Health Care Policy

Planned Parenthood, big abortion and the battle to save lives in Texas | Fox News

[R]emind me again why pro-abortion activists want healthy five-month pregnant women to abort their healthy child in dirty, unsafe abortion clinics?

via Planned Parenthood, big abortion and the battle to save lives in Texas | Fox News.

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

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

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

 

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

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

#Stand4Life Wendy’s Wasted Voice: Why Fighting the Texas Abortion Bill Was Not ‘Pro-Woman’ « Above the Law: A Legal Web Site – News, Commentary, and Opinions on Law Firms, Lawyers, Law Schools, Law Suits, Judges and Courts + Career Resources

Wendy Davis opposed a bill that gives women seeking abortions the same level of safety as women seeking LASIK on a Friday afternoon. Should I have feel empowered as a Texas woman that I can currently get a D&E for an unplanned pregnancy at a place with lower standards than where I could get a endoscopy for an acid reflux diagnosis? What is so “pro-woman” about lower health and safety standards for abortions?

via Wendy’s Wasted Voice: Why Fighting the Texas Abortion Bill Was Not ‘Pro-Woman’ « Above the Law: A Legal Web Site – News, Commentary, and Opinions on Law Firms, Lawyers, Law Schools, Law Suits, Judges and Courts + Career Resources.

Dr. Love on HB2 #Stand4Life

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“No Cost” Contraception (Obama Administration fantasy)

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

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

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

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

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

@GovernorPerry: Gov. Perry Calls Special Session to Begin July 1

AUSTIN – Gov. Rick Perry today announced a Special Session of the Texas Legislature will begin at 2 p.m. Monday, July 1.

“I am calling the Legislature back into session because too much important work remains undone for the people of Texas. Through their duly elected representatives, the citizens of our state have made crystal clear their priorities for our great state. Texans value life and want to protect women and the unborn. Texans want a transportation system that keeps them moving. Texans want a court system that is fair and just. We will not allow the breakdown of decorum and decency to prevent us from doing what the people of this state hired us to do.

The special session will consider the following issues:

• Legislation relating to the regulation of abortion procedures, providers and facilities.

• Legislation relating to the funding of transportation infrastructure projects.

• Legislation relating to establishing a mandatory sentence of life with parole for a capital felony committed by a 17-year-old offender.

via Office of the Governor Rick Perry – [Press Release] Gov. Perry Calls Special Session to Begin July 1.

Rush Limbaugh explains it all #SB5, #SCOTUS

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

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

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

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

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

You can watch the Senate video at this page.The

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

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

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

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

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

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

Chub, Scrub, Stuff and Stall #SB5 #TxLege

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

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

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

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

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

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

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

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

Stand for Life Sunday 6/23/13 1PM @ Texas Capitol #SB5 #HB60

#TxProlife and all Texas voters who would stop (or at least limit) the abortions of our little brothers and sisters are asked to join us in a prayerful, peaceful stand in favor of no abortions after 20 weeks, higher standards for abortion facilities and a requirement that the doctors who perform abortions maintain hospital privileges within 30 miles of the facility.

(seriously: doctors should have local hospital privileges, don’t you think?)

Please consider joining us at the Capitol when the House debates these Bills on Sunday. Wear blue, so we can show our numbers.

If you can’t attend, please pray for us and call your Representative’s office to ask for a “yes” vote on SB5 and HB60. Our best chance is to pass the Senate Bill, so the law will go through faster and with less chance of stalling. If the Senate has to agree with a different Bill, there may not be time.

Pray for a peaceful stand for life and courageous Legislators who will defend the Texans of tomorrow!

I won’t be able to follow this page very well during the meeting at the House, but should be able to keep up with those of you who contact me on Twitter, at bnuckols.

RX: Sack cloth and ashes for #SB303 opponents

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

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

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

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

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

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

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

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

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

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

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

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

Specious “Scientific” Argument for Abortion

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

Double trouble

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

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

Denouement: The Death of #SB303

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

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

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

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

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

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

Cloned human embryos announced

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

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

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

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

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

There are several ethical problems which surround this research.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

May 13, 2013

Chair Kolkhorst and members,

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

The reforms in SB 303 improve the Advance Directive Act by

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

·      Clarifying the succession of surrogates under state law,

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

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

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

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

 

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

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

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

Thank you for your time and attention,

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

Public Health Hearing on #SB303

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

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

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

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

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

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

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

Breast Cancer Research: “Parity induces differentiation and reduces Wnt/Notch signaling ratio and proliferation potential of basal stem/progenitor cells isolated from mouse mammary” epithelium

In other words, this may be the way that “parity-induced protection” (or decreased risk of breast cancer due to having a baby) decreases the chance of breast cancer: pregnancy “produces differentiation” of a certain group of progenitor cells.

 

Conclusions

By revealing that parity induces differentiation and downregulates the Wnt/Notch signaling ratio and the in vitro and in vivo proliferation potential of basal stem/progenitor cells in mice, our study sheds light on the long-term consequences of an early pregnancy. Furthermore, it opens the door to future studies assessing whether inhibitors of the Wnt pathway may be used to mimic the parity-induced protective effect against breast cancer.

via Breast Cancer Research | Abstract | Parity induces differentiation and reduces Wnt/Notch signaling ratio and proliferation potential of basal stem/progenitor cells isolated from mouse mammary epithelium.

This article acknowledges what we’ve known and suspected.  Wonder how that gene is affected by an elective abortion – and will we ever know?

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.

Dying, Naturally, in the Emergency Department

Here’s an excellent professional article about end of life care for patients that’s relevant to our discussion about SB 303.

Two Roads to Death

Two major pathways to death have been described: The easy and the difficult road Figure 1. Depending on the road a patient takes, the intensity of ED management may vary significantly. For instance, some patients are highly symptomatic at the EOL, requiring intravenous medications and even continuous drips to maintain comfort while others can be managed by relatively simple oral regimens in the home setting, with the support of hospice services.For symptoms like pain, the EM skill set proves sufficient as the management of healthy patients and those at the EOL is similar. EM treatment algorithms are less relevant, however, for symptoms like dehydration, delirium and dyspnea in the dying patient. For this reason, we will focus our attention on the unique approach to these common and often troublesome EOL issues.

via Dying, Naturally, in the Emergency Department.

New brain research shows two parents may be better than one

More evidence that we shouldn’t treat our children of tomorrow like lab rats by redefining marriage:

A team of researchers at the University of Calgary’s Hotchkiss Brain Institute (HBI) have discovered that adult brain cell production might be determined, in part, by the early parental environment. The study suggests that dual parenting may be more beneficial than single parenting.

Scientists studied mouse pups that were raised by either dual or single parents and found that adult cell production in the brain might be triggered by early life experiences. The scientists also found that the increased adult brain cell production varied based on gender. Specifically, female pups raised by two parents had enhanced white matter production as adults, increasing motor coordination and sociability. Male pups raised by dual parents displayed more grey matter production as an adult, which improves learning and memory.

“Our new work adds to a growing body of knowledge, which indicates that early, supportive experiences have long lasting, positive impact on adult brain function,” says Samuel Weiss, PhD, senior author of the study and director of the HBI.

Surprisingly, the advantages of dual parenting were also passed along when these two groups reproduced, even if their offspring were raised by one female. The advantages of dual parenting were thus passed along to the next generation.

To conduct the study, scientists divided mice into three groups i) pups raised to adulthood by one female ii) pups raised to adulthood by one female and one male and iii) pups raised to adulthood by two females. Researchers then waited for the offspring to reach adulthood to find out if there was any impact on brain cell production.

Scientists say that this research provides evidence that, in the mouse model, parenting and the environment directly impact adult brain cell production. While it’s not known at this point, it is possible that similar effects could be seen in other mammals, such as humans. The study is published in the May 1 edition of PLOS ONE. It was funded by the Canadian Institutes of Health Research (CIHR).

The research paper can be read online: http://dx.plos.org/10.1371/journal.pone.0062701.

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”