Pro-life

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

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

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

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

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

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

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

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

May 13, 2013

Chair Kolkhorst and members,

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

The reforms in SB 303 improve the Advance Directive Act by

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

·      Clarifying the succession of surrogates under state law,

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

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

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

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

 

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

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

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

Thank you for your time and attention,

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

Public Health Hearing on #SB303

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

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

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

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

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

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

Office of the Governor Rick Perry – [Press Release] Statement by Gov. Rick Perry on the Kermit Gosnell Verdict

Gov. Rick Perry today issued the following statement on the Kermit Gosnell verdict:

This trial and verdict shed light on a detestable and gruesome industry that takes the lives of hundreds of thousands of babies every year in communities across our nation. Those of us who believe in the sanctity of life will continue to fight for the day when abortion is nothing more than a sad footnote in American history.

via Office of the Governor Rick Perry – [Press Release] Statement by Gov. Rick Perry on the Kermit Gosnell Verdict.

Going Too Far with DNR? | Texas Catholic Conference

“Father Tad” is the Director of Education at the National Catholic Bioethics Center. The Texas Catholic Conference published his commentary on “DNR’s” on May 10, 2013.

These judgments are tricky to make, because the specifics of each case differ, and those specifics change with time and disease progression. DNR’s should be put in place only when the circumstances warrant it, that is to say, on a case-by-case, patient-specific basis. In other words, when CPR/resuscitation can reasonably be determined to no longer offer a hope of benefit to the patient or if it entails an excessive burden to him, at that time a DNR can be put into place.

Some of the possible burdens that may need to be considered in deciding whether to pursue resuscitative interventions for a patient would include some of the following: the risk of rib or other bone fractures, puncture of the lungs by a broken bone (or from the trauma of lung compression and decompression), bleeding in the center of the chest, cerebral dysfunction or permanent brain damage, the small risk (about 3 or 4 percent) that the patient might end up entering a vegetative state, and subsequent complications if the patient ends up staying on a ventilator for an extended period following the resuscitation.

During resuscitative efforts, elderly patients are more likely to experience complications or to have ribs break during CPR. Younger patients, on the other hand, tend to show a greater resilience and are often better able to tolerate CPR. Patients suffering from advanced cancer are also known to fare poorly following resuscitative efforts.

In terms of overall statistics, when a patient codes in the hospital and all resuscitative measures are taken, patients frequently do not end up leaving the hospital, especially when they are elderly or have other co-accompanying conditions. Based on data from the National Registry of Cardiopulmonary Resuscitation (NRCPR), studies have determined that patients who undergo cardiac arrest in the hospital have an overall survival to discharge rate of about 17 percent. The rate drops even lower (to around 13 percent) for cancer patients. In other words, the benefits are oftentimes few and short-lived, while the burdens tend to be high. There are, of course, exceptions — while many patients do not experience significant benefits from resuscitative measures, a small percentage do.

So when death is imminent, and disease states are very advanced (perhaps with multiple organ failure), and assuming other spiritual matters, such as last sacraments, have been addressed, a DNR order may not raise any moral problems. The key consideration in making the judgment will be to determine whether the benefits of resuscitation outweigh the burdens. So when death is imminent, and disease states are very advanced (perhaps with multiple organ failure), and assuming other spiritual matters, such as last sacraments, have been addressed, a DNR order may not raise any moral problems. The key consideration in making the judgment will be to determine whether the benefits of resuscitation outweigh the burdens.

DNR orders can be misused, of course, if they are broadly construed as calling on medical professionals to abandon or otherwise discontinue all care of a patient. Even as patients may be declining and dying of serious underlying illnesses, we must continue to care for them, support and comfort them, and use the various ordinary means that they may have been relying on, such as heart and blood pressure medications, diuretics, insulin, etc.

We should always seek to do what is ethically “ordinary” or “proportionate” in providing care for our loved ones, though we are never obligated to choose anything that would be heroic, disproportionate or unduly burdensome when it comes to CPR or other resuscitative measures.

via Going Too Far with DNR? | Texas Catholic Conference.

More than “a list of endorsements” (with Addendum)

An opponent of SB 303 and I have been discussing the Bill on an earlier post. She referred to my “list of endorsements.”  This is a fairly strong list of endorsements, at least for those of us who are believers, don’t you think?

The Texas Baptist Christian Life Commission is ” is pleased that SB 303 was recently voted out of the senate.”

Texas Catholic Bishops letter to members of the Texas House of Representatives urging support for SB 303

The Morality and Wisdom of Incremental Legislation: The Case for SB 303 by Rev. Tadeusz Pacholczyk, Ph.D.

Point by Point Refutations of Criticisms to SB 303

Texas Catholic Conference Handout comparing SB 303 with current law

Texas Catholic Conference’s response to NRLC’s analysis of SB 303

National Catholic Bioethics Center letter supporting SB 303

National Catholic Partnership on Disability letter supporting SB 303

Texas Catholic Conference Policy Backgrounder on Advance Directives Reform

Texas Catholics Bishops Conference been very active over in the many efforts over the years to reform of the Texas Advance Directive Act and all have signed the endorsement strongly urging passage of SB303 http://www.txcatholic.org/press-releases/336-texas-catholic-bishops-strongly-urge-house-vote-on-end-of-life-care.

I’ve relied on the National Catholic Bioethics Center ( Marie Hilliard and Father Tad) for their consistent and coherent efforts to preserve traditional medical ethics. NCBC has also endorsed the Bill, and written an excellent response to criticism of SB303.

Added 5/11/13 at 11:00 AM, more endorsements and information:

• Senate Bill 303
• House Bill 1444
• John M. Haas, Ph.D., President, National Catholic Bioethics Center, letter supporting SB 303
• Texas Catholic Bishops letter to members of the Texas House of Representatives urging support for SB 303

End-of-Life Ethics: Preparing Now for the Hour of Death – Catholic Update August©2006

Here is another discussion about the end of life for my Catholic friends who are trying to decide whether to support SB 303.

Life, however, is not an absolute good.

Treatment and life support

Questions about the use of medical treatments and life-support systems are distinct from—and yet often associated with—euthanasia. The scriptural insights can be very helpful with these issues, even if they cannot give details. As good stewards, we believe that death is not the final word, that life is not an absolute good. Therefore, we do not have to keep someone alive “at all costs.”

The Catholic tradition helps with the details, providing this guidance: ordinary means must be used; extraordinary means are optional. Ordinary means are medicines or treatments that offer reasonable hope of benefit and can be used without excessive expense, pain or other inconvenience. Extraordinary means do not offer reasonable hope of benefit or include excessive expense, pain, or other inconvenience. What is important to remember is that “ordinary” and “extraordinary” refer not to the technology but to the treatment in relation to the condition of the patient, that is, to the proportion of benefit and burden the treatment provides the patient (see the Vatican’s Declaration on Euthanasia, #IV, 1980).

Many people remember when Cardinal Joseph Bernardin of Chicago decided to stop the treatment for his cancer. The treatment had become extraordinary. He did not kill himself by this choice but did stop efforts that prolonged his dying. He allowed death to occur. (This distinction between allowing to die and killing, as in euthanasia or assisted suicide, is of great significance in the Catholic tradition. The rejection of this distinction by several U.S. courts raises serious concerns.)

Within the Catholic Church, debate still surrounds the question of providing medical nourishment through a feeding tube. Let’s look at two positions.

1) “Life must almost always be sustained.” This position holds that the withdrawal of medically assisted nutrition and hydration cannot be ethically justified except in very rare situations. The fundamental idea for this position is the following: Remaining alive is never rightly regarded as a burden because human bodily life is inherently good, not merely instrumental to other goods. Therefore, it is rarely morally right not to provide adequate food and fluids.

This position acknowledges that means of preserving life may be withheld or withdrawn if the means employed is judged either useless or excessively burdensome. The “useless or excessive burden” criteria can be applied to the person who is imminently dying but not to those who are permanently unconscious or to those who require medically assisted nutrition and hydration as a result of something like Lou Gehrig’s or Alzheimer’s disease. Providing these patients with medical nourishment by means of tubes is not useless because it does bring these patients a great benefit: namely, the preservation of their lives.

2) “Life is a fundamental but not absolute good.” This approach rejects euthanasia, judging deliberate killing a violation of human dignity. On the other hand, while it values life as a great and fundamental good, life is not seen as an absolute (as we saw in the section on scriptural foundations) to be sustained in every situation. Accordingly, in some situations, medically assisted nutrition and hydration may be removed.

This position states that the focus on imminent death may be misplaced. Instead we should ask if a disease or condition that will lead to death (a fatal pathology) is present. For example, a patient in a persistent vegetative state cannot eat enough to live and thus will die of that pathology in a short time unless life-prolonging devices are used. Withholding medically assisted hydration and nutrition from a patient in such a state does not cause a new fatal disease or condition. It simply allows an already existing fatal pathology to take its natural course.

Here, then, is a fundamental idea of this position: If a fatal condition is present, the ethical question we must ask is whether there is a moral obligation to seek to remove or bypass the fatal pathology. But how do we decide either to treat a fatal pathology or to let it take its natural course? Life is a great and fundamental good, a necessary condition for pursuing life’s purposes: happiness, fulfillment, love of God and neighbor.

But does the obligation to prolong life ever cease? Yes, says this view, if prolonging life does not help the person strive for the purposes of life. Pursuing life’s purposes implies some ability to function at the level of reasoning, relating and communicating. If efforts to restore this cognitive-affective function can be judged useless or would result in profound frustration (that is, a severe burden) in pursuing the purposes of life, then the ethical obligation to prolong life is no longer present.

Disagreements in the Church

How are these significantly different positions judged by the Roman Catholic Church? There is no definitive Catholic position regarding these two approaches. Vatican commissions and Catholic bishops’ conferences have come down on both sides of the issue. Likewise, there are Catholic moral theologians on both sides.

via End-of-Life Ethics: Preparing Now for the Hour of Death – Catholic Update August©2006.

Emphasis by underlining is mine. Edited 5/10/13 BBN

Are Feeding Tubes Morally Obligatory? – January 2006 Issue of St. Anthony Messenger Magazine Online

For my Catholic readers who are concerned about SB 303 and the discussion about a doctor’s decision that it’s medically appropriate to withhold artificial food and nutrition by feeding tube or IV:

Such persons, if treated with a feeding tube and intensive nursing care, can sometimes live for months or years. When they die, it is typically due to complications of feeding-tube treatment, such as pneumonia caused by food placed in the stomach going up the esophagus (foodpipe) and down into the lungs.

Thinking about using feeding tubes in a rare condition such as post-coma unresponsiveness is very different from thinking about using feeding tubes in more common diseases such as cancer, AIDS, Alzheimer’s disease, Lou Gehrig’s disease or Parkinson’s disease. Tube feeding in these types of patients will often result in great burden, no net benefit and multiple complications.

In very many such cases, tube feeding will meet the criteria by which it could be considered extraordinary or morally optional. These diseases continue to progress and get worse-no matter what treatment is offered. Complications such as pneumonia are much more common when feeding tubes are used for such patients.

Patients with dementia sometimes pull the tubes out and would need to be restrained in order to be fed. In fact, in these conditions it has even been difficult to show that the use of feeding tubes actually makes the patients live longer. Clearly, in many such cases, the burdens of treatment can be judged disproportionate with respect to the benefits, and the treatment could therefore be judged extraordinary or morally optional.

via Are Feeding Tubes Morally Obligatory? – January 2006 Issue of St. Anthony Messenger Magazine Online.

Opponents of SB303 Promote Doctors Without Conscience

The opponents of Senate Bill 303 may not realize it, but they are promoting the very thing they claim to oppose: elevating the patient’s right to determine his own care above the doctor’s conscience will result in doctors who practice medicine without consciences.

The consequences of elevating autonomy above non-maleficence (“first do not harm”)  go to the very heart of medical ethics. In fact, the promotion of patient autonomy is the common justification for euthanasia and elective abortion on demand.

The doctor is the one whose hands, conscience, and medical judgment will be writing the orders for or actually carrying out the resuscitation. Just as it’s not ethical to force doctors to cause the death of patients, it’s not ethical to demand that doctors write orders and perform interventions when their medical judgment indicates that the intervention will not be successful and will increase pain and suffering while prolonging the process of death.

As ethicist Gilbert Meilaendar noted at the President’s Bioethics Council Meeting in September 12, 2008,

[T]he reason for a physician being willing to risk his life in an epidemic was precisely that he didn’t think staying alive was the most important thing, that there was something else that was morally more compelling and obligatory even than preserving his existence. And that would have something to do with the personal integrity that you seem willing to think may be — one should be willing to set aside in embracing what one thinks is evil.

Vermont House passes aid-in-dying bill – News – Boston.com

The House rejected an amendment to allow the people of Vermont to vote on a referendum. The Vermont Senate has not passed the Bill.

MONTPELIER, Vt. (AP) — After a second long day of debate, the Vermont House gave final approval Wednesday to a bill that would allow terminally ill patients to ask their doctors for a lethal dose of medication.

via Vermont House passes aid-in-dying bill – News – Boston.com.

Hippocratic Oath and Lawyers at the End of Life

Doctors don’t swear oaths as part of our training anymore; and certainly not the Hippocratic Oath. After all, the Hippocratic doctor swears to follow his conscience, even when the patient disagrees. He must refuse to give women medicine or devices to cause abortion or to give poisons to kill patients, no matter who asks for it.

Neither doctors nor hospitals killed Terri Schiavo. Terri Schiavo was killed by her husband’s lawyers and the probate judge who forbade food and water by mouth and by IV or feeding tube.

Plan B, Minors, and the Obama FDA Appeal

Just after I hit “publish” on yesterday’s effort to explain the mechanism of Plan B and why we still shouldn’t allow minor girls to buy it over the counter, I found the news that the Obama Administration has decided that the FDA will appeal the ruling by a New York Federal Judge Edward Korman that gave the FDA 30 days to remove all age restrictions on Plan B, the “morning after pill.” This will not change this week’s decision to move the age requirement down to 15 years of age, it is a good, if minor, move.

USA Today has an article that’s typical for those who object to the appeal, written by Cecile Richards, the former National president of Planned Parenthood (and the daughter of the late Texas Governor Ann Richards).

The comments on CBS News’ coverage of the appeal point out one big problem that teens who have unplanned sex may also have: the “emergency” aspect of “emergency contraception.” One person suggests that Plan B should be available in vending machines and restrooms, as condoms often are. Several readers are concerned that teens who have unprotected sex plan won’t ahead or be able to find a pharmacy open when they need it..

Obviously, the writer of that comment doesn’t understand that the pill can be useful up to 5 days — and is still very effective (if it’s going to be) for at least a day or two. As I responded, there is a difference between a condom and Plan B: the latter is ingested and will have an effect, however small, on the hormonal balance of whoever takes it. Condoms don’t make people nauseous or throw up!

Plan B appeal angers W.H. allies – Kathryn Smith – POLITICO.com

I didn’t expect this!

President Barack Obama’s administration on Wednesday angered allies in women’s groups by appealing a judge’s ruling that the morning-after pill must be available over the counter to girls of all ages.

The administration has argued that the pill should not be readily available to young teens, so the appeal is consistent with that position.

via Plan B appeal angers W.H. allies – Kathryn Smith – POLITICO.com.

Plan B and Minors (Updated!)

Update 5/02/13: The Obama Administration has decided to appeal the judge’s ruling that the age restrictions must be removed completely from Plan B sales.

Because of a ruling by a Court in New York on April 5, 2013 and the April 30, 2013 announcement that the Obama Administration has published its intent to allow 15 year olds to buy Plan B over the counter without a prescription or adult supervision, the news is full of the controversy about whether or not Plan B is an abortifacient because it kills the embryo or blocks implantation.

(How about that: she’s old enough to buy over the counter emergency contraception, but she’s still young enough for her parents to buy her insurance until she’s 26!)

There is quite a lot of evidence that Plan B does not interfere with the embryo if fertilization occurs and none that it does. If, as the evidence supports,  it doesn’t cause the death of the human embryo, before or after implantation, Plan B is not an “abortion pill.”

But it still shouldn’t be sold over the counter to minors.

I don’t know anyone who thinks it’s healthy for 12, 14 or 15 years olds to have sex – whether boys or girls. While Texas does have the “Romeo and Juliet” defense ( when there’s no force, both are over 14 years old, opposite sex and within 3 years of the same age), 15 year olds can’t legally consent to sex. Texas law deems it a “crime of indecency” to have sex with a minor under 17.  Our State has also decided that 15 year olds can’t drink alcohol, can’t buy tobacco or Sudafed, and they usually can’t get a driver’s license.

We do this to protect them, because we know that they are not prepared to make good decisions. Their brains are not mature enough and they don’t have the experience and knowledge to adequately judge the difference between immediate gratification and future benefit. The fact is that most parents are their children’s best protectors and advocates. We are legally responsible for our children, but we are also morally responsible for them. We love them and don’t want them to hurt!

Parents need – and have the right – to know what our dependent children are doing and what medicines they are taking. By changing these regulations, the Federal government is moving between the parent and child — a much more sacred relationship than “a woman and her doctor.”

There is very strong evidence from good scientific experiments published in the last 10 years that Plan B does not interfere with the implantation or development of an embryo.

Plan B only works, when it works, by preventing fertilization for 4-5 days in the middle of the month – before ovulation – it delays ovulation so there is no egg to fertilize and by preventing the sperm from getting to the egg.

Plan B is a high dose of progesterone, the main hormone produced by the ovaries during the second half of a woman’s monthly cycle. Before ovulation, Progesterone or Plan B delays ovulation (the release of the egg from the ovary) and makes it difficult for the sperm to get to the egg.  At or after ovulation,   progesterone appears to slow the sperm’s travel to the egg (prevents fertilization) In nature, this prevents fertilization of an old egg – and its effect is one of the signs used by women who use “Natural Family Planning.”   Progesterone normally encourages the development of the lining of the womb after ovulation. In fact, doctors sometimes give Progesterone to women who have repeated miscarriages.

 It wouldn’t be ethical to conduct experiments on women who are ovulating and having sex, because those women might be carrying a human embryo that hasn’t implanted or who could be harmed. While it is true that there have been no experiments on women who might be pregnant, there are good studies which were done on ovulating women who have their tubes tied or who agree to abstain from sex during the experiment. Then, they were studied by checking repeat exams, blood work, ultrasounds and biopsies of the womb.  No evidence that Plan B interferes with implantation or damages the embryo has been found.

Current evidence is that Plan B decreases the risk of pregnancy for those women who take it properly, Plan B cuts the risk of pregnancy by 50- 70%. At the population level, it does not decrease either the pregnancy rate or the abortion rate. In fact, even women who have the pills in their medicine cabinet – who don’t have to pay $45 when they have unprotected sex – don’t use the pills consistently. This is true in countries like Scotland, the UK and Jamaica where teen girls can obtain the medication without a prescription or are provided the medication in advance of need.

I am a pro-life doctor who, like Texas law, believes that the individual begins at fertilization. I spend much of my time advocating for laws that protect the human right not to be killed and for traditional medical ethics. Yes, I am a Christian , but I prefer to make my arguments from the science side because I’m convinced that science will prove me right in the long run. After all, the “Nature’s Creator “ cited in the Declaration of Independence created science!

For the science, see these articles:

Added 8:00 PM 5/2/13 One of the best and oldest. I can email a copy of the entire article to anyone who needs it http://www.contraceptionjournal.org/article/S0010-7824%2805%2900045-4/abstract

• http://www.ncbi.nlm.nih.gov/pubmed/20670097
• http://humrep.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17537781
• http://linkinghub.elsevier.com/retrieve/pii/S0010-7824(12)00100-X
• http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1726-46342010000200010&lng=en&nrm=iso&tlng=en
• http://linkinghub.elsevier.com/retrieve/pii/S0010-7824(11)00106-5
• http://www.webmd.com/sex/birth-control/news/20070417/plan-b-doesnt-cut-pregnancy-rates
• http://jama.jamanetwork.com/article.aspx?articleid=200095

Update on the Texas Advance Directive Act (SB 303)

The Texas Advance Directive Act of 1999 (TADA) describes “Advance Directives to Physicians” (what most people would call a “Living Will”) and contains Section 166.046, an attempt to outline the procedure for resolving a disagreement between a doctor and patients or their surrogates about what is medically appropriate treatment.
The law currently in effect requires the doctor to notify the patient or the surrogate when he or she believes that their request is medically appropriate. If there is still a disagreement, the doctor asks the hospital to convene a meeting of their ethics committee. If the committee agree agrees with the doctor, and no other doctor is willing to take over the care of the patient, the treatment in question can be withheld or withdrawn. TADA doesn’t allow “Physician Assisted Suicide” and certainly doesn’t allow euthanasia, where the patient might be killed on purpose.

The Texas Senate passed Senator Bob Duell’s Senate Bill 303, which significantly improves current law.  SB 303

• Requires the doctor to notify the patient or his surrogate before writing a “Do Not Attempt Resuscitation” order,
• Prohibits the withdrawal of artificially administered hydration and nutrition except in extreme circumstances and
• Gives families 5 days instead of 2 to prepare for the ethics committee meeting and 21 days instead of 10 before the patient must transfer care to another doctor,
• Outlines the duties of the hospital to  treat all patients the same, regardless of age, disability, or ability to pay, to provide a trained liaison to assist the family, and requires timely copies of the medical records.

Because SB 303 still needs to pass in the House, Texas Alliance for Life asked me to help them make a video explaining how it reforms current law.

If you agree that SB 303 is a pro-life reform Bill please call your State Representative at 512-463-4630 and ask him or her to support SB 303.

My “Ethics 101” on the law: “Back to Basics on Texas Advance Directive Act”

Video Scrutinizes Late-Term Abortion Practices at Bronx Clinic – NYTimes.com

Caution: very graphic story. The video by Live Action is not for the unprepared, so I’m not going to embed it here.

Live Action has released another of their under-cover videos, this one focusing on a woman who is 23 weeks pregnant who claims to be seeking an abortion at 23 weeks pregnancy. Live Action is a non-profit, pro-life group that is notorious for videos that expose Planned Parenthood and other abortionists’ attitudes toward abortion as birth control, late term abortion, gender selection, prostitution and even race-selective abortions.

A  New York Times article, points out the different roles of the two women representing the clinic. But still, both women were matter of fact about the methods and results of a 23 week abortion.

Lila Rose, president of Live Action, said the group would release more videos as part of its campaign against late-term abortions. Sunday’s video was shot at the Dr. Emily Women’s Health Center on Southern Boulevard in the Bronx. The release comes as Gov. Andrew M. Cuomo, a Democrat, has thrown his support behind legislation that will guarantee a woman’s right to an abortion after 24 weeks of pregnancy, if her health is in danger or if the fetus is not viable. The current law permits abortion after 24 weeks only if a woman’s life is in danger, although it is not enforced because federal court rulings have allowed less restrictive late-term abortions.

via Video Scrutinizes Late-Term Abortion Practices at Bronx Clinic – NYTimes.com.

Obama Gives $13 Million Grant to Texas Planned Parenthood! @txprolife

We’ve all been hearing about the supposed “War on Women” by Conservative law makers – and, by extension, voters – in Texas. Well, President Obama and Secretary of Health Kathleen Sebellius just fired another shot in the war against Texas and State’s rights.

UPDATE: In an emailed statement, Texas Department of State Health Services spokeswoman Carrie Williams says that the agency just received notice that it will lose the Title X grant and is “reviewing the information to get a sense of the full impact.” The agency hopes the transition is smooth and the provider base remains strong, she wrote.
EARLIER: The federal government has pulled from the state of Texas millions in family planning funding, granting the money instead to a coalition led by the Women’s Health and Family Planning Association of Texas, which says it can serve a greater number of women with the available funds.
For more than four decades, federal Title X funding has been dedicated to funding family planning services and covering clinics’ infrastructure costs. The funds are generally granted to providers (like Planned Parenthood) and/or to state health agencies. In Texas since 1980, the majority of the funding has been administered by the Department of State Health Services — roughly $18 million in 2012, for example; since 2009, DSHS has been the sole grantor of Title X funds.

(Edit, maybe it’s only half of that.)

A Little History

Before this year, Federal tax dollars came back to Texas in two major funds: the Women’s Health Program and Family Planning, or Title X funds. Texas “matched” a certain amount and the Texas Department of Health and Human Services administered the dispersion of the money. Because the money paid for or freed up other funds for staff, marketing, and “infrastructure” or office overhead, PP was helped to keep their abortion clinics running. The overall effect was that State matching tax dollars helped PP to funnel patients, if not dollars, to their abortion clinics.

Texas was forced to make severe Budget cuts across the board in 2011, including Family Planning funds. This led to prioritizing what little money we had:

“State lawmakers cut funding for family planning services by two-thirds in the last legislative session, dropping the two-year family planning budget from $111 million to $37.9 million for the 2012-13 biennium. They also approved a tiered budget system for family planning funds, which gives funding priority to public health clinics, such as federally qualified health centers and comprehensive clinics that provide primary and preventative care over clinics that only provide family planning services.”

Texas Tribune

Options gang ready to go home

We’ve been in Joplin, Missouri, learning how to run an STI (sexually transmitted diseases) clinic. Now, we’re going home!

Trial shows abortion’s ‘coarsening’ impact

http://m.bpnews.net/bpnews.asp?id=40078

I’m quoted on Abortion and Breast Cancer Risk

Several media outlets sort of quoted my testimony against HB 2945 in the Texas State House Affairs Committee on Wednesday. However, they proved Mark Twain’s assertion that there are “lies, damned lies, and statistics.”

In my testimony against HB 2945, I also pointed to the National Cancer Institute’s webpage, “Reproductive History and Breast Cancer Risk,” which outlines the protective effect of pregnancy. After all, the only women and girls receiving this information are pregnant women and girls!

Unfortunately, Representative Farrar focused on the “peer review” status of the Mabye article (“Did it go through the Medline or PubMed?”), ignoring the NCI data.

In that (yes, Jessica, it’s “peer reviewed”) New England Journal of Medicine article, the authors note that, while their study found no increased risk overall, there is a protective effect of pregnancy and an increased risk for some women: “Induced abortion had no overall effect on the risk of breast cancer, but we found a statistically significant increase in risk among women with a history of second-trimester abortion.” This was a small number of cases, but it was also in spite of the authors’ acknowledging that unknown thousands of unrecorded abortions ( those before 1973 computerization of records) were probably not accounted for.

From the Texas Tribune:

Dr. Beverly Nuckols, a family doctor from New Braunfels and board member of Texas Alliance for Life, testified against the bill. She cited a study published by the New England Journal of Medicine in 1997 that showed pregnancy decreases the risk of breast cancer.

“No one would prescribe pregnancy to prevent breast cancer,” Nuckols said. “We’re just letting them know that if they have a risk factor in their family, this pregnancy may cut their risk of breast cancer in half.”

via House Panel Debates Changes to Booklet on Abortion | The Texas Tribune.

Others:

Austin Chronicle, “A Woman’s Right to Know the Truth”

Newsweek’s Molly McArdle: Why I Didn’t Write About Gosnell’s Trial–And Why I Should Have

Warning: the article is graphic.

“If I think about it for a moment, there are obviously lots of policy implications of Gosnell’s baby charnel house. How the hell did this clinic operate for seventeen years without health inspectors discovering his brutal crimes? Are there major holes in our medical regulatory system? More to the point, are those holes created, in part, by the pressure to go easy on abortion clinics, or more charitably, the fear of getting tangled in a hot-button political issue? These have clear implications for abortion access, and abortion politics.

“After all, when ostensibly neutral local regulations threaten to restrict abortion access–as with Virginia’s recent moves to require stricter regulatory standards for abortion clinics, and ultrasounds for women seeking abortions–the national media thinks that this is worthy of remark. If local governments are being too lax on abortion clinics, surely that is also worthy of note.

via Why I Didn’t Write About Gosnell’s Trial–And Why I Should Have – The Daily Beast.

Lest we forget — “After-birth abortion: why should the baby live?” Journal of Medical Ethics

#Gosnell would be vindicated if these “ethicists” have their way

There are two reasons which, taken together, justify this claim:

The moral status of an infant is equivalent to that of a fetus, that is, neither can be considered a ‘person’ in a morally relevant sense.

It is not possible to damage a newborn by preventing her from developing the potentiality to become a person in the morally relevant sense.

via After-birth abortion: why should the baby live? — Giubilini and Minerva — Journal of Medical Ethics.

Nurses quit Planned Parenthood because of ‘dangerous and dirty work conditions’

Guess what? Virtually no media notice!

Two Planned Parenthood nurses quit their jobs because of dirty and dangerous work conditions and what they called ‘a meat-market style of assembly-line abortions’.

The former employees of the Delaware branch have spoken out about what allegedly takes place behind its closed doors and said that a rush to get patients in and out leaves the operating tables soiled and unclean and that doctors don’t wear gloves.

Jayne Mitchell-Werbrich, former employee said: ‘It was just unsafe. I couldn’t tell you how ridiculously unsafe it was.

‘It’s not washed down, it’s not even cleaned off. It has bloody drainage on it.’

via A meat-market style of assembly line abortions: Nurses quit Planned Parenthood because of ‘dangerous and dirty work conditions’ | Mail Online.

Statistics and “Peer Review”

Typical of the reporting on the connection between abortion and breast cancer, a blogger at “RhealityCheck,” only reports half a sentence – the half that she likes.

I don’t know how long my comments will stay up, so here’s my part:

The author only quoted half a sentence. The article clearly states, “Induced abortion had no overall effect on the risk of breast cancer, but we found a statistically significant increase in risk among women with a history of second-trimester abortion.”

and

And here’s the link to the article in question. Please note that even this research must adjust for the age at first pregnancy and for number of pregnancies.

My testimony begins at 1 hour, 12 minutes in on the video of the hearing. I actually focused on the protective effect of pregnancy, especially early pregnancy, according to the National Cancer Institute. This information is only given to women and girls who are already pregnant, after all.

Interestingly, we learned how little the Committee members understood about scientific research and resources. Follow the hours of testimony on HB 2945 and HB 2365 and Rep.Jessica Farrar’s obsession and apparent slow realization about the meaning and significance of “peer review” and “PubMed” and “Medline.“At one point, 1:26, Ms. Farrar, who admits that she “barely got through biology,” asks whether the research was “peer reviewed” by “the Medline or PubMed.”

As the day went on, it seems that Farrar was educated that peer review is conducted by the Journals themselves, and that PubMed and Medline are merely indexes of scientifc literature.

State Rep Farrar: “Choice” to abort babies with spina bifida after 20 weeks

6:05/8:18 Farrar:  “So, so, this diagnosis is missed, they
have a fetal anomaly, the spine’s outside the body or something, you say you would not have an exception for that situation.”

Watch the video at 6:05 (See below ++) of the April 10, 2013 Texas House State Affairs Committee meeting hearing on HB 2364, by Representative Jodi Laubenberg,  as State Representative Jessica Farrar challenges a practicing OB/Gyn about his belief that abortion should not be performed when babies are found to have non-lethal “anomalies” after 20 weeks post-fertilization (or 22 weeks since last period).

I wonder how of you have heard of the trial of abortionist Kermit Gosnell* in Philadelphia, Pennsylvania? Most people, whether pro-choice or pro-life, are horrified by the way Dr. Gosnell and his staff treated the babies they delivered both alive and dead.

We also squirm at the intentional killing of children who could otherwise live.

The limit of viability for the unborn, using current medical technology, is 20 to 23 weeks gestation.  There have been reports of survivors born before this time. Who will be surprised when the limit moves even farther back? What will history say about us?

In fact, here in Texas, we have made it clear with our Prenatal Protection Act of 2003, spurred on by the deaths of Lacy and Connor Peterson, that our definition of individual (or person) includes all humans from fertilization to natural death.

++ Download the free Real Player app, open the video and then pull the timeline cursor out to 6:05. More Committee and Session videos are available at the Texas Legislature Online site.

*(Gosnell is accused of killing the babies who survive, of committing abortions after the legal age limit, and of mutilating the bodies of the babies after they were dead. One gruesome account is here.)

Texas will pay for destructive human embryo cloning at Texas Universities

The Committee Substitute was passed this afternoon with 9 yes votes in the House State Affairs Committee. The Chairman of the Committee, Byron Cook voted “yes,” after assuring the Committee that the Bill (which is not available online or in the Committee) will not outlaw human cloning at Universities.

Voting “no” were four brave Republicans – I’ll list them all as soon as I can verify and make sure I don’t miss anyone. Unfortunately, some of our conservative members weren’t present. I will also name them when I can do so without missing anyone.

I worked with Representative Raymond’s office to come up with good definitions, but I don’t know how much of those definitions made it into the final Bill.

Luckily, in spite of the lies we’ve read over the years, no one has yet been able to clone a human embryo.

What is now encouraged is the purposeful creation of a human embryo by cloning. The embryo may never be implanted, but the Bill declares that the nascent human should be killed and broken up

Lieutenant Governor David Dewhurst

Talking about Texas’s history of conservative pro-life and pro-family laws.

Texas Alliance for Life Leadership Luncheon

Joe Pojman, standing at the podium. Our President, Davida Stike is seated at the head table. Next up, our Lieutenant Governor, David Dewhurst.

Back to Basics on Texas Advance Directive Act

Laws relating to ethics debates are generally behind medical advances. This is good because it means that there *are* medical advances.

However, the debates often become emotional and heated, and the individuals who are affected face real dilemmas and emergencies. When law-making is controversial, it’s best to go back to the basics of ethics for guidance: the inalienable rights to “Life, Liberty and the Pursuit of Happiness,” the Declaration of Independence, and Constitution.

 
All laws limit our rights, but good laws strike a balance between seemingly conflicting rights: they are meant to prevent one person from harming another. Most laws prohibit or punish harmful actions, they don’t *compel* a desired action against our will. Nor do they prohibit actions based on thoughts and opinion. In other words, laws prohibit harming or taking from another, but they usually don’t make you protect, nurture or give to another.

 
However,since the right to life trumps the right to liberty and property, there are very rare circumstances when it is appropriate for laws to compel individuals to act for the benefit of another. Parents are required to care for and protect their minor children. Doctors and lawyers must be licensed, obtain certain levels of education, and follow specific, positive actions when they wish to withdraw from a professional relationship with a patient or client. These laws should only go so far as to protect the life and safety of the vulnerable, for a limited time with the goal of allowing safe transfer of the obligation of the person with more power to someone else.

 
On Tuesday, March 19, 2013, the Texas Senate Health and Human Services Committee, under Chair Senator Jane Nelson, heard testimony on two Bills that would change TADA: SB 303 from Senator (Dr.) Bob Duell’s  and SB 675 by Senator Kelly Hancock.

 
The Texas Advance Directive Act of 1999 (TADA), in addition to describing “Advance Directives to Physicians” (a “Living Will),  was an attempt to outline the procedure for resolving the disagreement between a doctor and patients or their surrogates regarding end of life care.

When I first read the Act, I (naively) thought it was malpractice protection for doctors who did not want to withdraw or withhold care, such as the Houston Methodist Hospital doctors who invoked the act when they repaired Dr. Michael Debakey’s aortic aneurysm against his previously stated wishes – http://www.theheart.org/article/762619.do – in 2006.

 
Most of the time, however, TADA is invoked in cases when the attending physician disagrees with a request to actively administer medical treatment that he or she believes is medically inappropriate. The steps laid out in the law involve the doctor’s notification of the patient or the surrogate, rules for assisting with transfer of care to another doctor who believes the treatment request is appropriate, and convening an ethics committee at the hospital. If there is no other willing doctor can be found and the ethics committee agrees with the doctor, the treatment can be withheld or withdrawn. It does not allow patients to be killed by medicines.

 
Unfortunately, the Act has become known as the “Texas Futile Care Law,” and divides even the pro-life community. One side says doctors and hospitals have too much power and are killing people. While I’ve heard horror stories about doctors who have abused or broken the law, I maintain that there is no “Futile Care Law,” only a difference of opinion as to who should decide what is medically appropriate treatment. In the few cases that have come under the Act, patients and their advocates report trouble finding other doctors willing to provide the treatment the first doctor thought was inappropriate. In my opinion, that difficulty is due to physicians’ common education and shared experiences.

Although TADA lays out requirements for hospitals and hospital medical ethics committees, the fact is that it applies to the “attending physician” who could be forced to act against his conscience. Texas law is clear that only doctors may practice medicine by diagnosing and treating patients directly or “ordering” other medical personnel. These treatments are not one-time events and they aren’t without consequences. They are interventions that must be monitored by observation and tests, and adjustments need to be made so that the treatment is effective and not harmful. Medical judgment is how doctors utilize our education, experience, and consciences as we plan and anticipate the effect of each medical intervention.

Senator Duell’s Bill, SB 303, significantly improves TADA. Among other things, the Bill would add protection of the patient’s right to artificially administered hydration and nutrition, increased access to assistance, records, and time before and after the ethics committee meeting, and prohibits so-called “secret DNR’s.”

Senator Hancock’s Bill, SB 675, focuses on the intentions and motives of the doctor, requiring the medical committee to decide whether the disagreement is due to: “(1) the lesser value the physician, facility, or professional places on extending the life of an elderly, disabled, or terminally ill patient compared to the value of extending the life of a patient who is younger, not disabled, or not terminally ill; or “(2) a disagreement between the physician, facility, or professional and the patient, or the person authorized to make a treatment decision for the patient under Section 166.039, over the greater weight the patient or person places on extending the patient ’s life above the risk of disability.”

Our laws normally prohibit actions and only very rarely compel people to act. Under the conditions laid out in SB 303, the doctor can be forced to act against his conscience and best medical judgment, but only for a limited, stated time. SB 303 improves the Texas Advance Directive Act by protecting the patient’s access to artificially administered hydration and nutrition. It also adds time to prepare for the ethics committee meeting and to transfer care a new doctor. It is an attempt to balance the patient’s wishes for medical intervention with the right of conscience of the doctor. In contrast, SB 675 would attempt to legislate intentions or thoughts, with none of the added protections of SB 303.

Edited 4/27/13 to fix the link to the article about Dr. Debakey and 4/30/13 for grammar and formatting – BBN.

Senate panel OKs abortion bill requiring stricter standards – Houston Chronicle

One woman claimed that the standards shouldn’t be the same as an ambulatory surgical center because they do abortions on 9 year olds!

Minimal standards are considered too much by the abortion industry. They’ve fought every move to keep women and girls safe, and whip out those coat hangers every chance they get.

Women who have D&C’s after a miscarriage have them at a hospital or surgical center, not at in an office setting. But according to the abortionists, healthy mothers having abortions – or 9 year old girls – should be happy with a clinic setting.

AUSTIN – Abortion clinics would be required to meet stricter standards under a bill approved 5-2 by the Senate Health and Human Services Committee Tuesday after emotional testimony over whether the measure would protect women’s health or risk it by causing clinics to close.

“My intent in filing this bill is only to protect Texas women who undergo this procedure,” said Sen. Bob Deuell, R-Greenville, who authored the measure with two fellow doctors, Republican Sens. Donna Campbell of New Braunfels and Charles Schwertner of Georgetown.

Planned Parenthood called the measure, Senate Bill 537, a “back-door abortion ban.”

via Senate panel OKs abortion bill requiring stricter standards – Houston Chronicle.

Cloned “Clone and Kill” Bill

I testified in front of the Texas House State Affairs Committee on Tuesday. The video is here, House State Affairs 2/20/13 (Free RealPlayer program required.) Mr. Raymond comes up at about 3:30 minutes in, and my effort starts at 8 minutes in. It’s short and sweet.)

HB 142, authored by Representative Richard Raymond of Texas’ House District 42 in Laredo, looks a lot like his HB 1829 from 2007. These are “clone and kill bills, which nominally ban cloning, but actually redefine cloning, and would force the killing of any human embryo intentionally killed by nuclear transplantation. HB 142 ignores the history of the last 6 years, and uses inaccurate terminology.

Watch this space for alternative language that would actually ban human cloning.