Tuesday, June 30, 2009
Monday, June 29, 2009
bye bye Pro life Ethicists
I thought I had a novel idea on how to instruct medical students in how to learn medical ethics: Why not use great literature?
For example, Tolstoy's story the Death of Ivan Ilych in mind: Where the dying man goes through denial and pain, while his family starts avoiding him.
It's a painful story, but in it we see a lot of the problems our patients face in death and dying.
The author looked at me strangely, and said: well, yes, but that's what the (then recently elected) Bush Bioethics panel had done.
And indeed, looked up the website I found that they had published such a book, and had excerpts on the web, that uses excerpts from great literature to begin discussions to teach ethics in medical schools or classes.
I should have guessed things had improved, since Bush had appointed Leon Kass to head the Ethics office.
I had read Kass' books, which were subtle and profound; they always made me think about consequences that are easily overlooked in our soundbite world.
And if you go to the website you will find a lot of books there, that not only discuss the dilemmas of medical ethics, they do so from various points of view and include discussions of subtle "side effects" on society that would result from embracing technological changes.
Such subtleties are often dismissed by more pragmatic, who pooh pooh such cautionary observations as exaggerated.
Later, Kass was replaced with Professor Pelligrino.
Pelligrino had long been marginalized by the bioethics community because he was pro life: He even defended the Hippocratic oath (how gauche).,
The opposition however to the bioethics panel was loud and constant, and it didn't help that some people who should know better took Kass' and others opinions out of context to call them right wing.
In actuality, the Bush panel had a wide range of ethicists, from all sides of the spectrum; but of course in this day and age unless one is 90% pro death it won't pass the test of the NYTimes.
But worry no more.
Two weeks ago, President Obama fired the entire Bioethics panel even though the panel was due to be changed next fall.
Apparently, those pushing the health agenda of the president couldn't wait, perhaps because they are busy pushing a health care bill that will probably be passed unread by Congress in the near future, as other recent bills on global warming and economic recovery were passed unread.
The the reason given for the sudden and premature firing of the entire panel was that the president didn't want a group to philosophically discuss all those nuances: he wanted a group that would develop a "shared conscensus", according to Reid Cherlin, a White House press officer.
President Obama will appoint a new bioethics commission, one with a new mandate and that “offers practical policy options,” Mr. Cherlin said.
But of course one suspects what this means is that the Obama administration wants a Bioethics panel to give him ethical cover for his health care policies, not one that will discuss the pros and cons and maybe show the overlooked pitfalls of things like medical rationing, legalized abortion paid for by all taxpayers, or not treating the elderly and the handicapped if some bureaucrat decides their quality of life is too low.
One only has to look to the British Health care system, where the bureaucrats of the N.I.C.E.(National Institute of Clinical Excellence) make the guidelines on what treatment is allowed and what treatment is inadvisable according to their "quality of life" calculation.
Similarly when Hillary Clinton was pushing the Clinton health care plan in the 1990's, she told Congress that the plan wouldn't withhold any medical treatment from a patient "unless it would not improve their quality of life".
In other words, one can easily imagine the US version of NICE telling doctors who wished to treat an older person, a handicapped or a retarded citizen, that the treatment would not "improve their quality of life" at all: It would merely allow them to live their own life, which (by the standards of many so called ethical criteria) was inferior.
And Nat Hentoff remarked: Improve their quality of life? Where is it in the constitution that says the government has the right to decide who won't get treated because of their quality of life?
When the now defunct Clinton Health Care plan was being pushed, one red flag to it's eventual agenda was that most of the ethicists advising the plan were pro euthanasia and pro rationing.
So one now waits to see how "fair and balanced" the Obama Bioethics panel will be.
Sunday, June 21, 2009
(Draft) Obama's weekend Culture of death moveI
the reason? Because it tended to be philosophical, and provided in depth discussion of nuances instead of issuing a "consensus" decision.
Actually, I've actually read the documents they issued, and they are indeed nuanced.
How gauche: That a bioethics council had nuances.
In Contrast President Obama wishes one that gives concrete opinions: helping the government give ethically defensible policy.
This has things upside down.
This hints that they will be (to use the phrase of Nat Hentoff) "Apologists for death", giving good reasons why one should withhold treatment from grandmom for the greater good of society or allow euthanasia using the phrase "choice".
One reason to dread such hijacking of philosophy is the quote from Thomas Murray of the Hastings Center, talking about quality control studies.
Uh, fellahs, that is economics under the guise of medicine, and it is not philosophy.
And for the last 20 years, the Hastins Center has been at the forefront of the idea of withhholding medical care according to one's quality of life.
One reason that I was against the Clinton health care plan is that the bioethicists behind their plan were openly behind such rationing for the handicapped and elderly, and some were behind euthanasia.
Arthur Caplan was even worried, mentioning that although these ethicists were not involved in promoting their pro rationing/pro euthanasia agenda back then, he worried what their invfluence could have in the near future.
Monday, June 15, 2009
Silencing the church
For example, the lay group "Catholic Answers" was reported to the IRS because it printed a "Voters guide" on Catholic issues (without naming names). They were eventually cleared of this charge, but the IRS decided that when they sent an email in 2004 suggesting that Senator Kerry should not receive communion, (i.e. without mentioning that you shouldn't vote for him) it was being political, so they were fined. But we all know the "sin" of Catholic Answers: it's anti abortion stance. And they are now counter suing the IRS for harassment.
If the elites of the country have decided that the issues such as abortion or gay marriage are merely "political" issues, they can report you to the IRS, and even if you are not guilty, you are punished.
To do this, they use "astroturf" organizations (i.e. organizations that appear to be grass roots organizations but are actually started and funded by those with a political agenda, and actually have few real members except for professional activists). For example, the complaints against Catholic Answers was done by "Catholics for Free Choice".
What people don't realize is that the cost and emotional strain of a lawsuit, which can go on for years and cost an organization hundreds of thousands of dollars, is enough to dampen the will of most pastors and bishops to speak on serious moral issues.
But the state of Connecticut has gone one step further.
Awhile back the state legislature tried to pass a bill mandating that "lay" groups take over the finances of the Catholic church.
This obvious threat against the church's independence and the First Amendment was withdrawn after a lot of bad publicity.
But during the threat, the local churches encouraged their parishioners to demonstrate against the bill, and some even hired buses to help their parishioners to do so.
Ah HA!. A "gotcha" moment.
The state of Connecticut now is saying that this action (on which was spent a measly $8000 dollars)and the fact that their website asked people to write the legislature to oppose a gay marriage bill means that the diocese is now to be considered as a lobby, since by law any "organization" that spends over $2000 dollars petitioning the legislature is a Lobbying organization and has to register with the state and submit frequent reports on every contact with the legislature. Anyone who was "lobbying" would have to identify themselves by wearing a badge. And the Church could be fined if the office of ethics received enough complaints about the church illegally lobbying for political issues.
But, unlike other "lobbies", this is assuming the Catholic church is an organization, not a group with 87 parishes and over 400 thousand members. This fact led Tim Carney at the Washington Examiner muse that if the law stands, it would mean that every priest giving a sermon would have to wear a button saying "Lobbyist" if he spoke on moral issues from the pulpit, and mused who was going to monitor every Sunday mass to see that their rules are enforced?
Supposedly, the Catholic church is protected by the first amendment, but of course this means taking it to Federal court and spending a lot of money to pay lawyers: money that could better be spent elsewhere.
Nor does the threat against the First Amendment stop there: Fox News reports that one local radio host, Harold Turner, who publicized the issue, wrote on his blog that people should "take up arms" and "make an example" of those sponsoring the bill was arrested for inciting violence, even though these phrases are usually taken to mean take up signs in a demonstration, or make an example of them by removing them from office.
So how does the saying go?
First they came for the Catholics, then they came for the radio hosts, and then they came for...well, I don't know.
But if I owned one of those small Christian radio stations that are all over the AM dial, I'd be worried.
thanks for the headsup from GetReligion Blog.
Monday, June 08, 2009
Not to be mistaken for the country of Malta, they are the smallest country in the world. Wikipedia has them listed as the sovereign Military order of the Knights of Malta.
There are actually a couple "Knights" groups that descend or claim to descend from the various knights hospitallers...and often nowadays they run charities or ambulance services.
But the KOM are a lay religious order that runs charities all over the world.
Today the order has 12,500 members, 80,000 permanent volunteers, 13,000 medical personnel including doctors, nurses, auxiliaries and paramedics. The goal is to assist the elderly, the handicapped, refugees, children, the homeless, those with terminal illness and leprosy in five continents of the world, without distinction of race or religion. In several countries including Ireland, Germany and France, the local associations of the Order are important providers of first aid training, first aid services and emergency medical services. Through its worldwide relief corps, Malteser International, the Order is also engaged to aid victims of natural disasters, epidemics and armed conflicts.
One item of trivia: they issue their own passports.
It retains its claims of sovereignty under international law and has been granted permanent observer status at the United Nations. SMOM is considered to be the main successor to the medieval Knights Hospitaller.
This makes it easier for them to work in war zones.
I first ran into them while working in Liberia. They were sponsoring leprosy clinics there, and I knew the nun who supervised these clinics, going from village to village to check people and give them medicines.
Nowadays, leprosy is easy to treat, with pills. The real problem is if the person is not diagnosed early enough, they end up with nerve damage and deformities, which then have to be treated with surgery.
But when I was working in Liberia, we started having a lot of civil unrest, and I made plans to leave the country, only to find that my employer refused to give me an exit visa.
So it was the KOM ambassador helped me to get out of my contract so I could leave: luckily for me, since there was a coup the next week (followed by an economic collapse, and ten years of civil war) and if I had been stuck there, I would have been in physical danger.
So another Catholic group that does a lot of good but gets little or no publicity.
Wednesday, June 03, 2009
An excerpt from the Bishop's letter that was sent last week to the Senate, House and White House on the issue of Health Care reform noted:
No health care reform plan should compel us or others to pay for or participate in the destruction of human life. To preserve this principle is morally right and politically wise as well. No health care legislation that compels Americans to pay for or participate in abortion will find sufficient votes to pass.
The bishops are well aware that such "reform" could very well incorporate abortion, euthanasia, and mandating that expensive care be limited for the disabled or elderly (under the guise of "futile care theory).
But the letter got no coverage in the media, of course.
So what about health care reform? The bishops are for it. For years they have insisted that universal health care should be provided for all, especially the poor and disabled.
But in the past, caring for the poor and disabled was done three ways: Via the family (so the church emphasized marriage), via personal help (so the church encouraged almsgiving and helping one's neighbor) and via church institutions. These hospitals, schools, orphanages and other institutions were built and staffed, often by religious orders.
Providing health care to the poor meant getting sisters and lay people to open hospitals to care for them. It meant lay physicians and nurses would be inspired by their faith to volunteer to work in poor areas instead of in more lucrative practices. And it meant that lay people would actively raise money to support these institutions.
But after Vatican II, a subtle change entered into the picture.
The Vatican II documents that encouraged cooperation with secular and non religious institutions quickly morphed into the idea that socialism was the way to respond to these problems. And indeed, in Europe, with it's aristocratic past, having the government replace the liege lord who helped his people in their times of need was a natural evolution. And indeed, many of the church institutions there are funded, at least in part, by governments.
But in the US, this meant a change: substituting the government program for the small local grass roots patchwork that had helped the poor, nursed the sick, and taught the children.
These ideas have infiltrated much of Catholic academia, and in this way they have managed to convince a generation of Catholics that supporting a certain political approach to poverty is "real Catholicism".
But one side effect of this emphasis on "social justice" was that our children were not taught other aspects of Catholicism,such as the importance of the Eucharist and prayer, a personal relationship with God, basic sexual ethics, the idea of personal responsibility, or how to serve God in the duty of our daily lives.
Let me give a concrete example of these two approaches to help the poor, using health care in poor rural areas as an example.
Quick, bishops. The poor people of Red Lake need medical care.
Do you arrange for a full time volunteer physician to set up a clinic at St. Mary's, and encourage your parishes to raise funds to help pay for medicine and equipment? Do you inspire your Catholic nursing and medical students to work a few years with the poor as a way of giving their talents to serve God?
Or do just form a committee to petition the government to do it?
The second, of course, is a lot easier. It allows Sister Modern and her group of academic "Am Church" types to feel self righteous when they write letters and lobby for socialized medicine, while living in a comfortable apartment, and going to meetings, all travel expenses paid, to discuss the needs of the poor.
In the meanwhile, how will the government run the clinic? Like they did in the old days: Require that every young person give two years to government service, and draft doctors and nurses to work in these poor and isolated areas.
(Actually in Red Lake, the physician shortage was overcome a third way: the tribe took over, and used their casino profits to increase the number and salary of doctors so that they could recruit physicians...but that's another story).
But multiply Red Lake by a thousand and therein lies the problem of "health care" as a right, rather than a responsibility.
If it is a "right" then who grants this "right"? Who is given the right to order health care personnel to give the care. especially if it means long hours in an isolated clinic without adequate help or equipment, and often in an area where your spouse cannot find a job, nor can your children get decent schooling?
And here is where abortion and the conscience rule that was recently revoked by the Obama administration comes into play. Because if health care is a right, and abortion is a right, then if you are the only doctor/nurse/pharmacist in town, you have no right to refuse to cooperate.
That is why those who applauded the President's actions always brought up the plight of the poor rural woman who had to travel to abort their child. Theoretically the physicians are still protected by other regulations made by Congress: but these regulations could indeed be overturned, especially if the government is in charge of the health care system.
I have no problem with socialized medicine, as long as it is not a monopoly (I did work in Federal or state facilities much of my career after all).
The danger is that right now it looks like that the Congress is going to rush through a bill where the government runs the show, without time for adequate public discussion.
And I suspect that the "deathmaking will be hidden in euphemisms and platitudes, (reproductive health instead of abortion, futile care not passive euthanasia) and this will not be recognized until it's too late.
As for the abortion wars, the Obama administration iand it's Catholic enablers are continuing to work to marginalize the bishops.
Nearly every day we read another news article stressing that Obama's speech and warm welcome at Notre Dame proves that most "catholics" support Obama despite (or even because of ) his support of abortion. Articles are even appearing in church related periodicals that are openly saying that it is these pro Obama Catholics are the real voice of the church, not the "orthodox" bishops, a mere "minority", who spoke against it.
So if my fears are realized, the new health care reform bill may indeed have items in it that will mandate Catholic hospitals or Catholic health care providers to ignore their consciences.
And if this happens, expect those bishops who oppose the bill or try to point out the dangerous details to be ignored, or have their opinions twisted by the astroturf groups set up by Obama's backers who are now widely quoted in the press as representative of mainstream Catholic opinion.