Posted on 09/30/2012 3:19:54 PM PDT by Brian Kopp DPM
Celebrate Life September-October 2012
The natural law tells us that, in the context of health care, 1) food and water are basic treatment and care, and should not be withdrawn lightly; 2) morphine must not be used aggressively to hasten death when a patient is not near the time of death; and 3) pain management must be properly titrated to avoid overdose.
In the early 1980s, the right-to-die movement identified a serious roadblock to its agenda: Society still considered the provision of nutrition/hydration as basic care. Journalist Diana Lynne recounted the moment in Terris Story: The Court-Ordered Death of an American Woman (2005):
Daniel Callahan, then director of the Hastings Center, observed in 1983, Denial of nutrition, may, in the long run, become the only effective way to make certain that a large number of biologically tenacious patients actually die. The problem was, he noted, providing food and fluids was still considered basic care. And a deep seated revulsion existed over the prospects of withholding or withdrawing nutrition/hydration. Callahans words rang true a short decade later, as they helped shape a more nuanced right-to-die movement that promoted a third path to deathnot wholly natural, not suicide, but something in between.
The third path to imposed death
There are two distinct wings within the right-to-die movement. The more militant wing, which includes Death with Dignity and Compassion & Choices (formerly known as the Hemlock Society), advocates decriminalizing physician-assisted suicide. The more nuanced wing, starting with the Euthanasia Society of America (founded in 1938), has undergone several benevolent-sounding name changes, including Concern for Dying, Society for the Right to Die, Choice in Dying, Partnership for Caring, and Last Acts Partnership.
Starting in the 1970s, the more nuanced wing sought to pass living will legislation (aimed at convincing patients to forego treatment) and eventually succeeded in all 50 states. It was bolstered by the Supreme Courts rulings in Cruzan v. Director, Missouri Department of Health (1990), which held that withholding or withdrawing nutrition/hydration was a patients right, and Vacco v. Quill and Washington v. Glucksberg (1997), which upheld two state assisted-suicide bans, but also distinguished between physician-assisted suicide, and withholding or withdrawing life-sustaining medical treatment and/or aggressive pain management.1
Congress indirectly endorsed this distinction in the Assisted Suicide Funding Restriction Act of 1997 by including safe harbor exceptions, which permit withholding or withdrawing life-sustaining procedures (including nutrition/hydration), and applying the principle of double effect to pain management.2 In recent years, the more nuanced wing has worked to pass state laws that prohibit assisted suicide but include similar exceptions.
Palliative care and the third path
Perry Fine, MD, a founding member of the American Academy of Hospice and Palliative Medicine, opposed the 1997 federal ban on funding assisted suicide. Yet, he liked its exceptions: Advocates of palliative care medicine should herald this aspect of the act.3
Traditional palliative care was symptom management. The theory was that patients offered adequate pain and symptom relief wont request physician-assisted suicide. However, shortly after the AAHPMs founding in 1988, palliative cares definition and scope were expanded, and this radically transformed version later became an official medical subspecialty.
Todays palliative care involves a palliative care team (which can include physicians, nurses, social workers, and chaplains) that helps the family determine when the patients care should be shifted away from cure and toward death. The team typically follows guidelines developed by a task force comprising five national palliative care organizations.4
You may recognize some of their recurring themes:
Everyone should have an advance directive to protect himself from unnecessary medical treatment at the end of life.
Withholding or withdrawing food and water is a naturaland even pleasantway to die and a perfectly ethical means of controlling the time of death.
The principle of double effect in the use of pain treatment justifies terminal (palliative) sedation.
Palliative care doctors condoned and encouraged Terri Schiavos death by starvation and dehydration in 2005. Shortly before Terri died, Fine told the Los Angeles Times, What my patients have told me over the last 25 years is that when they stop eating and drinking, theres nothing unpleasant about itin fact, it can be quite blissful and euphoric.5
How palliative care was hijacked
The success of the third path euthanasia movement required substantial funding. In the 1980s and 1990s, a small number of foundations, led by the Robert Wood Johnson Foundation and George Soros Project on Death in America (funded through his Open Society organization), focused on transforming palliative care. The same right-to-die advocates that palliative care was meant to counteract took control of its training and certification standards.
The RWJF began supporting certain bioethics centers and hospital ethics networks engaged in changing institutional practices, laws, and public perceptions regarding end-of-life care. Soros-funded medical school instructors, many of whom favored physician-assisted suicide, helped to institutionalize new attitudes throughout the health care field.
And Catholic health care, which should have been a bulwark of opposition, instead spawned a coalition of organizations (www.SupportiveCareCoalition.org) that has played a major role in transforming end-of-life care.
Soros-funded Diane Meier, MD,6 directs the Center to Advance Palliative Care, which is the nations premier public relations and training center for in-hospital palliative care programs. Eight Palliative Care Leadership Centers teach hospital administrators, doctors, nurses, social workers, and chaplains how to convince patients representatives to discontinue nutrition/hydration, as well as other medical treatment that is actually ordinary care.7
Take, for example, the nutrition/hydration guidelines for physicians at one Milwaukee hospital.8 They claim that non-oral feeding/hydration is considered a medical treatment, not ordinary care for dying patients, who are defined as not only those entering the syndrome of imminent death but also patients who have a progressive, incurable chronic medical condition, including dementia. They insist that, for all such patients, the benefits of non-oral feeding might not outweigh the burdens, and thus withdrawing non-oral feeding and hydration is neither euthanasia nor assisted suicide.
Another third path leader is Ira Byock, MD. After a historic meeting of leaders in end-of-life care in 1998, Byock, as president of the American Academy of Hospice and Palliative Medicine, and Karen Kaplan, as director of Choice in Dying, collaborated to form Partnership for Caring, a highly visible national collaboration intended to raise consumer demand for changes in end-of life careto bring about mandated universal access to palliative care.9
The third path in health care reform
By describing elderly patients as biologically tenacious and lamenting the persistent acceptance of life-sustaining basic care, those who want planned health care rationing unmasked themselves. Ezekiel Emanuel, PhD, formerly a key adviser to the Obama administration on health care reform, has written, [S]ervices provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.10
Thus, its no surprise that the 2010 Patient Protection and Affordable Care Act (Obamacare) provides major support for the palliative care movement.11 The National Quality Forum, a nonprofit now working closely with Health and Human Services, has identified a need to eliminate inappropriate/unwanted nonpalliative services at end of life to achieve its goal of making quality [health] care affordable.12
Written on the human heart
The deep seated revulsion Callahan complained of is, in reality, the natural respect for life inscribed in each of us by our Creator. Speaking to the Pontifical Academy for Life on Feb. 13, 2010, Pope Benedict XVI underscored the importance of the natural law:13
Bioethics . . . needs a reference that can guarantee a consistent reading of ethical issues that inevitably emerge. . . In this sphere the normative reference to the natural moral law comes into its own. Indeed, the recognition of human dignity as an inalienable right is founded primarily on this law, which is not written by a human hand but is engraved in human hearts by God the Creator. . . . Without the universal principles that permit the verification of a common denominator for all humanity, the risk of drifting into relativism in the area of legislation should not be underestimated.
A report published by www.LifeSiteNews.com (Feb. 15, 2010) on this papal address pointed out, [S]ome ethicists warn that modern bioethics is in fact a new normative system of ethics that, based on principles of utilitarianism, can never be compatible with natural law principles. . . . Under these principles, preserving the life of the human patient is not considered paramount.
A recent nationwide survey of hospice and palliative care doctors revealed that over half of the respondents complained that otherseven other doctors and health care professionalshave often identified their practices as murder, euthanasia, and killing.14 A commentary on this survey attributes the findings to misunderstandings of new developments in end-of-life care and portrays palliative care doctors as merely providing ethical pain and symptom control near the time of death.15
However, an article on factors that should trigger referrals to a hospitals palliative care team, shows that most triggers (especially those involving dementia) concern quality of life, rather than imminent death.16 This article likewise reveals that palliative care is not selling well outside of palliative medicine: An early barrier to the process involved attending physicians who were reluctant to order a palliative care consultation.
This conflict of cultures will continue. If youre unaware of how todays palliative medicine disrespects the natural law, youll be vulnerable when approached for a palliative care consultation in the hospital or nursing home. Youll have to rely on your God-given natural law instincts to understandand defendthe line between simple pain and symptom management, and hastened or imposed death.
Elizabeth D. Wickham, PhD, is cofounder and executive director of Life Tree, Inc., a pro-life Christian educational ministry. Dr. Wickham received her doctorate in economics from the University of Rochester and has taught at four state universities.
1See LiifeTrees Euthanasia Timeline.
2See Section 3(b) of the Assisted Suicide Funding Restriction Act of 1997, Public Law 105-12,105th Congress, 14 USC 1440.
3Perry G. Fine, MD, Legislative Update: Assisted Suicide Funding Restriction Act of 1997, APS Bulletin 8, no. 2 (March/April 1998), published by the American Pain Society.
4National Consensus Project for Quality Palliative Care, Clinical Practice Guidelines for Quality Palliative Care, 2004, p. vi. Click here to see the current guidelines, issued in 2009.
5Karen Kaplan and Rosie Mestel, Starving Isnt Such a Painful Death, Pittsburgh Post-Gazette, March 24, 2005.
6See the biography for Diane Meier, MD at www.NPCRC.org.
7Meiers CAPC offers a course on hospital cost avoidance achieved through palliative care programs.
8Palliative Care and Ethics Committees, Non-Oral Hydration and Feeding in Advanced Dementia or at the End of Life: Guidelines for Physician Staff, Froedtert Hospital, Milwaukee, Wisconsin.
9Karen Orloff Kaplan, MPH, ScD, and Ira R. Byock, MD, Partnership for CaringThe Voice for the Dying, Choices: The Newsletter of Choice in Dying 7, no. 4 (Winter 1998).
10Ezekiel J. Emanuel, Where Civic Republicanism and Deliberative Democracy Meet, The Hastings Center Report 26, no.6 (Nov.-Dec. 1996), pp. 1314.
11In the CAPCs June 28 media release applauding the Supreme Courts recent decision to uphold Obama care as constitutional, Meier said, This benefit [Obamacare] is of the utmost importance to CAPC and the field of palliative care. . . [W]e welcome the opportunity to ensure that essential palliative care is brought to all our nations patients.
12National Priorities Partnership, Priorities for the National Quality Strategy, September 2011, p. 7.
13Pope Benedict XVI, Address to Members of the Pontifical Academy for Life: Life an inalienable subject of law, LOsservatore Romano, Feb. 17, 2010, p. 10.
14Nathan E. Goldstein, MD, et al., Prevalence of Formal Accusations of Murder and Euthanasia against Physicians, Journal of Palliative Medicine 15, no. 3 (Mar. 8, 2012).
15Kevin OReilly, End-of-life care: Pain control carries risk of being called a killer, American Medical News, April 16, 2012.
16Mary Hicks, RN, MSN, APRN, and Elizabeth DiStefano, RN, BSN, No Patient Left Behind: Universal Screening for Palliative Needs, Health Progress, Jan.-Feb. 2011, p. 40.
The proper title for a Podiatrist is “Doctor” so what are you yammering about?
That is exactly what happened.
A vital topic, great article, with important comments by several people with their own experiences.
And derailed, defiled, and now hidden from view, all because of one person.
Disgusting.
Thank goodness, it’s back in the News Forum with the objectionable comments pulled.
There is a difference between hospice and palliative care. The original article specifically deals with palliative care. There are many wonderful hospices and many angels of mercy working within both hospice and palliative care but there are also ethical lapses in both fields.
Fixed it for you
Many med schools do not administer the Hippocratic Oath. Of those that do many use a modernistic version bereft of any traditional medical ethics references.
bump!
Okay that is just completely disturbing
Sincere thanks to all of you for sharing your very personal accounts of the passing away of loved ones. Each person’s experiences add to the knowledge of how to support those who are close to death, and care for the ones doing the support.
I love your tagline.
Modern society in four words ;-)
That was not my experience. Not at all.
sfl
I have had a number of people tell me that their family member was put to sleep with morphine in the same sort of scenerio and the family member feels terribly guilty and bad. Nurses tend to like to put patients to sleep. I would never leave an older person alone with a nurse. Always have family or private care nurse there.
There is no reason to put an unconscious person on morphine except to hasten death.
That happened to my mother, under hospice care while at home. I was only one family member out of many, and could not influence anything. I did not realize at the time 100% what was happening, but knew somethings was Terribly Wrong.
I am sorry to hear that. My wife works at a catholic hospital and we’ve used their hospice services for elderly relatives. They were in nursing homes, so that might make a difference.
The care we received for our loved ones was superb. They allowed them to pass without pain, and adhering to their wishes regarding their final days.
I wish everyone that has to go through this, had the experience we had.
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