Futile Care – Who's for the Blood and Gore?

Today the New York Times has a piece about the dilemmas of futile care.

What is futile care?

Glad you asked.

Futile care is essentially the idea that for many patients, there comes a point where medical treatment is useless, because it will not improve their condition. On its face, this seems reasonable, except for at least two points. One, we had better be careful about what we define as futile care. Why? Because, increasingly, feeding and hydration are being classified as medical treatments, ergo, they can be judged as medically futile and therefore withdrawn. Two, futile care arguments slip very easily into the realm of doing what’s cost effective. How so? Well, if there is an expensive medical intervention (and almost all medical interventions for these patients are expensive) wouldn’t the treatment be better utilized on someone who has a much better chance of getting better?

The NYT piece shows how biased the media has become when reporting on end-of-life issues, because it goes out of its way to tell us how awful and horrific end-of-life interventions can be.

The piece makes a stab at balance, noting that not all doctors think futile care is the way to go, and also acknowledges that sometimes it is more loved ones’ denial of the obvious, if painful reality. That’s fair enough – as far as it goes.

But read the opening sentence:

Aggressive treatment at the end of life — frantic CPR for a brain-dead accident victim, inserting a feeding tube in a dying Alzheimer’s patient — has become a staple of the health care debate. Critics argue that vast resources are squandered on care that is obviously futile.

No exactly nuanced, and it sets an unfortunate tone, especially entertaining the notion that it’s OK to starve Alzheimer’s people to death.

It goes downhill from there. Soon we are in the grimly grotesque world of a twenty-first century Frankenstein:

The subject of the first essay was a 2-year-old boy, severely brain-damaged from a birth defect. He was dead — his heart had stopped. His doctors and nurses knew that no matter how hard they might try to resuscitate him, they would never succeed. But they tried anyway; aggressively jamming large bore needles into his chest, pounding on him, applying paddles to shock his heart. One nurse was so upset she almost vomited.

Medically, this is accurate, I suppose. But you could couch open-heart surgery, drilling into a patient’s brain to relieve bleeding or even stitching up a gaping wound in exactly the same way – many medical interventions are gory, but that doesn't mean we don't do them. If we didn't, we'd never perform transplant surgery, amputations that save lives, or reattaching a severed limb, all interventions that are very often successful and for which patients are very grateful.

Later, in discussing CPR, the Times again prefers the gory option:

It’s a violent procedure, Dr. Helft said, “very invasive and disturbing.” Medical personnel press on a person’s chest with such force that they break ribs. They stab large bore needles into the chest to administer fluids and drugs. They shock the heart with bursts of electricity.

Well, not exactly. CPR does not necessarily mean ribs get broken. It's possible, and sometimes it happens, but suggesting that it's always the case is bunk. Emphasizing the gore betrays where the writer’s sentiments lie.

Here’s a further quote about that same little boy:

Dr. Helft explained why. “In a sense what it does is, it says that we are doing this procedure, using this procedure on the boy to benefit the family,” he said. “We are using this boy as a means to an end, an end unrelated to his own well-being. You will hear clinicians say this all the time: ‘Even though the patient is already gone, we are treating the family now.’ There are lots of other ways the family can be treated.”

OK, I see - the boy’s wellbeing was to be dead. That’s not a cynical observation. If you read much of the medical literature you can’t get away from the perception among many that death is a form of wellbeing over living and suffering.

Just like for your pet dog.

Let me be clear: There is clearly a time when reality means all medical efforts should cease. However, the trick is to know when to desist - and therein lies the judgment of the medicos, who are very far from perfect in what they can prognose.

The way they see it, however, Doctor Power should prevail.

Let’s look at the second reported case, DeeDee, an elderly woman with advanced Alzheimer’s disease who was subjected to “aggressive” resuscitation efforts and survived:

DeeDee was saved. She’s still demented, of course, and cared for round the clock by dedicated attendants.

See? What a waste of time, effort, and money. We still have to care for this demented woman around the clock, such a waste of energy and money.

Money spent on a demented old lady could have been better spent on people who are in their right mind.

Frightening.

Gotta Love the Dutch, Those Merciful Killers!

Let’s open the New Year as we left the old year, shall we?

You know - that part about how we are now becoming quite accustomed to killing people because somebody has decided they are not worth keeping alive.

All in the decedents’ best interests, of course.

Media in the Netherlands reports that there was an increase in the number of people euthanized in 2009 – including people in the early stages of dementia. No surprise there, but I think it’s instructive to look at what is reported, and the subtle subtexts that are nevertheless coercive in slanting a favorable impression of medicalized killing.

Sidebar: I’m not suggesting that the reporter deliberately thought this through, but I think it’s obvious that things in the Netherlands are so pro-euthanasia that the article’s bias is assumed to be “balanced coverage,” which it’s not.

From a piece DutchNews entitled More Cases of Euthanasia in 2009.

First, the obvious is reported, that there were more 200 more cases of euthanasia in the Netherlands last year than 2008, where the killing total was 2,500.

Then:

It is not known how many cases of mercy killing there actually are in the Netherlands, but in 2007 experts said around 80% of instances are registered with the monitoring body.

Well, mercy for whom, exactly? What exactly is the nature of this “mercy?” How can we be assured that the “mercy’ is not for those left behind who found the patient too much of a burden? What about the survivors benefitting from such “mercy” as they inherit goodies from the person they coaxed to assume a duty to die? No way to tell, of course.

“Merciful” because people are in unbearable pain and suffering? Not exactly, because many people who are euthanized are not in pain, and because, in the Netherlands, you can request euthanasia for just about any reason at all, pain or no pain.

Also, after all the fanfare in the Netherlands about making euthanasia legal so that it could be officially controlled, what do we find? Well, it’s not controllable.

Remember, too, that the registering “monitoring body” (sounds so nice, certain, and transparent) is a review panel that examines the circumstances of the killing AFTER it has occurred.

Now, here's the next snippet that contradicts the whole pain-and-suffering angle:

There were also six registered cases of euthanasia on elderly patients with senile dementia, all of whom were in the early stages and able to make their wishes known.

Ah, I see. Where to begin? Dementia, though tragic and unfortunate, is not physically painful (originally, at the top of the slippery slope, euthanasia was ONLY for untreatable physical pain among the terminally ill). Psychologically painful? Clearly, for persons who are aware that their faculties are diminishing, but how do other people make this determination? (Those with dementia don’t euthanize themselves, after all). Where is the bright clear line between someone with early dementia who requests euthanasia (in their right mind, so to speak) and someone who’s condition is more far advanced and is judged not competent to request euthanasia?

Don’t worry, the Dutch doctors have a solution for this latter group – they kill them too. The explanation? Had these people been in their right mind, they would have requested euthanasia anyway.

On we go:

The law states a number of criteria, which must be met before euthanasia can be administered. For example, the patient must be suffering unbearable pain and the doctor must be convinced the patient is making an informed choice. The opinion of a second doctor is also required.

More shooting fish in barrels here: Where’s the “unbearable pain” in dementia? How can a doctor ever possibly be sure that, knowing a diagnosis of dementia has already been made, calibrate that the dementia is not affecting the request for euthanasia?

Short answer, I’m afraid: All the contortions of logic and single-mindedness betray, with increasing smugness, that in many places we have decided who should live and who should die.

First those who are terminally ill and in untreatable pain. Then people who are not terminally ill but who might have physical or psychological pain. Then people who are judged to never be able to have a better quality of life. First adults. Then children.

Who’s next?

Useless Eaters . . No, Wait, “Complete Lives”

As jackbooted healthcare legislators attempt to force on us a bill that most people don’t want and that we can’t possibly pay for, we had better understand what this will likely mean.

First: The government will become your doctor.

Here’s how it will work:

You go to your doctor with symptoms a, b, and c.

After tests, your doctor or a specialist makes a diagnosis which determines what medical treatments are necessary.

The government is paying for your treatment, so the government decides which treatment you should get - if any at all.

The treatment the government decides you should get may well be based on a proposed treatment allocation idea called the Complete Lives System and devised, among others, by Dr. Ezekiel Emmanuel, President Obama’s Special Advisor for Health Policy.

The policy is laid out on a recent article in the Lancet. This from pages 428-429:

When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated . . . the complete lives system justifies preference to younger people . . . Additionally, the complete lives system assumes that, although life-years are equally valuable to all, justice requires the fair distribution of them.

Here’s what this means in plain language:

1. The Complete Lives System will divide Americans into those who are more worthy of treatment and those who are less worthy of treatment. Top priority will go to those between 15 and 40 (because they have the best potential for longer, healthier, and more productive lives, that is, “complete lives”).

2. The youngest and oldest will have less chance of a shot at medical treatment because, statistically, the chances of them attaining "complete lives" are much lower than among 15-40 year- olds.

3. Oh, yes, and even those lucky 15-40 year-olds who make the privileged cut might not get what they need, because “complete lives” will have to be distributed “justly” across the population.

There it is:

Living, or have great potential for a “complete” life? Between 15 and 40? The Government will likely OK necessary medical treatment (unless, of course, what should have been coming to you needs to be “justly" given to someone else).

Living, but don’t have such a great potential to get to a “complete” life? Younger than 15? Older than 40?

You are judged incomplete. You are damaged. You have little potential for attaining completeness.

Complete, you live.

Incomplete, you die.

If You’re Not Conscious, You’re Dead

Over the last few days the media have been marveling at the story of Belgian Rom Houben. In 1983, at age 20, Rom was severely injured in a car accident. He was diagnosed as being in a persistent non-responsive state (derogatorily often referred to as a persistent vegetative state).

Doctors using the standard diagnostic protocols reconfirmed Rom’s diagnosis several times over the years. Medical opinion was that he was severely brain damaged and permanently unconscious.

Doctors urged that his nutrition and hydration be removed so that he could die.

Thankfully, Rom’s mom refused.

For 23 years.

Then, enter Dr. Steven Laureys, who used state-of-the art diagnostic technology (unavailable until very recently) to examine Rom’s brain function.

Surprise, surprise.

Rom’s brain function was almost normal.

Bigger surprise: Rom was conscious.

He had been conscious for every one of those for those 23 long years, but was physically completely unable to move to tell anyone (he can’t even cry).

Using a fairly low-tech communication board and the tiniest movement of one finger, he’s now connected to his loved ones and the world.

Much of the media, and many bioethicists, are falling over themselves to spin this as the rarest of events.

Nope – there are hundreds of similar cases reported and validated worldwide.

Here’s the chilling part (after you get over trying to imagine what it’s like to be able to hear everything going on around you for 23 years but can’t let anyone know):

Bioethics is well on the way to redefining what death is. If some get their way, Rom would have most decidedly been pronounced ”dead” after his initial diagnosis years ago because others would have decided that (a) Rom had no quality of life and (b) because keeping people like Rom alive is futile, his organs could have been harvested for transplantation.

Making lemonade out of lemons, so to speak.

Imagine the unspeakable horror of being conscious and being starved and dehydrated to death, or euthanized for your organs.

No doubt in my mind that it’s already happened – repeatedly.

I’m also left with an even more heartrending question:

What might have been if Terri's husband had allowed Dr. Laureys to examine Terri Schiavo?

Palin’s "Death Panels" Are Already Here

Former Alaskan Governor Sarah Palin made some comments on Friday that seem to have gotten the pro-death healthcare reform side in a bit of a dither.

Here’s what Palin said:

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

Apparently the pro-healthcare reform lobby took exception to Palin’s assertion of a “death panel.”

Now, I’m not sure what else you call proposals for government apparatchiks to monitor and control the treatments doctors hand out, and who may well refuse to allow doctors to use some treatments, thereby resulting in the death of some of their patients.

But, as much as I think Palin’s comments are right on the money, let’s remember that we already have such death panels operating in hospitals all over the country.

And we’ve had them for quite a while.

Exhibit A: Texas.

When former President George W. Bush was Governor of Texas, he signed into law the Texas Advance Directives Act of 1999, the provisions of which allow exactly what Palin suggested – a panel that decides if some patients should die.

Here’s what the law allows: Any hospital can, legally, give notice that it is stopping all patient treatment 10 days after the decision has been conveyed to the patient’s loved ones.

The reason for stopping treatment? The hospital has decided that any more care is considered futile. That is, any more care is essentially useless and wasteful, because the patient will never get better.

This decision is made exclusively by the hospital panel. Loved ones have no say in how this is decided.

Not a word.

This decision can be made even if the family is able and willing to pay for all care themselves, and the law overrides any advance directives the patient may have had, saying, for example, that all treatment should be continued until death.

Utilitarian? As Palin might say, you betcha!!

The logic’s pretty simple, actually:

You’re not getting healthier; it’s a waste of money to spend any more treatment on you. We will use those expensive treatments on people who will have a better chance of getting better.

In other words, hurry up and die.

That’s what happened in the fight to keep treatment going to poor Emilio Gonzales in 2007, and to many others like him across the country.

In the interests of fairness, of course, loved ones, once informed of the hospital’s decision, may then “appeal.” That means hiring lawyers to get a court injunction to delay the end of treatment.

Yes, folks, in Texas you will need to hire a lawyer to prevent the hospital from killing your loved one.

If this isn’t a version of a “death panel,” I don’t know what is.

Is Obama the First Pro-Euthanasia President?

There’s been very little attention paid to an interview President Obama did with the New York Times the day of his major speech at Georgetown University on April 14. I was especially interested in the section of the interview dealing with health care, and to learn of the President’s perceptions of end-of-life issues. It’s not pretty. Read on.

For starters, President Obama opined:

I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because . . . when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such and you need to take such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.

Well, yes and no.

But the President’s slant is immediately concerning, because there’s a fine line between medical expertise and Doctor Power. What if the doctor says, “Well, you’ve got two weeks to live, and your quality of life is very poor, and all the expensive care we can give you will not help a bit, but assisted suicide is legal, quick, and very inexpensive?’ Should I then accept this pronouncement because he’s “the guy with the medical degree?”

If you think I’m stretching things a bit, it’s because of what came next from the President:

And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control. And right now we’re footing the bill for a lot of things that don’t make people healthier.

Not too hard to see the spin here. Now we’ll get the government saying, “OK, seeing that we pay for your medical care, we’re going to decide what care you get and what care you can’t have.”

And, more darkly, the specter of futile care emerges, because what the President was saying was, “If we’re paying for stuff that doesn’t make you healthier, we need to reconsider whether we want to pay for this treatment.”

Note the phrase is “to make you healthier” - not to alleviate your symptoms, or provide you with comfort care because you’re never going to get healthier.

Simple: If treatment makes you healthy again, you get it. If it can’t, you can’t have it, because we need it for people who can get healthy again.

Pure, unadulterated futile care.

Here’s what will happen, trust me:

The government already knows that medical care in the last weeks of life is where most medical dollars get spent. Same goes for money spent on people with significant, although not necessarily terminal disabilities. Marry that to the President’s commitment to cut health care costs, a society that increasingly thinks helping people die is just dandy, and a medical profession that is increasingly utilitarian, and you have the perfect plan to make people with severe medical problems, including those with disabilities, into Useless Eaters.

It got worse.

The President:

So when . . . I talk about the importance of using comparative-effectiveness studies as a way of reining in costs [which] . . . is an attempt to say to patients, you know what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that the blue pill, which costs half as much as the red pill, is just as effective, and you might want to go ahead and get the blue one. And if a provider is pushing the red one on you, then you should at least ask some important questions.

Ah, “comparative-effectiveness,” “objective studies.”

Science in the service of deciding who lives and who dies. Seems like we’ve heard this somewhere before.

Allow me to paraphrase my President:

Doctor to patient: “You know, what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that there’s no point in treating you any further. We’ve concluded that the blue pill, which will keep you comfortable until you die, is very expensive. The red pill, that costs a tiny fraction of the blue pill, can end your suffering quietly, effectively, and with dignity.”

Don’t believe me? See what happened to Barbara Wagner in Oregon, where the state refused an expensive treatment to help her live our her days, but offered to pay the pennies it would cost for her to commit assisted suicide.

But the President went even further, using a personal example when asked about end of life care:

. . . my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip . . .So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible. And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart . . .

OK, a very difficult situation, with difficult, but very common health decisions that needed to be made. BUT, then the President went on, back to setting us up for official pro-death thinking:

Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

See? Old, lying in misery in an expensive hospital bed, with a broken hip.

Pretty upsetting. Expensive, too.

What’s a grandson to do?

The President:

Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

Just so you know: Pro-death is going to be more than law. Here's the plan:

Have “conversations” with the public under the guise of measured reasonable argument. Subtly (and not so subtly) use doctors, scientists and ethicists who are pro-death to lead the way. Shape public opinion to utilitarianism, futile care, people as pure economic entities, and then the resistance to assisted suicide, and, eventually, euthanasia, will crumble.

Is Obama our first pro-death President?

I see no evidence that he’s not.

When Infants Die

Doc over at Mind, Soul, and Body has a thoughtful piece on some of the most difficult circumstances I can imagine – being faced with the prospect of a dying infant.

Dying infants break our hearts for all kinds of reasons, and parents and loved ones face a titanic struggle between what they face and what they believe.

You see, we carry around in our very beings a plethora of expectations around life, especially around the lives of a newborn:

Nobody should die young.

Parents shouldn’t have to bury their children.

We don’t care if it’s a boy or girl; we just want our child to be healthy.

But that is not what we find in the pediatric ICU. We find very, very sick babies. We find absolutely no prospect of recovery.

There will be no happy photos of first days at kindergarten, school, or college. There will be no endless, badly filmed video that will be played over and over again across the years, with chuckles all the while.

No first love, no getting married in clothes that years later will look so terribly dated.

All gone.

But not yet gone. Before us, a frail form clinging to what could have been.

Doc explains just how disabled and medically vulnerable these children are. His descriptions don’t make for easy reading, but they’re accurate.

He struggles, as do we all, with where to find the compromise between comfort care and the unrelenting reality that sooner, rather than later, every effort will fail.

But, in the end, it’s really not that complicated, because there are essentially two choices.

We can go the route of Peter Singer, who insists we should euthanize these infants, or, in Baroness Warnock’s harsh world, that they should be “put down.” Or we can take note of what happens routinely in the Netherlands, where dying babies are routinely euthanized because they have no hope of a “good quality of life.”

What hideously casual utilitarian decisions!

But, as Doc suggests, there is another, better choice: Supporting the family, gently explaining every option. Using every medical and palliative tool to provide comfort and ease pain. Being patient as families grieve.

All this, because we are dealing with a human life, an exceptional life, no matter how brief. 

A life worth just as much as anyone more perfect. 

Loving and gentle medical care so that whatever time is left can be spent making the memories, brief as they will be, to warm and console hearts after that Long Slow Goodbye. 

The Scots: Let’s Allow Assisted Suicide For CHILDREN

It’s coming thick and fast now, folks.

Killing people, that is, especially in the UK

If you’re going to be an overachieving country, it might as well be in the realm of assisted suicide.

Dan James. Valerie Grosvenor Myer.

And tonight’s Sky Real Lives channel airing of the filmed assisted suicide of Craig Ewert.

Remember, in all these cases, part of the pro-killing argument was that it wasn’t the act of assisted suicide that was bad; it was those pesky laws in the UK that prevented it.

So, aided and abetted by the largely uncritical media, the clarion call came from the seat of the former Empire: We need to change the law.

Not wanting to be seen as retrograde neanderthals to their English cousins, the Scots have stepped in to take the lead.

Scotland’s The Herald reports today that a Scottish MP, Margo MacDonald, is planning to introduce legislation that would legalize assisted suicide for children.

No, I’m not kidding. Wish I were.

Here’s MacDonald’s rationale: In Scotland, when parents divorce, and the children are 12 or older, the court takes into consideration the child’s choice as to which parent they wish to live with. Under some circumstances, the living choice is offered to younger children.

So, goes MacDonald, why not give the same legal status for choices about living or dying?

Get a load of the proposed legislation’s slimy rationale:

The outlined proposal would allow patients with degenerative, irreversible conditions to approach a doctor who would be specially registered to help terminate life at the patient's request.

OK, that’s standard let’s-kill-you-when-you-have-a-bad-disease language.

But, listen to this:

Assisted suicide would also be possible for patients who unexpectedly became incapacitated to an "intolerable" degree, or who simply find their life "intolerable" - although the latter case would require the doctor to seek a second opinion from another health professional.

So, now, if you think any “incapacitation” you have is a drag, or even if you think your life is just yucky, you have a way out. Remember, because we don't want to be too hasty, for this aspect of the legislation you’ll have to find not one, but two doctors who agree you should be done in. (Shouldn’t be difficult with a little doctor-shopping for medicos who share the pro-killing view of the world).

And now, potentially, in Scotland, you don’t even have to wait until you’re legally an adult.

Children have rights too, you know.

Eugenic Researchers, Genetic Testing, and Eugenic Discrimination

Yesterday’s Washington Post ran a story that should give us great pause.

The piece reported on advances in genetic testing that make it easier to detect many more anomalies at earlier stages of pregnancy. I think we should be very aware that a primary aim of genetic testing is eugenic.

First, what the tests mean in the real world: Medical tests, including all genetic tests, are not perfect. 

At the level of the family, what this means is that for a percentage of those tested, the results will be wrong. That is, a percentage of terminations will be of children who actually do not have Down Syndrome, or any other genetic defect, for that matter.

Second, what the tests mean at a societal level: Genetic in-utero testing unambiguously seeks to separate the genetically normal from the genetically defective. As the tests become more sophisticated, more subtle genetic differences will become apparent.

That means, inevitably, that we will increasingly separate a larger and larger group of people into a variety of genetically defective categories. Furthermore, the genetically different will be increasingly segregated, in whatever way, from those who are genetically similar.

Genetic discrimination. Genetic segregation. For more pregnant mothers, destruction of their pregnancies based on genetic makeup, nothing more, nothing less.

It’s already happening.

Example: Genetic discrimination of Down Syndrome children. The vast majority of Down Syndrome pregnancies are terminated, exclusively and only because they are (a) genetically different, and (b) because that difference is overwhelmingly seen as negative and undesirable. Parents are heavily, and routinely, pressured to terminate the pregnancy. There’s very little evidence that the doom and gloom is balanced by other realistic, but not necessarily negative information. 

Who are the people making the case for genetic difference being negative, undesirable, and therefore worthy or termination?

Why, the medical professionals and genetic researchers of course.

Enter Arthur L. Beaudet, of Baylor's Department of Molecular and Human Genetics, who opined in the Post article that these tests are “ready for prime time:”

For people who want the best possible prenatal diagnosis and want the maximum information, this is the best option.

Here’s what we can be sure of: What Beaudet is saying is that these tests provide the most accurate test for rooting out genetic anomalies.

Because that’s exactly what they want to do – get rid of the genetically different.

Don’t believe me? Listen to the good Dr. Beaudet:

Some of these disorders are quite burdensome. They require lifelong nursing care. In some cases these children never walk, never talk, never feed themselves . . . It can have a major impact on the family. People say, 'I wish you had given me the opportunity to know ahead of time. It's really destroyed our lives.' That's why women want to know.

This is a nakedly eugenic position.

Not even a show of pretense.

If you are genetically different, then you are a burden. Your quality of life will be bad. Your family will have to deal with you, what a hassle. You will have destroyed your family’s lives by you, yourself, being alive.

The good doctor is, I’m sure a distinguished professional in his field. Here’s a list of some other people distinguished in their fields, who thought eugenics was just fine:

Helen Keller, Alfred Nobel, Margaret Sanger, Adolf Hitler, Alexander Graham Bell, Woodrow Wilson, H. G. Wells, Winston Churchill, George Bernard Shaw.

Just to name a few. 

Ah, the Brave New World. I can’t wait . . .

The New Generation of Dr. Deaths

Never mind the difficulties of talking about euthanasia (see blog below), we better start talking about how, increasingly, doctors are acting, literally, as the sole authority on who gets to live or die.

It’s not only the Dr. Hootan Roozrokhs of the world, pumping patients full of morphine and atavan to hasten their deaths to get at their organs:

Doctor Power is alive in Britain.

No shock there. Still, read on:

BBC News reported last week that Ellie Westwood, 88, was in a government hospital where she was being “treated for dementia” and an infection following shoulder surgery. The infection spread to Ellie’s throat, making it difficult for her to swallow. Unsurprisingly, she became malnourished.

Enter Doctor Power:

Ms. Westwood [Ellie’s daughter, Kathleen] said she and her father were called into a room at Selly Oak Hospital on 8 February and told doctors had decided to withdraw all fluids, food and hydration.

They said they had begun giving Mrs. Westwood morphine "because she is dying."

Uh-huh.

Well, we are all dying in a sense, but Ellie wasn’t immediately dying. Her dementia obviously wasn’t rendering her “dying.” Neither was her infected throat, because she was being fed and hydrated via tubes.

No problem for Doctor Power - the doctors rationalized their death-making by declaring Ellie had "lost capacity," and that they, therefore, were in charge of her best interests. Under British statutes, if doctors judge that a patient has “lost capacity” they may make all further “medical” decisions - no questions asked.

What medical decision did Doctor Power decide was in Ellie’s best interest?

You had to ask?

Why, dying, of course.

Said Kathleen: "Well in their view the best interests was for my mother to die - and clearly by Monday she would have been dead.”

Kathleen didn’t want her mother killed.

Here’s the doctors’ response: ". . . 'it's happening, sorry.'”

Sorry, Kathleen, WE don’t care that you don’t want your mother killed. WE know the law. WE know OUR rights. WE are in charge. WE do what WE want. WE, repeat, WE Kathleen, know what’s best for mom. Don’t get in OUR way.

This story has a semi-happy ending. Kathleen didn’t take the intimidation too kindly, and eventually scuttled this episode of Doctor Power. Good for her.

A funny thing happened: As care continued, Ellie's condition improved - significantly.

mmm, what happened to the “dying” diagnosis?

Could it be that it was manufactured by Doctor Power?

Nah, surely that couldn’t be?

Of course it was.

I shudder to think about all those British government hospitals with thousands of Ellies who don’t have the Kathleens of the world to stand up for them.

We better start taking back the power. 

Doctor Power

At a recent international conference, I happened to be seated next to one of the presenters shortly after his erudite talk. His talk presented a scholarly and highly nuanced analysis and decision framework based on his understanding of the relevant philosophical and ethical literatures around death and dying. What was most intriguing for me was the part of his framework identifying who should be making these end-of life decisions.

Let's just say that the word doctor appeared much more often than words like patient, family, next of kin, spouse, or parent.

I engaged this distinguished ethicist and philosopher about his clear conclusion that, in most of his presented stages of decision-making, the doctor held full sway. I raised the concern of “doctor power” in light of how euthanasia in the Netherlands (and many other places, I’m sure) is often recommended (and carried out) by doctors without the permission of the patient -- or anyone else, for that matter.

Let’s just say he squirmed a little, and insisted that something got lost in the translation (he delivered his presentation in Italian, I heard the translated English version).

I don’t think so.

Let me be clear: Many physicians are a blessing to their patients, as they should be. However, only the truly naïve will believe that there are no doctors for whom euthanasia is an accepted, justifiable, and ethical practice.

In this day and age where the medical profession pretty much sees the “do no harm” part of the Hippocratic Oath as a quaint throw-back to a bygone era, and where, increasingly, medical decisions are economic decisions above all else, is it unreasonable to suppose that doctors everywhere, including in the US, sometimes act on their conviction that euthanasia is permissible without anyone’s permission?

Well, no. 

Doctor Power is here to stay. Remember Dr. Hootan Roozrokh?

No? Well, here’s what the Los Angeles Times story reported a little more than a year ago:

SAN LUIS OBISPO -- No one in the courtroom Wednesday suggested that Ruben Navarro could have avoided death for long.

But whether the severely retarded, comatose 25-year-old was nudged into it by an  impatient transplant surgeon is at the core of a legal proceeding unprecedented in the  United States.

Dr. Hootan Roozrokh, 34, has been charged with three felonies in Navarro's 2006 death. His case is being watched intently by medical professionals and ethicists across the country who fear that a conviction will discourage prospective organ donors and their families. . . .

At issue was whether Roozrokh, a San Francisco specialist on leave from Kaiser Permanente, improperly administered massive doses of morphine and Ativan, an antianxiety drug, in order to speed Navarro's death.

Doctor Power. Pure and simple.

Roozroh decided. Ruben died.

Ruben had been pumped so full of morphine and Ativan that when he finally succumbed, his organs were useless for transplantation.

Want to read about Hospital Power? Check out Annie’s story. I’ll have more to say about Annie later.

Maybe it’s time to find out how really well you know your doctor.

Couldn’t hurt to check……….