Tuesday, November 24, 2009

Kill Bill

Yes, more health care. As expected, al of the concessions of the house bill have been removed and then some! The senate bill is an abomination of death. There has been, of course, a lot of press about the abortion language in the bill, less so about euthanasia, so I thought I'd talk a bit about that. Of course, some people will immediately say “but the bill doesn't say we'll have euthanasia”, make a joke about “death panels” and start chanting “Sarah Palin” while rocking back and forth.

Yes, the bill doesn't say it will cover euthanasia explicitly. Then again it doesn't say it will cover cancer treatment, but we all expect it will. That's a silly argument, as the bill doesn't actually say what will be covered and what will not. But in fact, this bill does mention euthanasia, and in a very troubling way:

(a) IN GENERAL.—The Federal Government, and any State or local government or health care provider that receives Federal financial assistance under this Act (or under an amendment made by this Act) or any health plan created under this Act (or under an amendment made by this Act), may not subject an individual or institutional health care entity to discrimination on the basis that the entity does not provide any health care item or service furnished for the purpose of causing, or for the purpose of assisting in causing, the death of any individual, such as by assisted suicide, euthanasia, or mercy killing.
This is a conscience clause for those who do not “provide any health care item or service” for the purpose of “causing the death of any individual”. So, there's no language saying that euthanasia won't be covered under the plan, and language that says but not every doctor has to offer it. As troubling (or more) to me is the terminology. A health care item or health care service is something to heal or promote life. Here it is explicitly stated that we are redefining as a health care item or health care service something that is intended to kill the patient.

But that's not all. In section 1323 of the bill, on page 186 it reads:
(F) PROTECTING ACCESS TO END OF LIFE CARE.—A community health insurance option offered under this section shall be prohibited from limiting access to end of life care."
So while an individual doctor might not offer euthanasia, all insurance plans must cover it, and therefore you and I must pay for it. This is pretty telling language for a bill that is supposed to not support euthanasia. If the bill is not going to support it, this language would be unnecessary.


Before continuing on the topic, I'd like to clarify the terms I am going to use. There are different types of care: ordinary, palliative, proportionate and disproportionate. Ordinary care is, well, ordinary. It's the basic care we would give any human being at any time. It includes food, water, shelter from the elements, a reasonable room temperature. You are (hopefully) receiving ordinary care every day. Palliative care means relieving pain or other symptoms. When you take an ibuprophen or some cough medicine for a cold you are getting palliative care.

The Catholic Church requires that all people be given ordinary and palliative care. That means you are not to starve someone to death, leave them out in a blizzard, or withhold pain medication. The Catechism of the Catholic Church teaches:
2279 Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable Palliative care is a special form of disinterested charity. As such it should be encouraged.
The rest of health care is further divided into two categories: proportionate and disproportionate. Proportionate health care must meet all of the following conditions. It must have a reasonable chance of curing or contributing to the cure of the patient. It does not carry a significant risk of death, and it must not be excessively burdensome. Setting a broken leg, for instance, is proportionate health care. Care that does not meet these three criteria is called disproportionate. The Catholic Church considers offering proportionate care to be mandatory, although the patient does not have to accept it. Disproportionate care is not considered mandatory.
2278 Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.
There is considerable room for debating whether a procedure is proportionate. A pacemaker might be considered proportionate, but in the case of a patient with a terminal illness or other serious health conditions the risks and burden might put it in the realm of disproportionate care. Every case must be examined on its own merits.

“Mercy” Killing

According to a report by the New York State Task Force on Life and the Law titled When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context (emphasis added by me):
“American society has never sanctioned assisted suicide or mercy killing. We believe that the practices would be profoundly dangerous for large segments of the population, especially in light of the widespread failure of American medicine to treat pain adequately or to diagnose and treat depression in many cases. The risks would extend to all individuals who are ill. They would be most severe for those whose autonomy and well-being are already compromised by poverty, lack of access to good medical care, or membership in a stigmatized social group. The risks of legalizing assisted suicide and euthanasia for these individuals, in a health care system and society that cannot effectively protect against the impact of inadequate resources and ingrained social disadvantage, are likely to be extraordinary.

The distinction between the refusal of medical treatment and assisted suicide or euthanasia has not been well-articulated in the broader public debate. In fact, the often-used rubric of the 'right to die' obscures the distinction. The media's coverage of individual cases as a way of presenting the issues to the public also blurs the difference between a private act and public policy; between what individuals might find desirable or feasible in a particular case and what would actually occur in doctors' offices, clinics, and hospitals, if assisted suicide and euthanasia became a standard part of medical practice. Public opinion polls, focusing on whether individuals think they might want these options for themselves one day, also offer little insight about what it would mean for society to make assisted suicide or direct killing practices sanctioned and regulated by the state or supervised by the medical profession itself.”
Some people refer to euthanasia as “mercy” killing. The implication is that these people are “better off dead” because they are in pain or because they are suffering. The danger with this type of thinking is that instead of providing palliative care, our response to suffering is to kill. But killing is not palliative care. As Dr. Gregory Hamilton, the chair of Physicians for Compassionate Care, stated in an article in the Oregonian: "Comfort care results in a comfortable patient; assisted suicide results in a corpse.

I think it is important to recognize that the suffering “mercy” killing strives to end is that of those who don't want to watch, or care for, or bear the financial burden for those who are in need. As John Paul II wrote in Evangelium Vitae, "True 'compassion' leads to sharing another person's pain; it does not kill the person whose suffering we cannot bear."

When “mercy” killing is considered a viable option for health care, it becomes the preferred option by those who would seek to reduce costs. You can “mercy” kill someone for $35, while it is hard to find any reasonable medical treatment today that is cheaper. Legalized euthanasia will result in discrimination against the “undesirables” of society; the poor, the immigrant, the weak and elderly, and ultimately, their murder. As reported in Inside Catholic:
“Dr. Diane Meier, a former advocate of assisted suicide, said in a 1998 New York Times article, 'Legalizing assisted suicide would become a cheap and easy way to avoid the costly and time-intensive care needed by the terminally ill.'

Substantiating this claim is the fact that Oregon's Medical Assistance Program (OMAP) for the poor moved to provide physician-assisted suicide to its recipients as soon as the Death with Dignity Act was passed in 1997. Only 18 months later, the OMAP announced plans to cut back on pain medication coverage for the same population. Hospice care has also suffered -- the International Task Force reports that one Oregon insurance company has a paltry $1,000 cap on in-home hospice care. With the cost of a lethal overdose running about $35, there would be little motivation to pay any more for palliative treatment.”
Also, as noted, the issue is presented to the public by the media in a way which lumps all the issues into a single mass. The implication is that if any part is acceptable, the whole thing should be. Thus, many people equate euthanasia with refusal of treatment, when they are two radically different ideas. The difference is like the difference between a fireman being unable to save a life and the arsonist who set the fire. One is recognizing an inability to cure, the other is murder.

But Everything's Great in Europe!

Let's take a look at what has happened in a country that has euthanasia. According to the International Assisted Suicide and Euthanasia Task Force there are widespread abuses in countries that have euthanasia (bold is mine, italics are in original).
“The data indicate that, despite long-standing, court-approved euthanasia guidelines developed to protect patients, abuse has become an accepted norm. According to the Remmelink Report, in 1990:
  • 2,300 people died as the result of doctors killing them upon request (active, voluntary euthanasia).(7)
  • 400 people died as a result of doctors providing them with the means to kill themselves (physician-assisted suicide).(8)
  • 1,040 people (an average of 3 per day) died from involuntary euthanasia, meaning that doctors actively killed these patients without the patients' knowledge or consent.(9)

    • 14% of these patients were fully competent. (10)
    • 72% had never given any indication that they would want their lives terminated. (11)
    • In 8% of the cases, doctors performed involuntary euthanasia despite the fact that they believed alternative options were still possible. (12)

  • In addition, 8,100 patients died as a result of doctors deliberately giving them overdoses of pain medication, not for the primary purpose of controlling pain, but to hasten the patient's death. (13) In 61% of these cases (4,941 patients), the intentional overdose was given without the patient's consent.(14)
  • According to the Remmelink Report, Dutch physicians deliberately and intentionally ended the lives of 11,840 people by lethal overdoses or injections--a figure which accounts for 9.1% of the annual overall death rate of 130,000 per year. The majority of all euthanasia deaths in Holland are involuntary deaths.
  • The Remmelink Report figures cited here do not include thousands of other cases, also reported in the study, in which life-sustaining treatment was withheld or withdrawn without the patient's consent and with the intention of causing the patient's death. (15) Nor do the figures include cases of involuntary euthanasia performed on disabled newborns, children with life-threatening conditions, or psychiatric patients. (16)
  • The most frequently cited reasons given for ending the lives of patients without their knowledge or consent were: 'low quality of life,' 'no prospect for improvement,' and 'the family couldn't take it anymore.'(17)
  • In 45% of cases involving hospitalized patients who were involuntarily euthanized, the patients' families had no knowledge that their loved ones' lives were deliberately terminated by doctors. (18)
  • According to the 1990 census, the population of Holland is approximately 15 million. That is only half the population of California. To get some idea of how the Remmelink Report statistics would apply to the U.S., those figures would have to be multiplied 16.6 times (based on the 1990 U.S. census population of approximately 250 million).
Falsified Death Certificates ---In the overwhelming majority of Dutch euthanasia cases, doctors--in order to avoid additional paperwork and scrutiny from local authorities--deliberately falsify patients' death certificates, stating that the deaths occurred from natural causes. (19) In reference to Dutch euthanasia guidelines and the requirement that physicians report all euthanasia and assisted-suicide deaths to local prosecutors, a government health inspector recently told the New York Times: 'In the end the system depends on the integrity of the physician, of what and how he reports. If the family doctor does not report a case of voluntary euthanasia or an assisted suicide, there is nothing to control.' (20)

Inadequate Pain Control and Comfort Care -- In 1988, the British Medical Association released the findings of a study on Dutch euthanasia conducted at the request of British right-to-die advocates. The study found that, in spite of the fact that medical care is provided to everyone in Holland, palliative care (comfort care) programs, with adequate pain control techniques and knowledge, were poorly developed. (21) Where euthanasia is an accepted medical solution to patients' pain and suffering, there is little incentive to develop programs which provide modern, available, and effective pain control for patients. As of mid-1990, only two hospice programs were in operation in all of Holland, and the services they provided were very limited. (22)”
Consider more recent cases in the UK. According to the latest volume of the IAETF patients in the UK are being put in euthanasia protocols mistakenly or due to negligence or poor care. In the interests of brevity I will only cite two short passages:
An 80-year-old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened. Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients. Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying. [Sunday Times, 10/11/09]

Fenton lived to tell the tale. Not so for 76-year-old Jack Jones. Jones was hospitalized in the belief that his previous cancer had recurred and was now terminal. The family claimed he was soon denied food and water and put into deep sedation. But his autopsy showed that he did not have cancer at all, but actually had a treatable infection. The hospice denied wrongdoing but paid £18,000 to Jones’s widow. [Daily Mail, 10/14/09]
It Can't Happen Here

You might think doctors here in the US would certainly not be part of starving someone to death or withholding medication, but it happens. Consider the case of Terri Schiavo. According to media reports she was allowed to die “naturally”. The fact is she was allowed to die slowly of starvation and dehydration, while her parents sat and watched for 13 days, not being allowed to give her food or water. I can only imaging what it would be like to watch my child die, knowing that I could prevent it except the state forbade me from doing so.

Then there's the case of baby Gabriel.  The East Tennessee Children's Hospital (ETCH) “ethics” panel decided not to treat baby Gabriel, specifically the hospital was going to stop feeding him milk and giving him his medications. According to an Alliance Defense Fund press release:
“After doctors decided that Baby Gabriel was not worth treating, ETCH started discriminating against him by denying his basic care. Staff stopped bathing him, ceased applying cream to alleviate his chapped skin, reduced his diaper changes, and have not allowed his physical therapy. ETCH doctors have also discouraged Palmer's attempts to have her son transferred to other medical facilities where he could receive treatment.”
Consider the case of Barbara Wagner. Barbara was diagnosed with lung cancer and was hen told that the treatment prescribed by her oncologist would not be covered by insurance. Instead she was told the “health” plan would cover an alternative treatment, doctor-assisted suicide.
"'Treatment of advanced cancer that is meant to prolong life, or change the course of this disease, is not a covered benefit of the Oregon Health Plan,' read the letter notifying Wagner of the health plan's decision.

Wagner says she was shocked by the decision. 'To say to someone, we'll pay for you to die, but not pay for you to live, it's cruel,' she told the Register-Guard. 'I get angry. Who do they think they are?'"
So these things do happen, today, and they happen against the wishes of patients and their families in our “free” country. Do we really want to make this the norm, rather than the exception?


It's a pretty big issue. I think I just hope it never happens to me. I don't really know if I would want to keep alive, hoping or just stop suffering.

Wandered in from IComWeLeave.

The terminology in the health care bill has been just one of the problems I have with it. Thanks for your view point.

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