Things That Make You Go Hmmmm...

Today I presided over the first student led discussions in the bioethics course Im TAing, and while I was droopy eyed from having stayed up way past my bedtime…it was fun. The “kids” did an excellent job, and the discussions were lively. Honestly…most times when your boss asks you to TA a course it’s a horrendous chore…as you are usually trying to do it all on top of your already harried regularly scheduled programming. However with a class like this it is more like being a kid let loose in a candy shop…particularly if you are a kid with a lot of opinions. I actually can’t believe I’m getting paid to do this. Today we discussed the dreaded Abortion issue and Euthanasia, or "right to die". And as with any hot button topic there are strong opinions on both sides of the fence. Mine tend toward the liberal side.

The Greek translation of Euthanasia is dying well. This makes sense as I always think of this in terms of an end stage cancer patient for whom morphine no longer dulls the pain. I am fairly certain that if I had a terminal diagnosis and had to live out the rest of my days in pain I would want the right to die…painlessly. Kiss me goodbye and shoot me up…I’m gone.


Of the 50 states in this nation only two actually have legislation addressing a person’s right to die. They are Oregon and Texas. Leave it to Texas to lead the way in providing an excellent argument against these kinds of "dying with dignity" provisions with their Advance Directives Act of 1999 (AKA The Texas Futile Care Law). It seems that in Texas a health care provider can withdraw care to a patient irrespective of the wishes of the patient upon determination that life-sustaining treatment is medically inappropriate or futile by the attending physician(s) provided said health care provider give 10 days notice to the family or legal guardian. Say WHAT????? Take the following case for example:

NEW YORK — While Americans were riveted by dramatic events unfolding in Pinellas Park, Fla., a five-month-old Houston baby took his last breath after a hospital let him die despite his mother's objections.

Sun Hudson was born Sept. 25 with thanatophoric dysplasia, an incurable and fatal form of dwarfism. Doctors said his tiny lungs would never fully grow and that he would never breathe on his own.

Hudson's mother, Wanda, put up a fight when doctors advised removing Sun from a respirator. She said she did not believe in sickness or death.

But on March 15, a Texas law signed by then-Gov. George W. Bush in 1999 allowed the hospital to go ahead and take Sun off the respirator in defiance of Wanda Hudson's wishes.

While the battle over Terri Schiavo has drawn dozens of outraged protesters to her Florida hospice, Sun's story made nary a bleep on the nation's radar. The few media outlets that picked up his story predictably drew parallels to the Schiavo case, and some experts have charged the president with hypocrisy.

I invoke my bloggers right to comment: Bush…a hypocrite? The hell you say! Carrying on…

The Texas statute that Bush signed authorized the ending of the life, even over the parents' protest. And what he's doing here is saying, 'The parents are protesting. You shouldn't stop [treatment],'" John Paris, a medical ethicist at Boston College, told Newsday. But some experts said the two cases are quite different. As is true of other state laws, Texas' Advance Directives Act of 1999 privileges the input of the patient's spouse over that of adult children, followed by the parents if there is no written directive.

But ultimately, the decision to extend treatment is made by the doctors and hospital.

Supporters of this Act claim a utilitarian viewpoint stating that sacrificing this one life which has little chance to survive benefits the greater good by freeing up hospital resources for patients that are likely to recover from their ailments. I can see that argument, and it certainly is sound, but I fear that this is a slippery slope. Will there come a day when it is determined that the poor or indigent do not have as much right to live as...say...a business man with an insurance card? I am reminded of a story written by one of the writers at Broowaha. In it he recounts his "tale of the bum knee". Apparently his health care provider...Kaiser Permanente...assured him that the only reason for his pain was a few extra pounds and a lack of exercise. After getting a new job and a new insurance carrier, but no relief of pain after losing ~45 lbs, he went to see his new doctor. X-rays revealed that the knee was completely missing any sort of cartilage and was...in fact...bone-on-bone. Asking the new doctor if Kaiser may have made a mistake when they looked at their x-rays the physician replied "a 4-year-old child could see that the knee was wasted...A pre-med student with one good eye would be able to tell that the knee was basically shot almost immediately after viewing these x-rays." Is this a little like your new hair stylist telling you that your last hair stylist didnt know what he/she was doing? I dont know, but one thing is for certain...hospitals are big business and managed care has turned doctors into nothing more than trained monkeys.

I am sorry, but "greater good be damned". Hospitals…get their money from insurance companies, which we all know by now are far more concerned with the bottom line (as in $$$$$$) than they are with patient care and as such they should not be allowed to determine who lives and dies. That should be up to the family.

This brings us to the great state of Oregon. Ah…Oregon…the land of many trees. So many trees that once while driving inland from the coast I began to feel claustrophobic and happy that trees are rooted in the ground lest they decide payback for all that logging should be due. But I digress…the topic of conversation is the right to die.

What does Oregon have to say about the right to die? Well…Oregon figures that if a patient, determined to be of sound mind, can find two doctors to confirm the terminal diagnosis then that patient should be allowed to die. Painlessly…by drug overdose…the way I would like to if I’m ever in horrific pain and not likely to recover.

Why then did John Ashcroft…a member of the Bush administration oppose this measure? I mean...seriously...Why would a member of the Bush administration, working under the man that signed legislation giving hospitals the right to deny care in some cases...while requiring that care be given in another...suggest that doctors who administered such treatment would be prosecuted under some antiquated federal law that didn’t really apply anyway? Which side of the fence are these people on?

Could it be because it was the patient that was given the power and not the corporatized practice of medicine that exists in this country today? And while the Advance Directives Act supposedly levels the playing field between the rich and the poor...why is it that all of the cases in which the hospital denied care against the wishes of the family/patient comprise those that were either elderly or members of a minority class? Hmmm....I wonder.

It sort of brings to mind the following from Nazi Germany.

Translation: “60,000 Reichsmarks is what this person suffering from hereditary defects costs the People's community during his lifetime. Fellow German, that is your money too.”

And that's all I have to say about that.

But before homeland security comes to arrest me I’d like to discuss the Abortion issue. Now…most women I know want the right to make the most difficult choice they hope they never have to make. So…most women I know are on some form of birth control when engaging in intercourse. And there are many things to discuss when it comes to Abortion rights, but what I want to bring up now is…birth control. If birth control were used more often there would be little need for abortion, which was the suggestion of the kid with the blue mohawk. Allow me to paraphrase his words:

“Why do we have to even make abortion an option…I mean…sure…If a woman is raped or molested or something then It should be an option but why do we have to talk about it like its an alternative...like there is no other choice? Why don’t we talk less about abortion and more about prevention.”

LOVE the kid with the blue mohawk. He is absolutely right. Teaching abstinence doesn’t work. Nor does burying our collective heads in the sand and saying things like “My little girl would never do such a thing…we raised her right” doesn’t work. Prevention…in the form of birth control....now THAT? That works. Of course we have to get past the morality of certain groups that dont believe in birth control...that see it as a sin against god or the poison seeping into the ground and killing the roots of the traditional family structure, but they typically don't believe in abortion either...which presents an entirely different conundrum for society to deal with.

Lets not go there right now. Lets stick with the issue of birth control as an alternative to abortion.

And that issue is the issue of access. What am I talking about? Well...if you live in a large city then you may not be aware, but unfortunately, there is a movement in this country to allow pharmacists that have a “conflict of morality” with the whole idea of birth control to refuse to dispense it to women with valid legal prescriptions. This scares me to no end, and there is an article discussing the arguments pertaining to this issue that you can read here, but allow me to share with you my favorite passage:

Not surprisingly, many of the pharmacists that claim a conflict of conscience in regards to dispensing birth control are also opposed to abortion. The fact of the matter is that pregnancy prevention, by default, prevents abortion. If a woman, denied birth control, becomes pregnant and chooses to terminate the unwanted pregnancy is the pharmacist then an accessory to what he or she would consider murder? When viewed in this light you almost have to wonder if there aren’t greater issues at play. The ability of a woman to control when and how many children she bears is integral to our emancipation from the myopic role as homemaker. Therefore it could be argued that this is less about morality and more about rolling back the clock to a time when women’s choices outside the home were limited to that of nurse or teacher. If so, would these pharmacists be making a decision "based on politics, expediency, or self-interest"?

Yeah. Things that make you go hmmmm...

Oh…and since no post would be complete without some mention of William…it just so happens that he is a Republican. He voted for Bush the first time…but not the second. Hey…everyone’s allowed to make a mistake once or twice in their lives. Right? Right?

Crickets…