Life & death decisions: who chooses?

Scale of justice
Scale of justice (Photo credit: Wikipedia)

I was pleased to be included in a panel on Advance Directives recently for the Bar Association of San Francisco, surrounded by three very smart women. Organized & moderated by SF Bar’s John O’Grady, the panel included Harriette Grooh of HGA Personal Care Consultants, Sara Stephens of Good Medicine Consult & Advocacy, and Attorney Elizabeth Krivatsy. The audience — in post-event evaluations — gave us mostly all fives out of possible one to five ratings, which would be a nice touch to my resume if I had a resume. I was there as writer on end-of-life issues, and acknowledged as the wearer of two hats. My death & dying hat alternates with the abortion hat, which I explained was how never to be invited to cocktail parties.

But this panel’s focus was on end-of-life decision making: how, if we consider it, would we prefer to die? Most of us say: At home, at peace. Physician aid in dying — now legal in four states and a movement that is finally gaining ground around the U.S. — is key to peaceful death for many of us, and significant to my work in the area. But opposition to this rational, humane way to die comes from two powerful directions: The Catholic Church (NOT most Catholics, certainly not the excellent folks at Catholics for Choice) and the far right — mostly religious fundamentalists who somehow believe that pain and suffering at the end of life should never be shortened.

The issue becomes one of who chooses: the dying individual, or religious and political powers.

My hats are interchangeable. Comprehensive, justice-rooted women’s health cannot put the fetus in control and cannot take the potential decision to choose an abortion away from the individual. But opposition to this rational, humane way to live comes from two powerful directions. You guessed it: Catholic officialdom and the religious/political right.

Happily, there’s progress, slow but sure, in end-of-life justice and my hat is off to all — Compassion & Choices in particular — who are leading this battle. Unhappily, my other hat might need to be a helmet to protect against the slings and arrows of those opposed to reproductive rights.

Three cheers for Pope Francis

Dove peace
Dove peace (Photo credit: Wikipedia)

The Pope with the good name is all over the news these days with his remarks about the church being too obsessed with social issues, notably including abortion and birth control. And I say hooray for Pope Francis.

Not because I have any insight into his intentions, or any links with Catholicism beyond a bunch of good friends and an MFA from that fine Jesuit institution, the University of San Francisco. But because the Pope seems to be espousing peace and justice and inclusiveness, even going so far as to put them above dogma.

In case you missed it, Pope Francis told a fellow Jesuit interviewer, “It is not necessary to talk about these issues all the time. The dogmatic and moral teachings of the church are not all equivalent. The church’s pastoral ministry cannot be obsessed with the transmission of a disjointed multitude of doctrines to be imposed insistently. We have to find a new balance.”

Subsequent reports and commentaries and punditries have hastened to clarify that nothing has changed. Contraception is still forbidden, abortion is still a sin, and the remarkable folks of Catholics for Choice are presumably still in limbo. But compared to his predecessors, Benedict XVI and John Paul II, who were never noted for liberalism, this pope has a real heart.  His tone throughout the interview is conciliatory, and the message is all about mercy and compassion, love over dogma.

Dogma hasn’t been working very well. It’s an invitation to I’m-right-and-you’re-wrong conversations that end as fast as they begin: My Church Knows Best. My Religion Is The Only Religion. I’m Right And You’re Wrong. Let The Government Default.

If there are answers to the challenging issues of today, they are not being found in these sorts of exchanges. But if we were to start substituting kindness for meanness, conciliation for rigidity, collaboration for obstinacy, imagine what might happen. World peace.

You go, Pope Francis. Even if you spell it with a different vowel, I’m proud to share your good name.

Sad (abortion) stories; happy endings

“Beatriz,” as the 22-year-old pregnant woman in El Salvador was known, has now been delivered of a fetus that could not have lived. Beatriz is fine. She could have lost her life had the pregnancy continued. In another story out of El Salvador, the physician attending another Salvadoran woman named Melanie speaks of having performed an abortion to end Melanie’s 8+-week ectopic pregnancy, and Melanie says she was never worried about losing her life.

But the reality is that politics and religion control the issue of abortion in El Salvador; the woman and her physician are shuttled pretty far aside. (Melanie’s physician describes herself as “deeply religious.” She apparently has some coincidental belief that allows her to perform abortions when necessary.) Down near the end of these stories are statistics about the number of women and physicians who have been convicted of the crime of abortion. There are not a lot of them; but if you were one of them it can’t be good news.

The U.S. is happily not El Salvador. But there are certainly plenty of politicians, and not a few religiously motivated others, who seek to criminalize abortion. It is, in their view, morally wrong under any circumstance.

My question is:  Who knew best what should be done in the above cases? The El Salvadoran government? The Catholic church? Or perhaps Beatriz, Melanie and their physicians? Who knows better than the woman and her physician in the U.S.?

Sometimes, only personal stories tell truth.

(Unpaid plug: there are a lot of personal stories in my new book, Perilous Times: An inside look at abortion before – and after – Roe v Wade. You’re invited to consider them and I welcome your thoughts.)

Pope denounces abortion, gay marriage

With all due respect to the Catholic faith, and to the legions of good people, clergy and laity alike,who are among its believers, this space takes serious issue with the Vatican.

Pope Benedict XVI used a famous Portuguese shrine to the Virgin Mary on Thursday as a stage to denounce abortion and gay marriage, just days before Portugal is expected to join five European countries that have legalized same-sex weddings.

In a speech (in Fatima, Portugal) to Catholic social service groups, Benedict called for initiatives aimed at protecting “the family based on the indissoluble marriage between a man and a woman, help to respond to some of today’s most insidious and dangerous threats to the common good.”

He also said he expressed his “deep appreciation for all those social and pastoral initiatives aimed at combating the socioeconomic and cultural mechanisms which lead to abortion, and are openly concerned to defend life and to promote the reconciliation and healing of those harmed by the tragedy of abortion.”

The common good, according to the pope, would suffer from individuals being allowed to marry those whom they love. And tragedy? What he and his allies are invoking — in this drive to dictate what women may or may not do with their own bodies — is a return to the brutal reality of back-alley abortion. That will be the tragedy beyond healing.

The pope’s remarks came on the third day of a four-day visit (to Portugal) aimed at shoring up Christian belief in increasingly secular Europe, although it has been somewhat eclipsed by the sexual-abuse scandal confronting the Vatican in recent weeks. Benedict also has used the visit to signal a more forceful tone in confronting the abuse, which he has called a “sin inside the church.”

Although it is 90 percent Catholic, Portugal has seen a notable shift away from Catholic teaching in recent years. The country legalized abortion in 2008 and its Parliament recently approved a bill permitting same-sex marriage. President Aníbal Cavaco Silva is expected to sign the bill into law in the coming days.

The church has opposed the measure, but Portuguese society appears to be largely supportive.

Portugal would be the sixth country in Europe to legalize same-sex marriage, after the Netherlands, Belgium, Spain, Norway and Sweden. France and Denmark recognize same-sex unions, which convey many but not all of the rights enjoyed by married couples.

Individual rights, women’s rights and gay rights are slowly going forward in a few places around the globe.  Pope Benedict XVI would like us all to go backward.

Pope Decries Gay Marriage in Portugal Visit – NYTimes.com.

Catholic nuns urge passage of health bill

There’s hope. The U.S. Conference of Catholic Bishops may be trying to sink health reform because they feel they know best about women, but a few thousand good sisters are raising their own voices. And not just your everyday sisters.

Catholic nuns are urging Congress to pass President Barack Obama’s health care plan, in an unusual public break with bishops who say it would subsidize abortion.

Some 60 leaders of religious orders representing 59,000 Catholic nuns Wednesday sent lawmakers a letter urging them to pass the Senate health care bill. It contains restrictions on abortion funding that the bishops say don’t go far enough.

The letter says that “despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions.” The letter says the legislation also will help support pregnant women and “this is the real pro-life stance.”

This space, a space which claims several priests as good friends despite our frequent and vehement disagreements, hereby sides with the sisters. And offers a sincerely respectful three cheers.

Catholic nuns urge passage of Obama’s health bill – Politics – Wire – TheState.com.

Abortion, health reform and me: who is making our choices?

Am I the only person around who is squirming — make that fuming a little — over the concessions made to the anti-choice guys before the House passed its health reform bill? Does no one else find it offensive to turn from reading on page one of today’s New York Times about this sad state of events to page 14 for a large photo of President Obama shaking hands with Cardinal Sean O’Malley? They were meeting at the funeral for Senator Ted Kennedy in August, where reportedly the good clergyman told the president that the Congress of Catholic Bishops really wanted to support health reform ——– oh, but only if everybody caved to their wishes that abortion remain unavailable.

It is not as if we weren’t forewarned. I posted a brief note in this space a few days ago (see Abortion Foes Winning Health Concessions, 11/4, below) and tried to resume a position of calm.

It is hard to remain calm. Somewhere the lines about separation of church and state have to fuzz themselves back into reality. I believe in the right of the U.S. Congress of Catholic Bishops to tell Catholics how to behave (despite the fact that of my many Catholic friends I know almost none who pay any attention in matters of personal choice.) I even believe in the right of the Pope to tell the Bishops to tell their parishioners how to behave. I even believe in the responsibility of all individuals, including my Presbyterian self, to behave according to their conscience and their faith. I just hate being governed by someone else’s faith.

This is not a small distinction. My own church, admittedly starting with a small group here in woo-woo San Francisco, passed a fairly strong national resolution denouncing our country’s torturing folks and seeking justice. As far as I know, no one threatened the president about withholding support for these occasionally immoral wars we keep fighting unless the instigators of torture-in-our-name were sent to jail. However strongly I would like to see the latter happen, I believe there are limits to what faith communities should do.

I had personal experience with back-alley abortion, in the dark days pre-Roe v Wade. It was not pleasant. Is there any way a celibate Catholic bishop could even remotely understand the horrors to which he is condemning poor, desperate pregnant women with the relentless push to make abortion totally unavailable? No. I wish there were.

We still have got to have health reform. But what prices we are paying.

Doctors, lies and half-truths about dying

Is it painful? Will I be okay? Do I have any options? It’s hard to get answers to the first two of those questions about life’s end unless you know a really good psychic.  But as to the last one: Yes. The problem is, no one wants to talk about them.

When they do talk about them, medical professionals ignore reality, dismiss those with whom they disagree, and stop little short of outright dishonesty. For confirmation of this fact you are welcome to skip the next few paragraphs, which are included for the sake of trying to report facts while still a little angry.

A recent panel discussion at the Commonwealth Club of San Francisco was billed as a debate on the ethical issues of making end-of-life decisions. “A Good Death: Intersection of Policy and Practice” featured four experts in end-of-life policy and care. The focus was on palliative care, which has been the Big New Thing in medicine for the past decade or so. Palliative care — read: address the symptoms and keep the patient as pain-free as possible — has been around since about the beginning of time. Someone figured out, though, that if you gave it a fancy name and made it a medical specialty, which it now is, you could encourage doctors to concede that dying is part of the process and that dying patients might be better off, occasionally, if they were not treated to death. This was a step in the right direction.

The discussion, moderated by Steven Z. Pantilat MD, Professor of Clinical Medicine at the University of California San Francisco and Founding Director of the UCSF Palliative Care Program, addressed all of the proper, traditional issues: the importance of having advance directives, the need for open conversations with family and loved ones, the significance of cultural diversity around the end of life. The issues of hastened dying and physician aid-in-dying, of concern to many in the audience according to unscientific exit interviews conducted by several of us, were firmly brushed aside. A majority of Californians favor legalizing physician aid-in-dying and would want that palliative choice for themselves, but that’s what no one will talk about.

Panelists included Judy Citko, J.D., Executive Director, California Coalition for Compassionate Care , Sharon Fernekees-Jeans, Licensed Clinical Social Worker; Manager of Social Work Services and Spiritual Care, Eden Medical Center, Castro Valley, CA. and Kathe Kelly, R.N., B.S.N., O.C.N. City of Hope Nursing Research & Education, Duarte, CA.

“There really is no ‘good death’,” Pantilat said, likening life to a plane trip in which there is intense focus on the take-off (birth), followed by life experiences as the trip and concluding with attention needed for the landing at death. “The medical system wants to keep us aloft forever, with a bias toward prolonging life at all costs,” he said. Palliative care is in response to this philosoophy, which has led to “a source of suffering rather than the relief of suffering. In 2000, it was offered in one in five hospitals; now it is one in three.” Citko, explaining that “people are dying differently than in the past,” said that “today, most people have multiple chronic conditions.” Palliative care addresses this by allowing for curative treatment, as opposed to hospice care which requires forgoing curative treatment.

Panelists talked extensively about the need for advance directives and for conversations about medical treatments and end-of-life wishes.

Then came the audience questions. A number of sincerely posed questions (I read several of them) about aid-in-dying, or hastened dying for those who are near death and might wish to opt out of further suffering, brought this dismissal from Dr. Pantilat: “Regardless of what you say, if they have good care people don’t want that option.” This is simply not true. For 10 years the people of Oregon have shown that they want that option. In a poll taken when Californians were trying to pass a Death with Dignity law, despite well-funded opposition from the California Medical Association (to which a tiny percentage of physicians actually belong) and the Catholic Church, showed that a large majority of Californians want that option.

Citko, along those same lines, commented that there was “an undercover movement” afoot addressing aid in dying. I consider Citko a friend and I admire her expertise, but I had a Joe Wilson moment there. A long-time board member and committed volunteer with Compassion and Choices of N.CA, I am part of no undercover movement. Compassion and Choices is a widely respected nantional nonprofit, absolutely above ground and law-abiding. Among other things, we offer free consultation and support to dying individuals who want to know their options.

Recently I visited a comparatively healthy 93-year-old man who had called Compassion and Choices. He had had gall bladder surgery a few weeks earlier. “I will not go back to the hospital,” he said. “I’ve had a good life, and I want to have a good death.” I talked to him about his legal options should a life-threatening event recur. Shortly thereafter his daughter, a nurse who had met with us and taken notes, sent me an e-mail that sums up why we Compassion and Choices volunteers continue to work for this cause.

“You were like water for a thirsty man,” she wrote. I believe, despite Dr. Pantilat’s assertion that it does not exist, this man will have a good death. I wonder why so many people out there want to deny their fellow creatures such a small, humane thing.