.”
Texas Gulf Coast Planned Parenthood Director of Research, Melissa Farrell is very accommodating in the latest video release from the Center for Medical Progress. God help us!
We hear about the 40 to 50 abortions on babies 16 to 22 weeks at the abortion business and the fact that all 6 of their doctors perform these abortions.
They evidently have a lot of experience collecting “cadavers,” too.
And then, from about 9 minutes in, she shows the investigators the refrigerator where those cadavers are kept and the staff proudly sifts through a dish full of body parts. One was 20 week “twin.” Recognizable arms, legs, etc.
If you can’t bear to see the 4 to 5 month body parts, stop around minute 9. I couldn’t watch all of it at once.
Human developmental psychology 101: We learn “Mine!” long before we learn, “That’s not fair!” Before that, we learn that Mama is not part of us. We must develop self-awareness, that there is “Me,” and there’s everyone else, each causing our own effects on the universe. In direct opposition to the opinion of Supreme Court Justice Kennedy, object permanence is one of the first things we learn: we don’t each create our own universe.
Individualism and private property are basic to human nature, and integral to the development of the concepts of truth, love and justice. Truth can’t be known without first learning to manipulate our bodies and then objects around us. Love is just narcissism if there’s no “other.” Sharing and justice are meaningless without private ownership of property.
In contrast, in socialist and communist regimes, independence of the individual isn’t necessary. The individual must surrender his rights to the collective and “fairness” is determined by consensus or Committee.
If we learned anything from the Soviet experiment with socialism, it’s that Lamarckian evolution is false: DNA doesn’t change because of use or disuse. Laws don’t change human nature, any more than Stalin could change the cold-hardiness of wheat by gradually moving the planting fields farther north. In fact, laws that endure are those that lag behind changes in the thought of an overwhelming majority of individuals. Historically, precipitous changes in law imposed by an elite only function if backed by totalitarian regimes willing to confiscate, enslave and kill.
Socialism, in direct opposition of the philosophy laid out in the Declaration of Independence, and the science of human development, would regress us all back to psychological infancy, where a few may deem everything – and everyone – is “Me! and “Mine!”
(An excellent review of the five stages of self-awareness is available in <a href="http://tinyurl.com/ohzk963More popular discussions are here http://www.scientificamerican.com/article/when-does-consciousness-arise/” target=”_blank”>.pdf and here, and here .)
Edited to clean up the wordiness. 6PM 7-6-15. BBN
The TEA Party has proven that we are outside the influence of Party politics. We have demonstrated that we will work from within and for the Republican Party only as long as the Party will honor our principles.
However, I worry that many who have “gotten up off the couch” in the name of “Taxed Enough Already” are not well informed on the connection between inalienable rights and the social issues. Others don’t understand how and why Conservatives conflate those inalienable rights with small government and national defense.
Too many never get past the first three words of the Preamble of the Constitution:
We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.
With six months to go before the first Primaries, let’s spend our energies on educating our fellow voters about Conservative principles, rather than tearing down the various candidates. We don’t have to settle on an “electable” candidate – yet. And we certainly don’t yet have to compromise on values.
Pretty much whatever our politics, our client (sorry) lies in the past. Maintaining the programs of the Great Society? Returning to the vision of the Founders? Addressing as #1 priority the debt mountain we have built? Each of these is meritorious, and wherever our political lines lie for most of us each of them features. Point is not that they are misplaced priorities. It is simply that they hail from yesteryear. Left and right are stumbling into the future as their gaze is fixed on the past. (“How to bridge the Continental Divide; moving Camp David to the Valley; please, pols, start Asking Tomorrow’s Questions.” Nigel Cameron, President and CEO, Center for Policy on Emerging Technologies. )
“The shrill universal cry that we are at a “tipping point” is correct, but not as they would have us all believe, the tipping point that is fast approaching has to do with the old political and legal superstructures being torn apart from below by this powerful, complex, emergent force of scientific and technological evolution now unleashed. Reactionaries are doing all they can to bamboozle gullible people into helping support the status quo, to prop it up, which is unfortunate.” (Quote from C. James Townsend, in “The Singularity and Socialism, An interview with C. James Townsend” by BJ Murphy on Murphy’s “Serious Wonder” blog, distributed by the newslist/email of the Institute for Ethics and Emerging Technology.)
This week, two email subscriptions I follow converged with a common warning that government is reacting to and protecting the past. Each, one from the right and one from the left, urge politicians to allow innovation and technology to frame the debate on the economy.
” . . . The right of the People to keep and bear arms shall not be infringed.”
Since the Supreme Court affirmed (in the District of Columbia v. Heller) that the Second Amendment applies to individuals, there’s not much room in that statement for a need to justify *which* arms to keep and bear.
In fact, you have the right to your guns because of the inalienable right to life, not in spite of it. The right to defend your life is a corollary of the inalienable right to life, which is actually the right not to be killed.
“But,” someone asked me last week during an online discussion, “what about owning an AK-47, an armored tank, or even nuclear weapons?”
A gun or a tank in my neighbor’s yard is not a threat to my life, liberty or property until it’s pointed at me, by an imminent threat or in actuality.
On the other hand, nuclear materials are a real threat to the possessor and those around him, even without a trigger. Because they give off dangerous radiation and decompose (making them even more dangerous) it’s not unreasonable to regulate who may and may not possess nuclear materials, how they’ll be manufactured, stored and transported. Governments may ethically limit their possession because, like biological or chemical weapons, they’re hard to contain, much less accurately aim. They all are able to threaten people nearby, downwind and may even harm future generations.
Inalienable rights aren’t decided by government, much less personal opinion. They are negative and necessarily hierarchical. You may not enjoy a liberty that endangers the life of another, and the government can’t limit rights without prior evidence of a clear infringement of another’s rights.
(For more on rights and ethics, see “Why Ethics?“)
We may not ever solve the problem of an irresponsible tabloid press and sensation-seeking media, since the freedom of speech is too important to infringe. But we do have power over those we license as physicians.
Dr. Walt Larimore enters the vaccine debate in his blog, not by suggesting forced vaccination, only the regulation of physicians. I wouldn’t support the recommendation without some leeway — I’m certainly not going to approve of every vaccine without a time trial in this very diverse lab that is the United States.
However, Dr. Larimore and his guest author, Dr. Russell C. Libby, are right to raise the ethical and medic0-legal responsibility of physicians who are licensed by the State and who advocate against good science and medical standards.
From the article:
“State medical boards must decide if the actions of healthcare practitioners who advocate against vaccination and undermine the public health efforts of their communities warrant investigation and intervention. There are a number physicians and other licensed healthcare professionals who trivialize and discourage immunization, whether it be for philosophical, financial, or self-promotional reasons.
“When the patients they influence contract preventable disease and have bad outcomes or they cause the spread to a vulnerable population, they should be held liable for malpractice. If it is in the midst of an outbreak or epidemic, medical boards need to sanction or suspend licenses.”
I’ve spent quite a bit of time — especially over the last week – attempting to educate interested people (including a family member) about the safety and usefulness or efficacy of vaccines. My motto for these arguments has always been that, “Truth will out,” and, “If we’re right, we should be able to teach and convince.”
However, within the last week, an irresponsible Texas radio host trotted out the discredited and un-licensed doctor who fabricated the MMR/autism fraud and a Canadian newspaper published a hit piece on Gardasil. (You can find them easily on Google – I won’t give them “hits” from my page.)
When licensed physicians – men and women who should know better – spread demonstrable lies, even after being found guilty of fraud or when demonstrably spreading harmful misinformation, there should be consequences.
You’ve got to see this! From the blog, rebel.md:
“The same boards that treat doctors like criminals during our “secure board examinations” blatantly copy each other’s press releases. They’re more than “fellow members of the community of medical boards”, they’re in collusion against their own diplomats. Each board claims they are independently responding to their individual specialties, but they are clearly well-organized as a single entity against us. I’m not sure what the CEO of the ABP does for that $1.2 million salary, but writing original press releases doesn’t appear to be within his scope.”
You’ve heard it said that Doc So-and-So is “Board Certified,” right? That means that he (or she) has taken a test or two – the Board exams for his (- assume I’ve said, “or she,” from now on) specialty – and maintains a certain level of credentialing and Continuing Medical Education (CME). While not mandated by law, in many cases, it’s a necessary hoop through which to jump if a doc plans to get hospital privileges or insurance contracts.
For Family Physicians, that used to mean that we took 50 hours of CME each year and re-took our Boards each 6 or 7 years. (The “security” around those “secure board examinations” became so onerous that I was fingerprinted several times on the day I took my third set: Once on entry to the exam room, once when I returned from lunch and then when I returned from a trip to the bathroom. They graciously supplied facial tissues, since we weren’t allowed to bring in our own into the room. In fact, we were required to place purses, wallets, etc., in a locker during the exams!)
Over the last 7 or so years, the American Board of Family Physicians has phased in a convoluted system of make-work and extra tests to assure our “Maintenance of Certification” or “MOC.” (Believe it or not, that’s a trademarked name, belonging to the American Board of Medical Specialties, the overlord of all Certifications.) It’s expensive and time consuming and frankly, is of no practical use other than as a source of the CME, which we were getting anyway. That didn’t stop the Boards from attempting to convince the Feds that our licenses and/or pay should be tied to their certification.
And the profit is a big deal. MOC is a great source of revenue for the Boards, which used to only receive our $1000 or so when we took the Boards. Now, they make much more. In 2010 (according to the latest tax form I can find), the ABFM took in $24Million from family docs, paid the President of the Board just shy of $800,000, socked away $12M in “excess” revenue, and has over $72 M in assets. Family docs who work hard don’t earn 1/4 of what Dr. Puffer is paid.
Many of us refuse to play any more. When I resigned from the American Academy of Family Physicians, I decided to drop the pretense of Board Certification, also. The MOC process was impossible for my practice as a locum tenens, working in other doc’s offices.
And I’m not alone in my dissent. See Dr. Charles Kroll’s video on the corruption within the American Board of Internal Medicine (ABIM), here, and the letter from Dr. David D Fitzpatrick at the Authentic Medicine blog.
Well, the ABIM, unlike the ABFM which jumped on MOC before all the other specialties, sort of heard its members and has pledged to hold its fees stable (and struggle along on $43 Million a year in revenues) and delay a couple of requirements. The ABIM even apologized!
Well (again), the ABFM and the American Board of Pediatrics (ABP) certainly heard that! And they evidently were in the same meeting when it happened. How else to explain the fact that each sent out nearly identical letters to their members, including 120 matching words in phrases from 9 to 31 words long?
Contrast the Hippocratic ethic in which a physician recommends treatment to his patient, based on his best medical judgement in the patient’s interest, with that of the “veterinary ethic,” where decisions are made by the “payor” — or owner. Now, consider the effect of Government regulations which arbitrarily force doctors to learn protocols and guidelines (rather than adjust to the patient’s course of illness), to fit a patient’s illness into International Clinical Diagnoses (out to the nth decimal place) and which withhold payment when a patient becomes ill enough to need readmission to the hospital within 30 days of the last admission.
In an article published online by Cato, Dr. Jeffery Singer lays out the history of the destruction of Medicine as a profession. In the past, Dr. Singer described the ethical transition toward the “veterinary ethic.”
Each of these articles is worth your time and consideration. The first article gives one of the best explanations of the Government move to “coding” of medical diagnoses in exchange for
payment “reimbursement,” on through the forced move to Electronic Medical Records without evidence that patients will benefit and Accountable Care Organizations which assign patients to employee “providers.” The second, earlier article, reviewed the necessary change in medical ethics to allow doctors to practice without – or in contradiction to – their conscience.
Forget patient autonomy, long elevated by the lawmakers, lawyers and Ph.D’s (in the name of “Bioethics”) above the traditional physician Hippocratic values of beneficence and its foundation, non-maleficence. In the world of Government medicine, your life is in the hands of the “payor:” the Golden Rule of “He who has the gold makes the rules.”
“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.–That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed . . .”
Yes, I’m using the Declaration of Independence to explain the ethics of quarantine. In fact, I suggest that the inalienable rights to life, liberty and “the pursuit of happiness” actually requires that a “just government” quarantine people who endanger the life of others, while doing as much as possible to preserve the rights of those who are quarantined.
The threat of the Ebola virus has spurred the discussion about quarantine in the United States, due to the high mortality rate of the disease. We’ve forgotten the quarantines of the past and most people are unaware of the existence of Presidential Executive Orders concerning formal lists of “Quarantinable Diseases.”
Inalienable or fundamental rights are negative rights. Consider the proverb that “Your (inalienable) right to swing your fist ends at my nose.”
Negative rights are limited to prohibiting action, in contrast to positive rights, which would force others to act for our benefit. That means that we have the right not to be killed, enslaved, or coerced into acts by others – you have the right to swing that fist as long as you don’t hit anyone else by intention or accident.
However, when a third party’s action or negligence threatens to infringe on our fundamental rights we have the right to protect ourselves and our fellow citizens, in the form of government, have a duty to assist us.
This protection should involve the use of the least force possible, for the least time possible, and we must take care not to become guilty ourselves of unnecessarily infringing the inalienable rights of others by abusing the government enforcement of quarantine. When government acts to limit the liberty of people by quarantine, it is imperative to ensure that there is a real threat to the lives of others, to limit the time of quarantine to the time the person is a possible threat, and to protect the lives of those people by providing food, shelter and medical assistance for those who can’t provide for themselves.
Not only is it ethical to implement restrictions on people coming to this country from areas where the disease is epidemic, it is the duty of government to protect the right to life of our citizens by implementing procedures for involuntary quarantine within our borders.
Here’s a link to the ruling https://www.texasallianceforlife.org/wp-content/uploads/HB2-Stay-Ruling-CLEAN.pdf
Unfortunately, the Court allowed the El Paso abortion business to stay open, even though currently half of women seeking abortion travel to near-by New Mexico abortion businesses. Those women who go to the El Paso business will not have the protections guaranteed other women in Texas:
“Because of the long distance between El Paso and the nearest in-state abortion clinic, as well as the doubt that Jackson casts on whether we may
look to out-of-state clinics, the State has not shown a strong likelihood of success on the merits of the challenge to the physical plant requirements of
the ambulatory surgical center provision as applied to El Paso. Thus, the district court’s injunction of the physical plant requirements of the ambulatory surgical provision will remain in force for El Paso.”(Page 29)
Hopefully, women (and men) will protect themselves from unintended pregnancies now that more travel is involved to reach the abortion business sites.
If there is a market for the abortion businesses in other areas of the State, they will adapt. And Texas will prove whether or not there’s that market.
Read this article for a history (you probably don’t know about) of the many attempts and failures in healthcare reform over the last 20+ years.
In 2001, Rep. Bill Thomas (R-Calif.), chair of the House Ways and Means Committee, brought a tax credit bill to the House floor and passed it over objections of congressional liberals favoring Medicaid expansion. In the Senate, however, Majority Leader Tom Daschle (D-S.D.) blocked the tax credit bill twice. Nonetheless, as a political matter, conservatives were playing offense on health care policy for the first time in memory. While small, the proposal was a psychological victory for those who wanted to fix health care with more free markets.
A slightly tongue-in-cheek report about autologous stem cell therapy for an athlete:
Only three years ago Peyton Manning underwent stem cell therapy, a procedure so successful his neck is now strong enough to hold up a crippling Super Bowl loss. According to D. Orlando Ledbetter of the Atlanta Journal-Constitution, Falcons wide receiver Julio Jones received a similar, experimental procedure.
(Here’s a free site with that info on Jones – BBN edit.)
These therapies really are experimental at this point. However, veterinarians have been treating animals with their own stem cells for years.
The bone marrow cells for a bone injury seem less extreme than using fat stem cells that may not be functionally identified by the researchers.
I’m watching and have high hopes for the future, though!
Remember, no one is forbidden to buy anything. However, the US Government will not force people or their companies to pay for devices and drugs they believe are immoral.
The Affordable Care Act regulations issued by the federal government, however, required twenty different preventive methods or services, including sterilization and pregnancy counseling. Depending upon how lower courts now interpret the Hobby Lobby decision, companies that fit within the Court’s “closely held company” bracket and offer religious objections could be spared from having to provide any of those services through their employee health plans.
In three cases in which a federal appeals court had rejected the challenges to the mandate, the new Supreme Court orders told those courts to reconsider, applying Monday’s decision. The companies or their owners had taken those petitions to the Court.
On three petitions filed by the federal government, involving appeals court rulings rejecting the challenges by corporations. their owners, or both, the Justices simply denied review.
The latest wins came this month, when the Office of Personnel Management announced that government-contracted health insurers could start covering the cost of gender reassignment surgeries for federal employees, retirees and their survivors, ending a 40-year prohibition. Two weeks earlier, a decades-old rule preventing Medicare from financing such procedures was overturned within the Department of Health and Human Services.
Unlike Obama’s support for same-sex marriage and lifting the “don’t ask, don’t tell” ban on openly gay troops, the White House’s work to promote transgender rights has happened mostly out of the spotlight.
Some advances have gone unnoticed because they also benefited the much larger gay, lesbian and bisexual communities. That was the case Monday when the White House announced that Obama plans to sign an executive order banning federal contractors from discriminating against employees on the basis of their sexual orientation or gender identity.
In other instances, transgender rights groups and the administration have agreed on a low-key approach, both to skirt resistance and to send the message that changes are not a big deal, said Barbara Siperstein, who in 2009 became the first transgender person elected to the Democratic National Committee.
Cool! Security will need to be tight, though.
Google Glass was put to work as part of a system involving a QR code posted on the doorway to each patient’s room and software that can read the code and call up the record of the patient. Dr. Horng noted how each second counts in a hospital environment and fast access to timely information can be life-saving; Horng also said he wanted to use technology in a way that kept doctors in front of patients, not screens, away from the computer and back to the bedside
A machine lays down the titanium for the false hip, dot by dot, line by line as with a printer. In addition, the docs used the woman’s bone marrow stem cells to aide in healing.
Remember: Senator Bob Duell was instrumental in convincing the medical community to adopt voluntary procedures to protect patients and families affected by the Texas Advance Directive Act, even though actual amendments to the law have been blocked by the very people attacking him.
How much “freedom” does a third party Political Action Committee have in their paid ads? Is it wrong to challenge them legally when the ads are blatantly false?
In this case, the ad opens by implying that Senator Duell is responsible for the too-short 10 day period allowed to find alternate care when the family or patient disagrees with the doctor at the end of life.
Senator Duell was not in the Senate when the Texas Advance Directive Act was passed in 1999. Members of the PAC, Texas Right to Life, were present and lobbied in favor of the Act.
In contrast, Senator Duell has for years been a strong advocate for amendments that would have increased the power of families to protect their loved ones in the case of disputes with the doctor. The amendments would have changed the waiting period to at least a month before any disputed decisions by the doctor would take effect.
As to the challenge, Senator Duell has excellent support for his case:
The Texas Catholic Conference and Catholic Bishops of Texas, who supported Deuell’s bill, have debunked the claims. They said that Texas Right to Life “has tried to stoke fear through ridiculous claims of non-existent death panels and assertions that doctors are secretly trying to kill patients. Both claims are absurd.” The Catholic Conference also ripped Texas Right to Life for spreading “fabrications” about the position of Catholics on the issue.
Here’s one of the tough questions. (Lots of parenthetical explanations, too.)
I believe that the doctors should have gotten the best informed consent that they could obtain and allowed an attempt of vaginal delivery. I can’t bear the idea of “tying down” a mother for forced surgery while she begs me to stop. However . . .
We weren’t there and don’t know from this report the condition of the baby or the mother at the time that they wheeled them into the operating room.
It appears that they did wait “several hours.”
We have precedent that mothers in labor may not make life-changing and -threatening decisions. For instance, the law doesn’t allow Medicaid to be billed unless a mother consents to tubal ligation at least 4 weeks prior to delivery. Even with private insurance or cash-pay, few doctors will perform a sterilization without consent obtained in advance. (I understand that the purpose of this law is to prevent coercion and eugenics, but the one-size-fits-all seems patronizing to all mothers.)
I’ve assisted several women who became hysterical at the end of labor. (One woman stood up on the gurney several times, even as her baby was “crowning” and we were trying to prep her for the imminent delivery. I was a resident in training, and my supervisor ordered the sedation and restraints to protect her from falling from the bed, and the baby from a free-fall delivery from over our heads. She delivered her baby almost immediately after the last time we got her on her back – before the restraining orders could be followed.)
The mother in this story did present herself at the hospital, implying (and possibly signing) consent to the treatment by her attending obstetrician. If she had stayed home for the delivery, there would be no dispute in the first place.
We are beginning to hear how great for the State of Texas it is that Leticia San Miguel Van De Putte will be the Democrat nominee for Lieutenant Governor in November. The story is that she will cause more Latinos to register to vote in the hopes that she will represent the 38% of Texas voters better than the Anglo man who will be nominated by the Republican Party.
Think so? I don’t.
Democrat Senator Judith Zaphirini nominated Senator Leticia Van de Putte for Senate President Pro Tempore on the opening day of the Texas 83rd Legislature on January 8, 2013:
Move the cursor to 45 minutes in, when Senator Zaphirini introduces Leticia Van de Putte’s children and grandchildren. Listen to the words, watch the faces around her.
“Six children, six grandchildren! What blessings! I’m not sure at what point in time Senator Van De Putte became such an advocate for Planned Parenthood, but her children are so glad that it wasn’t earlier than it actually was.”
Just after posting the article about Great Britain’s new official exclusion of pro-life doctors, I received an email from AAPLOG, the American Association of Pro-life OB/Gyns, referring to this article:
“In medicine, the vast majority of conscientious objection (CO) is exercised within the reproductive healthcare field – particularly for abortion and contraception. Current laws and practices in various countries around CO in reproductive healthcare show that it is unworkable and frequently abused, with harmful impacts on women’s healthcare and rights. CO in medicine is supposedly analogous to CO in the military, but in fact the two have little in common.
This paper argues that CO in reproductive health is not actually Conscientious Objection, but Dishonourable Disobedience (DD) to laws and ethical codes.”
Read the rest for more about the “dishonorable doctors” who follow their consciences and well over 2000 years of “First, do no harm.”
Edited: BBN to add corrected url,
The Royal College of Obstetricians and Gynecologists in Great Britain have determined that any nurses or doctors who oppose any form of contraception may not complete training and will not receive certification in the specialty:
Doctors who oppose morning-after pill on conscience grounds face qualifications bar
Guidelines confirm that doctors and nurses who oppose controversial emergency contraception on ‘moral or religious’ grounds cannot receive key specialist qualifications
This is very possible in the US. Take a look here at some fairly recent history of attempts to keep docs from practicing with a conscience.
I wrote a very difficult letter today. I resigned from the organization that is supposed to support Family Physicians in our education, practice management and good medical care of our patients. Instead, the American Academy of Family Physicians too often strays toward forcing its members to be complicit with controversial policies such as condoning gun control and over-the-counter contraceptive drugs, and condemnation of “reparative therapy” for homosexual patients, even when those patients are unhappy with their sexuality. I write about my main conflicts and the “final straw” in the letter:
It is with great regret that I write this letter as notice that I have decided not to renew either my Texas or American Academy of Family Practice membership. While I am still a family doctor, neither the Texas Academy of Family Practice (TAFP) nor the American Academy of Family Practice (AAFP) represent my political or ethical views.
The political, social and ethical controversies were the main reason I remained in the Academy for the last few years since I left full time practice. I hoped that I could make a difference by volunteering my time and money as an active participant in the Texas Academy, the National Conference of Special Constituencies, the AAFP list serves, the Academy Legislative meetings in DC and our annual AAFP Congress of Delegates.
From the time of Hillary Clinton’s closed meetings on healthcare to the endorsement of the passage of the ACA before it was written, the political actions of the AAFP leaders has disappointed me in Washington, DC. Our practice hassle factors have grown and grown, too often with the blessings of – and sometimes due to the experiments with alternative methods of practice by – the Academy.
The AAFP advocated for elective abortion before I joined as a Student member and I accepted that the burden of persuasion was on those of us who disagreed.
However, the Academy’s decision to advocate for the redefinition of marriage in 2012 and the refusal to reconsider the extracted Resolution on marriage neutrality at the 2013 Congress of Delegates in San Diego were the final proof that there’s no tolerance for family doctors who hold conservative politics or traditional ethics in the Academy.
Unfortunately, our TAFP spokesperson to the 2013 AAFP Reference Committee on Advocacy misrepresented the Texas Delegation’s instructions from the Directors on marriage. As I remember the discussion and vote, the intention was to allow the Texas delegates wide latitude in voting on any final form of the Resolution.
I hereby resign from the Texas Academy of Family Physicians, the American Academy of Family Physicians and as a Fellow of the AAFP.
I waited to resign after nearly 30-year membership until the last minute before being dropped (for lack of paying my annual dues). There were several reasons for my hesitancy. For one thing, I didn’t want to be an undue influence on other members when they considered whether or not to write that hefty annual check to the Academy. For another, while I will continue to work with the AAFP and the Christian Medical and Dental Association to protect the right to life, marriage, the conscience rights of doctors within the profession of medicine and the specialty of Family Medicine, I do believe that it is important to work to persuade from within the organization. The biggest problem with finally writing the letter was that I was looking for a way to somehow keep my integrity while allowing the Academy to claim to represent me.
However, now that I’ve resigned, please consider sharing my letter with your family doctor. Many of them are unaware of the policies that our professional organizations push on good doctors of today and the students and residents who will be our doctors of tomorrow.
What about evolution?
The Obama administration said Thursday it is placing a grassland grouse known as the lesser prairie chicken on a list of threatened species, a move that could affect oil and gas drilling, wind farms and other activities in five central and southwestern states.
The decision by the Fish and Wildlife Service is a step below “endangered” status and allows for more flexibility in how protections for the bird will be carried out under the Endangered Species Act.
Dan Ashe, the agency’s director, said he knows the decision will be unpopular with governors in the five affected states — Texas, Oklahoma, Kansas, Colorado and New Mexico — but said the agency was following the best science available.
“The lesser prairie-chicken is in dire straits,” Ashe said in an interview. “The bird is in decline and has been in decline for more than a decade.”
The prairie chicken, a type of grouse known for its colorful neck plume and stout build, has lost more than 80 percent of its traditional habitat, mostly because of human activity such as oil and gas drilling, ranching and construction of power lines and wind turbines, Ashe said. The bird, which weighs from 1-1/2 to 2 pounds, has also been severely impacted by the region’s ongoing drought.
Biologists say a major problem is that prairie chickens fear tall structures, where predators such as hawks can perch and spot them. Wind turbines, electricity transmission towers and drilling rigs are generally the tallest objects on the plains.
The Fifth Circuit pointed out that Planned Parenthood offered no real evidence to support its challenge to the Texas provision. On the other hand, the State provided ample medical evidence to support the regulation. Citing the State’s expert Dr. Donna Harrison, the court noted that the FDA approved the RU-486 regimen with restrictions, including a patient agreement that requires the woman (and the physician) to confirm that she is no more than 49 days pregnant.
Further, the court rejected Planned Parenthood’s claim that chemical abortion is necessary for some women who cannot undergo surgical abortion—noting that the abortion giant provided no real evidence for that claim. To the contrary, Dr. Harrison testified that 6 percent of chemical abortions fail and eventually require surgery, meaning that it would be medically irresponsible for a physician to administer a chemical abortion to a woman for whom a later surgical abortion might be contraindicated.
It’s important to note that the decision marks one of the most straightforward applications of the Supreme Court’s 2007 Gonzales v. Carhart decision. Citing Gonzales, the Fifth Circuit concluded that the Texas chemical-abortion regulation does not require an exception for the life and health of the woman because the group of women who allegedly “need” chemical abortions (those for whom Planned Parenthood claimed surgical abortion is contraindicated) was vague and undefined, because Planned Parenthood failed to provide any evidence that such a group of women even exists, and because, as highlighted by Dr. Harrison’s testimony, there is disagreement regarding whether chemical abortions are “safer” for these women when subsequent surgical abortion—alleged to be dangerous for such women—may be necessary.
More of the oligarchy that passes for Courts these days: un-elected judges acting as though the Constitution gives the big questions to the appointed members of the Judicial branch, leaving only the small, inconsequential decisions to the People and our duly elected representatives.
A Federal judge has ruled that “non-viable” human beings – healthy babies in healthy mothers who are exactly what they should be at that stage of life – are not endowed with the inalienable right to life.
Wright left in place a portion of the law that requires doctors to check for a fetal heartbeat and to notify the pregnant woman if one is present.
Gov. Mike Beebe, a Democrat, had vetoed the bill, citing the viability standard. But Republicans, controlling the Statehouse for the first time since Reconstruction, overrode him with a simple majority vote.