"Expelled, The Movie" Conversation Continues

The many Anonymice are still discussing world views on a post from last October.

(In case you wondered where I've been:

We've had our primary, with one hotly contested local Republican race ending in a cliff-hanger. The same seat was decided by 54 votes out of about 20,000 in 2006. This time, it looks like the winner may be decided by about 38 votes out of 30,000, before the mail in ballots are counted. We're expecting a recount.

It turns out that the consequences of politics and policy became personal this last 2 months. We've spent the last year - over 14 months, now - working out a plan to remodel our 65 year old house only to find out that the city adopted the new provisional FEMA flood plain map, and we can't remodel - we have to fill in the basement, tear down the old house, and build 2-3 feet higher. I'll admit that I haven't reacted very well. But, still, the City's bureaucrat literally lost the plan for 6 weeks before telling us that the concrete-poured-in-place house and basement that's still plumb, smooth and level after more than 60 years might float up and turn on its side.)

Brain Death

Wesley Smith is blogging around the Web on the sad death of a 50 year old Atlanta man whose family took the doctors and hospital to court. Wesley rightly notes the poor communication.

The reporter is indeed a very bad communicator. I wonder about the reliability of the whole story because of the reporter's description of the patient: "he was brain dead and being kept alive by life support." While I can believe that the docs used "life support," the reporter goes on to say that the patient "passed away" when the ventilator was stopped and used the phrase, "pull the plug."

"Brain dead" patients are not alive and they're not on "life support." The doctors are using "artificial support." for the organs on a dead patient. (See this British Journal of Medicine article and comments, below.) Just as we support the body while waiting for the arrangements for organ donation (or for the birth of a child of a brain dead mother), it is customary to notify the family and give them a chance to "say goodbye" before discontinuing the ventilator and medications supporting the

Way down at the bottom, the article actually says,

"doctors told the family the stroke caused massive bleeding in Donald's brain. Four different physicians examined Fennell and his brain scans and determined his brain, including the brain stem which controls basic bodily functions like breathing, had ceased to function, according to court and patient records."

However, the problem started with the nurse who called security to have the family removed from the hospital because Mr. Fennell's 3 sons,

21, 20 and 18-year-old college football players— cried loudly and shouted "No!" when told their father was brain dead. After that, she said, security guards were posted at the door whenever they visited."

It's hard to talk to people who are shouting, but it's harder to talk to them when they've been kicked out of the building.

I'm trying to get my head around the medico-legal problem of delaying the declaration of death by the docs, scheduling a time to turn off the ventilator, and the comment about the machines being broken.

However, people don't live by laws alone. We often act from our hearts.

The New England Journal of Medicine published a review article describing the determination of death by neurological criteria in 2001. And here's an excellent (free) article from 2002, from the British Journal of Medicine that actually calls the ventilator and cardiac support "artificial support" and includes the ethical caveat that ""No physician engaged in euthanasia or medically assisted suicide should be responsible for diagnosing brain death.

Not coincidentally, the subject of yesterday's Secondhand Smoke was the case of an Orthodox Jewish man in Canada. The gentleman is on a ventilator and suffering from the effects of heart failure, pulmonary hypertension and renal failure. Three doctors, including one selected by the family have determined that he is dying and, even without the consent of the patient or the family, decided to remove the ventilator. The family has taken the doctors to court to prevent the removal of the ventilator on religious grounds.

One of the family's lawyers actually said that removing the ventilator is the same thing as smothering the patient with a pillow, and that (of the docs and nurses who must maintain the ventilator and adjust its settings):

"To do what they are suggesting would involve a physical act," he said. "You have to touch him, you have to remove the tubes. My reading of the law is that without consent ... they can't do it. I submit that is assault and battery."

(According to newspaper reports, the docs plan to remove the feeding tube, also. But that's not relevant, here, since Mr. Golubchuk will die within minutes if he is unable to breathe on his own off the ventilator. If any of the docs are making a fuss about the feeding tube, they are not very wise, since doctors and nurses aren't needed to maintain or monitor the feedings.)

An article from the Winnipeg newspaper on December 11 says that

"An orthodox rabbi consulted by the family quotes from guidelines on Jewish medical care that say it is imperative for doctors to prolong life, even if the patient is "suffering greatly" and asks for care to stop."

It's my understanding that Orthodox law forbids disconnecting the machine until the heart stops, even though there has been talk of a machine in use in Israel to randomly turn off ventilators so that the people won't have to. But I've never read that the Orthodox go so far as to demand that suffering be ignored.

In fact, withholding care under Orthodox Jewish law is acceptable. See the discussion about flickering candles, here. Here's a very well written review of Orthodox Jewish law on end of life, from the Virtual Mentor, the AMA ethics journal.

Do you suppose the family really believes that they should force other people to cause suffering? The family lawyer does point us to the ethics of intent and consequence of "a physical act." While the family may have the right to continue their father's suffering and to prevent the removal of the ventilator they don't have the right to force any particular doctor, nurse, or tech to act to violate their own conscience by adjusting, cleaning, and monitoring the ventilator.

Surely there's an Orthodox doc in the area who is willing to care for Mr Goubchuk and his family.

Ethics, Conscience and Cheating

Is there a difference between matters of conscience and things you shouldn't do? If there is something that would just get you in trouble but you don't believe it's wrong, how do you decide what to do?

The blog, Adventures in Science and Ethics, is one of the ScienceBlogs that I follow. (I love her "Friday Sprog Blogging" about her kids and the discussions about being a woman and having a family in Academia.)

There's a conversation on morality and cheating:

A reasonable ethical decision is one that you can defend -- to others, not just to yourself. You can give reasons why, of the choices available, this was the right way to go.

A course of action that you are taking pains to hide -- one which you would not want to have to defend to others -- is a red flag, ethically speaking.

Being able to justify a course of action to others is a more stringent requirement than being able to justify it to yourself. Folks who see themselves as living up to a high moral standard ought to keep that in mind and make sure their deeds can meet this requirement.

I was raised on the Bible, being taught to respect the authorities and to understand that a sin is a sin is a sin. However, I have a sense of "that's not fair" when I think of putting highway speed limits on the same plane as hurting someone else or even cheating on a test.

Court upholds Texas Prenatal Protection Act

In 2003, the Texas Legislature passed a Prenatal Protection Act, which named the unborn children of Texas individuals from fertilization to natural death. Texas law also calls the "individual" a "person." With the world the way it is after Roe versus Wade, and because most of us have compassion for a woman who believes she doesn't have a real choice, we had to make exceptions for the decisions of the mother, including abortion and - even when the child is not in her womb - for those she empowers, such as doctors and techs at in vitro fertilization clinics.

However, the law in Texas protects a woman and her child against some one else taking the life of her child against her wishes. We will also punish the murderer when we can't protect them.

Today, the Sixth Texas Court of Appeals upheld the conviction of a man for killing his pregnant girlfriend under our Prenatal Protection Act.

The man was dating two women when one became pregnant. He told the other woman that he would "take care of it," and then shot the mother of his child 3 times with a shotgun, once in the face.The jury determined that he knew the woman was pregnant and that he intended to kill them both. He was convicted of capital murder and sentenced to life imprisonment.

The Court decision plainly states:
"By expressly defining capital murder such that one of the victims may be any unborn child from fertilization throughout all stages of gestation, the statute leaves no ambiguity as to what conduct is proscribed. In particular, the plain language of the statute prohibits the intentional or knowing killing of any unborn human, regardless of age. No ordinary person reading the statute would have any doubt as to whether it encompasses victims at all stages of gestation."

We know that violence often begins when a woman is pregnant and that 25% to 30% of deaths during pregnancy are due to homicide, usually at the hands of the father of the child.

I hope that this Court opinion and the original law will save lives. I wish for a day when no one is in danger of being intentionally killed by someone else, much less a loved one. And I hope that the publicity about this law will cause everyone - the person about to get behind the wheel after drinking as well as the abusive husband or boyfriend, to consider the risk of harming a mother too dangerous to even think about.

I believe we are much more likely to overturn Roe now than we have been at any time since 1973, while still ending up with restrictions in at least as many States as we had then. And I believe that the reason why this is so is because more than half of our citizens are unhappy with elective intentional abortion on demand as it is practiced in too many States today.

I also believe that a pro-life Congress could restrict the Courts from interfering with the States' legislative actions on abortion tomorrow, on the grounds that it's obvious that the unborn are persons.

For one thing, we have 4-D ultrasounds now and babies born as young as 20 weeks go home healthy.
In addition, many minds were changed - are still being changed - by the debate over partial birth abortion.


However, the reality is that there is zero chance of getting a Human Life Amendment through the Senate, much less getting 2/3 of the States to ratify it if the States themselves are not already doing it. (Please read up on how the 13th and 14th were ratified: the Legislators from the Southern States were not allowed to participate.)

Far too many men and women think of abortion as insurance against their bad decisions, rather than one more (awful) bad decision.

There are still too many people who think rape and incest are appropriate reasons in themselves for an abortion. They haven't heard how many women decide to carry their children to term after rape or considered the very real humanity of the unborn child, who shouldn't be punished for his father's crime.

But we do have a chance at returning the choice to the States where the majority would restrict abortion except to save the life of the mother. And each person that we teach to think of the unborn child as a person, the closer we get to ending elective intentional abortion.