Bioethics

Wrinkle in Health Law Vexes Lawmakers’ Aides – NYTimes.com

Oh! What a tangled web we weave . . .

Under a wrinkle that dates back to enactment of the law, members of Congress and thousands of their aides are required to get their coverage through new state-based markets known as insurance exchanges.

But the law does not provide any obvious way for the federal government to continue paying its share of the premiums for the comprehensive coverage.

via Wrinkle in Health Law Vexes Lawmakers’ Aides – NYTimes.com.

Medicaid Expansion: money, politics, and plain talk

Ross Ramsey of the Texas Tribune only sees the political debate behind both HB2’s restrictions on abortion and Medicaid expansion.

The state didn’t expand its Medicaid program, and you’ll still find legislators across the spectrum thinking about the consequences, good or bad.

This summer’s debate on abortion restrictions turned entirely on politics. It wasn’t about the money.

via The Economic Debate Behind the Political Debate | The Texas Tribune.

Lay aside the silliness that any Conservative considers abortion simply about the money or politics. Let’s look at the Medicaid debate.  Rather than the TT’s simplistic view of “9 Federal dollars for every 1 dollar the State spends,” remember that the operative word in “Medicaid expansion” is “expansion.”

Under the expansion, the only criteria would be income. Any asset test or obligation to look for work would be forbidden by Federal law.

Healthy men and women who choose not to work, not those on disability – and even those whose employers offer some sort of health insurance would have come under the State’s Medicaid.  Many more would find it “cheaper” to quit work or avoid work and go under Medicaid and other benefits.(Back when I was delivering babies, I had several two-income families who found it better for mom to quit work after she became pregnant, since Medicaid picked up the cost of insurance and co-pays for her and the kids.)

I remember a tall, healthy-appearing (I’m qualified to judge, BTW) 30-year-old man who testified against HB2 and all its precursors. He not only showed up for repeated Committee meetings, he was there every time there for the House and Senate hearings. He loudly claimed to be a Texas law school graduate who is (STILL!) unemployed – and criticized and ranted at our Legislators for not “giving” him a job and benefits. Who wants to pay his Medicaid?

The expansion wouldn’t significantly cut the oft-quoted high rate of uninsured in Texas, even according to TT’s own numbers. Over 1/2 of Texas’ uninsured make too much money for Medicaid, and 1/3 make more than $50,000 a year.  Lawbreaking immigrants (someone’s bound to be insulted if I use the term “illegal immigrants”) make up 1/4 of the uninsured, but they wouldn’t be covered without breaking a few more laws. The disabled, low-income mothers and children and the elderly in nursing homes would have continued to be covered under current programs – at least as long as the money holds out.

La. already has Texas abortion limits | The Town Talk | thetowntalk.com

Louisiana has many of the same restrictions on the books, but they passed with few significant fights in the Legislature and none of the massive protests. The state has added nearly any legal limit it can find on abortion — and several that courts have said weren’t legal.

As they have added new statutes, the bills passed with overwhelming and bipartisan support and with Louisiana lawmakers acknowledging that they hope to lower the number of abortions with each restriction.

Unlike in Texas, Louisiana’s debates don’t showcase a deep divide between Republicans and Democrats. A handful of Democrats oppose the abortion restrictions, but often far more of Louisiana’s Democrats vote to support the measures. A few individuals show up to committee hearings to complain about the latest proposed abortion restrictions, but the bills don’t attract widespread outrage.

via La. already has Texas abortion limits | The Town Talk | thetowntalk.com.

Stories about PP closures and what to do if you need a doctor

What is PP doing with the $13 Million grant that the Obama Administration awarded them? Last March, the spokeswoman for the Women’s Health and Family Planning Association of Texas was crowing about the future use of the funds.

One thing it’s not doing is funding services in Bryan/College Station, Huntsville, and Lufkin, Texas.

In the meantime, everyone who is worried about low cost or free birth control and family planning should check into the Texas Women’s Health Program. For the most accurate and largest number of TWHP qualified doctors and clinics in your area, Texas’ Department of Health and Human Services has a search engine available here. More information, here. Use the “Advanced Search,” then choose Plan type:”Traditional Medicaid,” Provider type: “Specialist” (although this will actually bring up family physicians and other primary care docs). If you qualified at PP, you should qualify under this program, even if you don’t qualify for Medicaid. These docs give a 6 month or 12 month prescription, and the State will pay for screening, family planning.

Christian Medical Association on HB2

Here’s my piece for the Christian Medical and Dental Association’s “The Point,” a weekly newsletter on current events. (This isn’t a 250 word discussion — I snuck in 275 words!)

“At what point do humans become human enough to have the right not to be killed? How should society balance protection for women who choose to abort their children with the burden imposed by that protection?

“While 62 percent of Texasⁱ and 59 percent of U.S. votersⁱⁱ support a ban after 20 weeks, opponents of the bill stormed the Capitol, disrupted hearings and threatened lawsuits that will likely decide whether the law is enforced. In the middle of the noise, both sides told legislators painful stories about the effect of abortion on their lives.

“Texas’ new law bans abortion after 20 weeks, based on the possibility that the fetus can feel pain at the lower limit of viability since the lower brain structures are in place, the thalamo-cortical connections are developing and primitive memory and learning have begun.ⁱⁱⁱ There are exceptions for life and permanent injury for the mother and severe fetal anomalies. The law also requires that abortion facilities meet guidelines required of facilities that do similar procedures like D&Cs. Doctors performing abortions must obtain hospital privileges within 30 miles of the facility and follow FDA guidelines for medical abortions.

“Christian doctors are in a unique position to guide the public conversation toward one of ethics, rather than popular opinion, science or law. We must also demonstrate Christ’s healing love and forgiveness to those who are in pain because of abortion.”

 

Links and more references, here.

Freedom2Care: Protests tell a lot about a low level of health and safety at abortion clinics

. . . [A] Washington Post editorial protests that providing such basic safeguards will mean that “all but one of the clinics probably would close because of the associated costs.”

Such protests tell a lot about a low level of health and safety at those abortion clinics.

via Freedom2Care: Protests tell a lot about a low level of health and safety at abortion clinics.

Unfortunately, the Gosnell (and, possibly Texas’ Karpen) case tell us more about the effects of not monitoring State laws that are in existence.

But we do have evidence that the current standards are too low for health and safety. Over the last few months, as Texas’ Legislature considered new laws concerning abortion safety, we heard testimony from women who were required to stand in lines in narrow halls while waiting for their abortion, who were forced to walk out of the facility while hemorrhaging, and who were denied privacy. Most of all, we heard that the much touted claim that abortion is between a woman and “her doctor” is often meaningless, since the doctor doesn’t offer continuing care after the procedure.

Rep. Jason Villalba Closing Speech on HB 2 (#Stand4Life )

Texas Alliance for Life has posted the video of the speech given in the Texas House of Representatives by Representative Jason Villalba (District 114, Dallas) in favor of life and HB2. It’s a beautiful testimony to love and humanity, and an answer to all the claims that this Bill is simply a political ploy. Watch for the sonogram picture of the Villalba’s 13 week son and the Representative’s declaration that he will fight for his son and all the babies destroyed by elective abortion.

“Planned Parenthood web ad blurs distinctions” (DMN Fact Check)

So, after telling us all these years that they don’t spend money from tax funds for their abortion business, Planned Parenthood is now saying that their facilities are often in the same buildings as the “separate” affiliates that don’t do abortions and that meeting the standards of an ambulatory care center will shut down both businesses.

Planned Parenthood operates 10 abortion clinics in the state that would be mandated to raise to the new standards. The abortion clinics, by law, are separate entities and must be separately funded from health centers where cancer screenings take place.

Planned Parenthood officials acknowledged that, but said some abortion clinics and health centers are housed within the same buildings. She suggested that if it were too expensive to upgrade the abortion clinics, then it could also force a shut-down of the health care clinics in the same building.

Officials could not say how many of the 10 abortion clinics are adjacent or within the same building as health care centers.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund, responded by email and cited 55 health care centers already have been shuttered in Texas.

That assertion is based on legislative funding cuts from two years ago and is not related to the pending legislation.

And the previously closed health centers are not related to the assertion made in the advertisement.

Health centers that do not provide abortions would not be affected by the legislation.

via Fact check: Planned Parenthood web ad blurs distinctions | Trail Blazers Blog.

Scientific Huffington Post (!) Poll: Ban Abortion After 20 Weeks

20 week ultrasound

#Stand4Life across the US: 59% support a Federal ban on abortion after 20 weeks, even though the question didn’t include an exception for the life of the mother!

Remember that University of Texas/Texas Tribune Poll that showed that 63% or 62% (depending on whether the question mentioned pain or not) of registered voters in Texas wanted a ban on abortion after 20 weeks? Well, it seems that most US voters agree.This poll found that 59% of voters would support a ban, while only 30% oppose it.

The Huffington Post, not a conservative website at all, solicited a scientific poll by the same group that did the UT/TT poll, YouGov. These results agree with last month’s Gallup poll revealing that 64% of Americans believe that abortion should be illegal in the second 3 months of pregnancy and 80% would make it illegal in the last 3 months.

The HuffPost isn’t making a big deal out of the poll, focusing on the conflicting views of the public rather than on the results of the poll itself. In fact, from my GoogleNews search, it doesn’t appear that (as of 7 AM today) anyone other than a couple of blogs (at the Washington Post and the Weekly Standard),  National Right to Life, and LifeNews.com are reporting the poll!

ObamaCare’s ‘Liar’ Subsidies (but no qualifying)

Who’s surprised that ObamaCare has one more set of freebies for some, costs for all? How about that recent decision to delay employer reporting of benefits? Turns out that the subsidies won’t be delayed — so they will be based on an honor system. The honor of the people applying for the subsidies.

From the Wall Street Journal’s Taranto and “Best of the Web Today:”

 

HHS promises to develop “a more robust verification process,” some day, but the result starting in October may be millions of people getting subsidies who don’t legally qualify.

via Review & Outlook: ObamaCare’s ‘Liar’ Subsidies – WSJ.com.

Dr. Love on HB2 #Stand4Life

For a great testimony from a pro-life doctor, look at the House State Affairs Committee video from July 2, 2013 from 3:20 to 3:54 /8:38.

Watch Representative Sylvester (District 139) Turner question Dr. Mikeal Love (that first name is Greek) about whether or not abortionists have hospital privileges. Contrary to the statement by the Counsel of the Texas Hospital Association, Dr. Love reports that 2/3 of Texas abortionists have hospital privileges. Mr. Turner has a real problem understanding the emphatic confirmation that there are doctors whose primary practices are abortion and yet, do indeed have privileges at hospitals.

Representative Helen Giddings, District 109, also tried to trip up Dr. Love, but she only gave him more time to #Stand4Life. She becomes confused and asks whether all Obstetricians/Gynecologists are abortionists, since they all do D&C’s. (The D&C is the method of abortion, but not all D&C’s are abortions.)

Ridiculously, Sylvester Turner ends the questioning of Dr. Love by repeatedly asking whether Dr. Love was paid to give his testimony. Dr. Love answers, “No,” and then is asked again. Wonder if this is a case of a liberal accusing conservatives of doing what liberals are doing?

(I only wish I could speak as well as Dr. Love! I definitely enjoyed watching him debate for life!)

(Edit 7/4/13 11 AM for grammar — BBN link added, too)

Action Alert! Correct False Testimony by the Texas Hospital Association Representative

This is a rare Action Alert: Contact the Texas Hospital Association (phone number, 512-465-1000) about the completely false testimony of their representative, Ms. Stacy Wilson who testified against Section 2 of House Bill 2 before the House State Affairs Committee on Tuesday, July 2, 2013.

You can see Ms. Wilson’s testimony on the July 2, 2013 video of the House State Affairs Committee, available at the House video site beginning at 2:02/8:38.

Ms. Wilson testified as the Associate Counsel for the Texas Hospital Association, against Section 2 of HB 2. That section requires the physicians who perform elective abortions to have admitting privileges at a hospital within 30 miles of the place where he or she does the abortions. Section 4 of the Bill, against which Ms. Wilson did not testify, requires abortion facilities to meet the same standards as State-regulated Ambulatory Surgical Centers.
Ms. Wilson falsely argued that hospitals would not grant admitting privileges to doctors who perform elective abortions outside the hospital because the hospital wouldn’t allow elective hospitals within the hospital: “If you have a physician that is only practicing in a clinic . . . the hospital is unlikely to give privileges.”

Ms. Wilson is apparently unaware that the reason a doctor would have admitting privileges would be to treat complications of the abortion, including hemorrhage, uterine and bowel perforations, and infections after the abortion. There is no reason to claim that the purpose of those privileges would be to allow performing the abortion itself within the hospital walls.

Ms. Wilson repeatedly said that she doesn’t know whether any Texas doctors who perform elective abortions have admitting privileges in Texas hospitals: “It is possible, I mean, say, it’s unlikely, but it’s possible,” and, ““I don’t know of any.”

She also repeatedly stated that it would be wrong for the hospital to be required to grant privileges, while the Bill carries no such requirement: “My testimony is that requiring a hospital to grant privileges for procedures that occur outside the hospital, is an inappropriate.”

Sylvester Turner pounced on Ms. Wilson’s testimony, claiming that Section 2 would outlaw abortion in the State of Texas, since no doctor would be able to get hospital privileges: “We can’t get past this . . . This witness’ testimony is very critical.”

Ms. Wilson doesn’t see any benefit in the usual standard of continuity of medical care: “It seems to me that if a woman has complications, she’s going to come to the Emergency Department, whether her doctor has admitting privileges is irrelevant.” And, “I said that what the woman should do is come to the emergency room where the emergency personnel would render aid.”

Please call the Texas Hospital Association and demand that they correct the misrepresentations of Ms. Wilson.

Update: When you call, you can just ask to leave a message for the Legislative Affairs staff or ask to speak to that office.

“No Cost” Contraception (Obama Administration fantasy)

The Obama Administration has published its final rule on health insurance coverage of contraception. “Religious employers” are supposed to be happy with the Obama decree that insurance companies will provide contraception “at no cost.”

We all know that there’s no such thing as “no cost.” Everyone will “share” the cost, since everyone will be forced to buy health insurance.

Here’s the letter, thanks to one of the Conscience groups I follow:

From:   Lauren Aronson
             Director, Office of Legislation
             Centers for Medicare & Medicaid Services
 
Re:       Administration Issues Final Rules on Contraception Coverage and Religious Organizations
 
Today, the Obama administration issued final rules that balance the goal of providing women with coverage for recommended preventive care – including contraceptive services prescribed by a health care provider – with no cost-sharing, with the goal of respecting the concerns of non-profit religious organizations that object to contraceptive coverage.  The final rules reflect public feedback received in response to the Notice of Proposed Rulemaking issued in February 2013. 
 
Today’s final rules finalize the proposed simpler definition of “religious employer” for purposes of the exemption from the contraceptive coverage requirement in response to concerns raised by some religious organizations.  These employers, primarily houses of worship, may exclude contraceptive coverage from their health plans for their employees and their dependents. 
 
The final rules also lay out the accommodation for other non-profit religious organizations – such as non-profit religious hospitals and institutions of higher education – that object to contraceptive coverage.   Under the accommodation these organizations will not have to contract, arrange, pay for or refer contraceptive coverage to which they object on religious grounds, but such coverage is separately provided to women enrolled in their health plans at no cost.  The approach taken in the final rules is similar to, but simpler than, that taken in the proposed rules, and responds to comments made by many stakeholders.
 
With respect to an insured health plan, including a student health plan, the non-profit religious organization provides notice to its insurer that it objects to contraception coverage.  The insurer then notifies enrollees in the health plan that it is providing them separate no-cost payments for contraceptive services for them for as long as they remain enrolled in the health plan. 
 
Similarly, with respect to self-insured health plans, the non-profit religious organization provides notice to its third party administrator that objects to contraception coverage.  The third party administrator then notifies enrollees in the health plans that it is providing or arranging separate no-cost payments for contraceptive services for them for as long as they remain enrolled in the health plan.  The final rules provide more details on the accommodation for both insurers and third party administrators.

 
To view the Final Rule: http://www.ofr.gov/OFRUpload/OFRData/2013-15866_PI.pdf
 
To view technical guidance on the temporary enforcement safe harbor visit: http://cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/preventive-services-guidance-6-28-2013.pdf
 
To view the self-certification form for eligible organizations visit: http://cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/index.html#Prevention
 
If you have any questions, please contact the CMS Office of Legislation. Thank you

@GovernorPerry: “This is a human rights issue.” #TxProlife #TxLege

My children, the Governor’s children, and  all children of human beings are also humans. The question in the mind of some people is, “when are they *human enough* for the advocates of elective abortion on demand?”

The Governor and Texas law affirms that it’s from the moment of fertilization. Unfortunately, not everyone agrees with us.

The Governor spoke in support of the right not be killed for every one of our children today, at the National Right to Life National conference in Dallas. You can read his speech at his website, here.

I’m especially proud of the way he praised our pro-life Texans and commended the work we do to support women and girls who find themselves pregnant but are afraid that they aren’t ready, can’t afford the child, or just didn’t want to be pregnant at that time in their lives.

The Governor is taking heat for his comments about Senator Windy   Wendy Davis’ history. This is a woman who should know as well as any of us that an unplanned pregnancy is not the end of plans for the future and should be counted as “unplanned joy.” (That phrase is one of the themes of Feminists for Life.)

Here’s to our Governor Rick Perry!

Rush Limbaugh explains it all #SB5, #SCOTUS

Rush was talking about the Supreme Court ruling on gay “marriage,” but he might as well have been talking about the Texas Dems, Cecile Richards, and last night’s Mob at the Texas Capitol:

I have often said that what animates people on the left — what motivates them, what informs them — is defeating us. No matter how, no matter what, no matter what it means. Their hatred for us overwhelms anything else. No matter the result, victory that includes impugning and demeaning and insulting us is what they seek. It’s what makes them happy. Now, the left politicizes everything, and in this case, hardball politics became the name of the game.

Chaos, Mob, not filibuster, subverted Texas Senate #SB5 #TxLege

In the Texas Senate, the filibuster is a method of allowing a minority viewpoint known. The minority Legislator is allowed to speak without time limits and without unwanted interruptions, as long as he or she follows the rules laid out beforehand.

Yes, Senator Windy Wendy Davis began a filibuster. She knew the rules, and she broke them. Her fellow Democrat Senators engaged in stalling tactics, but it was the noise and chaos in the gallery that made the three minutes of difference that killed the Bill.

You can watch the Senate video at this page.The

Senators West, Whitmire,Watson, Ellis, Van de Putte, Zaffirini, and (of course) Senator Davis proved to all of us that they value the elective abortion of human beings above orderly government and Legislators.

I was, unfortunately, not shocked that Senator Leticia Van de Putte encouraged the gallery to disrupt the Senate. It also appears that she lied about the timing of her motion to adjourn. See the roll call vote beginning about 12:19/15:50. Note that she spoke and that the temporary President, Senator Duncan, responded after the roll call began. 12:31

I was surprised that the gallery wasn’t cleared much earlier, even though it might have meant that I would have had to leave. However, until the last hour, the outbreaks were intermittent and quickly calmed down.

My friends and I were very concerned about the reaction of those who so clearly showed no respect for the rest of us and who greatly outnumbered the State Troopers.  Every seat was full, the pro-life crowd was greatly outnumbered and the halls were crammed with more people in orange.  When the standing and shouting became constant, the Lt Governor signaled to the Troopers who began to remove people in an orderly manner.

More Troopers arrived, but they were constantly at risk of physical confrontation, with some of the Orange shirts resisting the request for them to file out. At one point, the Troopers were forced to lock the West doors of the Gallery and the Mob continued to push from the hall and fill the Rotunda.

I certainly didn’t want to be in the middle of a fight with these people and am grateful that the Troopers kept some semblance of order. I don’t believe that there was a way to clear the gallery earlier or with less disruption than we had and am proud of the State Troopers.

BMJ on RCOG Fetal Awareness White Paper #SB5 #TxProlife

The Royal College of Obstetricians and Gynecologists published their white paper on “fetal awareness” in 2011. (Royal College of Obstetricians and Gynaecologists. Fetal Awareness – Review of Research and Recommendations for Practice. London: RCOG Press 2010 http://www.rcog.org.uk/files/rcog-corp/RCOGFetalAwarenessWPR0610.pdf  Accessed June 24, 2013).

 
Here is a peer-reviewed, “editor’s choice” editorial outlining the flaws in that paper. “Fetal awareness and fetal pain: the Emperor’s new clothes” by Dr Martin Ward Platt, Newcastle Neonatal Service, of the Royal Victoria Infirmary http://fn.bmj.com/content/96/4/F236.long#ref-1 (Accessed June24, 2013).

 
The author, Dr. Platt, points out that the evidence for no fetal awareness until birth has no evidence in humans, only in animals. He further points out that it goes against our experience with sleep/wake cycles and what we know about the ability of the fetus to learn his mother’s voice and other learning, including long-term effects on brain anatomy and response to pain:

“So, what is the evidence that the human fetus lacks ‘awareness’? In a word, there is none. The only evidence, including the bit about the chemical environment, is in sheep and one or two other experimental animals. I have looked at the references in the report, and the references in the references, and when I finally got back to the primary literature I found no evidence for the contention that human fetuses lack awareness, or exist in some different conscious state, beyond the unwarranted extrapolation from sheep.

“In contradiction to the notion of the ‘unaware’ fetus, the everyday experience of pregnancy – the felt behaviours and responses of the unborn baby, especially to sound – as well as much primary research literature on the human fetus, contains strong evidence for an opposite view. There is an extensive literature, in humans, on fetal sleep and wakefulness, fetal motility, fetal memory, fetal hearing, fetal breathing and its control and fetal behaviour – and these are just examples that scratch the surface. None of this work is easily reconciled with the notion of a permanently unconscious human fetus. The third point in box 1 is simply not true.”

and

“. . . the precautionary principle of prevention and treatment of pain in case it is being experienced, which is an ethical rather than a scientific argument, nor does it affect the evidence in relation to the long term neurobiological effects of pain experiences in preterm babies.”

and

 

. . . “One notices statements in the report such as: “Interpretation of existing data indicates that cortical processing of pain perception, and therefore the ability of the fetus to feel pain, cannot occur before 24 weeks of gestation”. We could rewrite this as ‘in theory they can’t feel pain, therefore they don’t’. It is the substitution of wishful thinking for empirical enquiry. It reminds me of my days as a medical student when I was taught that once the periosteum was anaesthetised, bone marrow aspiration was painless because there were no nerve endings in the bone. As soon as I came to perform bone marrow aspiration I realised that, whether there were supposed to be nerve endings or not, the procedure caused deep bone pain. So: should we deny patients’ real experiences on entirely theoretical grounds, or accept them and look harder for the underlying cause? We now know that bone is richly innervated, but older techniques of bone histology were unable to demonstrate the fibres.”

BTW, Here’s the part of that (debunked by Dr Platt) 2011 RCOG paper that I found most interesting:
“One possible solution is to recognise that the newborn infant might be said to feel pain, whereas only the older infant can experience that they are in pain and explicitly share their condition with others as an acknowledged fact of being.”

Chub, Scrub, Stuff and Stall #SB5 #TxLege

Orange t-shirts admittedly outnumbered those of us in blue at the Texas State Capitol on Sunday, June 23. However, in the long run, what mattered in the passage of the House version of Senator Hegar’s Senate Bill 5, sponsored in the House by State Representative Jodi Laubenberg, is that Texas voters had sent a clear majority of pro-life Republicans to the House of Representatives.

If you’ve always wondered about the meaning of “chubbing,” look at the 6/23/13 record of the House video, available at the House website. Pro-abortion Democrat after Dem took the microphone to bring an amendment, with fellow pro-abortion Dems standing to ask questions and run out the clock.

You can also watch the effects of “POO,” or calling for “points of order” around 4:30 PM. House Democrats called for a review of the Rules, resulting in adjournment and restart after a delay of 2 hours.

As to those t-shirts, someone showed up with 1000 t-shirts to give away. Where did that money come from?  Interestingly, the women who gave out the shirts also wore Planned Parenthood buttons and successfully instructed those in the shirts how to act in the Gallery. And the orange shirts obeyed immediately.

One theme the Dems repeat is that SB 5 is not the protection for women that the Republicans say it is. They claim that pro-life laws are not about human life and ethics, but rather, simply about winning Republican primaries. This is a great example of “projection” of one’s own motives and wishes onto another. While I believe that Jessica Farrar would abort everyone with spina bifida and that Thompson is convinced that the embarrassment of the trauma of rape and incest is cured by abortion, the ultimate reason for the long night of interruptions and delays is that the clock is running out on the Special Session. If the Dems manage to delay long enough, SB 5 will not pass in the House. Even when it passes, the time used up in the House decreases the time that will have to be wasted in blocking it by filibuster in the Senate.

In the long run, the Democrat members in the Texas Legislature have repeatedly called for unfettered and unregulated elective abortion on demand.They claim that abortion is better for women and families than spending money on babies and children, that allowing babies to be born will ruin women’s lives, that it’s better to abort children with “fetal anomalies” and “birth defects” even when the “defective” human could live and make his or her own way through life. Senfronia Thompson even brought out a coat hanger to shake at the House and claimed that the cure for the “embarrassment” of the trauma of rape and incest is abortion, even after 20 weeks. Every one of the Dems seemed to have no understanding that the facility improvements will not be required for 15 months.

SB5 was passed finally in the House this morning. It will now have to go back to the Senate. There may not be time enough for reconciliation with the Senate version because of delays caused by both the House Republicans and House Dems. I hope that the protections in the Bill become law to protect the women who make the choice to abort their children and to protect the lives of fetuses at 20 weeks and greater.

Edited 7/11/13 for grammar and spelling errors – BBN

2/3 Texans support ban on abortion after 20 weeks

They also found that the majority of Texas voters would support restrictions on abortion that are greater than those we have today.

The University of Texas and the Texas Tribune have published the results of a poll that included questions about voters’ opinions on abortion. The poll of registered voters in Texas, recruited by an organization called “YouPoll.”

Q37. What is your opinion on the availability of abortion?

1.    By law, abortion should never be permitted.                         16%
2.     The law should permit abortion only in case of
rape, incest or when the woman’s life is in danger.                     30
3.     The law should permit abortion for reasons other than rape, incest, or danger to the woman’s life, but only after the need for the abortion has been clearly established.                     13
4.     By law, a woman should always be able to obtain
an abortion as a matter of personal choice.                                    36
5.    Don’t know                                                                                               5

Q38. Do you think that laws restricting abortion here in Texas should be made more strict, less strict, or left as they are now?
1.   More strict                                                        38%
2.   Less strict                                                         26
3.   Left as they are now                                    21
4.   Don’t know/no opinion                              14

By answering “3. The law should permit abortion for reasons other than rape, incest, or danger to the woman’s life, but only after the need for the abortion has been clearly established,” the respondents would actually support laws that are much more restrictive than current law.  However, it’s being reported as though current law requires a need to be established, and to match the answers in Q38.

2/3 of those polled  support for a ban on abortion after 20 weeks, whether or not the abortion causes pain to the fetus. The poll asked half of those polled one question and half another, with very similar results:

C.    [SPLIT SAMPLE a AND b]

a.   Prohibiting abortions after 20 weeks based on the argument that a fetus can feel pain at that point.

1. Strongly support               49%    
2. Somewhat support            13        
3. Somewhat oppose               8        
4. Strongly oppose                 19        
5. Don’t know                         11

b.   Prohibiting abortions after 20 weeks.
1.   Strongly support                            47%
2.   Somewhat support                        15
3.   Somewhat oppose                         8
4.   Strongly oppose                             22
5.   Don’t know                                     9

Rather than reflecting people’s knowledge that 20 weeks – or 5 months – is very close to our current viability of 22-23 weeks, I believe that the responses reflect our conflicted and complicated feelings about abortion in general.

Texas State House Affairs Committee Video

The video is online at this page.

House State Affairs disruption #TxLege #HB60 #SB5

“There are many ways to kill a child, and abortion may be the kindest way to do it.”

That first line was not only a statement made by one woman who testified tonight (watch the meeting at the House website, here), it was a recurring theme at the House State Affairs Committee meeting on June 20,2013, even though there is no evidence that increased elective intentional abortion has ever decreased child abuse.

But, the suggestion that it is acceptable to kill children was not what disrupted the meeting of these Texans.  After many, many times of reminding them not to film the proceedings, not to engage in outbursts that broke up the meeting, Chair Byron Cook announced that he would limit the testimony in order to bring up the second Bill on the Agenda. At that point, the crowd began shouting and some tried to speak without being called to their turn. The Chair called a brief recess and testimony resumed. (Personally, I agree with the Chair that the crowd should be better behaved and with the citizens who had signed in that they should be allowed to speak.)

Earlier this week, Representative Jessica Farrar (D- 148, Houston) sent out this email:

Friend,Governor Perry has declared war on women.  Last week he vetoed the Texas Lilly Ledbetter Act because he thinks women should be paid less than men for doing the same work.  Now, he has added bad women’s health bills restricting safe access to abortion to the Special Legislative Session. This week is your only opportunity to speak out against these bills.Come to the State Capitol this Thursday afternoon and evening, June 20th, when the House State Affairs Committee will hold a hearing on these bad bills.  The hearing will begin at 1:00 p.m. or upon adjournment of the House in Room JHR 140.Please prepare a three minute testimony on the subject, and speak from your heart. What you say can make a difference.  Be ready for a long night, as the hearing will go on as long as it takes.You can also fight back against Rick Perry’s war on women by helping to elect Democrats who will stand up for equal pay and women’s health issues. Please consider donating $5, $10, or $25 to the Texas House Democratic Campaign Committee to ensure that our key Democratic legislators return, and that we are able to gain seats in the House.  Your support now will build the foundation we need to ensure this war on women will go no further.Sincerely,Jessica

Pol. Adv. paid for by the Texas House Democratic Campaign Committee, Lon Burnam, Treasurer.
P. O. Box 1925, Austin, TX 78767

Although Rep. Farrar admitted early on Thursday night, that “there are two lives involved” in abortion,   she is the one who suggested that we should abort every child with spina bifida in Committee, back in the regular Session. Below are some of the other continuing themes we’ve heard during testimony in favor of the status quo and against any new restrictions on abortion providers.

Texas has a culture of hate for women, so we should abort children (male and female) in order to prevent a “brain drain.”

A married Social Worker told us that she was “elated” after her abortion to be relieved of a responsibility she never wanted. Another woman said that her friends had abortions between 18 to 24 years old, claiming that it was before they were able to choose their majors in college or decide on an outfit! Many men said that they were “relieved” not to be burdened with unwanted children. One that really stuck out was 24 years old when he enabled the abortion of his own child.

One man, an angry 30 year old unemployed lawyer, echoed the wish of many of those who came at the call of the Texas Democrats. He and the others believe that the Texas Legislature should work on laws that will give him a job, healthcare benefits. (And child day care, Medicaid for all, maybe even an allowance for stay at home women.)

There were the usual complaints that men in the Legislature were trying to control the women of Texas (ignoring that the author of the Bill, many of the co-authors and a great many of the voters who put them in office are women) and the repetitive accusations that only religious bigots are “anti-choice.”

“There are many ways to kill a child, and abortion may be the kindest way to do it.” Maybe, because then the child will never know. But there are no GOOD ways to do it.

Addendum (or a couple of other recurrent themes):

1. The claim that abortion will prevent the consequences of post partum depression. Abortion is never treatment for what is properly called “perinatal” depression. In fact, perinatal depression can be triggered by miscarriage or spontaneous abortion and by elective interventional abortion.

2. Don’t forget that women and children will be harmed most by the limits on abortion and that Texas’ legislature should let President Obama give us free expanded Medicaid and Obamacare!

Update: the video can be viewed, here, at the Texas Legislature Online website.

Edited 6/21/13 at 9:00 AM to add the link to the video and add the ‘tag” HB60 – BBN

Edited 6/21/2013 for typos and to fix the penultimate (how often do I get to use that word?) paragraph “post partum depression,” not “post partum abortion.” (The latter is not possible, yet.) BBN

“Cognitive dissonance” vs. “right or wrong”

Another study claims to find psychological differences between conservatives and liberals:

In two experiments, we investigated the possibility that conservatives would be more strongly motivated to avoid dissonance-arousing tasks than liberals.

via PLOS ONE: “Not for All the Tea in China!” Political Ideology and the Avoidance of Dissonance-Arousing Situations.

The task?

“Because we were interested in reactions to dissonance-arousing situations, all participants were asked to write counter-attitudinal essays. Thus, if a participant indicated in the initial survey that he or she preferred George W. Bush and Macs over Barack Obama and PCs, respectively, this participant would be instructed to write essays arguing that Obama is a better president than Bush and that PCs are better computers than Macs. Participants assigned to the high choice condition were able to respond “yes” or “no” to the request; if they responded “yes,” they were directed to the essay task, and if they responded “no,” they were instead taken to the next section of the experiment. Participants assigned to the low choice condition were simply directed to the essay-writing task.”

My title reveals my own dissonance with the authors.  If there’s no right or wrong, if all views are of equal weight and validity, why argue – or do research – in the first place?

The authors begin with a weak premise: that subjects’ willingness to write a positive essay about a given politician (in this case Bush vs. Obama and Reagan vs. Clinton) reveals their comfort with “cognitive dissonance” (Miriam-Webster definition, here. “Simply Psychology” discussion, here), or the ability or willingness to hold two different beliefs at one time. The classic example is knowing that smoking is bad for you while continuing to smoke.

In fact, they found that while not one conservative was willing to voluntarily write an essay claiming that Obama is better than Bush, conservatives were more likely to follow explicit instructions when not given a choice. In addition, there was no real difference between conservative and liberal participants/ willingness to write “dissonance-arousing” essays about non-political issues like Macs vs PCs or tea vs. coffee.

The authors do not mention principles at all and only use the word, “values” in the discussion about statistics and in the following sentence,

“Subsequent research in psychology and neuroscience has corroborated the notion that, all other things being equal, adherence to conservative (vs. liberal) ideology is associated with certainty-oriented forms of epistemic motivation and behavior, including . . .  a reluctance to acknowledge and engage in integrative policy trade-offs involving potentially conflicting values.“

I’m used to having conflicting views on certain topics. When confronted with the evidence in real life, I try to admit that the dichotomy exists and, for important issues, weigh the importance of one in favor of the other. That doesn’t mean that I’d easily lie or betray my values for the sake of “policy trade-offs,” much less in voluntary participation in an experiment. (I would have been one of the refusals in the “low choice”  arm.)

As an example, I was once asked to write an opinion on a sexual abuse case, assuming that I’d be testifying on the side of the victim. When I learned that the attorney was working for the defendant, I could only continue after deciding that I had an obligation to keep my word, that my problem was my fault for not asking more questions, and that the facts of the case were such that I wouldn’t really be much help for the defense, anyway. I even explained the latter to the attorney before writing and billing for my opinion.

At least the authors do admit that “many people hold stronger attitudes about political than non-political matters.”

RX: Sack cloth and ashes for #SB303 opponents

Searching the news for stories on #SB303, led me to accusations that supporters of the Bill gossiped with Capitol staff and “maligned Texas Right to Life, stooping so low as to criticize our sartorial manners, footwear selections . . . “

When you stop laughing enough to read further, notice that the premise of the article, after turning private gossip into public gossip, is that elaborate conspiracies hidden within the minds of doctors, nurses, and entire staffs of “hospitals” and “facilities” judge the “futility of the patient’s life.”

“We agree that some treatments do stop achieving the intended goal of that specific treatment, such as dialysis no longer filtering uric acid from the blood.  When a treatment or therapy is in fact medically futile, no physician would ever continue that, and a properly informed patient or his surrogate would not want to continue futile or harmful treatment, and nothing in current law or in any of Texas Right to Life’s past or present proposals would require the continuation of such medically futile treatment.  Physicians would not continue medically futile treatment anyway.”

“Conflicts arise when the futility judgments are transferred from the efficacy of a medical treatment to a value judgment on the futility of the patient’s life.”

Isn’t the entire conversation about whether the doctor determines the “efficacy of a medical treatment?” No,thanks to articles like this one, the debate on medical conscience is all about pretending to read minds and gossip about the motives of doctors, hospitals, bald-faced claims that the Texas Conference of Catholic Bishops is only interested in the “$$$” from Catholic hospital systems. Every discussion I’ve attempted with the opponents of reform devolves into accusations that I “want to kill” patients.

In the grim tale told by TRTL,the physician’s conscience and medical judgment isn’t denied or even trivialized as equal to a lobbyist’s choice of suits or shoes. We, the doctors who are currently the only ones licensed by the State of Texas to write orders and administer treatments, are either ignored altogether or treated as a tool for some mythological eugenic “hospital committees that have decided by their own subjective standards that the lives of these patients have little or no value and should therefore be denied medical treatment.” They object that the physician’s finding that, in his or her  “reasonable medical judgment, resuscitation would be medically ineffective” is not defined in the law and accuse us of deciding “that imminent death is better than resuscitative efforts.”

Frankly, I have no idea what that last means, since resuscitation is only needed in the event of imminent or actual natural death, when the heart or breathing stop functioning.  Based on this statement and the note about failure of dialysis, I’m certain that no doctors were consulted by or gave feedback to the authors. Again, the lack of physicians who oppose SB 303 is not an indication that we are all involved in a conspiracy. Instead, it is proof of our medical judgment – and consciences.

The end sought by the opponents of SB303 is “treatment-pending-transfer,” including “resuscitative efforts” prescribed by law, not doctors, on every patient who has not specifically refused in advance. When the doctor’s medical judgement and conscience lead him to determine that such would be medically futile, they demand that the doctor set aside conscience and medical judgment and do exactly what they say no doctor would do.

Complete autonomy on the part of patients and their families awarded by legislation the ability to demand what they want, when they want, as long as they want and with as much legal liability as possible cannot turn around the failure of organ system after organ system, and physiological cascade after cascade. All of which we doctors can measure and predict with good certainty.

The authors of this article are proud of their “successful” campaign to ensure for at least two more years, that patients and their surrogates

• don’t have the right to be notified of DNR’s placed on their charts,
• have no protection against the removal of artificial nutrition and hydration,
• don’t have the right to medical records before the medical ethics committee meets,
• don’t have the right to be accompanied in the medical committee meeting, and
• don’t have an additional 7 days to prepare for the medical ethics committee and an additional 14 days to find another doctor willing to accept responsibility for the medical treatment of the patient.

If there is any clothing I’d suggest that the authors wear, it’s the sackcloth and ashes of the repentant sinner.

Specious “Scientific” Argument for Abortion

There is no more “scientific” justification for killing humans with “fetal anomalies” before birth than for killing them after birth. The decision to kill is always a moral decision – or an immoral one.

Would this author support “after birth abortion” for the babies born with the same anomalies? That must make all those around her – or working at her organization – who were born with or diagnosed with other “variable onset anomalies” feel secure and supported!

Of particular concern are two classes of fetal anomalies that cannot be detected early in a pregnancy. First are the variable-onset fetal anomalies. These anomalies begin at variable gestational ages but are often detected beyond 20 weeks. Second are the late-onset anomalies that develop late in the gestational age of the fetus, typically in the second or third trimester, or are undetectable until the abnormality is at the end-point of a pregnancy. Importantly, the 20-week bans passing across the states generally do not include exceptions for lethal fetal anomalies, meaning women are forced to carry fetuses with anomalies to term, regardless of viability.

I’m not making a simple “anti-choice” statement. We know that in nearly all cases, abortion at this stage is more dangerous for the mother than carrying to term.

Talk about the pot calling the kettle black, here’s the “science:”

Advocates of 20-week abortion bans generally rely on junk science based on the pseudoscience of fetal pain to warrant the state laws prohibiting third trimester abortions. Their claims stem from erroneous assertions that the fetus feels pain at 20 weeks, despite several comprehensive literature reviews demonstrating no credible evidence of fetal pain until the third trimester.

This is not how science is done. Science is not a consensus, it’s observation and reporting of data that can be reproduced. The definition “agreed” upon by pro-abortion advocates involves emotions and is nothing but a neo-scientific construct, that igores real scientific evidence of higher brain response to noxious stimuli.

The same ethics hold for abortion as for any other intentional, elective killing of a member of our species: only kill when it’s absolutely necessary to save another life endangered by the first – the life of the mother.

“Science Progress” is a branch of “Center for American Progress,” the far-left public policy organization begun by John Podesta.

Cloned photos, graphs and data: Errors in groundbreaking paper : Nature News & Comment

If they can kill you, why not lie a little, too?

And so much for “peer review:” Rush to publish: The Cloning article I wrote about last week was “accepted” 3 days after submission, 12 days to publishing in the journal.

That big story from Cell really, really wanted cloning humans to be true.

 

The first problem was an image duplication. Figure 2F, which shows a cloned stem-cell colony “with typical morphology”, is reproduced in the top left of Figure 6D where it is labelled as “hESO-7” — an embryonic stem-cell line derived not from cloning but from in vitro fertilization (IVF). Mitalipov says that the duplication was intentional but that the labelling was reversed. The top left panel in 6D should have been labelled hESO-NT1, indicating a cloned colony, as in Figure 2F. The top right figure should have been hESO-7.

He says that label reversal also explains another set of duplicated images — the top right figure in 6D and the top right figure in Supplementary Figure S5. With the labels reversed, the identical images are both representing the hESO-7 cell line. “Then everything falls into place,” Mitalipov says.

Double trouble

Even so, the decision to use the same image to illustrate two different properties, once to show typical morphology (2F) and once as a basis for comparison of cell markers between embryonic stem cells from normal IVF embryos and cloned embryos (6D), is “not ideal,” says Martin Pera, a stem-cell expert at the University of Melbourne, Australia. “It’s considered bad form, unless you have a reason to do it.”

via Stem-cell cloner acknowledges errors in groundbreaking paper : Nature News & Comment.

Texas Judge: Lesbian Couple Can’t Cohabitate –

Some people still try to convince us that it’s a good thing that children have people other than their parents living in the home, in spite of the evidence.

This woman wants out of the contract she agreed to when she got the divorce that was the end of another contract: her marriage. Can’t help but wonder whether a case like this will this be the end of true marriage in Texas. And the end of the rule of law and honoring contracts.

They also said in the statement that the clause “is a burden on parents, regardless of their sexual orientation, that takes away and unreasonably limits their ability to make parental decisions of whom their children may be around and unreasonably limits what the United State Supreme Court has identified as the liberty of thought, belief and expression.”

via Texas Judge: Lesbian Couple Can’t Cohabitate – ABC News.

 

For a mega-study using data from the CDC, see this article, Blackwell DL. “Family structure and children’s health in the United States: Findings from the National Health Interview Survey, 2001–2007.” National Center for Health Statistics. Vital Health Stat 10(246). 2010.

Denouement: The Death of #SB303

The 83rd Legislature of the State of Texas still has a couple of weeks to go, and it ain’t over ’till both the House and Senate are sine die, but it appears that SB 303 did die over the weekend.

Representative Susan King, who broke her leg last Sunday, just the day before the marathon meeting of the House Public Health Committee, has done an incredible job of working with Senator (Dr.) Bob Duell in their attempt to reform our State’s Advance Directive Act through SB 303.

The Committee Substitute which Representative King presented in the Committee had all of the benefits I wrote about last week, as well as a revision to prohibit a doctor from writing a DNR order against the wishes off a competent patient.

(Talk about unintended consequences: current law is silent on “DNRs,” so it’s apparently legal for a doctor to order that resuscitation not be performed on a competent patient without any discussion with the patient, much less obtain consent!  I have sincere doubts that any doctor would do so, but there have been allegations. Even though the ones who claim to have knowledge – and who have not produced one iota of proof – are the same disingenuous cynical scaremongers (I’ll call them “CS2”) I’ve mentioned before, this reform would be a good.   And should be accepted on its face.)

Because of the egregious misrepresentations of the  CS2, Committee Chair Lois Kolkhorst declined to allow SB303 out of the Committee as it was written. Rep. King tried one more time, with a bare bones CS1 containing the protection against DNRs for competent patients and the prohibition against withdrawal of Artificial Hydration and Nutrition, except when it would harm the patient or hasten his death.

So, for the next two years, when you hear the CS2 complain about Texas “death panels” or read a plea for funds to fight “secret DNRs” and withdrawal of food and water in Texas hospitals, remember the CS2 who killed pro-life reform in the 83rd Legislature.

Cloned human embryos announced

If we can still believe scientific journals, Cell reports in the June 6, 2013 issue indicate that  scientists have succeeded in cloning human embryos.

The term used for cloning by the group is “reprogramming” fibroblasts using somatic cell nuclear transplantation. However, there’s no longer an attempt by the authors or members of the scientific press to create a new “unfertilized blastocyst” or pre-embryo: the embryos are called embryos, morula, and blastocysts.In recognition that these are not quite the same as embryonic stem cells derived from embryos produced by direct fertilization, the stem cells derived from the cloned blastocysts are designated as “Nuclear Transfer Embryonic Stem Cells” or NT-ESC.

Tachibana’s group obtained well over a 100 oocytes from women who underwent ovarian stimulation and transvaginal retrieval.

The growth of four embryos to the blastocyst stage resulted in NT-ESC, after differentiation into a blastocyst with a trophoblast (precursor of the placenta) and the inner cell mass (the part that will develops into the actual body of the human). These embryos were destroyed to harvest the ICM.

The report details years of research to find the optimum technique for cloning human embryos. It was found that the mitotic stage of the oocytes, MII, is critical. The researchers further developed a protocol utilizing caffeine and electrical stimulation to induce activation of the fused nucleus from the skin cell and donor oocyte. In addition, the authors found that “higher quality oocytes,” those more likely to form viable embryos, resulted when the ovarian stimulation yielded fewer than ten oocytes. If larger numbers of oocytes were produced due to the ovarian stimulation, somatic cell nuclear transfer was less likely. In fact, the first four clones that developed far enough to produce NT-ESC came from one woman who donated eight oocytes in one cycle, resulting in the production of five cloned embryos.

There are several ethical problems which surround this research.

First, as strongly noted by the Center for Bioethics and Culture, the ovarian stimulation risks abuse of women who might be placed at risk due to the hormones administered to induce ovulation. As noted in the paper,

“In the context of generating patient-specific pluripotent stem cells, reproducible results with various patient-derived somatic cells and with different egg donors are a necessity.”

Although the donation is called voluntary and anonymous, the women were compensated for their “time, effort, discomfort, and inconvenience associated with the donation process.”    I can’t help but wonder about how long the anonymity will last for the one woman whose oocytes yielded those first four successful clones and NT-ESCs or for the two women whose oocytes yielded the clones confirming the reproducibility of their method, in the second stage of the research. Or how much pressure they will face to continue to donate “voluntarily.”

The lack of concern for the women involved is revealed in this interview with the authors at The Scientist,

““I was worried that we might need a couple of thousand eggs to make all these optimizations, to find that winning combination. But it actually took just 128 [eggs], which is a surprisingly low number to make 6 [hESC] lines.””

6 NT-ESC lines were derived from 128 harvested oocytes, for a yield of 4.6% In later stages, the success rate was still 2 NT-ESC lines from 7 embryos and 15 oocytes, or 13% of oocytes.

The primary objection is that 100% of the human embryos were created in harm’s way and must be destroyed to harvest the NT-ESCs.

These embryos are delayed human twins, artificially induced. Although the first cell of these embryos began in the lab, as the result of highly technical and involved procedures, they are human embryos and near-identical twins of the somatic cell nucleus.   There is indirect acknowledgement that the embryos are twins of the donor of the fibroblasts by the reporting that tests of the chromosomes of the cloned embryos show that the DNA matches that of the donor of the fibroblasts, a patient with Leigh’s syndrome.

The sources of fibroblast nuclei raise other ethical dilemmas. The first research was carried out using female fetal fibroblasts. Later research involved creating human embryos with Leigh’s syndrome.  Leigh’s syndrome results from a genetic defect of the mitochondria, the cell “power plant,” which is inherited from the mother and only found in the cell cytoplasm, not the nucleus. Reports are already ignoring the fact that the donor’s twins were produced with the express intention of destroying them for their inner cell mass. At least one is predicting that this is a technique which can be used to create future children for mothers who have the abnormal mitochondria.

The report, Tachibana et al., “Human Embryonic Stem Cells Derived by Somatic Cell Nuclear Transfer,” Cell (2013),http://dx.doi.org/10.1016/j.cell.2013.05.006, is available on-line and in PDF (as of today).

My Testimony on #SB303 (Conscience, Rights, Medical Judgment and Law)

Note: I’ve heard that there’s a new Committee Substitute that will soon be introduced that is more explicit on DNR’s, especially on informed consent and on competent patients.

If laws demand that physicians perform acts against our consciences, you will end up with only doctors without consciences willing to perform the acts in question.

After a few more words about the meeting of the 83rd Texas Legislature Public Health Committee, I’ll post my written testimony that I turned in to the Committee. You can watch the video of the meeting, here. My testimony begins about 4:59/8:20.

I spoke just before midnight, after many others had covered the good (or bad, depending on their opinions) reforms in SB 303, so I didn’t really go in to those when I talked. Instead, I explained how I handled the few times I’ve had to write DNR’s without consent from the patient or a surrogate.

I also talked about the medical judgement of physicians, about the definition of the “right to life”as a negative right. This means that I can be prohibited from killing, but not that I can be forced to indefinitely act against my conscience and medical judgment. It’s a tough concept, meaning no one can claim that their right to life means that they can take my food and shelter, my labors or my liberty to keep them alive.

Then, I explained that yes, doctors have a special relationship, a covenant or, at least, a professional relationship due to our privilege of practicing medicine. But the duties aren’t unlimited and they are not all one way. The 10 days plus 21 days in the version of SB303 that we were discussing that night should be a sufficient time trial or test of time for the patient and the doctor’s decisions about the medical treatment, including DNR’s, that the family demands.

The explanation about the nature of medical judgment that I gave is in the written testimony:

May 13, 2013

Chair Kolkhorst and members,

The Texas Advance Directive Act of 1999, created a procedure for resolving disagreements between doctors and their patients or surrogates about which interventions are medically appropriate. The experiences of patients and doctors during the few times that procedure has been invoked over the years, revealed some problems.

The reforms in SB 303 improve the Advance Directive Act by

·      Giving patients and their surrogates much more time and assistance than current law provides in order to prepare for the ethics committee meeting and, if necessary, to find a new doctor willing to accept responsibility for the care of the patient,

·      Clarifying the succession of surrogates under state law,

·      Protecting the patient’s access to artificially administered hydration and nutrition,

·      Restating Texan’s belief that patients should be treated equally regardless of age, disability or ability to pay,

·      Adding a whole new section regulating the implementation of Do Not Attempt Resuscitation orders, which our State law hasn’t addressed at all in the past, and

·      By protecting the conscience rights of doctors from undue threat of civil, criminal and regulatory liability.

 

After all, while the hospital provides structure in the form of policies and the medical committee provides oversight about ethics and standard of care, it’s doctors like me, not hospitals or committees, who practice medicine using our medical education and experience guided by conscience, or medical judgment. Medical judgment, not lawyers and paperwork at the bedside, is what enables me to predict the effectiveness of interventions before I order them.

Like all but a handful of Texas doctors, I’ve never had to ask for a medical ethics committee review, but I have had to ask another doctor to co-sign a DNR when I couldn’t find a legal surrogate. As a family doctor, I’ve found that algorithms and “cookbook medicine” or lines of succession for absent family members sometimes aren’t enough when a patient’s physical condition is deteriorating quickly or even when disease runs its expected course, causing organ system after organ system to fail. 

Ethics and laws generally lag behind medical advances. Once upon a time, people who couldn’t breathe for themselves were considered to have died a “natural death,” but we keep changing the rules about what we expect human bodies and the “art” of medicine to do. Please support the necessary and important reforms in SB 303.

Thank you for your time and attention,

Beverly B. Nuckols, MD, FAAFP, MA (Bioethics)

Public Health Hearing on #SB303

Last night, an emergency meeting ot the 83rd Texas Legislature’s Public Health Committee addressed Senate Bill 303, by Senator Duell in a 12 hour long meeting. Representative Susan King, who authored the Companion Bill in the House and sponsored SB303 in this meeting, appeared only one day after a fracture of her tibia. This woman is a hero!

I also want to thank Chair Lois Kolkhorst for ensuring that the meeting was held so that SB303 – and all the people who are so passionate about patients rights and good medicine in Texas could be heard.

It was wonderful to see all the people who volunteer so much of their time to influence Texas law – even when they disagreed with me. What a pleasure to meet new friends, including a gentleman whose name I can’t recall (will fix this later) and Jacqueline Harvey, Ph.D.

Here’s an excerpt from Dr. Harvey’s testimony,

While opponents say that S.B.303 grants power to providers to remove care patients in irreversible conditions, I’d remind them again that one cannot extend to providers power which they already legally possess. Opponents claim that S.B. 303 adds this broad definition, when in fact; this broad definition was established in TADA and is current Texas Law. What S.B. 303 does is add protections to prohibit discrimination against persons with disabilities by ensuring that care may be removed only when harmful (i.e. treatment would fail, hasten patient death, exacerbate another medical condition or cause unnecessary pain). These conditions are standard medical ethics a la “do no harm.”

I’ll write more after I get a chance to review the video of the hearing. There’s some sort of glitch at the Legislature Audio and Video page. (Might have something to do with 12 hours of recordings, ending after 2 AM)