NEW! Washington State to Allow `Dignity' Deaths

NEW! Extinguishing Physician Conscience

Abuse of Elderly With Dementia by Family Caregivers Common, Survey Suggests

Four Charged in Multi-State Suicide Assistance Probe

"Brain Death" Test Causes Brain Necrosis and Kills Patients: Neurologist

California Man Wakes Up From Coma Right Before Life Support Disconnected...

Washington State to Allow `Dignity' Deaths. Terminally ill patients with less than six months to live will soon be able to ask their doctors to prescribe them lethal medication in Washington state. But even though the "Death with Dignity" law takes effect Thursday, people who might seek the life-ending prescriptions could find their doctors conflicted or not willing to write them. Many doctors are hesitant to talk publicly about where they stand on the issue, said Dr. Tom Preston, a retired cardiologist and board member of Compassion & Choices, the group that campaigned for and supports the law. Washington State, Montana, and Oregon now allow assisted suicide. [http://www.google.com/hostednews/ap/article/ALeqM5gEOj2lhkuVJCGiPp-q1UD2ehPnEAD96LDB1O0
AP; ALL Pro-Life Today, 3Mar09]
 

Extinguishing Physician Conscience
By Mary L. Davenport, MD
The largest generational cohort in American history, the Baby Boomers, will be the first Americans to be denied available effective life-saving treatments for reasons of cost. The seeds for this mass liquidation have already been planted.

Imagine that it is 2016, and you are a 65 year old boomer. You have been admitted to your local community hospital with malaise, fatigue, vomiting and cloudy mental status. You have had blood pressure problems and diabetes for a few years, and have just been diagnosed with renal failure. As you drift in and out of consciousness, you are vaguely aware your old family practice physician, who had taken care of you for 20 years, is not around. A religious man, he quietly retired from medical practice in 2014, after the full force of the Obama administration‘s removal of conscience protection for physicians in February, 2009, came into effect.

You feel vaguely uncomfortable as you are placed in a darkened room in the Comfort Care wing of the hospital. In moments of lucidity, you wonder if you shouldn't have some oxygen, an IV or SOMETHING! But the appropriate therapy, kidney dialysis, is not on the approved list of treatments for patients over 65, having been deemed too expensive. The new regulations from the Department of Health and Human Services were presented just last month to your hospital's Futile Care Committee. It was decided at the highest levels that for those over 65 years of age, renal dialysis would not be a beneficial treatment, that the alternatives of a kidney transplant were too expensive, and that your quality of life on chronic dialysis would be too diminished.

Your children wonder why you are not in an ICU. They are told that you will be placed on a morphine drip to make you more comfortable as you pass away, and that this is the highest standard of care for your diagnosis and age. It is called terminal sedation. You signed an advanced directive indicating that you did not want extraordinary care for a terminal condition, and under the new protocols renal failure, although treatable, qualifies as a terminal condition.

Your children frantically try to find their old family doctor. But your health plan replaced him with a large group of younger physicians, the hospital's Consortium for Health, a private-public foundation that was created to promote efficiency and reduce wasteful spending in medical care. By 2014 when he left, your family doctor was a dinosaur, having been trained in an earlier era. His medical school was one of the last to retain the original Hippocratic Oath.  It affirmed the covenantal relationship between the physician and patient, overseen by God, and that whatever the physician did would be for the patient's benefit.  You had felt safe entrusting your health to Dr. O'Brien's professional judgment.

Not only did the Hippocratic Oath your doctor took decades ago took specifically forbid physician assisted suicide and abortion, it also established patient confidentiality so that your secrets would never be disclosed. That is, until 2012, when physicians participating in the national healthcare system, which included ALL licensed physicians, were mandated to submit your visits to the unified electronic medical record system.  This data base was created in 2003 to coordinate medical care, detect emerging health threats, and exchange clinical information. Your doctor was very uncomfortable with this policy despite reassurances that HIPAA regulations would maintain your privacy.

But forces beyond any individual's control began to erode your relationship with your doctor long before he left the practice of medicine. The insurance companies stopped paying him in the late 1990's for hospital care, preferring to hire "hospitalists" or "intensivists" for greater efficiency in reducing hospital stays. Since office visits were reimbursed at lower and lower rates, your doctor had to see more and more patients in the office to just stay even. So although O'Brien knew you well and was trained to treat conditions such as renal failure or pneumonia, he stopped treating patients in the hospital.

Around 2007 both the hospital and office physicians began to be paid by a formula that rewarded them for saving money on medical care.  When your family doctor was forced to join the Consortium in 2012 because the health plans stopped contracting with individual physicians, a powerful new computer system tracked each doctor's prescribing habits, referrals to specialists, and utilization of expensive lab tests. But your doctor was an "outlier" in this new system, having been brought up in Hippocratic tradition of doing what was necessary for the individual patient, rather than the Greater Good, the newer communitarian ethic followed by the younger doctors. He was financially penalized for doing too much for his patients, since the formulas based 30% of physician income on "efficiency."

Your old doctor could tolerate the erosion of his income, but had trouble with the new regulations that insisted that he discuss and refer for "all legal procedures." Since by 2013 physician assisted suicide was legal in 21 of 50 states, the Consortium enumerated the conditions that mandated the "euthanasia talk", including multiple sclerosis, metastatic breast cancer, and many others. He could never actually bring himself to violate his original Hippocratic Oath that not only forbade assisting his patients in committing suicide but also prohibited even mentioning it. It was impossible to rid himself of the idea that a physician's role was to assist in healing and that medical killing was antithetical to his professional integrity.

Back in 2007, ACOG, the ob/gyn's professional organization, issued Ethics Committee Opinion 385, contending that ob/gyn doctors had the duty to either do abortions or have offices in close proximity to abortion doctors to whom they would refer patients. There was an outcry from professional organizations of pro-life ob/gyns, Catholic physicians,  and other Christian doctors. Especially troubling to many was the assertion in  Committee Opinion 385 that defined conscience as a sentiment, and measured its "authenticity" by the degree to which a provider would suffer "guilt, shame or loss of self esteem" if it were violated. Your doctor and many of his colleagues regarded medical killing as anathema, and were incensed by describing their integrity as a physicians as a "feeling". But by 2013 the protests had died down, and the ethics committee recommendation for ob/gyn's had evolved into a mandate for family practice doctors under new rules enforced by the Department of Health and Human Services.

The final blow came in early 2014. Back in 2008, in Benitez v North Coast Women's Care Medical Group, the California Supreme Court ruled against ob/gyn doctors who did not want to provide intrauterine insemination to a lesbian couple because of their religious beliefs. Although most European nations did not allow the buying or selling of eggs or sperm, and restricted fertility therapies to heterosexual married couples, the California courts not only permitted but required health care providers to cooperate in any reproductive therapies for any patient regardless of sexual orientation or marital status.

Although the birth of octuplets in 2009 with assisted reproductive technology to a single woman with six other children initially created a brief public uproar, ultimately no legislation was passed protecting physicians who did not want to participate in a patient's procreative endeavor. Your physician had a 68 year old bipolar single male patient who wanted to have an heir. The patient requested that your doctor appeal to the Consortium to provide him with a donated egg and surrogate mother for his desired offspring. Since your doctor did not want to be used as a tool in his patient's peculiar agenda and was legitimately afraid of an expensive lawsuit that would decimate his dwindling retirement funds if he refused, he decided at this point to quit medicine altogether and move to a sunny warm state.

Your family doctor had been inspired as a young man by study of the U.S. Constitution and other foundational documents that he thought would forever ensure his liberty. He had studied the same "Rules of Civility" that the young George Washington had encountered in 1747.  One of the most memorable of these maxims was "Labor to keep alive in your breast that little spark of celestial fire called conscience." It was clear to him that conscience here referred to man's innate understanding of moral right and wrong. When the American Founders would later declare independence from Great Britain in 1776, it was by virtue of this "spark of celestial fire" that they would establish the principles of human equality, unalienable rights, and government by consent as the foundations of American constitutional government.

Just before he left for his retirement home, your doctor was deeply disturbed to see the concept of conscience mocked in the New England Journal of Medicine by University of Wisconsin law professor R. Alta Charo in her article "The Celestial Fire of Conscience - Refusing to Provide Medical Care."  Charo's presentation did not acknowledge that many Americans do not believe that abortion, assisted suicide, and embryonic stem cell therapies are legitimate medical care in the first place. Her article also did not distinguish between emergency and elective care, and merely regards the health care provider as a tool for whatever ends the patient wants to achieve. Attorneys such as Ms. Charo claimed the right to take whatever cases they want, but seem deny the same basic right to physicians. Patients can always seek the care of other providers.

Your doctor (and many other Americans) believed that failure to protect physician conscience will destroy the trust and accountability that is essential to the physician patient relationship. If the physician and patient cannot freely collaborate, ultimately another agenda -- that of the health plan or state -- will replace it, to everyone's detriment.

Dr. Davenport is an obstetrician/gynecologist in private practice in El Sobrante, California.
[9March2009; See the link to the article for several imbedded hyperlinks:   http://www.americanthinker.com/2009/03/extinguishing_physician_consci.html]

 

Abuse of Elderly With Dementia by Family Caregivers Common, Survey Suggests. About one-third of family caregivers admit to abusive behavior toward their family member with dementia, mainly verbal abuse, a new survey suggests.
Although levels of physical or frequent abuse were low, those with the most abusive behavior might have been afraid to report it in this voluntary survey, the researchers say.

"I think this sends a message to family carers who are having these problems that they're not alone and sends a message to professionals that this is something that really warrants asking about routinely," first author Claudia Cooper, MD, from the department of mental health sciences at University College London, in the United Kingdom, told Medscape Neurology & Neurosurgery.

"There is this feeling that elder abuse is something that is severe and rare, and outside of a few serious cases, it doesn't happen," she added. "We've shown that's not true, and so we hope that would encourage professionals to ask about this."
Their report is published online January 22 in BMJ.

Common Problem

Elder abuse has been put forward as a priority for both the British and American governments, but most of the action in the United Kingdom at least has focused on the reduction of abuse toward vulnerable elders by paid caregivers, the authors write. The inference is that caring family members would not act abusively when there is a family relationship with the person with dementia.

However, the current work by Dr. Cooper and colleagues on this problem stemmed from conversations they had with family caregivers in their own psychiatric practices, she said. "When you actually started to ask routinely, a lot of carers had had these experiences and wanted to talk about them. We began to feel that maybe this was something doctors needed to be asking routinely about, but we didn't have the evidence."

To determine the prevalence of abusive behavior among family caregivers, they carried out a cross-sectional survey of 220 family members of people with dementia living at home who had been newly referred to secondary psychiatric services.

They used an instrument that had been developed for family caregivers of frail elderly by Scott Beach, PhD, from the University of Georgia, in Athens, and colleagues. The survey was administered by 3 trained psychiatrists; caregivers were asked about abusive behaviors ranging from shouting and swearing or threatening the patients with institutionalization, to hitting, slapping, or withholding food.

They could respond on a sliding scale ranging from "never" to "sometimes," "most of the time," or "all of the time." The threshold for abuse was defined as those behaviors reported "sometimes."

They found that 115 caregivers, over half, reported some abusive behavior (52%; 95% CI, 46% – 59%), and 74, one-third of caregivers, reported important levels of abuse (34%; 95% CI, 27% – 40%). Abuse was mostly verbal; only 3 caregivers (1.4%) admitted to occasional physical abuse.

Reluctant to Report?

However, some may have been reluctant to report abuse, they note; the consent sheet specified that the researchers would respect confidentiality, "but we cannot keep it a secret if anyone is being seriously harmed."

"It was predominantly verbal abuse that they were admitting to, but I think it's nonetheless important in that it's an important sign of people who need more help," Dr. Cooper pointed out.

"We suggest that any policy for safeguarding vulnerable adults must consider strategies directed toward families who provide the majority of care for older people, rather than exclusively formal caregivers," the authors conclude. "Considering elder abuse as a spectrum of behavior rather than an 'all-or-nothing' phenomenon could help professionals to feel more able to ask about it and therefore offer appropriate help."

Beyond just asking about this as part of good dementia care, Dr. Cooper added, "it's about what you do when you find it." A simple example may be the recommendation for more respite care, she said.

However, there are currently few evidence-based interventions to reduce abuse, she added. "The problem is we don't know enough about how to prevent abuse, and this is going to be our next area of study."

The study was funded by a research training grant to Dr. Cooper from the Medical Research Council. The researchers report no competing interests.
[BMJ. Published online January 22, Susan Jeffrey, Medscape Medical News 2009, January 27, 2009; www.medscape.com/viewarticle/587445]

Four Charged in Multi-State Suicide Assistance Probe. A wide-ranging investigation into an alleged suicide assistance ring led to charges against four people and raids in nine states as authorities looked
into how many deaths might have been involved.

Four members of the Final Exit Network were charged Wednesday with helping a
58-year-old Georgia man end his life by inhaling helium. The group assigns
those seeking to end their lives a guide who instructs them to purchase two
new helium tanks and a hood, known as an "exit bag," the Georgia Bureau of
Investigation said.

It wasn't immediately clear how many deaths were being investigated by law
enforcement agencies that include the FBI, but authorities in Arizona were
looking into whether a death there involved the group.

Group members Thomas E. Goodwin, who was identified as the organization's
president, and Claire Blehr, a member, were both arrested Wednesday at a
home in northern Georgia, the Georgia Bureau of Investigation said. The
arrests came after a sting operation in which an undercover agent posed as a
member of the group.

Maryland authorities arrested the organization's medical director, Dr.
Lawrence D. Egbert, 81, of Baltimore, and Nicholas Alec Sheridan, a
Baltimore man who is a regional coordinator for the group.

The four were charged with assisted suicide, tampering with evidence and a
violation of Georgia's anti-racketeering act.
Their charges stem from the June 2008 death of John Celmer in an assisted
suicide in Cumming, about 35 miles north of Atlanta, said GBI spokesman John
Bankhead.

Authorities were executing search warrants at 14 sites in Arizona, Georgia,
Florida, Maryland, Michigan, Ohio, Missouri, Colorado, and Montana,
according to the GBI and the Maricopa County Attorney's Office in Arizona.
Included in the searches were a group office in Georgia and a company in
Montana that authorities said supplied items used in suicides.

Also raided were the homes of group volunteers in the other seven states.
Maricopa County Attorney Andrew Thomas said Arizona detectives are
investigating whether the group assisted in a Phoenix woman's death.

Bankhead said new members of the group pay a $50 fee and follow an
application process. When ready to commit suicide, the member is led through
the process by two guides, he said.

The group's vice president said it supports those with irreversible
illnesses who choose to end their lives, but its volunteers don't actively
participate in the life-ending procedures. The group started in 2004 and has
3,000 dues-paying members.

"When they choose to exit, as we call it, we just hold their hand. That's
about it," said Jerry Dincin, who's also a clinical psychologist in Chicago.

He said members are given a book, "The Final Exit," that outlines how they
can end their lives. He said volunteers never encourage the members to commit suicide, but support them if that's their choice. [http://seattletimes.nwsource.com/html/nationworld/2008786163_apassistedsuicidering.html ; AP, G. BLUESTEIN]
 

"Brain Death" Test Causes Brain Necrosis and Kills Patients: Neurologist. One of the medical world's key diagnostic tools for determining "brain death" preliminary to organ retrieval, actually causes the severe brain damage it purports to determine, neurologist Dr. Cicero Coimbra told attendees at a conference last week. With the so-called "apnoea test," Coimbra said, brain damaged patients who might be recoverable are deprived of oxygen for up to ten minutes, rendering the injuries to the brain irreversible.

"Diagnostic protocols for brain death actually induce death in patients who could recover to normal life by receiving timely and scientifically based therapies," Dr. Coimbra, head of the Neurology and Neurosurgery Department at the Federal University of Sao Paulo, Brazil, told the participants at the "Signs of Life" conference on "brain death."

Addressing an assembly of about 170 physicians, philosophers, ethicists, lawyers, students, journalists, Dr. Coimbra said that it is the apnoea test, routinely applied to patients who have suffered acute brain injuries, that frequently causes "brain necrosis," or permanent and irrecoverable brain damage that is accepted as "brain death".

The test is applied in emergency rooms or ICUs, often with an "organ procurement agent" standing by to ask relatives for approval for organ retrieval. A patient who needs assistance breathing is removed from the ventilator for up to ten minutes, cutting off oxygen to the brain and slowing the heart rate.

If the patient fails to begin breathing without assistance after this time, he is declared "brain dead" and his organs may be legally removed. Since the world-wide adoption of the "brain death" criteria, developed at Harvard University in 1968, Dr. Coimbra said, "The lives of thousands of human beings, including children, adolescents and young adults, are lost every year in each country."

The premise of the standard Harvard Criteria for "brain death" is that lack of brain function implies absence of blood circulation to the brain, which is what causes brain necrosis, or the irreversible death of brain cells. But since the definition of the Harvard Criteria, he explained, medical scientists have discovered that the absence of discernable brain function cited by the criteria is not the same as "brain necrosis," or true brain death. In many cases where there is no discernable brain activity, patients have recovered with appropriate treatment.

Dr. Coimbra cited one study supported by the National Institutes of Health in 1975, that found that of 226 comatose patients determined to be "brain dead" for at least 48 hours, only 50 percent were later found to have "pathological signs of necrosis." 21 percent of the patients had no signs of dead brain cells. Even patients who show no signs of synaptic activity, a condition of the "brain death" diagnosis, are still recoverable at that point.

For patients, he explained, with only less serious brain damage, who are submitted to the apnoea test, "the test will cause total necrosis of the brain." The apnoea test increases carbon dioxide concentrations in the blood. This increases the intra-cranial pressure and causes final reduction of the brain circulation.  

But, Dr. Coimbra said, the information that the apnoea test causes severe, irreversible brain damage, is being suppressed. Even with this knowledge of the danger of the apnoea test and the fact that some patients who are declared brain dead can and frequently have recovered, the legal definition of "brain death" is itself irreversible.

He told the conference of an experience in his clinical practice as a neurologist involving a 15 year-old girl with a severe brain trauma. She was declared "brain dead" but he treated her with thyroid hormones and she began to recover. She started breathing and having seizures, he said. "But a 'dead' brain cannot seize. That brain cannot express convulsions and she was having convulsions." This meant that a diagnosis of "brain death" even according to the Harvard Criteria, did not apply.

"And so I went to the doctors in the ICU that, up to that time, were denying proper care to that patient under the assumption that she was brain dead." One of the attending physicians in the ICU, he relates, wrote on the girl's chart that even recovery could not reverse a legal definition of "brain death."
The physician wrote the following statement, a photocopy of which was shown at the conference: "If the diagnostic criteria for a brain death are fulfilled at a certain time, the person is legally dead no matter whether those criteria become no longer fulfilled later on."

This incident showed, he said, that medical professionals attending patients officially declared "brain dead" "feel at risk" of legal action from families.

"That is why there is such a fearful repression when we start talking about those subjects in medical forums."   

Read related LifeSiteNews.com coverage:

"Brain Death" as Criteria for Organ Donation is a "Deception": Bereaved Mother
http://www.lifesitenews.com/ldn/2009/feb/09022306.html
Doctor Says about "Brain Dead" Man Saved from Organ Harvesting - "Brain Death is Never Really Death"
http://www.lifesitenews.com/ldn/2008/mar/08032709.html
[25Feb09, Hilary White, ROME, LifeSiteNews.com]

"Brain Death" is Life, Not Death: Neurologists, Philosophers, Neonatologists, Jurists, and Bioethicists Unanimous at Conference.  If a patient is able to process oxygen from the lungs into the bloodstream, maintain a normal body temperature, digest food and expel waste, grow to normal adult size from the age of four to twenty, and even carry a child to term, can he or she be considered dead? Can a person who is "dead" wake up and go on later to finish a university degree? Can a corpse get out of bed, go home and go fishing? Can he get married and have children?

These are among the real-life stories of patients declared "brain dead" presented by medical experts at the "Signs of Life" conference on "brain death" criteria last week.

Ten speakers, who are among the world's most eminent in their fields, sounded a ringing rebuke to the continued support among medical professionals and ethicists for "brain death" as an accepted criterion for organ removal.

Dr. Paul Byrne, the conference organizer, told LifeSiteNews.com he was delighted with the success of the conference, that he hopes will bring the message that "brain death is not death" inside the walls of the Vatican where support for "brain death" criteria is still strong.

Dr. Byrne, a neonatologist and clinical professor of pediatrics at the University of Toledo, compared the struggle against "brain death" criteria with another battle: "I'm sure that slavery was at one time well-accepted in the United States, and that people saw big benefits to slavery. And yes, it was difficult to go away from that but it was absolutely essential."

"Slavery was doing evil things to persons. This issue of 'brain death' was invented to get beating hearts for transplantation. And there is no way that this can go on. It must get stopped."

Participants came from all over the world to attend the Signs of Life conference, with speakers from Quebec, Alberta, Ontario, Germany, Poland, the US, Brazil and Italy. The conference hall was packed to standing-room only with physicians, clergy, students, journalists, and academics. Conference organizers told LifeSiteNews.com that they had expected no more than a hundred to attend and were surprised but very pleased with the crowd of over 170 for the one-day event.

"It's here to demonstrate clearly that 'brain death' never was true death.

"When there are attacks on life, then we, as physicians, defend it and that is what this conference is for."

The Signs of Life conference, sponsored privately by various pro-life organizations, including Human Life International, American Life League and the Italian organization Associazione Famiglia Domani, stood in opposition to the second PAS conference, which was titled, "The Signs of Death."

Related:
Doctor to Tell Brain Death Conference Removing Organs from "Brain Dead" Patients Tantamount to Murder
http://www.lifesitenews.com/ldn/2009/feb/09021608.html




California Man Wakes Up From Coma Right Before Disconnecting Life Support.  A California man awoke from a coma right before his doctors were about to disconnect his life support. The story gives more credence to the notion that families should avoid making premature decisions to take the life of a loved one, because of the possibility of recovery.

Mike Connolly is a 56-year-old man whose heart stopped in late January and he lay in bed comatose for about four days when his family decided to give doctors permission to remove his life support.

That's when Connolly recovered and interacted with his world around him once again.

According to the North County Times, Connolly's stepson Mike Cooper was reading Scripture by his bedside when he noticed a tear going down Connolly's cheek. Cooper soon left the room, only to return moments later when heard another family member cheering and hollering.

"He said Mike was responding," Cooper told the newspaper. "I didn't believe him, but I went back in there, and it was true. You would say his name, and he would turn his head toward you. It was a miracle."

The news was surprising because doctors has said Connolly had brain damage from his heart stopping and would never recover from the coma.

Now he is making steady progress and the same physicians say he will make a full recovery.

Martin Nielsen, Connolly's pulmonary doctor, told the newspaper he is surprised by his full recovery and called it miraculous.

"When we get a guy like Mike Connolly, it's almost like a miracle," Nielsen said. "I've never seen anybody come back like he has."

Connolly's heart stopped beating for 35 minutes and doctors speculate his brain went without oxygen for at least 10 minutes -- making his recovery even more spectacular.

"Generally, the rule of thumb is if you go for more than four minutes without oxygen, you will see severe damage to the brain," Nielsen said.

Connolly himself is joking with his medical staff now about what happened to him, but said he still feels the pain of the CPR.

"Judging by the way my sternum feels, I'm pretty lucky," he said. "This is all still sinking in, and I think it will be for a long time."

Connolly's family needs financial help to defray the costs of his hospital stay and anyone can donate to it in care of his name at Marilyn Cipriani, 1075 Shadowridge Drive. Unit 70, Vista, CA 92081.
[Printed from: http://www.lifenews.com/bio2759.html; 20Feb09, Ertelt, Oceanside, CA LifeNews.com]