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.
The Veterans Administration demoted two women who defrauded the agency and manipulated other employees, to cost the agency $274,000 and $129,000. The agency also rewarded a woman who covered up malpractice with a promotion! None of the women were prosecuted. No one demanded restitution! Instead, they kept their jobs and at least two were sent to work at the already-corrupt Phoenix VA hospital system.
From the Washington Examiner:
“. . . The VA’s watchdog found officials had used the program to get around prohibitions on giving raises to employees.
“Graves, who allegedly pressured another VA official to transfer so she could take his job, was reassigned to the Phoenix VA hospital, where a national scandal involving a cover-up of patient wait times erupted last year.
“The same day the VA announced it would not fire Rubens and Graves and instead shuffle them around within the agency, the VA also announced it had named a scandal-plagued official from the Vermont facility to run the Phoenix hospital.”
So, THAT’S the meaning of “good enough for Government work!!!
I suspect that there is more to this story than a couple of quotes. I really would like to see the video or, at least, read the entire transcript.
However, Dr Carson, as quoted here, is mistaken.
It was appropriate for government to intervene, as Mrs Schiavo’s right not to be killed was being infringed.
The case was a show trial, an act (actually, a series of acts) intended to cause death, supported by the euthanasia activists and went much beyond “the right to die.” No, this was about the right to kill.
Mrs Schiavo wasn’t allowed to die due to the progressive breakdown of her organ systems. Instead, a woman who was able to swallow and breathe was subjected to medical and law enforcement intervention – the act of removal of her feeding tube rather than simply ceasing to use it, morphine injections and – most egregious of all – the judge’s order requiring local Sheriff’s deputies to prevent her mother and loved ones from giving her oral hydration and nutrition.
The only outcome possible was to cause her intentional death and to infringe on her inalienable right not to be killed.
There is a huge difference between withholding medical intervention involving repetitive invasive procedures and forbidding care that can be provided by loved ones.
Please read the link – or at least the entire quote I’ve pasted here – before commenting.
The immigration debate and its ability to divide the Republican Party and split the Conservative vote is not new. Here’s a commentary about the dispute in light of the 2012 Presidential election, written in 2011. (Scroll down the page to “On Immigration,” Saturday, May 21, 2011.)
Dr. Jerry Pournelle has served our Nation in many capacities (including serving in the Army during the Korean War), but he’s probably best known, to those who know his name at all, as the author of Science Fiction written from a conservative, libertarian-leaning viewpoint. I strongly recommend his essays, including this one from 2011:
“We aren’t going to deport them all, and no Congress or President will do that, nor could even if it were thought desirable. The United States is not going to erect detention camps nor will we herd people into boxcars. We can’t even get the southern border closed. Despite President Obama’s mocking speech, we have not built the security fence mandated a long time ago. We probably could get Congress to approve a moat and alligators, although there are likely more effective means. We can and should insist on closing the borders. That we can and must do. It won’t be easy or simple, but it’s going to be a lot easier than deporting 20 million illegals. Get the borders closed. We can all agree on that.
“That leaves the problem of the illegal aliens amongst us. We can and should do more to enforce employment laws; but do we really want police coming around to demand “your papers” from our gardeners and fry cooks and homemakers?”
This is not a trivial point. I advocate for the necessity of identifying illegal aliens and would prefer that the process begin in the country of origin. However, in practical terms, how would the “Maria” Dr. Pournelle describes, who was brought here as a child, “begin the process?”
Defense and security requires that we secure the border and that we identify as many who are here illegally as possible. A first step would be to better track people who enter on Visas: what are all those computers at border entry spots for?? We should also cease the fiction that our schools don’t know which families with children are undocumented. We should hold employers accountable, but be very careful about instituting new government papers and government computer lists of eligible workers.
We must determine common ground for the sake of success. As pointed out four years ago by Dr. Pournelle, errors will be used against us, with the hard cases like “Maria” will be splashed across media and social networks. Without common ground, and with emotional demands to “deport them all,” we’ll still be debating this four years from now. And our citizens – and the illegal aliens – will remain at risk from the violent and criminal, if not from the terrorist.
The final – or at least the penultimate, if you count the Perry case – death knell has rung for the Public Integrity Unit in Travis County. Jurors have found a state employee charged with felony fraud not guilty.
This was another case of Travis County DA attempting to embarrass Governor Perry and the Legislature. One of the rumors whispered about to justify the indictment of Governor Perry for abuse of power by vetoing State tax funds for the PIU was that he was trying to squelch this indictment and trial.
The Unit was based in the office of the Travis County District Attorney’s office, but funded by State taxes and part of our biennial budget. Back in the ’80’s, Travis County DA Ronnie Earle convinced the State Legislature to fund it, although other PIU’s in other counties exist, but aren’t funded by the State. This is the State agency that indicted and convicted Tom Delay for breaking a law that didn’t exist, only to have the case overturned by the State Appeals Court — after 9 years.
Earle also tried to convict Kay Bailey Hutchison, way back in 1993, after a failed attempt to become Senator in her place. That case was handled so badly by DA Earle that the judge ordered the jury to acquit on the first day of trial.
Just last year, the State Legislature removed the ability to oversee Legislative and political matters from the Travis County DA’s office and moved it to the Texas Rangers’ purview.
Just to be sure which agency we’re talking about and because no story about the PIU is complete with out it, here’s a pic of the DA that was the second person to head the Unit and who was convicted of drunk driving. Although she certainly threatened and abused the law enforcement officers and staff, for some reason the PIU never indicted her for abuse of power.
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.”
Liberty is not simply the freedom to act, it’s the more fundamental freedom not to act. Remember the proverb that “The right to swing your fist ends at the tip of my nose?” True liberty includes the right *not* to make a fist at all. To force the hand of a person against his will other than to defend the higher-priority right to life is to enslave him.
The same sex marriage ruling and protected status for “sexual orientation” is the latest socialist infringement on the inalienable right to liberty. In the name of “equality,” “fairness” and even “liberty,” they attempt to give government the ownership of all property and the means to earn it.
In particular, they demand that people of conscience either deny their faith or get out of government and public activities, including business and earning a living. (For real life examples, read the earliest few comments, here. Or here.)
People who want what they want, when they want it, and from whom they want it seem to have no problem forcing other citizens to act against their will. In order to devalue the right of conscience and religion they deny the rights in the First Amendment of the Constitution – or the very existence of inalienable rights at all.
The Board of Labor of Oregon just gave us a perfect example just this week. Brad Avakian, the judge in the Sweet Cakes Bakery case, has slapped the couple with a gag order. He would deny them free speech as well as the free exercise of their religion.
Here’s the justification for that order.
(Thanks to Kelsey Harkness!)
The Supreme Court of the United States, States and local governments cannot create a world of gumdrops and lollipops, where everyone likes everyone and everything they do. There is no right not to be inconvenienced, much less the right not to be offended. The right to liberty of anyone may not be infringed for the benefit of another person’s pursuit of happiness without significant distress to society and government.
Read the Declaration of Independence to see what happens when governments attempt to do so.
Here’s where we are, according to Red State:
The Senate has already approved the TPA. On Friday, the House voted on it. The TPA portion was actually approved by a tiny majority, however it did not pass because it was tied to another provision: TAA, which failed miserably. In essence, the TAA is a multi-faced welfare program for those allegedly “hurt” by trade deals.
“TPA ensures that only 51 votes are needed in order to pass the TPP. If you don’t think Obama and the Chamber of Commerce can engage in some bi-partisan vote whipping, you are living in fantasy land.”
“Is not this a lamentable thing, that of the skin of an innocent lamb should be made parchment?” (William Shakespeare, Henry VI, Part 2, just after the more famous, “The first thing we do, let’s kill all the lawyers.)
The Senate took a House Bill, H.R. 1191, that originally amended ObamaCare (so that the IRS would know for certain that volunteer firefighters, paramedics, and other emergency personnel aren’t counted as employees) and changed it completely in order give birth to the “Iran Nuclear Agreement Review Act of 2015.”
It’s appropriate that a bill that originally amended ObamaCare was changed this way, since ObamaCare was passed in the first place by Harry Reid’s Senate amendment to a bill that as originally titled, “Service Members Home Ownership Tax Act of 2009.”
From the Senate record:
SA 1140. Mr. CORKER (for himself and Mr. Cardin) proposed an
amendment to the bill H.R. 1191, to amend the Internal Revenue Code of
1986 to ensure that emergency services volunteers are not taken into
account as employees under the shared responsibility requirements
contained in the Patient Protection and Affordable Care Act; as
Strike all after the enacting clause and insert the
SECTION 1. SHORT TITLE.
This Act may be cited as the “Iran Nuclear Agreement
Review Act of 2015”.
SEC. 2. CONGRESSIONAL REVIEW AND OVERSIGHT OF AGREEMENTS WITH
IRAN RELATING TO THE NUCLEAR PROGRAM OF IRAN.
The Atomic Energy Act of 1954 (42 U.S.C. 2011 et seq.) is
amended by inserting after section 134 the following new
“SEC. 135. CONGRESSIONAL REVIEW AND OVERSIGHT OF AGREEMENTS
“(a) Transmission to Congress of Nuclear Agreements With
Iran and Verification Assessment With Respect to Such
“(1) Transmission of agreements.–Not later than 5
calendar days after reaching an agreement with Iran relating
to the nuclear program of Iran, the President shall transmit
to the appropriate congressional committees and leadership–
“(A) the agreement, as defined in subsection (h)(1),
including all related materials and annexes;
“(B) a verification assessment report of the Secretary of
State prepared under paragraph (2) with respect to the
“(C) a certification that–
“(i) the agreement includes the appropriate terms,
conditions, and duration of the agreement’s requirements with
respect to Iran’s nuclear activities and provisions
describing any sanctions to be waived, suspended, or
otherwise reduced by the United States, and any other nation
or entity, including the United Nations; and
“(ii) the President determines the agreement meets United
States non-proliferation objectives, does not jeopardize the
common defense and security, provides an adequate framework
to ensure that Iran’s nuclear activities permitted thereunder
will not be inimical to or constitute an unreasonable risk to
the common defense and security, and ensures that Iran’s
nuclear activities permitted thereunder will not be used to
further any nuclear-related military or nuclear explosive
purpose, including for any research on or development of any
nuclear explosive device or any other nuclear-related
“(2) Verification assessment report.–
“(A) In general.–The Secretary of State shall prepare,
with respect to an agreement described in paragraph (1), a
“(i) the extent to which the Secretary will be able to
verify that Iran is complying with its obligations and
commitments under the agreement;
“(ii) the adequacy of the safeguards and other control
mechanisms and other assurances contained in the agreement
with respect to Iran’s nuclear program to ensure Iran’s
activities permitted thereunder will not be used to further
any nuclear-related military or nuclear explosive purpose,
including for any research on or development of any nuclear
explosive device or any other nuclear-related military
“(iii) the capacity and capability of the International
Atomic Energy Agency to effectively implement the
verification regime required by or related to the agreement,
including whether the International Atomic Energy Agency will
have sufficient access to investigate suspicious sites or
allegations of covert nuclear-related activities and whether
it has the required funding, manpower, and authority to
undertake the verification regime required by or related to
“(B) Assumptions.–In preparing a report under
subparagraph (A) with respect to an agreement described in
paragraph (1), the Secretary shall assume that Iran could–
“(i) use all measures not expressly prohibited by the
agreement to conceal activities that violate its obligations
and commitments under the agreement; and
“(ii) alter or deviate from standard practices in order to
impede efforts to verify that Iran is complying with those
obligations and commitments.
“(C) Classified annex.–A report under subparagraph (A)
shall be transmitted in unclassified form, but shall include
a classified annex prepared in consultation with the Director
of National Intelligence, summarizing relevant classified
“(A) In general.–Neither the requirements of
subparagraphs (B) and (C) of paragraph (1), nor subsections
(b) through (g) of this section, shall apply to an agreement
described in subsection (h)(5) or to the EU-Iran Joint
Statement made on April 2, 2015.
“(B) Additional requirement.–Notwithstanding subparagraph
(A), any agreement as defined in subsection (h)(1) and any
related materials, whether concluded before or after the date
of the enactment of this section, shall not be subject to the
exception in subparagraph (A).
“(b) Period for Review by Congress of Nuclear Agreements
“(1) In general.–During the 30-calendar day period
following transmittal by the President of an agreement
pursuant to subsection (a), the Committee on Foreign
Relations of the Senate and the Committee on Foreign Affairs
of the House of Representatives shall, as appropriate, hold
hearings and briefings and otherwise obtain information in
order to fully review such agreement.
“(2) Exception.–The period for congressional review under
paragraph (1) shall be 60 calendar days if an agreement,
including all materials required to be transmitted to
Congress pursuant to subsection (a)(1), is transmitted
pursuant to subsection (a) between July 10, 2015, and
September 7, 2015.
“(3) Limitation on actions during initial congressional
review period.–Notwithstanding any other provision of law,
except as provided in paragraph (6), prior to and during the
period for transmission of an agreement in subsection (a)(1)
and during the period for congressional review provided in
paragraph (1), including any additional period as applicable
under the exception provided in paragraph (2), the President
may not waive, suspend, reduce, provide relief from, or
otherwise limit the application of statutory sanctions with
respect to Iran under any provision of law or refrain from
applying any such sanctions pursuant to an agreement
described in subsection (a).
“(4) Limitation on actions during presidential
consideration of a joint resolution of disapproval.–
Notwithstanding any other provision of law, except as
provided in paragraph (6), if a joint resolution of
disapproval described in subsection (c)(2)(B) passes the
Congress, the President may not waive, suspend, reduce,
provide relief from, or otherwise limit the application of
statutory sanctions with respect to Iran under any provision
of law or refrain from applying any such sanctions pursuant
to an agreement described in subsection (a) for a period of
12 calendar days following the date of passage of the joint
resolution of disapproval.
“(5) Limitation on actions during congressional
reconsideration of a joint resolution of disapproval.–
Notwithstanding any other provision of law, except as
provided in paragraph (6), if a joint resolution of
disapproval described in subsection (c)(2)(B) passes the
Congress, and the President vetoes such joint resolution, the
President may not waive, suspend, reduce, provide relief
from, or otherwise limit the application of statutory
sanctions with respect to Iran under any provision of law or
refrain from applying any such sanctions pursuant to an
agreement described in subsection (a) for a period of 10
calendar days following the date of the President’s veto.
“(6) Exception.–The prohibitions under paragraphs (3)
through (5) do not apply to any new deferral, waiver, or
other suspension of statutory sanctions pursuant to the Joint
Plan of Action if that deferral, waiver, or other suspension
“(A) consistent with the law in effect on the date of the
enactment of the Iran Nuclear Agreement Review Act of 2015;
“(B) not later than 45 calendar days before the
transmission by the President of an agreement, assessment
report, and certification under subsection (a).
“(c) Effect of Congressional Action With Respect to
Nuclear Agreements With Iran.–
“(1) Sense of congress.–It is the sense of Congress
“(A) the sanctions regime imposed on Iran by Congress is
primarily responsible for bringing Iran to the table to
negotiate on its nuclear program;
“(B) these negotiations are a critically important matter
of national security and foreign policy for the United States
and its closest allies;
“(C) this section does not require a vote by Congress for
the agreement to commence;
“(D) this section provides for congressional review,
including, as appropriate, for approval, disapproval, or no
action on statutory sanctions relief under an agreement; and
“(E) even though the agreement may commence, because the
sanctions regime was imposed by Congress and only Congress
can permanently modify or eliminate that regime, it is
critically important that Congress have the opportunity, in
an orderly and deliberative manner, to consider and, as
appropriate, take action affecting the statutory sanctions
regime imposed by Congress.
“(2) In general.–Notwithstanding any other provision of
law, action involving any measure of statutory sanctions
relief by the United States pursuant to an agreement subject
to subsection (a) or the Joint Plan of Action–
“(A) may be taken, consistent with existing statutory
requirements for such action, if, during the period for
review provided in subsection (b), the Congress adopts, and
there is enacted, a joint resolution stating in substance
that the Congress does favor the agreement;
“(B) may not be taken if, during the period for review
provided in subsection (b), the Congress adopts, and there is
enacted, a joint
resolution stating in substance that the Congress does not
favor the agreement; or
“(C) may be taken, consistent with existing statutory
requirements for such action, if, following the period for
review provided in subsection (b), there is not enacted any
such joint resolution.
“(3) Definition.–For the purposes of this subsection, the
phrase `action involving any measure of statutory sanctions
relief by the United States’ shall include waiver,
suspension, reduction, or other effort to provide relief
from, or otherwise limit the application of statutory
sanctions with respect to, Iran under any provision of law or
any other effort to refrain from applying any such sanctions.
“(d) Congressional Oversight of Iranian Compliance With
“(1) In general.–The President shall keep the appropriate
congressional committees and leadership fully and currently
informed of all aspects of Iranian compliance with respect to
an agreement subject to subsection (a).
“(2) Potentially significant breaches and compliance
incidents.–The President shall, within 10 calendar days of
receiving credible and accurate information relating to a
potentially significant breach or compliance incident by Iran
with respect to an agreement subject to subsection (a),
submit such information to the appropriate congressional
committees and leadership.
“(3) Material breach report.–Not later than 30 calendar
days after submitting information about a potentially
significant breach or compliance incident pursuant to
paragraph (2), the President shall make a determination
whether such potentially significant breach or compliance
issue constitutes a material breach and, if there is such a
material breach, whether Iran has cured such material breach,
and shall submit to the appropriate congressional committees
and leadership such determination, accompanied by, as
appropriate, a report on the action or failure to act by Iran
that led to the material breach, actions necessary for Iran
to cure the breach, and the status of Iran’s efforts to cure
“(4) Semi-annual report.–Not later than 180 calendar days
after entering into an agreement described in subsection (a),
and not less frequently than once every 180 calendar days
thereafter, the President shall submit to the appropriate
congressional committees and leadership a report on Iran’s
nuclear program and the compliance of Iran with the agreement
during the period covered by the report, including the
“(A) Any action or failure to act by Iran that breached
the agreement or is in noncompliance with the terms of the
“(B) Any delay by Iran of more than one week in providing
inspectors access to facilities, people, and documents in
Iran as required by the agreement.
“(C) Any progress made by Iran to resolve concerns by the
International Atomic Energy Agency about possible military
dimensions of Iran’s nuclear program.
“(D) Any procurement by Iran of materials in violation of
the agreement or which could otherwise significantly advance
Iran’s ability to obtain a nuclear weapon.
“(E) Any centrifuge research and development conducted by
“(i) is not in compliance with the agreement; or
“(ii) may substantially enhance the breakout time of
acquisition of a nuclear weapon by Iran, if deployed.
“(F) Any diversion by Iran of uranium, carbon-fiber, or
other materials for use in Iran’s nuclear program in
violation of the agreement.
“(G) Any covert nuclear activities undertaken by Iran,
including any covert nuclear weapons-related or covert
fissile material activities or research and development.
“(H) An assessment of whether any Iranian financial
institutions are engaged in money laundering or terrorist
finance activities, including names of specific financial
institutions if applicable.
“(I) Iran’s advances in its ballistic missile program,
including developments related to its long-range and inter-
continental ballistic missile programs.
“(J) An assessment of–
“(i) whether Iran directly supported, financed, planned,
or carried out an act of terrorism against the United States
or a United States person anywhere in the world;
“(ii) whether, and the extent to which, Iran supported
acts of terrorism, including acts of terrorism against the
United States or a United States person anywhere in the
“(iii) all actions, including in international fora, being
taken by the United States to stop, counter, and condemn acts
by Iran to directly or indirectly carry out acts of terrorism
against the United States and United States persons;
“(iv) the impact on the national security of the United
States and the safety of United States citizens as a result
of any Iranian actions reported under this paragraph; and
“(v) all of the sanctions relief provided to Iran,
pursuant to the agreement, and a description of the
relationship between each sanction waived, suspended, or
deferred and Iran’s nuclear weapon’s program.
“(K) An assessment of whether violations of
internationally recognized human rights in Iran have changed,
increased, or decreased, as compared to the prior 180-day
“(5) Additional reports and information.–
“(A) Agency reports.–Following submission of an agreement
pursuant to subsection (a) to the appropriate congressional
committees and leadership, the Department of State, the
Department of Energy, and the Department of Defense shall,
upon the request of any of those committees or leadership,
promptly furnish to those committees or leadership their
views as to whether the safeguards and other controls
contained in the agreement with respect to Iran’s nuclear
program provide an adequate framework to ensure that Iran’s
activities permitted thereunder will not be inimical to or
constitute an unreasonable risk to the common defense and
“(B) Provision of information on nuclear initiatives with
iran.–The President shall keep the appropriate congressional
committees and leadership fully and currently informed of any
initiative or negotiations with Iran relating to Iran’s
nuclear program, including any new or amended agreement.
“(6) Compliance certification.–After the review period
provided in subsection (b), the President shall, not less
than every 90 calendar days–
“(A) determine whether the President is able to certify
“(i) Iran is transparently, verifiably, and fully
implementing the agreement, including all related technical
or additional agreements;
“(ii) Iran has not committed a material breach with
respect to the agreement or, if Iran has committed a material
breach, Iran has cured the material breach;
“(iii) Iran has not taken any action, including covert
action, that could significantly advance its nuclear weapons
“(iv) suspension of sanctions related to Iran pursuant to
the agreement is–
“(I) appropriate and proportionate to the specific and
verifiable measures taken by Iran with respect to terminating
its illicit nuclear program; and
“(II) vital to the national security interests of the
United States; and
“(B) if the President determines he is able to make the
certification described in subparagraph (A), make such
certification to the appropriate congressional committees and
“(7) Sense of congress.–It is the sense of Congress
“(A) United States sanctions on Iran for terrorism, human
rights abuses, and ballistic missiles will remain in place
under an agreement, as defined in subsection (h)(1);
“(B) issues not addressed by an agreement on the nuclear
program of Iran, including fair and appropriate compensation
for Americans who were terrorized and subjected to torture
while held in captivity for 444 days after the seizure of the
United States Embassy in Tehran, Iran, in 1979 and their
families, the freedom of Americans held in Iran, the human
rights abuses of the Government of Iran against its own
people, and the continued support of terrorism worldwide by
the Government of Iran, are matters critical to ensure
justice and the national security of the United States, and
should be expeditiously addressed;
“(C) the President should determine the agreement in no
way compromises the commitment of the United States to
Israel’s security, nor its support for Israel’s right to
“(D) in order to responsibly implement any long-term
agreement reached between the P5+1 countries and Iran, it is
critically important that Congress have the opportunity to
review any agreement and, as necessary, take action to modify
the statutory sanctions regime imposed by Congress.
“(e) Expedited Consideration of Legislation.–
“(1) In general.–In the event the President does not
submit a certification pursuant to subsection (d)(6) or has
determined pursuant to subsection (d)(3) that Iran has
materially breached an agreement subject to subsection (a)
and the material breach has not been cured, Congress may
initiate within 60 calendar days expedited consideration of
qualifying legislation pursuant to this subsection.
“(2) Qualifying legislation defined.–For purposes of this
subsection, the term `qualifying legislation’ means only a
bill of either House of Congress–
“(A) the title of which is as follows: `A bill reinstating
statutory sanctions imposed with respect to Iran.’; and
“(B) the matter after the enacting clause of which is:
`Any statutory sanctions imposed with respect to Iran
pursuant to ______ that were waived, suspended, reduced, or
otherwise relieved pursuant to an agreement submitted
pursuant to section 135(a) of the Atomic Energy Act of 1954
are hereby reinstated and any action by the United States
Government to facilitate the release of funds or assets to
Iran pursuant to such agreement, or provide any further
waiver, suspension, reduction, or other relief pursuant to
such agreement is hereby prohibited.’, with the blank space
being filled in with the law or laws under which sanctions
are to be reinstated.
“(3) Introduction.–During the 60-calendar day period
provided for in paragraph (1), qualifying legislation may be
“(A) in the House of Representatives, by the majority
leader or the minority leader; and
“(B) in the Senate, by the majority leader (or the
majority leader’s designee) or the minority leader (or the
minority leader’s designee).
“(4) Floor consideration in house of representatives.–
“(A) Reporting and discharge.–If a committee of the House
to which qualifying legislation has been referred has not
reported such qualifying legislation within 10 legislative
days after the date of referral, that committee shall be
discharged from further consideration thereof.
“(B) Proceeding to consideration.–Beginning on the third
legislative day after each committee to which qualifying
legislation has been referred reports it to the House or has
been discharged from further consideration thereof, it shall
be in order to move to proceed to consider the qualifying
legislation in the House. All points of order against the
motion are waived. Such a motion shall not be in order after
the House has disposed of a motion to proceed on the
qualifying legislation with regard to the same agreement. The
previous question shall be considered as ordered on the
motion to its adoption without intervening motion. The motion
shall not be debatable. A motion to reconsider the vote by
which the motion is disposed of shall not be in order.
“(C) Consideration.–The qualifying legislation shall be
considered as read. All points of order against the
qualifying legislation and against its consideration are
waived. The previous question shall be considered as ordered
on the qualifying legislation to final passage without
intervening motion except two hours of debate equally divided
and controlled by the sponsor of the qualifying legislation
(or a designee) and an opponent. A motion to reconsider the
vote on passage of the qualifying legislation shall not be in
“(5) Consideration in the senate.–
“(A) Committee referral.–Qualifying legislation
introduced in the Senate shall be referred to the Committee
on Foreign Relations.
“(B) Reporting and discharge.–If the Committee on Foreign
Relations has not reported such qualifying legislation within
10 session days after the date of referral of such
legislation, that committee shall be discharged from further
consideration of such legislation and the qualifying
legislation shall be placed on the appropriate calendar.
“(C) Proceeding to consideration.–Notwithstanding Rule
XXII of the Standing Rules of the Senate, it is in order at
any time after the committee authorized to consider
qualifying legislation reports it to the Senate or has been
discharged from its consideration (even though a previous
motion to the same effect has been disagreed to) to move to
proceed to the consideration of qualifying legislation, and
all points of order against qualifying legislation (and
against consideration of the qualifying legislation) are
waived. The motion to proceed is not debatable. The motion is
not subject to a motion to postpone. A motion to reconsider
the vote by which the motion is agreed to or disagreed to
shall not be in order. If a motion to proceed to the
consideration of the qualifying legislation is agreed to, the
qualifying legislation shall remain the unfinished business
until disposed of.
“(D) Debate.–Debate on qualifying legislation, and on all
debatable motions and appeals in connection therewith, shall
be limited to not more than 10 hours, which shall be divided
equally between the majority and minority leaders or their
designees. A motion to further limit debate is in order and
not debatable. An amendment to, or a motion to postpone, or a
motion to proceed to the consideration of other business, or
a motion to recommit the qualifying legislation is not in
“(E) Vote on passage.–The vote on passage shall occur
immediately following the conclusion of the debate on the
qualifying legislation and a single quorum call at the
conclusion of the debate, if requested in accordance with the
rules of the Senate.
“(F) Rulings of the chair on procedure.–Appeals from the
decisions of the Chair relating to the application of the
rules of the Senate, as the case may be, to the procedure
relating to qualifying legislation shall be decided without
“(G) Consideration of veto messages.–Debate in the Senate
of any veto message with respect to qualifying legislation,
including all debatable motions and appeals in connection
with such qualifying legislation, shall be limited to 10
hours, to be equally divided between, and controlled by, the
majority leader and the minority leader or their designees.
“(6) Rules relating to senate and house of
“(A) Coordination with action by other house.–If, before
the passage by one House of qualifying legislation of that
House, that House receives qualifying legislation from the
other House, then the following procedures shall apply:
“(i) The qualifying legislation of the other House shall
not be referred to a committee.
“(ii) With respect to qualifying legislation of the House
receiving the legislation–
“(I) the procedure in that House shall be the same as if
no qualifying legislation had been received from the other
“(II) the vote on passage shall be on the qualifying
legislation of the other House.
“(B) Treatment of a bill of other house.–If one House
fails to introduce qualifying legislation under this section,
the qualifying legislation of the other House shall be
entitled to expedited floor procedures under this section.
“(C) Treatment of companion measures.–If, following
passage of the qualifying legislation in the Senate, the
Senate then receives a companion measure from the House of
Representatives, the companion measure shall not be
“(D) Application to revenue measures.–The provisions of
this paragraph shall not apply in the House of
Representatives to qualifying legislation which is a revenue
“(f) Rules of House of Representatives and Senate.–
Subsection (e) is enacted by Congress–
“(1) as an exercise of the rulemaking power of the Senate
and the House of Representatives, respectively, and as such
are deemed a part of the rules of each House, respectively,
but applicable only with respect to the procedure to be
followed in that House in the case of legislation described
in those sections, and supersede other rules only to the
extent that they are inconsistent with such rules; and
“(2) with full recognition of the constitutional right of
either House to change the rules (so far as relating to the
procedure of that House) at any time, in the same manner, and
to the same extent as in the case of any other rule of that
“(g) Rules of Construction.–Nothing in the section shall
be construed as–
“(1) modifying, or having any other impact on, the
President’s authority to negotiate, enter into, or implement
appropriate executive agreements, other than the restrictions
on implementation of the agreements specifically covered by
“(2) allowing any new waiver, suspension, reduction, or
other relief from statutory sanctions with respect to Iran
under any provision of law, or allowing the President to
refrain from applying any such sanctions pursuant to an
agreement described in subsection (a) during the period for
review provided in subsection (b);
“(3) revoking or terminating any statutory sanctions
imposed on Iran; or
“(4) authorizing the use of military force against Iran.
“(h) Definitions.–In this section:
“(1) Agreement.–The term `agreement’ means an agreement
related to the nuclear program of Iran that includes the
United States, commits the United States to take action, or
pursuant to which the United States commits or otherwise
agrees to take action, regardless of the form it takes,
whether a political commitment or otherwise, and regardless
of whether it is legally binding or not, including any joint
comprehensive plan of action entered into or made between
Iran and any other parties, and any additional materials
related thereto, including annexes, appendices, codicils,
side agreements, implementing materials, documents, and
guidance, technical or other understandings, and any related
agreements, whether entered into or implemented prior to the
agreement or to be entered into or implemented in the future.
“(2) Appropriate congressional committees.–The term
`appropriate congressional committees’ means the Committee on
Finance, the Committee on Banking, Housing, and Urban
Affairs, the Select Committee on Intelligence, and the
Committee on Foreign Relations of the Senate and the
Committee on Ways and Means, the Committee on Financial
Services, the Permanent Select Committee on Intelligence, and
the Committee on Foreign Affairs of the House of
“(3) Appropriate congressional committees and
leadership.–The term `appropriate congressional committees
and leadership’ means the Committee on Finance, the Committee
on Banking, Housing, and Urban Affairs, the Select Committee
on Intelligence, and the Committee on Foreign Relations, and
the Majority and Minority Leaders of the Senate and the
Committee on Ways and Means, the Committee on Financial
Services, the Permanent Select Committee on Intelligence, and
the Committee on Foreign Affairs, and the Speaker, Majority
Leader, and Minority Leader of the House of Representatives.
“(4) Iranian financial institution.–The term `Iranian
financial institution’ has the meaning given the term in
section 104A(d) of the Comprehensive Iran Sanctions,
Accountability, and Divestment Act of 2010 (22 U.S.C.
“(5) Joint plan of action.–The term `Joint Plan of
Action’ means the Joint Plan of Action, signed at Geneva
November 24, 2013, by Iran and by France, Germany, the
Russian Federation, the People’s Republic of China, the
United Kingdom, and the United States, and all implementing
materials and agreements related to the Joint Plan of Action,
including the technical understandings reached on January 12,
2014, the extension thereto agreed to on July 18, 2014, the
extension agreed to on November 24, 2014, and any materially
identical extension that is agreed to on or after the date of
the enactment of the Iran Nuclear Agreement Review Act of
“(6) EU-iran joint statement.–The term `EU-Iran Joint
Statement’ means only the Joint Statement by EU High
Representative Federica Mogherini and Iranian Foreign
Minister Javad Zarif made on April 2, 2015, at Lausanne,
“(7) Material breach.–The term `material breach’ means,
with respect to an agreement described in subsection (a), any
of the agreement, or in the case of non-binding commitments,
any failure to perform those commitments, that
“(A) benefits Iran’s nuclear program;
“(B) decreases the amount of time required by Iran to
achieve a nuclear weapon; or
“(C) deviates from or undermines the purposes of such
“(8) Noncompliance defined.–The term `noncompliance’
means any departure from the terms of an agreement described
in subsection (a) that is not a material breach.
“(9) P5+1 countries.–The term `P5+1 countries’ means the
United States, France, the Russian Federation, the People’s
Republic of China, the United Kingdom, and Germany.
“(10) United states person.–The term `United States
person’ has the meaning given that term in section 101 of the
Comprehensive Iran Sanctions, Accountability, and Divestment
Act of 2010 (22 U.S.C. 8511).”.
” . . . 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.
Update, January 25, 2016 Read about the endorsement from Governor Perry
“I wanted to talk about him, who he was, see if I could get a handle on Ted Cruz the man, not Cruz the caricature I’d seen through the political lens. What I found was a very different person than what I had been led to believe.”
Look, my hobby is tilting at windmills. My theme song often seems to be “To Dream the Impossible Dream,” but let’s be honest. No matter how much we want to overturn Obama’s amnesty EO, Ted Cruz did no one any good on Saturday except Harry Reid, who got the chance to play with to his Senate majority- and with the nuclear option for judicial nominees – for an extra 48 hours.
If you’re willing to trade lifetime appointments to the Federal bench, the fight to fight would have been the “Amendment in the form of a Substitute” for the Intelligence Authorization Act for Fiscal Year 2015 (http://www.againstcronycapitalism.org/2014/12/rep-amash-congress-last-night-gave-massive-new-citizen-surveillance-powers-to-the-president/) with its incremental addition to legal infringement of our 4th, 5th Amendment rights snuck in at midnight, too late to read. (Now that you have a chance, read Section 309.)
Then, if you just wanted to shame someone for something, how about that last? Both the Cromnibus and the IAA were last minute re-worked drafts that virtually no one had the opportunity, much less the time, to read. We the People were promised by the Republicans that we would get 3 days to read EVERY Bill. These two Bills should have made that promise absolutely front and center on every Republican mind.
Come to think of it: Did Cruz give us a chance to evaluate his resolution before the vote???
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.”
The New England Journal of Medicine has some free articles you might want to read this week. (I’m afraid you will have to register – will you let me know if you do?)
The first asserts that we’re stuck with ObamaCare – but it calls ObamaCare, “ObamaCare.” The author, Jonathan Oberlander, Ph.D, also acknowledges that the only way the ACA (the Affordable Care Act) is “Affordable” is if the Federal government hands out cash subsidies. In fact, if the Supreme Court rules that the language of the law forbids subsidies in States that don’t have their own exchanges,
Here’s an excerpt:
“The calendar cannot be turned back to 2009. The ACA has made some irreversible changes in U.S. health care.
“Even if they have unified control of the federal government in 2017, Republicans will confront the reality that Obamacare has redefined U.S. health policy and the terms of the debate. In practice, future repeal legislation would probably not scrap the whole ACA, but rather remove specific provisions and remake other policies to conform to a more conservative vision. A Republican President could, through waivers and other means, undermine Obamacare in important ways, but he or she could not eliminate it.
“The Supreme Court’s decision to hear a case (King v. Burwell) challenging the legality of providing premium subsidies in federal exchanges is crucial to the GOP precisely because the chances for legislative repeal of Obamacare are so remote. The Court can seriously damage the ACA in a way that congressional Republicans cannot. A decision to prohibit subsidies for helping the uninsured to purchase coverage in the 34 states that have federally run exchanges would destabilize the health insurance marketplaces and unravel the individual and employer mandates in those states, exacerbating the already large disparities in insurance coverage among states. It would cause both a sizable increase in the uninsured population and sizable losses for the insurance industry and medical care providers as millions of Americans lost their health coverage. Such a ruling could, in turn, produce enormous pressures on affected states and Congress to adopt measures to stave off those outcomes. Yet the ACA’s shaky political foundations would complicate policymakers’ responses, and Obamacare’s opponents would be emboldened to resist any fixes. A ruling against federal subsidies could have a spillover effect, dampening the chances for Medicaid expansion in some states.“ (Emphasis mine)
The ACA appears to be on track to destroy the financing of health care in our country, whether or not it is fully implemented.
What “executive priorities” would you like to see implemented by Executive Order of the new Republican President, beginning January 20, 2017?
Even as a “dream,” it’s not easy to write all this. It’s easy to see the objections and possible pitfalls. I need help. I suggest not enforcing any law that can’t be justified in 2 to 3 sentences, using “Life, liberty and the pursuit of happiness” and a plain reading of the Constitution and the Bill of Rights. No “penumbras,” no nuances. Make it plain and transparent enough that even Gruber’s criteria of “the stupidity of the American voters” is met.
Same 90 day deadline Obama set for his immigration fiat?
Here’s a short list:
Take a look at what the New York Times calls the swing. (Their site has more detail than my little pic.)
The majorities have been too large and too long on the Dem’s side. It’s time for more conservative, small government, pro-family, pro-life, and pro-security government from the Right. We’ve made a good first step
Expedited pathway to citizenship for legal residents since the Revolutionary War. 7000 non-residents given citizenship for service in the Korean War and over 20,000 in World War II. And 90,000 naturalized from 2002-2013, since President Bush signed the July 3, 2002 Executive Order 13269.
Isn’t this exactly the sort of immigration that we want to encourage: men and women willing to lay down their lives for our Nation?
“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.
Occasionally speaking of herself in the third person, Joann Fleming, the self-proclaimed head of an East Texas “Tea Party” group, led a press conference at the Texas State Capitol on Wednesday. The Fleming gang demanded that Governor Rick Perry and Attorney General Greg Abbott order a Special Session of the Texas Legislature (cost: well over $1 Million) in order to spend the Rainy Day Fund (cost: up to $4 Billion) and that the Governor declare martial law (cost: immeasurable).
Fleming (“. . . if you’re like me, your brain will be screaming to you . . .”) shrilly stated that the Federal government has no right to tax Texans “except when they have declared war or a state of emergency” and that “Maybe we can’t count on our State officials to protect us, either.” Calling Texas a “sanctuary State,” Fleming ignored the fact that Governor Perry “alienated some potential supporters after his push to ban so-called “sanctuary cities” in Texas.”
Failed 2014 Republican Congressional candidate, Katrina Pierson, who once called a US Marine Captain “deformed” because of his war injuries, took the stage to complain that 50% of Texas’ budget comes from Federal dollars! Where does she think “federal dollars” come from? In fact, through 2010, Texas was a “donor State. Since then, Texas received a bit more than Texas taxpayers sent to Washington – if you count Medicare, Social Security and the money that supports the military in our State. Sounds like pay back to me.
Another member of the gang, a lawyer, said that the Governor (and Attorney General?) had been getting bad legal advice. When asked what difference this plan would make, since Texas can’t legally deport illegal aliens, the lawyer suggested that the Governor should ignore the law, order the Guard and DPS to deport illegal aliens, and bypass Immigration and Customs Enforcement. He said that the worst that could happen is that President Barack Obama and Holder could sue.
Article 1, Section 10 of the United States Constitution:
“No State shall, without the Consent of Congress, lay any Duty of Tonnage, keep Troops, or Ships of War in time of Peace, enter into any Agreement or Compact with another State, or with a foreign Power, or engage in War, unless actually invaded, or in such imminent Danger as will not admit of delay.”
Under the usual circumstances, the National Guard is under the command of the President of the United States, rather than control of the Governor. As explained by the (far-right wing) Red State last year, the National Guard is not the “militia” of the several States. Instead, the men and women serving in the Guard are considered ‘troops.”
It is true that in times of “imminent danger” the Governor may declare a state of emergency and call up the Guard for duty within the State. You may even remember that in 2010, then-US Attorney General Napolitano told Governor Perry that if he wasn’t happy with the 250 troops sent to the Texas border, he was welcome to call them up himself and pay for it. Unfortunately, the current US Attorney General is Eric Holder.
The emotional demand by one woman, Alice Linahan of Women on the Wall, that Governor Perry and General Abbott “Show us that you’re actually different from Obama,” sums up the cognizant dissonance of the entire press conference. The gang seems to have no understanding of how quickly President Barack Obama and Attorney General Eric Holder ignore the law, at the same moment that they condemn it.
Forty years ago the words “fertilization” and “conception” meant the same thing to doctors, lawyers, and embryologists alike: the joining of the 23 chromosomes in the sperm with the 23 chromosomes in the oocyte (“egg”) to form a new complete, unique human organism. “Contraception” was defined as any method that worked before the existence of the embryo by preventing fertilization. These were the hormonal treatments and devices that prevent ovulation of the egg and condoms, diaphragms and sterilization that serve as “barriers” between the sperm and egg. Drugs and devices that may or may not end the life of the embryo after fertilization were legally and correctly called “abortifacients.”
However, legalized abortion and the ability to accomplish fertilization through in vitro methods led to new legal definitions of “pregnancy” and “conception” as beginning at implantation rather than fertilization. Even in vivo, healthy human embryos in healthy mothers were deprived of legal protection as human beings for at least the first 5 – 10 days of their lives, the window of opportunity for implantation when the developing embryo grows to hundreds of cells organized in 2 or 3 recognizable tissue layers and interact with the mother’s body in ways that may affect the timing of birth or risk of diabetes and other health concerns. Possible abortifacients that work after fertilization but before implantation were redefined as “emergency contraception.”
In spite of what you may have heard on the news, the June 30, 2014 Burwell v. Hobby Lobby decision by the Supreme Court of the United States (SCOTUS) didn’t deny birth control for anyone. Everyone may still purchase his or her own FDA-approved birth control. SCOTUS simply ruled that the government can’t force some employers to buy things that they believe are immoral.
In fact, Hobby Lobby only asked to be exempt from purchasing insurance plans that paid for specific drugs and devices used for “emergency contraception.” Before the passage of the Affordable Care Act (“ObamaCare” or ACA), the company purchased insurance that included true forms of contraception, including,
- Those that prevent ovulation by preventing the normal ups and downs of the hormones estrogen and progesterone, such asBirth-control pills with estrogen and progestin (“Combined Pill”),Birth-control pills with progestin alone (“The Mini Pill”),Birth control pills (extended/continuous use), Contraceptive patches, Contraceptive rings,Progestin injections, andImplantable rods
- Those that act as “barriers” to fertilization by preventing the union of sperm and egg: Male condoms, Female condoms, Diaphragms with spermicide, Sponges with spermicide, Cervical caps with spermicide, Spermicide alone, Vasectomies, Female sterilization surgeries, and Female sterilization implants.
The problem is that regulations written by the Obama Administration mandated that all insurances pay for all pregnancy “preventatives” approved by the FDA, including drugs and devices that may function after fertilization to end the life of the new human embryo:
- Pills that mainly delay ovulation but may impair implantation and development of the placenta if fertilization takes place, such as over-the-counter Plan B and generic levonorgestrel tablets, and ella, which requires a prescription, and
- Devices that mechanically and hormonally make the uterus inhospitable to implantation by the embryo, such as intrauterine devices like the copper-T, Mirena, and ParaGuard. These are inserted up to 5 days after unprotected intercourse to prevent implantation and then left in place to prevent fertilization and implantation for as long as 5-10 years.
Although the words we use do not change the fact that the human embryo is the same human life before implantation as after, they can change his or her legal status.
For questions about the decision and history behind it, read this!
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.
I’ve had privately insured and Medicare patients – and at least two families visiting our town from Canada – ask me to keep records about one or another history or ailment. I told them I’d do my best, but explained the legal problems with Medicare laws. Since 1997, doctors have been prosecuted for refusing to allow Medicare auditors to see everything in the office. One woman doctor was arrested for refusing to unlock a drawer in her (private?) desk.
And now, the IRS wants control of your medical care.
The confidentiality of the medical relationship and records has to be maintained or patients will not disclose the true nature of their problems. This results in harm to the patient and prevents the physician from truly helping the patient.
Ignoring the law, another County Clerk unilaterally decides to issue marriage licenses. This is how the law has been undermined in California and other States. (And why it’s important to vote “down-ballot.”
That was on display in Colorado on Wednesday afternoon, when the county clerk in the liberal city of Boulder announced she would issue same-sex marriage licenses even though the 10th Circuit — which along with Colorado and Utah includes, Kansas, New Mexico, Oklahoma and Wyoming — stayed its decision pending appeal. The state’s attorney general declared the licenses invalid because Colorado’s gay marriage prohibition is still the law, but Clerk and Recorder Hillary Hall said she would continue to issue them until stopped by a court.
The 15,000-member Christian Medical Association, which along with other faith-based organizations had filed a friend-of-the-court brief in a U.S. Supreme Court case examining free speech and assembly rights, lauded the decision announced today in the case, McCullen v. Coakley.
“The Court simply reaffirmed that the First Amendment’s protection of peaceful speech and assembly is a cornerstone of this nation,” explained CMA CEO Dr. David Stevens. “Hopefully such decisions will begin to address the alarming growth of coercive assaults on the free speech of anyone deemed not politically correct by the government.”
The brief, submitted by the Christian Legal Society, sought to counter a Massachusetts law that had attempted to ban peaceful pro-life speech on public sidewalks, by prohibiting many citizens from entering a public street or sidewalk within 35 feet of an abortion facility.
“The fact that the government was bent on not only banning peaceful speech and assembly, but also penalizing its citizens with fines and jail, demonstrates the type of coercion that can happen when governments decide to enforce their own ideology,” stated Dr. Stevens.