Continuing the search for civil discourse on health reform

Another week, another series of town meetings on health reform.

The Center for Practical Bioethics continues to speak out for civil discourse on health reform, with the aim to provide information, help people gain understanding and find common ground.

Here's Center activity for the week of August 24-28:

End of Life Scare Take II

Podcast: 13 minutes 45 seconds

John Carney
VP for Aging and End of Life
Center for Practical Bioethics
August 28, 2009

There is confusing language about advance care planning in the US House version of healthcare form. But it is not inaccurate … and actually protects the interests of the elderly and disabled.

That’s according to John Carney, a vice president at the Center for Practical Bioethics. He talks about it in this edition of The Bioethics Channel.

Don’t give up on advance care planning
Testimony – Myra Christopher
Congressman Dennis Moore (D-KS)
August 27, 2009

It is our hope that when you and your colleagues return to Washington in the next few days that you will not succumb to the political pressures to withdraw the advance care planning provisions of the pending legislation.

Health Care Forum
Hosted by the United Methodist Church of the Resurrection
Leawood, KS
August 25, 2009

This forum featured a panel discussion including Myra Christopher, president and CEO of the Center for Practical Bioethics, and Sam Turner, president and CEO of Shawnee Mission Medical Center and a member of the Center’s board of directors.

The elderly and disabled would be protected
John Carney
Kansas City Star
August 23, 2009

The language of the measure could have been more clearly crafted, but it’s not erroneous. It actually protects the interests of the disabled and elderly, rather than jeopardizing them. It’s not dangerous, just poorly worded.

An Ethical Grounding in Social Justice

Rosemary Flanigan

August 28, 2009

I think too many people see the Patient Self-Determination Act as an expression of autonomy—which it is—but we are social beings, too, and we do not live like ice cubes in an ice cube tray.

So there is always tension in our decisions: good for me/good for others.

So I shall argue that if, in the next 15-20 years, we can chip away at the gross individualism that marks our present culture, if we can adjust our expectations of what I think healthcare should do for me and broaden my understanding to include others (what are the implications for others of my insisting on a feeding tube in my last weeks/months of life?) then I think we are on the way.

And who can help do this? Every community service, every religious body, every schoolroom, wherever people are together trying to fulfill a task.

We need to make explicit reference to our duties and responsibilities to others.

Too idealistic??? Let me know.

The Future of Bioethics

We had the neatest discussion Monday here at the Center and I decided I would use it for my next Ethics Brown Bag meetings for September.

With all the discussion of healthcare reform swirling around, I am going to ask the participants:

Fifteen to twenty years from now, what will be the defining characteristics of the U.S.?

And then, How will these characteristics shape and influence healthcare delivery?

And finally, What will be the ethical issues involved and how best can we address such issues?

Increased individualism? Going green? Rising or ebbing expectations? If you take any one and place it like a template over health and healthcare, you’ll see a trend. And each trend has ethical implications we might need to address.

I hope my hearty friends who attend these sessions will not disappoint me. Anyone interested?????

Krauthammer on "The Truth About Death Counseling"

Our friend Christian Sinclair makes some good points about the realities of advance care planning in this post to his blog, Pallimed.

Dr. Sinclair participated in The Bioethics Channel podcast that focused on end of life care as a part of healthcare reform. It's a 15 minute 32 second segment with Myra Christopher of the Center for Practical Bioethics. It was recorded July 3, before "death panels" entered the public debate.

The link is here.

Pallimed: A Hospice & Palliative Medicine Blog: Krauthammer on "The Truth About Death Counseling"

Teach an Integrated Ethics Class

Rosemary Flanigan

August 21, 2009

Thinking back on our years of preparing ethics committees to integrate ethics into every aspect of healthcare delivery in the institution leads me to suggest what Hans Uffelmann proposed years ago:

Sensitize (What’s the Problem?),

Analyze (What are the Facts?),

Synthesize (What ought I/we Do?)

and Actualize (“Can I/we Behave Morally?)

In other words, instill the understanding that there is no “purely factual” element in the entire curriculum! It is all fraught with ethical implications! And much of it is open to argument. (How do you justify placing one value over another? How do you justify proceeding with such obviously risky consequences?)

But over and beyond it all, an integrated ethics class will be successful when the students remember and follow the example of their mentor! She could be a brilliant “presenter” but if her “being a good nurse” doesn’t come across, the endeavor will be easily forgotten.

So constantly raising the ethical threshold by her example will win the day.

Speaking out on misinformation in health debate

A news conference August 19 in Kansas City took aim at misinformation marring the debate on health reform.

Myra Christopher of the Center was quoted extensively, chastising reform critics for frightening the elderly with false claims that reform proposals in Congress would limit end-of-life care.

That’s “fear-mongering and demagoguery,” Christopher said. “I think it’s absolutely despicable.”

Here are links to coverage:

Clergy, community leaders say the health debate has been marred by misinformation, Kansas City Star, August 20, 2009

Health Care Reform Supporters Slam 'Fear Mongering', WDAF-TV 4, August 19, 2009

Faith Leaders Ask For Civil Discourse On Health Care, KMBC-TV 9, August 19, 2009

False Information Muddles Health Debate, KCUR Radio, August 20, 2009

Health Reform Hot Buttons

The furies continue to rage over healthcare reform and the Center for Practical Bioethics is planning some educational offerings for the Kansas City community in October.

I have no problem with argument if it could just remain civil. An article in the current Newsweek tries to analyze why the hot buttons are being pushed so fast. I’ll re-read it for some discussion next week.

But now I go to my ethics brown bag where I shall attempt to hear arguments pro and con an 85 year old’s receiving a kidney transplant.

Rationing is not a dirty word—but I just wish it were self-chosen instead of imposed.

We’re not there yet.

An End of Life Setback

Word out on the hustings (!) is that the removal of the end-of-life “consultation” from the reform bill has set back (and heaven knows it was back far enough already) any talk about end-of-life issues.

Therefore, I think our ethics committees should redouble their efforts to carry out into the communities Caring Conversations or whatever instrument is used in your locality.

The scare tactics have sent many back on their own resources, which might be nil. Thus, the educational outreach, indicated in most ethics committees’ mission statement, is needed as never before.

Do any of you encourage such outreach? I know I’ve slipped in my enthusiasm. HELP!

Healthy Question: What's the shouting really all about?

Myra Christopher of the Center for Practical Bioethics is dismayed that it's becoming controversial to discuss end of life care.

"To imagine that that's a bad thing is beyond me," she says in an August 15th article in the Kansas City Star.

Here's the link:

Healthy question: What’s all the shouting really about?
Alan Bavley and Dave Helling
Kansas City Star
August 15, 2009

Introducing: The Rosemary Flanigan Chair at the Center for Practical Bioethics

Rosemary Flanigan, PhD
Terry Rosell, DMin, PhD

August 7, 2009
13 minutes 57 seconds

In 2006, the Center for Practical Bioethics announced the establishment of the Rosemary Flanigan Chair at the Center for Practical Bioethics. Three years later, the Center is ready to announce the first holder of that chair.

Rosemary Flanigan and Terry Rosell talk about the chair and what it means in this edition of The Bioethics Channel.

Link: Introducing -- the Rosemary Flanigan Chair at the Center for Practical Bioethics

Understanding Conscience and Tolerance

Rosemary Flanigan
August 5, 2009

I think in a pluralistic culture like ours, the key to understanding conscience lies in tolerance, not in trying to change anyone’s conscience decisions—but in seeing how our society can adapt.

Now in some cases, adaptation is uncalled for, e.g., if something were illegal. But isn’t the sign of a civil civic society the measures taken by individuals, institutions, and society itself to support sincere conscience decisions—if possible.

Example: I know a hospital in which an ER doctor cannot in conscience prescribe a certain medication for rape victims, claiming that it is abortifacient. Even though the hospital’s policy is that such medication be prescribed because it is not seen to be such, the doctor cannot agree.

So the ER staff have agreed among themselves that they will be available whenever a rape victim comes into the ER. I call that adaptation or tolerance.

Yes, yes, I know there are some weird “conscience decisions” out there that make “toleration” heroic. But I have argued that, with the pharmacist in the one-drug-store town who will not fulfill certain prescriptions, that’s druggist’s professional association, by certifying him/her, assumes responsibility to cover when the occasion warrants.

PLEASE, disagree with me! Tell me I’m naïve!!!