Gynecology and Obstetrics Policy makers respond to doctors on conscience

It appears that the American College of Obstetricians and Gynecologists and ABOG (the American Board of Obstetricians and Gynecologistsmay be about to abort their efforts to change laws concerning conscientious refusal in Washington. It remains to be seen whether they will deliver on their promise to support -- without limits - the Conscientious Refusal to perform or refer for certain procedures. (I'm sorry, I can't resist obvious puns, even on such a serious subject.)

LifeEthics has been covering the controversy over the American College of Obstetrics and Gynecology's "Opinion #385, Limits of Conscientious Refusal in Reproductive Medicine," which states that,

Providers with moral or religious objection should either practice in proximity to individuals who do not share their view or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient's physical or mental health, providers have an obligation to provide medically indicated and requested care."

First, "medically indicated" should be up to the physician and not dependent on autonomy - the patient's wants and wishes. Remember that Joseph Kennedy, the father of John and Robert, had his daughter lobotomized because she was too wild. At that time, according to Joe, the lobotomy was medically indicated.)

Obviously, this is not a moral obligation - but one that can be enforced by the use of the words "standard practice" and "standard reproductive services." In other words, abort, refer, or face lawsuits and risk your board certification. And the definition of "emergency" varies.

We also reported that the Secretary of Health, Michael O. Leavitt, had written to the Presidents of the American College of Obstetrics and Gynecology, the professional organization that supposedly sets the standard for these professionals, and the American Board of Obstetrics and Gynecology which certifies and tests OB/Gyns Presidents of ACOG and ABOG. He informed them that they were in danger of risking their own funding for training programs and status by any attempt to override the protections for Conscience in Federal funding regulations.


Even NPR noticed and covered the controversy.

The leaders at the Christian Medical and Dental Association have let CMDA members know that the President of ACOG, Kenneth L. Noller, MD, responded to the Fellows (certified OB/Gyns) last week and Norman F. Gant, MD, the President of ABOG, responded to Secretary Leavitt by letter on March 19, 2008.

Dr. Gant doesn't have a clue what the Secretary is talking about:

I am responding to your letter addressed to me asking about the American Board of Obstetrics and Gynecology’s stand with respect or to a physician’s choice to violate their conscience by referring patients for abortions or taking other objectionable action, or risk losing their board certification.” I can only say that I do not know where you came up with any suggestion, much less documentation, that the American Board of Obstetrics and Gynecology has ever asked anyone to violate their own ethical or moral standards.

And Dr. Noller reassures the Fellows that in this case, an Opinion is just an Opinion (and we're supposed to forget the attempts to change the laws):

We want to be clear the Opinion does not compel any Fellow to perform any procedure he or she finds to be in conflict with his or her conscience and affirms the importance of conscience n shaping ethical professional conduct. For example, while this is not a document focused on abortion, ACOG recognizes that support of or opposition to abortion is a matter of profound moral conviction and ACOG respects the need and responsibility of its members to determine their individual position on this issue based on their personal values and beliefs. We want to assure members with a diversity of views on this issue that they have a place in our organization.
Ethics Committee Opinions provide guidance regarding ethical issues. This Committee Opinion is not part of the “Code of Professional Ethics of the American College of Obstetricians and Gynecologists.” This Committee Opinion was not intended to be used as a rule of ethical conduct which could be used to affect an individuals initial or continuing Fellowship in ACOG. Similarly, it is not cited in the American Board of Obstetrics and Gynecology’s “Bulletin for 2008,” and “Bulletin for 2008 Maintanence of Certification” and an obstetrician-gynecologist’s board certification is not determined or jeopardized by his or her adherence to this Opinion.
Conscience has an important role in the ethical practice of medicine. While this Opinion attempted to provide guidance for balancing the critical role of conscience with a woman’s right to access reproductive medicine, the Executive Committee has noted the uncertain and mixed interpretation of this Opinion. Thus, the Executive Committee has instructed the Committee on Ethics to hold a special meeting as soon as possible to reevaluate ACOG Committee Opinion #385.

Dr. Nurse? Why not just Doctor?

Get ready for Dr. Nurse, who will call himself/herself "Doctor," but who, after 4 year bachelor's degree in nursing, has gone to the Doctor of Nursing school for two years with a one year internship -- that's compared to the 4 years of college, 4 years of medical school, followed by at least 3 years of residency that Family Physicians, Pediatricians and Internal Medicine docs devote to training..

The Wall Street Journal reports (please let me know if you can't access this page) that the National Board of Medical Examiners will begin testing these "DrNP" candidates this fall.

From the Wall Street Journal:

As doctors face shrinking insurance reimbursements and rising malpractice-insurance costs, more medical students are forsaking primary care for specialty practices with higher incomes and more predictable hours. As a result, there could be a shortfall ranging from 85,000 to 200,000 primary-care physicians by 2020, according to various estimates.

So,the supposed reasoning behind the new doctorate is this shortage of primary care doctors. That shortage has been artificially encouraged by all sorts of federal interventions. For some reason, no one's considered paying Family Doctors more!

Instead, there are schemes to divide and re-divide the Medicare "Pie." There are the rural health clinics, which are paid more by Medicare and Medicaid than your local family doctor, pediatrician or internal medicine doc for seeing the same patients. In order to qualify, the clinic -- get the distinction, there, not the doctor, but who ever it is that owns the clinic and contracts with doctors and hires the rest of the staff - must hire at least one "mid level practitioner" to see patients. They can't hire a doctor to do the same work and/or for the same money -- they must hire a Physician Assistant or Nurse Practitioner.

As the article notes, the main reason for the loss of primary care physicians, however, is the low pay for the thinking part of what we do, compared to the procedures of specialists, such as all the varieties of surgeons, urologists, gynecologists and gastroenterologists. We analyze, examine and determine treatment or treatment change, resulting in "Evaluation and Management" visits. Rather than the codes used for procedures, the E&M visits are divided into levels of payment based on a set of check lists and diagnoses. The money from Medicare - followed closely by the insurance companies - has consistently shifted from the office visits toward the procedures.

Needless to say, the smart medical students -- or at least the ones more interested in money than in your family history, living arrangements and whether Junior ate his peas and carrots will become interventional sub-specialists, not a Family Physician or Pediatrician.

A few years ago, Medicare payments increased for home health agencies, which encouraged RN's and LVN's to leave the hospital. Medicare quit paying your family doc to "scrub in" with the general surgeon or orthopedist as an assistant during your gall bladder surgery, colon resection or hip replacement. But, they did pay the surgeon enough to justify the hiring of a nurse practitioner or physician assistant. And studies said there was no difference or even better outcomes, since the "team" worked better in the Operating room and the peri-surgery procedure became more efficient.

(Of course, the NP or PA won't be available to your wife or kids for questions next week, and won't watch the effect of your new level of activity on your blood pressure or diabetes. And your family doctor may no longer even know that she should, since she won't even find out about the surgery until your next visit or hospitalization. But that has nothing to do with the outcome of the surgery, right?)

The increase of Federal funding for Nurse Practitioners has exacerbated the loss of good RN's and LVN's - leading to more of the Federal pie going to nursing schools. And the DrNP will probably have the same effect. The WSJ article mentions the lack of faculty in the nursing schools. The funding will have to come out of the Medicare and Federal "pie."

However, what patients need to consider is whether the DrNP training can truly accomplish the same training in 3 years that our Medical Schools can do in 5 to 7 years. Some have said that mid levels can handle 80% of what doctors do.

It's that 20% that is the difference between knowing what you don't know and planning for the 2 AM crisis.

"Objectivity is Bias" (meaning, healing, integrity)

Our recent conversation about conscience and medicine and the ongoing conversation about science and controversies is reflected in the NPR "Speaking of Faith" replay of an interview with, and publication of an essay by, Dr. Rachel Naomi Remen. (The outline and much of the story is available in text, here.)

"An answer is an invitation to stop thinking about something, to stop wondering."

Dr. Remen speaks of the stories that we share, the meaning that we need to find in those stories and acknowledges that objectivity is in itself a bias. Scary thought: that some data is ignored in science, medicine and public policy because it doesn't fall within the parameters that we've already decided is acceptable.

There's a description that most of us who have any medical training at all will recognize: the med student looking at the veins of strangers and judging their suitability for drawing blood or inserting IV's:

On one very rare summer afternoon off I remember traveling home to visit my parents on the subway, realizing only after a while that I had been unconsciously scanning the veins of the bare-armed people around me, wondering whether my skills with a needle were good enough to allow me to successfully draw blood from them. This sort of training changes the way you see things, the way you think. Gradually things that had been central in my previous life became vague and faded into the background and other things more heavily rewarded became overdeveloped. After a time I just forgot many important things.

Actually, what seems a demeaning way of looking at the human body isn't necessarily a proof that medical training leads to depersonalization and instrumentalization of our fellow humans, if we recognize the new viewpoint as an outgrowth of our wish as students and doctors to heal, prevent and relieve pain. Finding the underlying meaning or connecting it to a story that has a "better" meaning can inform our conscience, help to maintain our integrity and prevent some suffering of our own as profession.

About 20 minutes into the interview, there's the story of Dietert, who continued weekly chemotherapy injections as the only way to continue the contact - the touch and communication - with his doctor. In the meantime, the doctor was depressed because the "only thing" he had was failing to cure the patient. I worry about this: how often do we only offer and only validate active intervention, science and the material, rather than the passive, spiritual or psychological valuable - the intangible moral worth - like the listening that Dr. Remen offers so generously?

Early in the interview, Dr. Remen speaks of her mystic, Orthodox Jewish grandfather who described the birthday of the world as an accident, when the vessels containing the light of the world were broken and the striving of each of us to heal the world, to reveal the light around us and especially in our fellow human beings. I recognize her grandfather's conversation with the world, and with God, as I was raised surrounded by the knowledge of the love of God.

Now, I am just as guilty as anyone else of deciding that if you don't at least relate somehow to the same meaning that I do. If you don't seem to even live in the same reality that I do, you must be wrong and may even be insane. You'd benefit from my "fixing" you (her word, not just mine), either by inundating you with facts and references and some arguing or by some medical or technological intervention, like a nice shot of Haldol ("vitamin H") or an antipsychotic medication.

But I think - I hope - my best skill is listening, learning your language and meanings, and trying to translate between our two perceptions (even if I have to admit to myself that I really think of it as my understanding and your misunderstanding).


What too many people don't realize is that it's actually easier to interfere than to refrain. (So we end up with drug resistant bacteria, because it was easier to write the antibiotic than to explain viruses and risk your anger. Or it's easier to hook you up to chemotherapy, a ventilator or dialysis than to explain that I'm probably not going to be able to cure or even heal you. At least it looks - it feels - like I'm doing something!)

The interview and the essay point to the need for meaning in the practice of medicine beyond "objective" science and even healing that we can achieve as doctors - and society. I love the how and when, the molecules and causes. I believe in the germ theory and the disease model of Western medicine. I need and love my tests and measurements. But what drives me (and gets me in trouble) are the why's and what if's, what is right or ethical. It's probably what drives you, too or you wouldn't be reading this blog.

(I think Dr. Remen's Orthodox Jewish grandfather and I would have had a nice conversation during this season of Hanukkah and Christmas, when our two traditions celebrate light and dedication, revelation and reconciliation, watching and listening expectantly and generously.)

Doctors, Abortion and Conscience

The debate on medical ethics has definitely moved from "Our Bodies, Our Choice," to "My Choice, You Don’t Have a Choice." Autonomy, the "I want" ethics, trumps the right to life, the right to liberty and the physician's duty to do no harm. Where once laws were written to punish doctors who harmed patients, doctors are now threatened with lawsuits and the loss of our licenses for refusing medications or procedures demanded by patients and their surrogates.

The American College of Obstetricians and Gynecologists ethics statement, "The Limits of Conscientious Refusal in Reproductive Medicine" is a case in point. Abortion is so important to the ACOG Ethics Committee that they deny the right not to be killed and threaten the right not to be enslaved by calling abortion the “standard reproductive care that patients request” and demands that doctors who “deviate from standard practices” (object to abortion) “practice in proximity to individuals who do not share their views or ensure that referral processes are in place” (with a willing abortionist). The President of ACOG then wrote letters asking Congress for laws to force these limits on our consciences: doctors who object to abortion should either change their practice so that they don't take care of women and girls or move close to a willing abortionist.

The Christian Medical Association and 28 other pro-life, pro-family organizations have written a letter criticizing ACOG’s Statement as “a profound misunderstanding of the nature and exercise of conscience, an underlying bias against persons of faith and an apparent attempt to disenfranchise physicians who oppose ACOG's political activism on abortion.”

GrannyGrump posted several reasons conscientious doctors should consider elective intentional abortion bad for the mother. I agree with her that abortion is wrong because it is bad for women. I also believe that she begins from the same viewpoint that I do: Even if abortion weren't bad for women, it would still be wrong.

Elective intentional abortion is immoral because it takes the life of a human being. If the mother's life is in danger, she has the right to self preservation and it is moral to help her save her life. Even then, the child's life should also be protected if at all possible. The intent can never be to produce a dead child.

State officials have mandated that all medical students learn to perform abortions in New York and that all pharmacies stock and dispense contraceptives in Illinois and Washington. ER doctors are forced to dispense Emergency Contraception in Connecticut, California, Massachusetts, New Jersey, New Mexico, New York, Ohio and Washington. How long before autonomy supersedes the physician's right to conscience at the end of life since the American Medical Association has condoned the use of Oregon's "Physician Assisted Suicide" law (now renamed and redefined as "Aid in Dying")?

Laws against the conscience are a poor substitute for medical ethics and will result in the death of those same ethics. The end result of limiting the physician’s conscience is cook book health care written in court rooms by lawyers and judges. The practice of medicine will no longer be a profession, much less a calling, practiced by men and women of conscience. It will become a job done by people capable of following orders, doing what they believe is wrong.

Some Bloggers shouldn't reproduce

They shouldn't reproduce their thoughts in writing, that is.

Take a look at the comments on "Laws, conscience, medicine and bloggers," for a perfect example of "they just don't get it."

Freedom of conscience is part of the Washington State law. The Governor threatened to replace the members of the State Pharmacy Board if they voted against an invalid law. The pharmacists do not have to dispense over the counter medications.

All sorts of red herrings have been raised to defend the law, including accusations that someone might refuse to prescribe medicines for HIV patients and insulin for diabetics.

This is also a good example of my editorial style. You would be shocked by some of the answers I've typed and erased.

Science retracts another

There's good news and bad news.

The good news is that the scientific review process does work. Science is retracting (all of these Science and Nature articles are behind a paywall) an article that has been proven to include forged photographs, due to the questions about these photographs from other researchers. Although the actual research and premise of the research my have some validity, it needs to be replicated and validated in other labs, by other researchers.

The bad news, I'm afraid, is that the reason that the article came under scrutiny in the first place (and the reason we will hear about it over and over and over) is that the findings were hailed as further proof from a study of very early mouse embryology that the embryo is a unique organism from fertilization, since the immediate result of the first division showed different fates and different genetic markers.

There is nothing here to discount the fact that the zygote is an organism. In fact, the cdx2 marker is indeed found mostly at one end of the zygote and most of it ends up one of the cells after division. The article, "Your destiny from day one" in Nature.com (behind a paywall) covered the work by R.L. Gardner and Magdalena Zernicka-Goetz:

Nature 418, 14-15 (4 July 2002)
"Developmental biology: Your destiny, from day one"

by Helen Pearson

The mammalian body plan starts being laid down from the moment of conception, it has emerged. Helen Pearson considers the implications of a surprising shift in embryological thinking.

Your world was shaped in the first 24 hours after conception. Where your head and feet would sprout, and which side would form your back and which your belly, were being defined in the minutes and hours after sperm and egg united.

More proof has been produced in other research, there's some, here, and a review in this article by Robert P. George and Patrick Lee in the New Atlantis. From this year there's the report from M.-E. Torres-Padilla et al. [Nature 445, 214–218; (2007)] described this way in Nature (sorry, also subscription only):

Nature 445, 157 (11 January 2007) Published online 10 January 2007
"Developmental biology: Marked from the start"

Helen Dell

Not all cells in the early mammalian embryo are created equal. Even at the four-cell stage, embryonic cells that follow a particular pattern of division already have their developmental fate assigned to them. No cell will contribute exclusively to a specific cell type in the later embryo. But the progeny of some cells make a greater contribution to the 'inner cell mass' — the stem cells destined to become the fetus — and its surrounding 'trophectoderm', which forms extraembryonic structures such as the placenta. The progeny of other cells will make a greater contribution to other extraembryonic structures.

However, I'm afraid we should expect to see this scandal used against those of us who would protect embryonic human life.

Here's more on the Deb scandal from the Columbian Missourian

Trust me: I'll act against my conscience

The title throws you for a loop, doesn't it?

Trust me to do what? Follow the law, when I can violate my own conscience? Practice ethical medicine when I promise not to have any personal convictions to guide me? What are laws and ethics to a person who has no conscience?

This month's American Journal of Bioethics - unfortunately available only by subscription - is devoted to exploring the conscientious objection of pharmacists (and by extension, doctors and nurses, and everyone of us) who refuse to dispense emergency contraception (EC).

I do not believe that there is any evidence that the progesterone-only EC, Plan B, has abortifacient post-fertilization effects. In other words, I believe that anyone who objects to Plan B on the grounds that it causes the loss of a human life is mistaken.

However, I don't believe that they should be forced to perform acts that go against their consciences or subjected to a special conscientious objector review board, as advocated by all but one of the "open peer commentary" on the "Target Article" by Robert F. Card, (Abstract here), "Conscientious Objection and Emergency Contraception."

Card obviously has a bias against those of us who believe that human life begins at fertilization and that all humans have the right not to be killed. Nevertheless, as one commenter, Farr Curlin, MD, notes (It's worth reading all this, trust me):

Card (2007) does not merely claim that practitioners are obligated to provide EC; he argues that they are obligated to do so even if they have a conscientious objection. This last clause may seem harmless on the surface, but a closer look reveals that it effectively saws off the limb on which the first clause and all medical ethics sit. To begin, what is a conscientious objection, but an individual’s judgment that it would be unethical for him or her to act in a certain way? A genuine conscientious objection, even if misinformed, is an expression of a commitment to acting morally, and although religious persons are somewhat more likely to report conscientious objections (Curlin et al. 2007), judgments of conscience need not be informed by explicitly religious ideas. Moreover, all ethical arguments are appeals to conscience. As such, acting conscientiously is the most fundamental of all moral obligations.

....


Indeed, the very act of presenting evidence and making arguments presumes that the one to whom those arguments are directed, whether practitioner or juror, is committed to acting according to their best judgment after taking all relevant considerations into account. It would be useless for an attorney to make arguments to jurors if those jurors were not committed to deciding a verdict based on their best judgment of the guilt or innocence of the defendant. Likewise, it is useless for Card or anyone else to make ethical arguments if practitioners are not committed to practicing according to their best judgment of what is in fact ethical. A commitment to acting conscientiously is as fundamental to the moral life as a commitment to judging impartially is to the work of a
juror.

(Un)Ethical Science Journals

I guess the first question should be, "Where is the scientific and ethical justification for demanding public funding of science without public restraints?"

The next is, "When there is public disagreement, what is the ethical way to conduct the discussion about the disagreement?"

I'm sure that the answer to the second is not "hit and run."

Wesley Smith adds a new bit of information to the story I wrote about last week, concerning an attack on Maureen Condic, PhD, for her informational article on the lack of promise of embryonic stem cells.

It seems that that the journal Nature Neuroscience has refused to allow Dr. Condic, a respected neuroscientist herself, to respond to the editorial on their pages.

Why, Wesley, the editors didn't display enough courage to sign their names. I'm not surprise that they continue to take the less courageous road.

Explaining

This is a re-write of a post I made as part of the conversation about Emilio Gonzales's treatment at Wesley Smith's Second Hand Smoke.


I'm a family doctor because I have always seen the patient as part of the family and (ideally and sometimes not so ideally) the family as integral to the patient's condition and health care. We do treat family members, even if we never see them.

However, when the family's needs conflict with the patient's, the patient's interest has to come first. We naturally identify with a mother's wish to keep her child alive. However, when the doctors sense that we are treating the mom at the expense of the child's care and comfort as he is dying, the duty is to the child, our patient.

The determination as to what the best interests are in each case depends on whether it is true that (as the blogger-published report of the Ethics Committee says) the baby is having increasing injuries requiring aggressive treatments due to the ventilator, more uncontrollable seizures, progressive spastic muscle effects, loss of brain tissue due to the disease and what I suspect is multiple organ failure (liver and kidneys) due to both his underlying cell malfunction and the lactic acidosis.


I just don't believe in conspiracies that would allow a deception to play out over a month. Jerri Ward wrote on Wesley Smith's blog about the earlier hearing on February 19th, and said that the mother originally did not want the child to have a tracheostomy and a permanent feeding tube. Evidently, the mom and doctor were in such conflict that a new attending was named.

The nurses I know would be tearing themselves up over the condition of the baby as it is. To have the doctors write orders that make them cause the baby pain, over and over, without seeing the good of healing or at least a little relief of pain, is abuse of them, as well.

Patients have taught me lessons in caring for them as they die. Even in my first week as a phlebotomist nearly 25 years ago I had to draw blood from a brain dead child. The only way I could get through it was to care for this child and be grateful to his parents for being generous enough to donate his organs. I still treated him - and was encouraged to treat him by my bosses and the nurses caring for him - as though he were a living, feeling person. I count it a blessing that I was able to do what I could to respect them and do what I had to do without causing more pain and injury.


Instead of caring and concern for this mother and Emilio, the fuss and attention is focused on personalities and organizations.

It's shocking to me to see the use of the word "futile" brought up over and over - even though it's not in the law at all. It's used as some sort of weapon and focus to call in the troops. There are bad doctors, bad nurses, bad judges, husbands, wives, children and bad examples of surrogates. This law does not make it any easier for them to end a patient's life. The doctors and hospitals still have to answer to the public, courts and community. No doctor wants his failure to heal made part of a public press event and no hospital wants to be known as a place where patients are killed if they don't go home well. The formal process laid out in the law gives structure to very hard times in the lives of patient's families. (and I've offered several times to come to the aide of anyone in Texas who suspects that the law is used to cause the death of someone who is not dying)


What's worse is the attack mode and personalized accusations in the press and the blogs. Who would have ever thought that anyone would publish the names and phone numbers of a Bishop, accusing him of complicity with murder?

We can be sure we're being mocked by our traditional non-pro-life counterparts. At the American Society of Bioethics and Humanities meeting last year in Denver, it seemed as though most of the sessions knocked the concept of conscience and individual rights that trump the community's.

We're fighting the skeptics and unbelievers - not to mention those who claim to be believers yet feel the need to justify their complicity with abortion and push for embryonic stem cell therapy for their diabetic daughters, etc. The claims that nurses and doctors just want to empty a bed in the hospital make it harder to assert that our beliefs are not just personal opinions, that they are matters of right and wrong. Not to mention that we don't come off as good Christians when we make statements that assume the worst of nurses and doctors or when we ally with someone whose reaction is to attack a Bishop.

"Living Life's End"

The title is from a 2005 essay by Gilbert Meilaender in First Things. Not surprisingly, Dr. Meilaender speaks with much more clarity than I ever could in discussing the sort of dilemma that we face when considering the baby, Emilio Gonzales, and the treatment vs. the care he is to receive from his doctors, his mother, and the State and the distinction between letting "die those who were clearly dying," and “letting patients die who are in fact not dying.”

We are not abandoning the care of Emilio by saying, "This much and no more." If he requires constant painful intervention and technology while his condition continues to deteriorate, we do not cease to care for him when we cease to intervene and use technology.

As Dr. Meilaender points out,

On the one hand, we should not aim at their death (whether by action or omission). We shouldn’t do whatever we do so that they will die. On the other hand, because we do not think that continued life is the only good, or necessarily the greatest good, in every circumstance, we are not obligated to do everything that might be done to keep someone alive. If a possible treatment seems useless or (even if useful) quite burdensome for the patient, we are under no obligation to try it or continue it. And in withholding or withdrawing such a treatment, we do not aim at death. We simply aim at another good: the good of life (even if a shorter life) free of the burdens of the proposed treatment.(emphasis mine)

The reports at the Capitol are conflicting with what is being told at the North Country Gazette, Prolife Blogs, and Second Hand Smoke. And with one another.

No one that I know is arguing that Emilio is not dying - or that he could have died from any number of past events if the doctors had not intervened. It is time to stop intervening.

There is also a difference between causing another to do his duty and forcing another to act against his conscience and what he believes is his duty because you very much want him to do what you want him to do. How often do you want your doctor and your ICU nurse to practice going against her or his conscience? How often should the State force an action - a repeated action that causes other people to be forced to act - against a professional's conscience?

The Texas Right to Life lobbyists told me that they are offended because the Ethics Committee mentioned Emilio's "dignity." If the report published by the North Country Gazette is the actual Committee report, the members affirm Emilio's human dignity - but say that the aggressive treatment is an assault against his human dignity:

• The current aggressive treatment plan for Emilio amounts to a nearly constant assault on Emilio’s fundamental human dignity, and with little, if any, corresponding benefit to Emilio. Thus the burdens associated with such care clearly outweigh its benefits.

A trial of care including the ventilator, the feedings, and the chest tubes for a pneumothorax were appropriate. When Emilio continues to require more invasive care, when we can not keep him the same, much less make him better, it is time to stop hurting him, at least.

To force the doctors, nurses, phlebotomists and all the other people who are caring for Emilio to put aside their concern for his best interests, to subjugate their consciences and duty to Emilio for his mother's wishes is simply wrong.

To accuse them and even the Bishop of the diocese of Austin, of acting with the intention to "murder" Emilio (as June Maxam of the North Country Gazette quotes Melanie Childers as doing here and as "plb" quotes NCG here), to state that the hospital Ethics Committee is willing to speed Emilio's death in order "to free up a bed" (as Jerri Lynn Ward is quoted as saying in this news article: “You have a treating doctor who makes the initial decision, then you have an ethics committee at that same hospital with, frankly, a very clear conflict of interest,” Gonzales' attorney Jerri Lynn Ward said. “They have something, a bed they can free up basically, if their decision goes unchallenged."
, is simply evil.

(Edit 8:30 AM 3/21/07 addressed the "dilemma" of spelling)

Bad, Bad Doctors (Religious, with Consciences)

The NEJM has a free on line article evaluating the results of a survey of doctors, "Religion, Conscience and Controversial Clinical Practices," which is a perfect example that far too much of the effort of "medical ethics" or "bioethics," goes into deciding who can be killed.

"In recent years, several states have passed laws that shield physicians and other health care providers from adverse consequences for refusing to participate in medical services that would violate their consciences. For example, the Illinois Health Care Right of Conscience Act protects a health care provider from all liability or discrimination that might result as a consequence of "his or her refusal to perform, assist, counsel, suggest, recommend, refer or participate in any way in any particular form of health care service which is contrary to the conscience of such physician or health care personnel." In the wake of recent controversies over emergency contraception, editorials in leading clinical journals have criticized these "conscience clauses" and challenged the idea that physicians may deny legally and medically permitted medical interventions, particularly if their objections are personal and religious. Charo, for example, suggests that the conflict about conscience clauses "represents the latest struggle with regard to religion in America," and she criticizes those medical professionals who would claim "an unfettered right to personal autonomy while holding monopolistic control over a public good." Savulescu takes a stronger stance, arguing that "a doctor's conscience has little place in the delivery of modern medical care" and that "if people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.""

"If physicians' ideas translate into their practices, then 14% of patients — more than 40 million Americans — may be cared for by physicians who do not believe they are obligated to disclose information about medically available treatments they consider objectionable. In addition, 29% of patients — or nearly 100 million Americans — may be cared for by physicians who do not believe they have an obligation to refer the patient to another provider for such treatments. The proportion of physicians who object to certain treatments is substantial. For example, 52% of the physicians in this study reported objections to abortion for failed contraception, and 42% reported objections to contraception for adolescents without parental consent."

Not surprisingly, these "controversial" "legal" practices are abortion "for failed contraception," giving "birth control to teenagers between the age of 14 and 16 if their parents do not approve," and "sedation to unconsciousness in dying patients." For some reason, the authors do not give results or even discuss the other "Controversial Issues in Medicine": Physician assisted suicide, withdrawal of artificial life support or abortion for congenital anomalies.



First, "elective" abortion is neither mandatory nor beneficial.

Second, I guess that the first discussion must be whether or not "legal" implies that a practice is necessarily "beneficial," moral, or required.

Third, the legality of providing contraceptives to minors under the age of consent, against their parents' wishes, is questionable, except in Federally funded clinics, where it is mandated under Title X funding for Family Planning clinics.

Fourth, it is illegal in most states to participate in "Physician Assisted Suicide."

And fifth, the "monopolistic control" is distraction. Are all professionals who are licensed by the government required to do whatever is demanded of them by whomever can use their services? Let's see: architects, engineers, all those media types?

If so, I'd like to ask Alta Charo - who, after all is a licensed lawyer, working for a State University that receives Federal funds - to give me some good, solid quotes that do not advocate the taking of human life or the defamation of those of us who act on our convictions.





Take a look at the survey and the article. Take the survey.

Do you agree with the "bioethicists" quoted in the introduction?

Calling all scientists

The Aspen Ideas Festival is a meeting that I had never heard of until recently (I actually found it Googling for "Bioethics and Politics" and "Bioethics and Policy" which are names I've come up with for alternative blogs in case I decide to change my focus) There are audio recordings and transcripts online which contain segments that should be fascinating to many of us, whether our primary interest is religion, politics or bioethics.

If you want to see who are considered the elite thinkers in this country - at least by others who consider themselves elite thinkers - take a look at the website and listen or watch some of the sessions from the July, 2006 event.

One segment is audio-only, "Politics and technology." Nigel Cameron links to it on his blog, and he was the sole prolife member of the panel. Other panel members include Neal Lane, a professor of Physics and Astronomy at Rice University at Houston, Texas and Assistant to the President for Science and Technology and Director of the White House Office of Science and Technology Policy from 1998-2000, Doroth Shore Zinberg, a sociologist and lecturer in Science, Technology and Public Policy at Harvard, and Lawrence Krauss, a professor in Physics and Astronomy who has written The Physics of Star Trek.

The one thing that all of the panelists agreed to in the very enlightening hour and a half, is that all of us should become involved in policy making, whether it's in politics, our professional associations, or in teaching about science and ethics in our local communities and churches. I love it when people so much more brilliant than I agree to even part of the mission and vision that I wrote for LifeEthics:

We encourage all of our members, especially medical and scientific professionals, to become involved in setting the policies of their communities, associations, schools and businesses in order to ensure that those organizations maintain high ethical standards.

We educate the public and professional communities on current events concerning the right to life and liberty of humans. Our members mentor one another in opportunities to serve in professional and academic capacities to fulfill our mission. We monitor and alert our members and the public about unethical scientific research and medical therapy. We are active in our own institutions and associations in order to influence the policy decisions of the organizations that represent us.

We use standard scientific and medical definitions and verifiable scientific data whenever possible in our position statements and deliberations and expert opinions only when the evidence is not available.

(The full panel would not be in agreement with the section that is struck.)

Bioethicists aren't needed

Well, they didn't come right out and say it.

Moreno and Berger are still stomping their feet at Ramesh Ponnuru for doing his job. After all, he's an editor for a magazine covering "Republican/conservative news, commentary, and opinion."

Moreno has a Ph.D. in philosophy, and Berger is an Assistant to Moreno and two other Fellows at the socialist "Center for American Progress Institute for Bioethics. I suppose that it could be said that they are doing their jobs, too, except for the way they argue their point.

They argue that scientists and the "scientific community" do not recognize that there are "viable alternatives" to embryonic stem cells. Because they are certain of this opinion, they have attacked a report that proposes research "Without Destroying Human Life."

If these two bioethicists are so certain that that scientists are the final authorities as to what should be done, what is their justification for "bioethicists" (other than to make arguments for the scientists who lead them, that is)?

Biased bioethicist's slip is showing

Every time I note someone else's editorial or grammatical mistakes, I (later, of course) find that I've made some glaring mistake of my own in that comment. I'll try to avoid that here, but read closely, just in case.

Nevertheless, . . .

Bioethics.net, the blog of the editors (and pseudoeditors) of the American Journal of Bioethics, a couple of especially snide, petty and biased comments, today.

If you could identify with anyone called a "mouth breathing Pentecostal," don't read the first (which I believe is a rant from authored by Art Caplan) concerning the ensoulment of cloned humans (my previous discussion is here) unless you can brush off the insult. (However, perhaps someone who does read it could tell me how the editors and pseudoeditors (e&p) could believe that Ben Franklin "wouldn't have allowed a column as dumb as Answer Fella to exist in the first place.")

In my own snide, petty manner, I'm copying the slip up of the e&p before they repair it further:

Well, listening was New Republic National Review Senior Analyst Ramesh Ponnuru, and you can watch what Berger and Moreno do to his analysis of their piece on the CAP site linked above. No point quoting it, I'm just not capable of typing even one more time either the work by or the critique of the New Republic/Weekly Standard on stem cells.

Note the strike-out on the first "New Republic," but, as yet, none at the second.

I've asked the e&p to explain the difference between their own "progressive" (read: "prochoice, pro-embryo destruction, and - with rare exceptions - non-believers) editorial relationships and the conservatives' (read: "prolife and believers - again, with rare exceptions - in a Creator") relationship with like-minded publications.

In contrast to the frequent and incestuous association of the "progressives" with the very organizations they're supposed to be reviewing, of course.

"Forcing" women to talk to their doctors

This pro-abortion rant from the San Antonio Current is really reaching:

Frank Corte is a pro-life legislator who wants to control Texas’s women and health professionals. With HB 21, he wants to deny women the ability to review abortion warnings privately on video, and instead force them to hear it directly from the doctor; with HB 23, he’d force pharmacists who handle emergency contraception to post “If you believe that life begins at fertilization ...” warnings.

The SA Current is spinning their commentary on the 80th Legislature as though it's a review of TV shows during sweeps week. The Current is a free/throwaway rag, found in lobbies and vestibules of businesses all over town. They advertise themselves as

The Current strives to capture the times in which San Antonians live. We attempt to challenge our readers, by being provocative, irreverent, skeptical, funny, vibrant, and imaginative. We earn our readers' trust by being devoted to fact and dedicated to artful storytelling.

Make that an emphasis on "provocative, irreverent and skeptical."

Texas has a great "Woman's Right to Know Law," designed to fully inform the older - usually surviving - victims of abortion of the nature and consequences of abortion. There's a companion document that lists resources that provide help to pregnant women and young families, which is intended to enable women to chose not to kill their children.

The abortionists hate this booklet and the information that they are required by State law to give the woman, as well as the informed consent process that the State mandates. They've worked out all sorts of ways to avoid the booklet and having the doctor provide the consent, from showing the girls and women the book and telling them they have the option of reading it (or not), to placing stickers on front that state that the information is inacurate. The main tactic is to set up "informed consent" procedures so that the doctor (herself or himself) does not actually have to tell a girl or a woman what he or she is going to do and what will happen.

However, since this "choice" is "between the woman and her doctor," shouldn't the consent process be between the "woman and her doctor?" (Forget for a moment that in real life, the great majority of abortionists never meet their patients before the day of the procedure, unless they do follow the letter of the Texas Womans Right To Know law.)

The irreverence continues in the Current's discription of the legislators who would introduce bills to make the punishment for sexual abuse of children more severe. I hate the death penalty and extremely strict, mandatory prison terms, but recognize that they are sometimes appropriate. (A few years ago, we had a prison break, and the 7 escapees ended up killing a policeman before they were caught.) Child sexual predators are known to be prone to recidivism. This article tells us that these men usually molest 80 to 120 children before they are caught, and tells the stories of Jacob,Jessica, Megan, and Ashley.)

Here's how that Current article views these stories:

Having campaigned successfully for reelection on a kill-all-repeat-child-rapists platform, Dewhurst is now Senate President and determined to pass Jessica’s Law, a Bill O’Reilly-endorsed, sex-offender-punishment proposal that includes a mandatory 25-year sentence for repeat child molesters. Dewhurst can’t introduce legislation on his own, but he’s got a team of senators under his command. They include: “2005 Crimefighter of the Year” Bob Deuell, who’s sponsoring SB 68 to make a second child-rape charge a capital offense; hard-nosed Democrat Rodney Ellis, whose SB 97 would remove the statute of limitations for certain sex offenses; and Florence Shapiro, who ushered through a series of “Ashley’s Law” sex-offender bills in previous sessions.