January 2010 - Page 5 of 5 - Fran Moreland Johns

January 3, 2010

Catholic bishops mandate treatment to keep comatose patients alive

Catholic hospitals across the country face a new mandate this year to provide life-sustaining treatment to comatose patients regardless of the wishes of those patients and/or their families, and even when there is no hope of recovery.

The U.S. Conference of Catholic Bishops issued the directive Nov. 17 to the more than 1,000 church-affiliated hospitals and nursing homes in the United States and to all Catholic doctors and nurses. Invoking a 2004 speech by Pope John Paul II, the bishops said Catholics must provide nutritional assistance to patients with “presumably irreversible conditions … who can reasonably be expected to live indefinitely if given such care.”

A previous directive let Catholic hospitals and doctors decide whether the burdens on the patient outweighed the benefits of prolonging life. The bishops said the new policy was guided by “Catholic teaching against euthanasia” and by John Paul’s observation that providing food and water “always represents a natural means of preserving life, not a medical act.”

The issue of whose wishes will be observed — the patient’s or the bishops’ — is certain to be raised. And in the case of a comatose patient, having someone else to advocate in one’s behalf will be critical.

Catholic hospital officials say the November decree isn’t rigid and leaves room for accommodating patients’ wishes. But the bishops’ language appears to conflict with a hospital’s legal duty to follow a patient’s instructions to withdraw life support, as expressed in an advance written directive or by a close relative or friend who knows the patient’s intentions.

Courts have ordered hospitals to disconnect feeding tubes when an unconscious patient’s wishes were clearly established. The best-known case involved Terri Schiavo, the Florida woman who died in 2005 after 15 years in a coma and unsuccessful attempts by her parents and Republicans in Congress to keep her alive.

The decree itself does not require life-sustaining care that would be “excessively burdensome for the patient” or would cause “significant physical discomfort.” If those exemptions don’t apply, a hospital will send a patient elsewhere rather than violate his or her expressed wishes, the (Catholic hospitals) organizations said.

The Catholic Health Association of the United States, which represents both hospitals and nursing homes, said a facility’s ethics committee would probably meet with the doctor and the patient’s representative to “explore the alternatives” whenever a patient’s decision to withdraw life support clashed with Catholic doctrine.”In some instances, this might include the transfer of the patient to another facility,” the association said.

Considering the number of Catholic hospitals, nursing homes, doctors and nurses under the bishops’ directive and the number of people who would not choose to spend their final weeks and months hooked up to tubes and wires, ethics committees are going to be very busy. It is hard to make sense of this across-the-board imposition of one religion’s views on countless patients whose own wishes may differ.

New Catholic mandate on comatose patients.

California/Health/seniors/USA/Women

January 3, 2010

Montana court affirms aid in dying

by Fran Johns

Montana has become the third U.S. state to give terminally ill adults the right to choose aid in dying. The decision, which came from the State Supreme Court on New Year’s Eve, 2009, was handed down by the highest body for state issues and thus cannot be appealed. The other two states honoring a patient’s wish to choose aid in dying are Oregon, which has successfully maintained its Death with Dignity legislation for more than a decade, and Washington, which passed a similar law last year.

The Montana ruling came too late for one plaintiff.

Roberta King, of Missoula, the daughter of plaintiff Bob Baxter, said, “My father died without the peace and dignity he so dearly wanted for himself and others. He feared when he filed this lawsuit that he would not live long enough to benefit from it. I’m sure he would be deeply gratified that other terminally ill Montanans will have the choice and comfort that aid in dying affords them.”

The Montana case was backed by Compassion and Choices, with C&C Legal Director Kathryn Tucker serving as co-counsel to the plaintiffs/respondents. (Full disclosure: I serve on the board of Compassion and Choices’ Northern California chapter.) The decision gave Tucker a major boost for her New Year’s celebrations. She was quoted on New Year’s Day as saying,

Montanans trapped in an unbearable dying process deserve, and will now have, this end-of-life choice. This is the first state high court to find protection of this choice, and makes clear that in Montana, patients are able to make this choice and physicians can provide this care without risking sanction.”

Others, including medical professionals and critically ill patients who invested long hours in seeking the new ruling, were equally gratified.

Dr. Stephen Speckart, a Missoula cancer specialist and a plaintiff in the lawsuit, said, “This decision affirms that a terminal patient’s fundamental right to self-determination will guide end-of-life health decisions. I regularly treat patients dying from cancer, and many of these deaths are slow and painful. Terminal patients will no longer be forced to choose between unrelenting pain and an alert mental state as they approach the end of their lives from terminal diseases. The comfort this brings to their last days can have an immeasurable benefit.”

Missoula attorney Mark Connell, who argued the case to the Supreme Court on behalf of the plaintiff physicians and patients, described the decision as “a victory for individual rights over government control.” Connell added: “The Montana Supreme Court has now recognized that, where intensely personal and private choices regarding end-of-life care are involved, Montana law entrusts those decisions to the individuals whose lives are at stake, not the government. I know Bob Baxter would be very pleased that the court has now reaffirmed that these choices should be left to the terminally ill people in our state.”

Steve Johnson, 71, of Helena, who is terminally ill with brain cancer, hailed the decision and asked the Montana medical profession to provide patients like himself with aid in dying. “I approach the end of my life with a clear mind, and I would like to work with my doctor to minimize the pain and maximize the peacefulness in my dying. I would like my physician to be able to respect and honor my choice to die with dignity. Adults like myself should have the option, if terminally ill, to request physician aid in dying. It’s only compassionate to minimize unnecessary suffering at the end of life, and to let me make the choice about how much suffering to endure, based on my own values and beliefs,” said Johnson.

The movement had widespread support across the state.

Montana State Sen. Christine Kaufmann, Rep. Dick Barrett and twenty-nine other state legislators; the American Medical Women’s Association, the American Medical Students Association, and a coalition of Montana clinicians; the American College of Legal Medicine; the American Civil Liberties Union of Montana; the Montana Human Rights Network; the Northwest Women’s Law Center; terminal patients’ surviving family members; Montana religious leaders; and Montana’s leading constitutional law experts had urged the Court to find in favor of the terminal patient’s right to receive aid in dying from their physicians.

According to Compassion and Choices president Barbara Coombs Lee, the battle for “the right to choose a humane and compassionate death will continue. (We) encourage terminally ill patients to call 800 247-7421 if they would like information about aid in dying, or suggestions on how to open a dialogue with their physician and loved ones.”

General interest/Health/Lifestyle/Money

January 2, 2010

CIA casualties highlight endless wars

by Fran Johns

While we were watching bejeweled balls drop in Times Square, or fireworks over San Francisco Bay, pyrotechnics of a different sort were going on as usual around the globe, some of them more or less our fault — because people don’t like us or our government policies or our religious persuasions — some of them happening in our name. The news-making American casualties were not military personnel this time, but civilians in the employ of the Central Intelligence Agency.

The report of this attack sums up where we are, in the last few words of the first paragraph: America’s far-flung wars.

The deaths of seven Central Intelligence Agency operatives at a remote base in the mountains of Afghanistan are a pointed example of the civilian spy agency’s transformation in recent years into a paramilitary organization at the vanguard of America’s far-flung wars.

Is it possible we are fighting too many wars, too far-flung?

If you Google around a while, you can discover (for instance, on a college librarian’s eponymous and aptly named site, topsy.org) that many of the lists of exactly where and with whom we are fighting battles have been removed — but that there are a lot of them out there. We have “overseas operating sites,” which our thankfully now-former president sought to have “optimally positioned to respond to potential 21st century military threats” all over the globe.

PBS NewsHour on New Year’s Day featured one segment in which Georgetown University professor Christine Fair attempted to articulate the various factors involved in current impossible wars going on in the mountainous regions of Pakistan, Afghanistan etc. The Pakistan Taliban, she explained, are actually “a network of networks;” the insurgents include Afghan soldiers, or perhaps non-soldiers dressed in some of the uniforms acquired by stealing a truckload of them, which happened not long ago. PBS’ Ray Suarez then asked if there were any way of stopping this chaos. “I don’t think so,” was the answer.

Hello? Could we think about our foreign policy a while?

Even without easily accessible lists (it is somewhat comforting to know that amateurs can’t Google up strategic maps of these overseas operating sites,) everybody knows we have personnel, uniformed and otherwise scattered around from Germany to South Korea to Thailand to Honduras to wherever. We don’t know how many of them are fighting little wildfire battles, either in person or through U.S.-trained surrogates. In the recent C.I.A. tragedy, the survivors can be forgiven for anger and grief, but some of the response is still unsettling:

There was an air of defiance among intelligence officials on the day after the attack, and some spoke of their fallen comrades using military language.

“There is no pullout,” the American intelligence official said. “There is no withdrawal or anything like that planned.”

Is anybody, anywhere, considering the fact that we can’t keep fighting everybody everywhere, forever? The pundits (reinforced by Defense Department spokespeople) like to say that if we were to pull out — of Iraq, Afghanistan, Uganda, pick your piece of the globe where we’re actively or just-behind-the-lines at war — there would be chaos. But there’s already chaos.

What if we started taking a few of those trillions currently funding endless wars and diverting them into building schools, hospitals, community centers, friends? After the chaos, could we then emerge with more friends and fewer aspiring-martyr enemies?

Maybe not. But it would be nice, just once, in all the interminable debates about terrorists and security and rooting out the bad guys, to hear someone suggest changing course, waging peace. For now, we seem mired in countless un-winnable wars. It would be heartening to think we could get off the Through the Looking Glass course outlined by former Defense Secretary Donald Rumsfeld in 2002 and quoted by columnist David Sirota today:

As we know, there are known knowns. There are things we know we know. We also know there are known unknowns. That is to say, we know there’re some things we do not know. But there’re also unknowns unknowns; the ones we don’t know we don’t know.

We know how many wars we are fighting. We know we’re not winning many of them. We know that peace on earth isn’t getting any closer these days.

C.I.A. Takes On Bigger and Riskier Role on Front Lines – NYTimes.com.