Posts Tagged ‘Catholic’

May 25, 2012The Religious Right’s Assault on Palliative Care

Anti-choice forces are taking aim at end-of-life care. They’re after people at the end of a long decline who exercise their right to stop life-prolonging technology or treatment. Their tactic is to tie the hands of doctors attending those patients, when palliative treatment might ease the patient’s chosen death. They seek to undermine the widespread agreement among doctors: Treatments can be stopped, and should be stopped as humanely as possible, when patients’ wishes are clear.

But the medical establishment’s support for patient choice exists within a particular, and peculiar, bioethical framework. Doctors usually invoke the Catholic doctrine of double effect to explain how they can perform an act, such as administering sedatives and disconnecting a ventilator, knowing the two acts will cause the patient’s death. The doctrine holds that a person is not responsible for what they know will ensue as the product of their actions, so much as what they intend. In essence, “my intention was not to cause death, my intention was to ease suffering.”

A problem arises for palliative care physicians when people question their intention. Since it is impossible to prove a thought, doctors will always be vulnerable to accusations about intentions. This vulnerability is exploited when anti-choice advocates promote legislation that 1) raise the bar on what will pass for lawful practice and thought, 2) magnify penalties for those found guilty of forbidden thoughts and intentions and 3) encourage scrutiny and whistleblowing by onlookers and medical colleagues. And the medical lobby has done little to oppose these bills.

Recent events illustrate the danger.

Georgia HB 1114, passed last month to prohibit assisted suicide. Shaped by Georgia Right to Life and the Georgia Catholic Conference (thanked from the floor of the House) and with no visible objection from the physician community HB 1114 purports to outlaw suicide assistance. Here I would like to affirm my strong support for clear laws and harsh penalties for those who incite and abet suicide.

But a mere 19 of this bill’s 57 lines address actual criminal behavior. The bill’s drafters wasted few words on perpetrators of violence, guns, nooses and other atrocities by which online predators and other malicious enablers encourage self-destructive impulses of the mentally ill. The heinous crime of inciting a despondent or disturbed person to kill themselves seems almost an afterthought in this bill.

The bulk of the bill — 37 lines — frets over patient decision-making and medical treatment in minute detail. It focuses on doctors more than the voyeurs and predators that endanger society. The new law repeatedly specifies that any withholding, withdrawing, prescribing, administering or dispensing must be solely intended and calculated to relieve symptoms and never to cause death. Some tried to allow treatment that “eases the dying process,” but the lawmakers deemed that language too permissive and generous.

Georgia lawmakers not only paste targets on healthcare professionals, they also armed those taking aim at forbidden intentions with the state’s RICO (Racketeer Influenced and Corrupt Organization) law. The heavy artillery of RICO magnifies the state’s policing authority, extends penalties, adds civil liability and enables prosecution of individuals only tangentially involved in the patient’s care.

A recent study showed onlookers and watchful colleagues already threaten palliative care physicians with accusations of murder and euthanasia. Over half of palliative physicians report they have endured such accusations at least once, some as often as 6 times, over the past 5 years. And in the bills they promote, anti-choice advocates enable these watchdogs.

Patients need more legislative vigilance on their behalf. Dying patients need a voice in our nation’s statehouses. Without one, the creation of thought crimes, threats of exorbitant punishment and hyper-vigilant whistle-blowers could stunt the future of palliative care.

Mar 16, 2012Two Movements Approach the Tipping Point

After years of gains and setbacks, the national movement for same-sex marriage is enjoying a period of remarkable success. Massachusetts and Connecticut became first adopters in 2004 and 2005 and that came after twenty years of advocacy. Turmoil followed, especially in California. But in 2009 three states (Iowa, Vermont, New Hampshire) approved same-sex marriage. New York followed last June, and now the Washington and Maryland legislatures have acted in quick succession. Delaware’s governor predicts his state is not far behind.

It’s making me think about similarities between the movement for death with dignity and LGBT dignity. Like other movements for human liberty, seminal events mark a trajectory toward inevitable success.

1. It starts with consciousness-raising. As human rights lawyer Sylvia Law describes, one day a light comes on. People experience their own private “Aha!” moment. Then more do, and multiple sparks of recognition illuminate the injustice for all to see. In the 1970s LGBT advocates worked hard to muster light in the darkness of false assumptions, degradation and violence.

For end-of-life choices, common wisdom was that with death, comes suffering. We’ve heard doctors tell a family, “We all have to suffer some, don’t we?” In our movement sparks first fly when people witness end-of-life agony and indignity and think, “This is not right.” Grief magnifies outrage, and awareness dawns that American law and medicine fails us at life’s end.

2. Soon fear, shame and guilt no longer keep outrage in check. People in our movement share this with LGBT communities. We all have stories of deaths of loved ones. Maybe we shrank from the bedside and let doctors continue with tubes, needles and machines long after any good could come of it. Maybe we heeded an urgent plea to increase the morphine and speed death’s advance. Or maybe we didn’t and feel guilty for that. Maybe Dad shot himself when he was dying of cancer and the family lives with that trauma.

Powerful forces conspire to keep talk of death taboo. We’re told it’s wrong to seek the relief of death when cancer’s final agonies take hold. But telling our stories at kitchen tables, church basements and community gatherings turns fear into courage, grief into action. My most moving experiences come when we open a conversation about end-of-life choices, see pent-up emotion flood the room and see how eagerly people sign up for advocacy and public service.

3. The Vatican fights both movements. Catholic hierarchy uses its political power to oppose both movements. With hysterical doomsday rhetoric, it denounces gay and lesbian human rights as an “ideology of evil” and the movement for end-of-life choices as a “culture of death.” To defeat Death with Dignity bills, local bishops have deployed their lobbyists and issued threats of shunning and denunciation from the pulpit to non-Catholic lawmakers and denial of the sacrament of communion or excommunication, to Catholic ones. In a surprising turn of events, Roman Catholic leaders in Maine announced they will play no role in fundraising, staffing, advertising, or campaigning against marriage equality.

I hope Catholic leadership’s decision to stay its hand in Maine arises from a calculation of changing sentiment in society. If Gays and Lesbians are beyond religious oppression it’s because they are no longer vulnerable to shame and guilt for who they are or the rights they seek. Today lawmakers are more likely to embrace their Gay and Lesbian sons and daughters publicly than abandon them in silence and vote against their liberty.

If the pattern holds, it won’t be long before lawmakers are telling stories of the tragically painful deaths they’ve witnessed, rejecting the rhetoric of shame and voting courageously to empower people with choices at the end of life.

Apr 4, 2011Sierra Vista Chooses Community Over Catholicism

Last week Sierra Vista Hospital, in rural Southeast Arizona, abandoned its affiliation with the Catholic Carondelet Health Systems. One year into a 2-year trial period, reality apparently hit home. The hospital board could no longer ignore daily picketing by concerned citizens, growing discontent of physicians barred from delivering high quality medical care and mounting evidence that strict doctrinal enforcement undermines a community’s trust in its medical provider. An informative PBS story (see the bottom of this post for the video) 4 days prior may have influenced board members as well.

Compassion & Choices supporters were especially concerned that end-of-life wishes be heeded and honored. Thus, we enthusiastically join Cochise Citizens for Patient Choice in celebrating this victory for quality care and patient self-determination. I hope this signals the start of a trend among hospitals to avoid mergers binding them to religious doctrine.

Over the last century Catholic institutions grew, prospered and assumed an ever greater market share in the healthcare industry. Today more than 600 Catholic hospitals deliver care to 1 in 6 patients in the United States each year. Since 1971 these hospitals have followed written doctrinal direction from the National Conference of Catholic Bishops, which in turn follows the Vatican.

A publication called Ethical and Religious Directives for Catholic Healthcare (ERD) lays it all out. Until recently hospitals could interpret the ERD according to their own conscience, and they usually found ways to meet the needs and expectations of their communities. But the local bishop is final decision-maker and an increasingly conservative hierarchy is flexing its doctrinal muscle across the nation. This leaves hospitals with a stark choice: buckle under pressure from Catholic authority or break the shackles of Vatican oversight.

The tension plays out in different ways.

Last May Bishop Olmstead of Phoenix terminated the church’s 116-year relationship with St. Joseph’s Hospital for terminating a woman’s pregnancy to save her life. The hospital, its parent corporation, Catholic Healthcare West, and the Catholic Health Association all backed the decision of Sister Margaret McBride, who led the hospital’s ethics committee. Now she is excommunicated, Mass no longer occurs in the hospital chapel, and the community knows its hospital will not allow Bishop Olmstead to obstruct a life-saving procedure.

Similarly, St. Charles hospital in Bend, Oregon, refused to accede to demands from Bishop Robert Vasa to stop performing tubal ligations for women seeking to limit their pregnancies. Founded by nuns 92 years ago, St. Charles is no longer a Catholic health center and delivers about 250 tubal ligation services per year.

But in Texas, Bishop Alvara Carrada stopped tubal ligations at St. Michael’s and Trinity Mother Frances Hospital in 2009. Now women who give birth there by caesarean section must endure the risks and inconvenience of a second surgery, at a different facility, to have their tubes tied. Exposing patients to unnecessary surgical risk falls below the standard of care in every community.

For Compassion & Choices, the chief hazard of the ERDs is the stipulation that advance directives are valid so long as their instruction does not conflict with Catholic teaching. Since the local bishop interprets and enforces Catholic teaching, it’s uncertain how a person’s wishes might be viewed should the need arise. Compassion & Choices offers a Dementia Provision as an advance directive addendum, and it seems almost certain to run afoul of recent Catholic teaching on tube feeding.

Catholic dogma and community medical expectations are on a collision course. Hospitals serving diverse communities cannot shoulder the weight of strict ERD enforcement as America’s population ages and vests itself in end-of-life choice and control, as new technologies to treat infertility emerge and as therapies developed with embryonic stem cell cultures come on line.

To me, the most striking aspect of these events is how totally tone deaf Catholic leaders are to growing disenchantment with their edicts. They care not at all that Catholic hospitals deliver healthcare to Lutherans, Presbyterians, Jews, Muslims, Buddhists and Atheists as well as Catholics. They demand Catholic doctrinal adherence from all.

Catholicism’s place in American society has changed dramatically over the past twenty-five years. The hierarchy has exaggerated its political power by extracting obedience from Catholic elected officials and controlling their votes. But the criminal cover-ups and harboring of public menaces have decimated its moral authority.

The PBS story features Bishop Weinandy, executive director for the Secretariat of Doctrine, and Richard Dorflinger, Associate Director, Secretariat of Pro-Life Activities, both at the US Conference of Catholic Bishops. Weinandy defends Bishop Olmstead’s preference for a woman’s death over a pregnancy termination with this: “If you directly said the mother could not live unless we aborted the child then that would be contrary to Gospel values and the teaching of the church.”

That may be a reason enough for Weinandy and Dorflinger, but it shocks the conscience of most Americans and conflicts with their expectations for responsible health care. The Washington Post offers an example from the ranks of Catholic moral theologians. It cites Rev. James Bretzke of Boston College, “who supports the directives but said he might now hesitate if a female relative sought some care at a Catholic hospital.”

When Reverend Bretzke’s hesitation spreads to a critical mass of alert healthcare consumers, as it did in Sierra Vista, I predict Catholic healthcare institutions will do the right thing. In increasing numbers they will reject their assigned role as enforcer of Vatican doctrinal ideology, and serve their communities instead. If not, purchasers of healthcare — patients, employers and insurance carriers — will shun them in the marketplace, preferring providers unencumbered by obedience to dogma that harms patients.

Watch the full PBS episode. See more Religion & Ethics NewsWeekly.

Oct 14, 2010Dying patients should have the right to make informed choices

Guest blog by Audrey Roll-Shapiro of Bellingham, Washington. Audrey and her family were not informed about Washington’s Death With Dignity Act until her husband Norman endured an agonizing death. Their story first appeared in the Bellingham Herald.

My husband, Norman Shapiro, died from esophageal cancer at our home on April 21, 2010. He was 88 years old and was a revered father, stepfather, uncle, and member of the Bellingham community.

Norman was diagnosed with cancer in September of 2009. Although he tried chemotherapy and radiation, there was no question that his cancer would prevail. As his health deteriorated, we accepted that death was near, and Norman became a patient of Whatcom Hospice, which is owned by PeaceHealth, the Catholic health care system that also owns St. Joseph Hospital. He wanted to be kept as comfortable as possible, to have his pain managed, and to die with dignity.

Although Whatcom Hospice’s caring, attentive staff did what they could, Norman still had a bad death. It was clear to me, my daughter, and his niece, that he was suffering tremendously, and we were all traumatized by watching helplessly as he died a slow and agonizing death. Not once did any Whatcom Hospice staff mention that Norman had other options, such as palliative sedation (sedation to unconsciousness until death) or aid in dying under the Washington Death With Dignity Act (DWDA). I learned about the DWDA the day after Norman died.

Feeling betrayed, angry, and even more grieved, I wrote a letter to the director of Whatcom Hospice, and then met with him to find out why Norman and I were denied information about the DWDA. During our meeting, he said that the DWDA was “contrary to our values.” He also confirmed that it is Whatcom Hospice’s policy to not discuss the option of the DWDA, to not refer patients to other organizations that will, and to “not acknowledge the existence of Compassion & Choices of Washington” (877.222.2816, www.CompassionWA.org), the only organization in Washington that supports patients who want the option to use the law.

While Whatcom Hospice has the legal right to refuse to participate in a patient’s use of the DWDA, the law does not authorize withholding information necessary for patients to provide informed consent, one of the most important principles of medical practice. If a medical provider is opposed to the option, they have an ethical duty to refer patients to another source of information. In effect, Whatcom Hospice made Norman’s choice for him by failing to inform him of all of his end-of-life options.

Norman served in the U.S. Army Air Corps during World War II at Okinawa, Japan. When Whatcom Hospice imposed its religious and moral values on my husband, it trampled on the freedoms he fought to uphold.

Norman had a long-held belief in choice at the end of life; if he had been aware of the DWDA, I know he would have chosen it. My daughter and I believe it was wrong for PeaceHealth and Whatcom Hospice to put its faith-based, internal policies ahead of Norman’s right to make fully informed decisions about his end-of-life choices.

Audrey Roll is an expressionist artist who interprets the West with colorful painting and sculpture, often combining the two. Her pieces are in major collections including the Kennedy Center and the Kiplinger Collection in Washington D.C., and the Whitney West in Wyoming.

May 6, 2010Find Yourself a Good Hospital

Since November, when the United States Council of Catholic Bishops (USCCB) voted to change the Ethical and Religious Directives for Catholic Health Care, I have written frequently how the new policy could result in continued tube feeding for thousands of unconscious and severely demented patients in Catholic hospitals and nursing homes. Newly released research highlights the problem.

Representatives for Catholic hospitals downplay it. Sister Carol Keehan, executive director of the Catholic Health Association, said she doesn’t see much conflict between patients’ and families’ end-of-life wishes and the new directive. “Advance directives are held in great respect in Catholic hospitals,” she said in a recent interview. “Some might like to say there’s a terrible problem, but there isn’t.”

Catholic hospitals have attracted unwanted attention over this change in policy, and they assert the attention is unwarranted, because mentally compromised patients are in nursing homes, not hospitals. Alan Sanders, director for the Center for Ethics at St. Joseph’s Hospital in Atlanta, says that as an acute care facility, St. Joseph’s is unlikely to encounter a decision to remove a feeding tube from a patient in a persistent vegetative state.

Well, not exactly. Recent evidence indicates hospitals, not nursing homes, are the usual site of decisions to insert feeding tubes. A 2003 study reported more than one-third of nursing home residents with advanced dementia have a feeding tube, and a new study shows whether they get one depends much on the hospital they’re admitted to. The Providence Journal reports,

Dr. Joan M. Teno, the chief author of the study, said the results show that it’s not the wishes of the patients that are driving these decisions. “It really is the hospital culture that is determining this…. This doesn’t look like a process that is respecting patient choice.”

Hospitals vary widely in their incidence of feeding tube insertion. Even hospitals in the same community can differ greatly in how often they place a feeding tube in demented patients. In spite of evidence proving the tubes increase suffering and do not prolong life, some hospitals have even increased their utilization in recent years.

The survey of more than a quarter-million hospital admissions from 2000 to 2007 showed that during the last two years of the survey, Roger Williams Medical Center and Kent Hospital stopped using the tubes.

Nationally, 12 percent of the hospitals fell into the same category.

But at St. Joseph Health Services of Rhode Island, which runs St. Joseph Hospital and Our Lady of Fatima Hospital, use of the feeding tubes actually increased during the last two years of study – 7.7 percent of patients got them, up from 6.9 percent during the broader period of 2000 to 2007.

That’s more than the national rate of 6.2 percent in 2007, an average that has been declining since 2000.

Teno said that within the past year, U.S. bishops decreed that feeding tubes must be given for all patients – Catholic and non-Catholic – who have lost the ability to eat or drink, unless they are actually close to death.

That philosophy, “I think, partially explains the results with St. Joe’s, being a Catholic health-care system,” said Teno.

The study illuminates other factors influencing feeding tube insertion.

For-profit hospitals and larger hospitals were more likely to use the tubes, Teno and her colleagues found. Black and Hispanic patients were nearly twice as likely to get them as whites.

Teno said she is concerned that Catholic hospitals may be trying to override the wishes of patients when they insist on feeding tubes.

Advance care planning, the study says, also has an important role in reduction of potentially unnecessary procedures. Although it’s not fool-proof (590 patients were given feeding tubes despite written orders to forgo artificial hydration and nutrition!) patients with a living will and durable power of attorney for health care were far less likely to have tubes inserted.

Once again, our advice proves sound: prepare an advance directive, talk to your doctor, talk to your loved ones. Because you can’t be sure whether the policies of a for-profit hospital, or a Catholic one, might impose an unwanted feeding tube, consider adding this Sectarian Health Care Directive addendum. And help Compassion & Choices set enforceability standards for advance directives. We want feeding tube decisions to follow your wishes, not institutional policies of profit or doctrine.

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