"If we pervert this, we will all lose."

July 31, 2009

Over the last week or so opponents of healthcare reform have been latching on to end of life provisions in the House bill, claiming it would promote euthanasia among our nation’s seniors.

In the July 3 edition of The Bioethics Channel, Myra Christopher and Dr. Christian Sinclair of Kansas City Hospice both expressed concern that the debate would turn in that direction.

“This is not about trying to save money on the backs of dying people,” Myra said.

Dr. Sinclair said he was hopeful end of life and palliative care would not become “buzzwords” subject to being demonized.

Unfortunately, that’s exactly what has happened.

You can listen to Myra’s and Christian’s remarks by clicking on the link below. The interviewer is Lorell LaBoube, the Center's director of communications.

Look for more commentary on this issue soon.

Link: Health Reform and End of Life Care, abbreviated version, Bioethics Channel, July 3, 2009, 2 minutes 12 seconds

Medical Futility Blog -- by Thaddeus Pope: Health Care Costs and the Elderly

Medical Futility Blog -- by Thaddeus Pope: Health Care Costs and the Elderly

Interesting post here from our friend Thaddeus Pope at the Medical Futility blog. The nine minute video report from Religion & Ethics Newsweekly is well worth viewing.

At the Center for Practical Bioethics, we continue to monitor how end-of-life care will ... or should ... be included in health care reform.

A shelter for intoxicated homeless -- a cause for ethics committees?

Rosemary Flanigan
July 24, 2009

Denise, an email correspondent, has thrown down a gauntlet.

To the question, “How can our ethics committees do something ‘practical?’” she says: Needed: a shelter (other than a hospital bed) for intoxicated homeless. And she buttresses her request with good ethical principles and sees it as a matter of distributive justice.

That set me to thinking: What if the ethics committee at Denise’s hospital were to send a request to all ethics committees in our city to garner support for such an idea? I can see the committee chairs calling on the VP for Mission Effectiveness or the Development office to see if funds were available.

But a lot of spade work would have to be done first—and that is the place where my own lack of imagination and ingenuity bogs down.

HELP!! How “practical” ought ethics committees to be?? Anyone who isn’t on vacation, help us out here!!!

Healthcare reform bad for seniors?

House bill includes advance care planning

Starting to see and hear more about aging and end of life provisions in proposed health reform measures.

A guest column in the New York Post by the former lieutenant governor of New York, Betsy McCaughey, states in part:

One troubling provision of the House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration."

This mandate invites abuse, and seniors could easily be pushed to refuse care. Do we really want government involved in such deeply personal issues?

When you read the language in the bill, it sounds a lot like rather basic advance care planning. The link to the entire bill … 1,018 pages … is:

http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf

You can scroll down rather easily to pages 425 to 430.

What do you think?

Don't just stand there. Do something!

Arthur Derse, MD, JD

15 minutes 19 seconds

Many of us have seen it … the emergency room portrayed on television. Frantic. Quick decisions to save lives. At the same time, a place for end of life.

In this environment, how should emergency physicians address end of life issues?

Dr. Arthur Derse, the director of medical and legal affairs and associate director of the Medical College of Wisconsin's Center for the Study of Bioethics, addresses this question in this edition of The Bioethics Channel.

Link: Don’t Just Stand There. Do Something., The Bioethics Channel, July 17, 2009.

Note: The Bioethics Channel is a free podcast. To subscribe via iTunes click here or you may click on medicalchannelsonline.libsyn.com/rss.

A Deja Vu Moment for Healthcare Reform

Nearly a year ago Steven Schroeder, MD came to Kansas City to talk about healthcare reform, how it was needed and how it came so hard.

The Distinguished Professor of Health and Health Care at the University of California - San Francisco and former president and CEO of the Robert Wood Johnson Foundation said at the 2008 Flanigan Lecture that it would take four things to move the country toward healthcare reform:

1. Economic depression mobilizes the middle class

2. Charismatic president pushes legislation

3. Business asks for help

4. The medical profession mobilizes

He’s come pretty close, hasn’t he?

Links:

Video Dr. Schroeder – Why Reform Comes Hard, You Tube, 8 minutes 52 seconds, August 5, 2008

Lecture: Healthcare Reform Needed but Comes Hard, July 31, 2008, 52 minutes 12 seconds

Locked in Theologies

Rosemary Flanigan

Our celebration of the 25th anniversary of the Center includes a series of talks given by the program planning team—and mine was last Wednesday with a title that Myra Christopher gave me: Religion. Healthcare Policy. Do the Twain Meet?

I used Richard McCormick’s 1974 case which he wrote up as “To Save or Let Die” and published in the Journal of the American Medical Association. The “policy” or guideline is how to determine when a severely malformed baby ought to be allowed to die—and it is simple and eminently reasonable (can it be ascertained that the baby is so damaged that he/she cannot enter into relationships—because loving God and neighbor is the purpose we have life in the first place).

The discussion avoided, thank goodness, crazy religious practices. But afterwards, George Flanagan, chaplain at the Kansas City Veterans Administation Hospital, told me of persons so locked in their “theologies” that they can’t hear proposals for another way to doing things.

McCormick had always held that moral experience is eminently reasonable—that means to me that one can engage with others (though not necessarily agree) using the power of reason.

I guess some of those of whom George was speaking would think, “If I already know the answer, why reason?”

Discouraging, isn’t it???

Link: Religion. Healthcare Policy. Do the Twain Meet?, Rosemary Flanigan lecture, July 8, 2009. 1 hour 6 seconds

Plan to Age Better

Letter to the Editor
Kansas City Star
July 13, 2009

We were delighted that issues of aging warranted Ellen Goodman’s attention (7/5, Opinion, Unprepared for this age of millions).

Kansas City is already engaging a host of folks in these issues well beyond taking the car keys away from an elderly loved one. We are designing efforts that could keep seniors mobile by creating aging friendly environments and finding safer passage for younger and older people.

About two dozen organizations are addressing these issues through an initiative called KC4 Aging in Community. The goal is to plan today for tomorrow’s aging population, which we now know will more than double in the next 20 years in Kansas City.

If we shed our Peter Pan notions of never growing old and begin crafting solutions in Kansas City neighborhoods that recognize geriatric genius, our foothold on the future will find steadier ground.

We might just find the journey a little less shaky and a little more rewarding.

John Carney
Vice President, Aging and End of Life
Center for Practical Bioethics

The Unrealistic Pursuit of Immortality

Myra Christopher
July 10, 2009

I wish every family in America struggling with treatment decisions for an incapacitated, frail, elderly loved one would read Jane Gross’s article, “Sisters Face Death With Dignity and Reverence”, in the New York Times July 9.

It reframes the end-of-life care debate in this country from what Gross refers to as the “American black-and-white way of thinking: either we have to throw everything we’ve got at keeping people alive or leave them on the sidewalk to die.” And it describes the benefits of palliative care and hospice over the unrealistic pursuit of immortality via aggressive medical intervention by telling the stories of a group of elderly Sisters of St. Joseph living together in convent in New York.

Over and over again, I see loving families make terrible decisions because we have come to believe wrongly that in all circumstances more healthcare is better healthcare. Yet, there is a growing body of data that, at the end of life, it is simply not true.

Without question, modern medicine has tremendous benefits to offer. I am regularly astounded by what can be and what is done for the benefit of patients, but when applied indiscriminately, I am also often horrified.

In the Times article, Sister Mary Lou Mitchell, the president of the Sisters of St. Joseph congregation, is quoted as saying, “We approach our living and our dying in the same way, with discernment, maybe this is one of the messages we can send to society, by modeling it.”

I hope so, Sister.

Links:

Sisters Face Death With Dignity and Reverence, New York Times, July 9

Making Your Wishes Known for End-of-Life Care

Medical Futility Blog -- by Thaddeus Pope: End-of-Life Decision Making - A Summary and Primer

Medical Futility Blog -- by Thaddeus Pope: End-of-Life Decision Making - A Summary and Primer

Chaplains and Ethical Analysis

Rosemary Flanigan

July 8, 2009

If you had the chance to talk to chaplains-in-training, what would YOU talk about?

Every chance I get, I talk about how to do an “ethical analysis.” Chaplains seem to be the last great listeners in healthcare delivery today, but their “listening” can profit from some structure—and teaching them how different ethical theories structure their listening, then teaching them, with examples, how to use something like Potter’s Box for structuring their responses seems a good way to spend time with them.

Hopefully, ethics committee members, especially the consultation teams, should be able to do this like second nature. But how helpful it would be to have many other in-hospital groups develop the same way of thinking.

Often after an ethics committee meeting I wish everyone in the hospital could have been present!!

Health Reform & End of Life Care

Myra Christopher
Christian Sinclair, MD

15 minutes 32 seconds

President Barack Obama says he does not want to see bureaucracies making end of life decisions. Meanwhile, measures are being filed in Congress to address various aspects of end of life care.

Myra Christopher, president and CEO of the Center for Practical Bioethics, and Christian Sinclair, MD, of Kansas City Hospice talk about the President’s remarks and proposed legislative approaches to end of life care in this edition of The Bioethics Channel.

Link: Health Reform & End of Life Care, The Bioethics Channel, July 2, 2009

Is healthcare an American "right?"

Art Caplan thinks so in a column on MSNBC.com. But a survey shows around 55% disagree with the good doctor Caplan.

Dr. Caplan believes health reform can be pushed through by the well-intended Obama administration by answering one single, fairly simple ethics question: Is health care a right that every American should have?

What do you think? Find links to Dr. Caplan column and the online survey below.

Links:

Details, schmetails: Think big on health care, Arthur Caplan, Ph.D., msnbc.com, June 26, 2009

Online survey click here.

Religion-Healthcare Policy. Do the Twain Meet?

Rosemary Flanigan, PhD

What does it mean to have a “religious consciousness” and how does having such a consciousness affect our thinking as we deal with life and death issues as well as a host of bioethical issues facing us today?

In this edition of The Bioethics Channel, Rosemary Flanigan, PhD explores how religion may affect healthcare policy.

Link: The Bioethics Channel, June 24, 11 minutes 47 seconds