Connecticut

Feb 7, 2013Aid-in-Dying Legislation Advancing Around the Country

by Compassion & Choices staff
February 7, 2013

Bills Clear Committee in New Jersey and Vermont

With Compassion & Choices’ staff deploying across the country, working in tandem with our top-flight state-based campaign teams, aid in dying has taken off in state legislatures. Thanks to our sound strategy, the dedication of our allies and the commitment of supporters like you, there were positive developments in four out of the ten states where we are actively engaged.

The New Jersey Assembly Health and Senior Services Committee approved an Oregon-style aid-in-dying bill on Thursday by a 7-2 vote with two abstentions. Before the vote, committee members heard moving testimony on the measure, which brought several to tears. Compassion & Choices President Barbara Coombs Lee and a doctor representing the state psychological association were among experts supporting the bill. The urgency of the need for aid in dying was brought forward by a terminally ill Catholic woman whose father shot himself to death after a prolonged illness; she wants the option to use aid in dying. Director of Government Affairs Theresa Connor and other legislative staff are meeting with bill sponsors, committee members and allied organizations to ensure the bill advances. More

Feb 5, 2013Supporters Call for Passage of Compassionate Aid-in-Dying Legislation in Connecticut

Supporters of legislation that would allow terminally ill, mentally competent patients the right to choose aid in dying said today they welcome public debate of end-of-life issues. They urged lawmakers to pass legislation raised by the Public Health Committee in January.

Barbara Coombs Lee, President of Compassion & Choices, was joined today at a press conference by legislators, clergy members, doctors and nurses, and relatives of patients who have been faced with difficult end-of-life decisions. Coombs Lee said with more than a dozen years of experience with aid-in-dying laws — in Oregon, Washington and now Montana — there is proof that the laws work as intended, with none of the problems opponents have predicted.

“Doctors, patients, clergy, and the majority of Connecticut residents support the right of patients to make end-of-life decisions without government interference,” Coombs Lee said. “Critics raise fears of abuse or coercion but evidence and experience do not support these fears. Connecticut’s residents should enjoy freedom both in how to live and, when their time comes, how to die.”

The Connecticut legislature has never raised or held a public hearing on an aid-in-dying proposal, supporters noted.

Jan 14, 2013Right to Die: Comforting Control at the End of the Line

by Ilene Kaplan
Hartford Courant
January 11, 2013

Personal freedom, a core value among all Americans, means control of our lives at all times. We cherish and protect personal choice. After a lifetime exercising this freedom, people should not be denied control when excruciating illness is poised to claim their body.

Terminally ill patients want control at the end of their life, just as they’ve always controlled their other health decisions. They want assurance that if suffering and indignity make living unbearable, they have the means to peacefully end it.

Legislation has been introduced in the General Assembly that would allow a physician to prescribe medication to a mentally competent, terminally ill patient who can self-administer the medication to bring about a peaceful death. I hope, after appropriate debate, such a bill will be passed. It is time we give grown-ups the freedom to choose and let physicians willing to provide this choice feel safe in doing so. Connecticut needs a rational public policy for every end-of-life option.

In states where it is legal, aid in dying provides great comfort not only for the very few who actually use it, but for many others in just knowing the choice exists. For patients staring an unbearable death in the face — and those close to them witnessing this anguished decline — the option to end their suffering in a peaceful way is an enormous comfort. It is not for the government or anyone else to say that is wrong. More

Jul 20, 2012Palliative Care Deserves Physicians’ Attention

By Joe Cantlupe
HealthLeaders Media
July 19, 2012

Do you know about palliative care, the comprehensive treatment for the very sick, but not for those who are dying?

Some doctors do not.

As a physician, do you feel it is a sign of “failure” on your part, when longtime patients have grown tired of treatments, and simply want comfort as they approach end of life?

Some physicians think it is.

As the population ages, and hospitals prepare to care for more chronically ill patients, more physicians should get acquainted with palliative care, to not only to improve patient care, but as a potent cost-savings tool.

With palliative care, hospitals can avoid needless tests and procedures, in part, because patients no longer want them. Palliative care is the comprehensive treatment focused on pain, symptoms and stress of serious illness, or even spiritual assistance for the very sick. Some studies have shown it can extend life.

Still, although not widely practiced, palliative care is becoming part of the discussion among healthcare leaders to improve care, especially for the elderly. In May, a panel of healthcare leaders met in Chicago as part of a HealthLeaders Media Breakthroughs session that focused on improving readmission rates for hospitalized cardiac patients. The talks veered off into other topics, among them palliative care, as well as hospice, or end of life care.

“Obviously, it’s probably one of the most complex topics we could discuss,” said Greg Johnson, DO, chief medical officer for Parkview Health, Ft. Wayne, IN, during the panel discussion. ”I also think that when we talk about end-of-life care, we need to approach it with more curiosity and information than with judgment and direction,” Johnson says.

Although there were almost no palliative care programs in America a decade ago, about 63% of hospitals with 50 or more beds have a palliative care team, according to the Center to Advance Palliative Care. It is likely that palliative care is going to expand, but it is still largely misunderstood, even among physicians.

For those patients who are weary of dealing with their pain, tired of medical procedures, and who want to live their days as fully as possible, palliative care may be the answer. In cases of people even more seriously ill, and possibly closer to death, hospice may be the correct treatment option. Too often, physicians don’t pose the question: Patient, what do you want to do?

Bruce Robinson, MD, MPH, director of the chief of geriatric medicine at Sarasota Memorial Hospital in Florida told me how, too often, physicians may articulate their hopes for patients, even when it’s a terrible illusion.

“The patients want to keep that hope,” he says. “The doctors want to just do what they do and that’s how they make their living, so they are happy when a patient says, ‘I want you to do something. I want to pretend I’m not dying.’ So stuff gets done.”

Other physicians may not endorse palliative care, or even hospice care, because they wrongly feel those programs may reflect poorly on their own work, healthcare leaders tell me. Some doctors may see those programs as symbolic that they have given up hope, that all those procedures, all the plans for their patients, were for naught. That’s too bad.

At the Breakthroughs session, panel member Johnson raised the point that physicians “feel like it’s a failure” to have such discussions involving palliative or end of life care. That shouldn’t be the case, he says. “We have to be willing to follow-up what the patients’ goals are,” Johnson says.

“Because what I’ve seen too frequently is the patient will have stated their goals of care and then somewhere that gets overwritten. And we see the 94-year-old patient that didn’t’ want anything who is on on a ventilator for a month. And that’s a very sad thing.”

The essential question for palliative care is “how do we manage symptoms so the patient can feel as good as possible, and have optimal life experience? The conversation in chronic care management goes a long way,” said panel member Kathleen Martin, RN, vice president of patient safety and care improvement for Griffin Hospital, Derby, CT.

While palliative care is increasing, its generally poor name recognition, among the public, as well as among healthcare workers, including physicians, is a significant obstacle, Timothy E. Quill, MD, a professor of Medicine, Psychiatry and Mental Humanities at the University of Rochester School of Medicine and Dentistry tells HealthLeaders Media.

“Palliative care has a name recognition issue,” Quill says. “About 20% of the public may know what it is, but once people and patients learn what it is, their question becomes: ‘why didn’t I get that earlier, why isn’t that the care for all seriously ill people?’ Hospice care has a higher name recognition, but it’s for people at the end of life,” he says.

While there is some uncertainty what exactly is palliative care, some healthcare facilities are offering both palliative and hospice care programs, which they see as crucial to improve care among the elderly, and offering as many options to them as well as their families.

The Hospice of the Valley, in San Jose, CA, is one of those facilities that serves both populations. There is an increasing need for mental health or community-based programs to assist the patients, says Sally Adelus, president/CEO of the Hospice of the Valley, told HealthLeaders Media.

Because the scope of care is evolving for the elderly populations, it’s important that physicians work closely with families to consider palliative or hospice care options. The Sutter Health system, a network of doctors and hospitals in northern California, has an advanced illness management program that partners with patients and families to better coordinate care for palliative patients and also consider end of life options, says Brad Stuart, MD, chief medical officer at the Sutter Care at Home in Fairfield, Calif.

Stuart says it’s important that both disciplines (palliative and hospice) “collaborate for the best outcomes we can have.” Much of the focus for improved patient care, especially those in palliative care, is moving toward ” focusing on goals of patients in their own lives.”

Even in the hospice and palliative care world, however, there are “turf” struggles, as in many other areas of healthcare, he says. “We’re trying to change the medical culture. It’s an uphill battle,” Stuart says. Physicians gaining knowledge about such care is a start, he adds.

Jun 22, 2012The Bishops’ Politics: Why Are Women’s Health and Lives Subject to The Catholic Lobby?

By Imani Gandy
RH Reality Check
June 18, 2012

Many of the religions practiced in the United States support a woman’s right to access reproductive health care, including abortion and contraception, as a matter of free exercise of conscience. The Catholic Church is the one of the few, if not the only religion that is fundamentally antithetical to any notion of women’s reproductive health, freedom, and justice. Unfortunately, the Catholic Church as represented by the U.S. Conference of Catholic Bishops, more than any other, directly influences American politics.

Take, for example, the controversy that has been raging for the past four months about President Obama’s contraception mandate. After Republicans lost their collective mind about access to contraception, whinging that President Obama was destroying the Constitution and the very fabric of society as we know it by daring to include women’s reproductive health under the rubric of the Affordability Care Act, President Obama offered an accommodation to religiously-affiliated employers that protested being required to offer birth control coverage as part of their insurance plans. The accommodation will allow such religiously-affiliated employers not to offer birth control; instead, insurance companies for those employers will have to reach out directly to employees and offer contraception coverage for free, without going through the employer. Writing about the accommodation, Amanda Marcotte noted that Obama had punked the GOP: “Obama just pulled a fast one on Republicans. He drew this out for two weeks, letting Republicans work themselves into a frenzy of anti-contraception rhetoric, all thinly disguised as concern for religious liberty, and then created a compromise that addressed their purported concerns but without actually reducing women’s access to contraception.”

In February – when Obama announced the accommodation – two entities on opposite sides of the birth control issue (Planned Parenthood and the Catholic Health Association) were satisfied. Sister Carol Keehan, the president and CEO of the Catholic Health Association (“CHA”), noted, “The Catholic Health Association is very pleased with the White House announcement that a resolution has been reached that protects the religious liberty and conscience rights of Catholic institutions.” She further noted that the accommodation adequately responded to the concerns of the CHA: “The framework developed has responded to the issues we identified that needed to be fixed. We are pleased and grateful that the religious liberty and conscience protection needs of so many ministries that serve our country were appreciated enough that an early resolution of this issue was accomplished. The unity of Catholic organizations in addressing this concern was a sign of its importance. This difference has at times been uncomfortable but it has helped our country sort through an issue that has been important throughout the history of our great democracy.”

Four months later, however, the CHA has reversed its position in what can only be described as a flip-flop of epic proportions. On Friday, the CHA sent a five-page letter to the Department of Health and Human Services stating that the accommodation no longer “adequately meet[] the religious liberty concerns.” Odd — that wasn’t CHA’s position four months ago.

Nonetheless, the CHA now claims that the contraception mandate — which exempts actual houses of worship, but not faith-based institutions like hospitals and schools that don’t primarily serve or employ people of the Catholic faith – should be further restricted, and that the exemption should be broadened to include hospitals and schools. Plainly, it is a purely political move. As Michelle Boorstein notes, the CHA’s about-face comes as just as polls show that Romney and Obama are tied among Catholic voters. (Four out of the five last presidential elections were won with the Catholic vote.)

Given that the U.S. Conference of Catholic Bishops and organizations like the Catholic Health Association play a critical role in American politics, the question becomes, then, for how much longer are we going to permit religion to have a place in our political discourse? And, at what point does the health and safety of American women become paramount to any issues of religious conscience? There is a clear and present danger that the health of American women – especially the health of minority and low-income women – will be subject to the political whims of the Catholic Church.

One stark example of this unholy union of political and religion is the increasing number of mergers between secular and Catholic hospitals. Hospitals throughout the country are struggling to remain solvent. As hospitals face increasing financial difficulty, mergers between secular and Catholic hospitals seem to be an oasis in a desert plagued by financial uncertainty. Certainly, such mergers seem to be a solution more desirable than closing hospitals. But at what cost?

Catholic hospitals are required to obey the U.S. Conference of Catholic Bishops’ list of ethical and religious directives. Often when Catholic hospitals merge with secular hospitals, the secular hospital is thus required to obey the ethical and religious directives of the Catholic Health. This means that many women’s healthcare services are no longer offered at the newly-formed hospital. Such services including abortions (even those that are medically necessary), birth-control, vasectomy and tubal ligation, and many kinds of infertility treatment. Additionally, Catholic hospitals specify how ectopic pregnancies must be treated, and that treatment differs from how they are treated in secular hospitals.

Such restrictive rules have a catastrophic effect on women in communities where the only option may be to obtain healthcare services at a newly merged hospital which finds itself suddenly required to follow Catholic religious and ethical directives or risk severe punishment. For example, in 2009, the ethics committee of St. Joseph’s Hospital and Medical Center, a hospital in Phoenix operated by Catholic Healthcare West, Phoenix voted to permit a medically necessary abortion to save the life of a woman (11-weeks pregnant) whose pulmonary hypertension would have killed her if she did not have an abortion. That hospital was later stripped of its Catholic access, and Margaret McBride, a nun on the ethics committee was automatically excommunicated — all because of a decision that almost certainly saved the life of a breathing already-alive woman. (As of December 2011, McBride has been returned to good standing, and is no longer excommunicated.)

The impact of the merger between Catholic and secular hospitals disproportionately and negatively impacts women, and in many cases, the merger debate becomes about whether a community is willing to sacrifice the health of women in order to promote economic and community growth or ensure that hospitals remain solvent. Such debates arise when a community attempts to merge a secular and Catholic hospital so that the newly-formed hospital can remain in compliance with religious and ethical directives while still offering “sinful” women’s health care services.

But even when such creative solutions are proposed, those solutions may not entirely assuage the fears of women’s health activists. For example, in Waterbury, Connecticut, a proposed hospital merger between two hospitals has sparked grave concerns among those who insist that the continuation of reproductive healthcare services must be a priority. St. Mary’s and Waterbury hospitals, and a for-profit company, LHP Hospital Group, plan to build a new 800,000 square-foot private hospital at a cost of $400 million, with each hospital having a ten percent stake. Additionally, the hospital seeks state approval for a separate “ambulatory” center which would be located near, but not inside the new hospital.

As Teresa Younger, the executive director of the Connecticut Permanent Commission on the Status of Women points out, “the agreement by LHP and Waterbury Hospital to follow the ethical and religious doctrines for a ten-percent owner of the facility is problematic.” Moreover, it I questionable as to whether requiring women who have undergone a C-section to visit a separate facility for a tubal ligation comports with the best “standards of practice.”

Mergers like the one being debated in Waterbury are occurring nationwide, and it seems that the health of women – many of whom are not Catholic in the first place – is being sacrificed at the behest of the Catholic Church. It is unacceptable. The tension between religious doctrine and women’s health should always be resolved on the side of women’s health, especially where, as here, the decision-making process of Catholic leaders seems entirely political and not conducted in good faith.

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