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Human Exceptionalism

Life and dignity with Wesley J. Smith.

Brittany Maynard: The Vultures Circle



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I wasn’t going to write about the Brittany Maynard assisted suicide frenzy. Maynard is apparently dying of brain cancer at age 29, and has decided to mount a pro-assisted suicide campaign, announcing she will kill herself on November 1.

I wasn’t going to write about Maynard because I am not critical of her. No one knows what our limits might be. But more importantly, she is a living, very ill woman. No way I am going to do anything to add to her burden.

But then, I started getting many media calls to comment: Three minutes on TV talking her planned suicide, and next up, “Kim Kardashian shocks again!”  No way.

And so I changed my mind. I felt the need to unleash–not at her–but at those who are exploiting her tragedy for their own purposes.

First in line–although Maynard would surely disagree–are assisted suicide advocates:

- Assisted suicide movement leaders are always on the lookout for attractive cases to further their cause, and clearly believe they have one in Maynard because of her youth, beauty, and the tragedy of her condition.

- The movement has obviously orchestrated an expensive and very well planned media campaign to use her planned suicide to force open the door to doctor-prescribed death. I mean the story is all over the place. That doesn’t happen by accident.

- More than that–and most egregiously–by validating and extolling her self-termination, assisted suicide advocates make it harder for her to back off the ledge.

 I saw this in the Nancy Crick case in Australia. Assisted suicide advocates and the ghoul Philip Nitschke–were all with her when she planned to kill herself. Then, when Crick had doubts, they backed away from her. The message was clear, kill yourself and we are your friends. Don’t, and we don’t care about you.  When she finally did the deed, she had assisted suicide advocates in the room with her. When she took the poison, they applauded.

Even worse, are the media.

- Media know they are being played.  But, if it bleeds, it leads!

- By breathlessly pushing the Maynard story, the media are pushing suicide. This totally violates media guidelines for reporting suicide stories issued by the World Health Organization. 

- Why is this case making headlines? There have been hundreds of assisted suicides with nary a peep from the media. And cases that make legalized prescribed suicide look bad are assiduously ignored.

- Many of the stories read as if she has no choice but to kill herself.  No mention of the potential of hospice and other care opportunities to alleviate her suffering. 

- By pushing suicide as death with dignity–and by giving so much attention to her death–the media tell others that suicide is the right answer for them too

- Many media support assisted suicide and are using Maynard for ideological reasons.

- This is like 60 Minutes playing the video of Jack Kevorkian murdering Thomas Youk, with Mike Wallace repeatedly asking, “Is he dead yet? Is he dead yet?” Or the BBC playing the video of a death at one of the Swiss suicide clinics. 

- And here’s the thing: If she kills herself on November 1, they will barely remember who she was on November 3. 

So, if anyone wants to talk to me about the above, it would be my pleasure. But Maynard? Nope.

The whole spectacle makes me sick.

#vultures

Really? Stanford Doc Says No Jahi Life



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This is disturbing. Two internationally respected neurologists conclude that Jahi McMath isn’t brain dead, and the Stanford court appointed independent expert isn’t even curious to see what is going on?

Apparently not, as Dr. Paul Graham Fisher says the evidence presented “isn’t enough.” But what about the videos appearing to show here reacting to requests? From his letter to the judge dated October 6, 2014:

Videos of hand and foot movements, coincident with verbal commands heard on audio cannot confirm or refute brain death, and are not substitute for in-person serial neurological examinations by a physician.

But surely, they are cause to agree that those serial examinations should be performed!

Dr. Fisher notes that no serial apnea tests have been performed. Fine, do the tests!

What about the EEG? 

A “flat” electroencephalogram (EEG)…is not required for the determination of brain death…The EEG performed 9/1/14 was not performed in standard conditions, but rather, at an apartment…

Fine, do it right and see what, if anything, is cooking! 

What about blood flow to the brain, as reported in Machado’s declaration per MRI? The right test wasn’t performed, Fisher says. OK. do the right test.

Menarche commencing, indicating sexual maturing? “Not relevant.” But Shewmon testified that is unprecedented in the literature.

His bottom line conclusion:

Overall, none of the current materials presented in the declaration refute my 12/23/14 examination and consultation finding…None of the the declarations provide evidence that Jahi McMath is not brain dead.

That’s not true. They might not provide sufficient evidence, but certainly the videos of Jahi’s apparent conscious reaction to requests to move her limbs–and the testimony of internationally respected physicians that she is not brain dead–is “evidence.”

I find it stunning that Fisher isn’t even curious enough to want to perform a thorough reexamination pursuant to the criteria he thinks determinative. 

More, it seems to me that relying on tests from 10 months ago when current tests–even if insufficient–at least appear to show things may have changed (or not gone as earlier predicted) is a matter of digging in the heels rather than seeking objective truth.

Here’s my bottom line as one who believed she was dead last year:

- Maintaining trust in the integrity of the system, alone warrants a second look.

- So does the interest of science, because we may have witnesses an unprecedented event in brain death science.

- So does the potential future of a little girl.

“Not enough? Fine. Conduct the kinds of tests and examinations that would be sufficient. 

If this were a death penalty case, the level of evidence presented would create sufficient doubt to justify a reopen because the case involves life and death.  If we can do that for a murderer, surely we can for an innocent and potentially alive little girl. Let’s make sure Jahi McMath is really dead.

 

 

 

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Bioethics Push Poll to Allow Killing for Organs



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To donate vital organs, a donor must be dead.

This is known as the “dead donor rule, I have been warning that utilitarian bioethicists and transplant medical professionals want to shatter the DDR to permit killing living living profoundly cognitively disabled patients for their organs.

Now, we see what appears to me to be a push poll type question in a study measuring popular support for such a change in the law. 

A push poll seeks to obtain a desired answer by the way the question is framed. Here is the question from “Abandoning the Dead Donor Rule?” in the Journal of Medical Ethics:

Jason has been in a very bad car accident. He suffered a severe head injury and is now in the hospital. As a result of the injury, Jason is completely unconscious.

He cannot hear or feel anything, cannot remember or think about anything, he is not aware of anything, and his condition is irreversible. Jason will never wake up.

As we have seen in recent stories of awake and aware patients diagnosed in a persistent vegetative state–and perhaps, the Jahi McMath brain death case–this question sets up a false premise. Few, if any, cases are this clear cut,this sure. Indeed, the more we learn about the brain and consciousness, the less we know–as demonstrated by the proven brain interactivity in some patients thought to be completely unaware.

Thus, it seems to me that the question was posed in this unrealistic way to obtain a desired result of allowing the harvest.

Back to the question:

He also cannot breathe without mechanical support, but is on a breathing machine that keeps his lungs working. Without the machine, Jason’s heart and all other organs would stop within minutes. Although he will never wake up and cannot breathe without the support of the machine, Jason is still biologically alive.

In such scenarios, a patient can already be a donor by having life support removed, and IF–it doesn’t always happen as expected–he goes into cardiac arrest, be declared dead a few minutes later and obtain organs.

But that important fact isn’t mentioned in the question posed:

Before the injury, Jason wanted to be an organ donor. The organs will function best if they are removed while Jason’s heart is still beating and while he is still on the breathing machine. If the organs are removed while Jason is still on the machine, he would die from the removal of organs (in other words, the surgery would cause Jason’s biological death).

The question then asks how many people think that would be okay, and based on the push poll nature of the question, obtain a majority support for killing for organs. 

Moreover, were the dead donor rule be killed, the patients harvested would not be limited to the relatively few cases such as described above.

Polling is like statistics, you can make them say anything. 

Study: Awareness Without Brain Function



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Since we have been spending so much time recently discussing brain death, I thought this intriguing story–describing a study demonstrating we can remain aware after cessation of brain function during the dying process–worth mentioning. From the Telegraph story:

Scientists at the University of Southampton have spent four years examining more than 2,000 people who suffered cardiac arrests at 15 hospitals in the UK, US and Austria

And they found that nearly 40 per cent of people who survived described some kind of ‘awareness’ during the time when they were clinically dead before their hearts were restarted. One man even recalled leaving his body entirely and watching his resuscitation from the corner of the room…

Although many could not recall specific details, some themes emerged. One in five said they had felt an unusual sense of peacefulness while nearly one third said time had slowed down or speeded up. Some recalled seeing a bright light; a golden flash or the Sun shining. Others recounted feelings of fear or drowning or being dragged through deep water. 13 per cent said they had felt separated from their bodies and the same number said their sensed had been heightened.

If this is true, it seems to me, strict materialism isn’t. And if everything in life results from evolutionary processes what possible natural selection benefit would continued awareness during death convey?

MRI Test Proves Jahi Not Brain Dead!



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If the concept of “justice” matters–and if we care about the integrity of the system that bears its name–the Jahi McMath case must be reopened. This from someone who wrote publicly last year that I thought she was dead.

The other day, I posted about UCLA neurologist Alan Shewmon’s opinion that Jahi is not only alive, but conscious.

Now, Dr. Calixto. Machado, while more objectively clinical in his language than Shewmon, is equally unequivocal–based on objective medical tests–that Jahi is not brain dead. In other words, she is alive.

Machado, a very credentialed neurologist, medical professor, and recipient of the American Academy of Neurology Lawrence McHenry Award in 2005 because of his research in the field. In short, he is a very respected expert in the field of brain death.

He also believes that brain death is a real phenomenon. From his declaration under penalty of perjury:

I must affirm that I am a defender that brain death means death of the human being, and it is a state with no hope of recovery. Moreover, I am a Corresponding Fellow of the American Academy of Neurology (AAN), and I consider that AAN Criteria for Brain Death Diagnosis represent one the most outstanding and reliable Guidelines in the world for confirming the diagnosis of brain death.

Dr. Machado viewed the EEG of Jahi–without knowing whose test it was–and concluded that the patient’s test showed:

The neurophysiological data is not consistent with the classical EEG isoelectric pattern found in brain-dead cases.

He then personally performed the MRI test. Here is his astounding conclusion:

The MRI shows that the subject had suffered a serious brain injury. It is possible to observe ribbons at the level of the cortex, indicating preservation of neocortex.

Had she been brain dead without cerebral blood flow since January of 2014, we would not expect to see the structure of the brain to be as it is now; it would have, most likely, liquefied. This brain did not liquefy, but has maintained tissue structure.

This is in fact for me the most important finding in this case to deny that she is brain-dead, because considering the concept of brain death (BD), that per definition an irreversible absence of cerebral blood flow (CBF) should be present, in this case, with more than 9 months of evolution with the possible diagnosis of BD, I would have expected to find the classic description of the “respirator brain” (brain liquefied, without any nervous system structure, etc.).

Machado then discusses a “heart rate variability test” that, he testifies, also is not consistent with brain death. Ditto the videos of Jahi appearing to respond to requests to move her arm or leg. He also notes that Jahi has started to menstruate, “unprecedented” in the literature.

This medical expert concludes his testimony–his emphasis:

It is my opinion, as one who is a defender of brain death, and who believes that brain death does occur, and can be confirmed through testing of the type conducted on Jahi McMath, that this patient DOES NOT ACTUALLY FULFILL THE BRAIN DEATH CRITERIA AND HENCE SHE IS NOT BRAIN DEAD, considering the whole brain criteria of BD.

Not only should this case be reopened, what possible reason would there be to force the declaration of death to remain on record without hearing all the evidence that seems to indicate she is very much alive?

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World’s Destitute Often Die in Agony



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One of Dame Cecily Saunders’ few regrets, the great medical humanitarian told me when I interviewed her for my book Culture of Death, was that hospice–which she pioneered–was not widely available in the developing world. Too many dying poor people continue to die in agony, she told me, characterizing the situation as a “tragedy.” If only she had more time, the then octogenarian said sadly. Bringing hospice to the world’s poor would be her work’s focus.

Saunders died in 2005 (here is my tribute to her in the Weekly Standard.) Alas, things have apparently not improved since. From, “Dying Without Morphine,” by Ronald Piana in the New York Times:

IMAGINE watching a loved one moaning in pain, curled into a fetal ball, pleading for relief. Then imagine that his or her pain could be relieved by an inexpensive drug, but the drug was unavailable. Each day, about six million terminal cancer patients around the world suffer that fate because they do not have access to morphine, the gold standard of cancer pain control. The World Health Organization has stated that access to pain treatment, including morphine, is an essential human right.

I don’t like every good public policy being elevated into a “right.” There is too much of that. I mean, if everything good and laudable is a “right,” the very concept loses its potency. And it doesn’t actually accomplish the goal. But human exceptionalism certainly dictates that we have a duty to remedy this awful situation.

Enough semantics. More from the piece:

If it were just about the money, the solution — subsidized access — would be obvious. However, the issue is complicated by a dizzying array of bureaucratic hurdles, cultural biases and the chilling effect of the international war on drugs, which can be traced back to the 1961 United Nations Single Convention on Narcotic Drugs that standardized international regulation of narcotics.

Driven by its lopsided concern over the illicit use of opioids, a class of drugs that includes heroin, the Single Convention drove countless, onerous country-level restrictions on morphine use, for fear that it would be abused.

I am sure that is true, and Piana gives examples of success stories, such as in Uganda.

But his remedy seems incomplete. The best way to overcome these issues is promote prosperity in these countries–not dependency. That means fostering economic growth, expanding electrification using whatever means are at hand, and reforming cultures to eradicate corruption and value the rule of law. 

That’s difficult these days, what with sectarian chaos, the radical environmental movement’s inhumane war on humans that seeks to hobble economies in the name of “saving the planet,” and the general lack of access to sophisticated medical care in many of these countries.

Good for Piana for pricking our consciences. Bringing palliation to the poorest among us is a very worthy cause.

It should remind those of us in the prosperous West that the quality of life we enjoy did not arise by accident.

“We Like Abortion”



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I have highlighted that the “pro choice”  movement is coming out as pro-abortion. The goal is a “reverse reversal of Roe v. Wade” as too restrictive, to permit an absolute right to abortion at any time for any reason.

More evidence: Writing in the politically progressive In These Times, Sady Doyle reviews a pro abortion book and enthuses, that she really likes fetus killing. From, “Abortion Isn’t a Necessary Evil: It’s Great:”

Personally, I like abortion. I’ve never needed one. I’m still glad to have the option. I’m glad for the people I’ve known who got pregnant at the wrong time, with the wrong people, and didn’t have their lives ruined by it.

If Pollitt gets her way, more of us might feel free to admit that, hey: We like abortion.

But some women have had their lives ruined by their abortions. They regret it every day.

I understand why someone who doesn’t think a fetus is a human life would think it should be legal, or even if human, available in restricted circumstances.

But pro-abortionists know human fetuses are fully human–and they still celebrate the killings. That’s very ugly.

Abortion–like slavery in the 19th century–has profoundly distorted and decayed our society’s moral sensibilities. It isn’t a healthy thing.

UCLA Neurologist: Jahi “Alive!” “Awake!”



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I know and deeply respect Dr. Alan Shewmon, professor emeritus in neurology at UCLA. He is a world renowned expert on the brain, particularly dealing with pediatrics. 

A source has sent me a declaration under penalty of perjury that Shewmon signed on October 3, 2014, testifying that Jahi McMath is not only alive, but now also awake! From his declaration (my emphases):

Based on the materials provided to me so far, I can assert unequivocally that Jahi currently does not fulfill the diagnostic criteria for brain death. The materials include extensive medical records from St. Peter’s University Hospital, which I am still in the process of reviewing, videos of Jahi moving her hand and her foot in response to verbal requests by her mother, images from an EEG done in her apartment on 9/1/14, images of a brain MRI scan done at Rutgers on 9/26/20-14, and heart rate variability analysis by my colleague Dr. Calizto Machado based on the EKG channel from 9/1/14 EEG. 

Wait, there’s more:

Jahi does not currently fulfill criteria for brain death on several grounds. First and foremost, the videos and the personal testimonies to me of several trustworthy witnesses of her motor responsiveness (yourself [lawyer Nolan], Drs. DeFina and Machado) leave no doubt that Jahi is conscious and can not only hear but even understand simple verbal requests (“move your hand,” “Move your foot,” even, “move your thumb.”)

Thus, the very first of the “three cardinal findings in brain death,” according to the American Academy of Neurology’s Practice Permiters for Determining Brain Death in Adults (and all other diagnostic criteria for brain death that have ever been proposed, for that matter)–namely “coma or unresponsiveness”–is not fulfilled.

More, Jahi now has periods:

Corpses do not menstruate. Neither to corpses undergo sexual maturation. Neither is there any precedent in the medical literature of a brain-dead body beginning menarche and having regular menstrual periods.

The MRI:

Jahi’s recent MRI scan shows vast areas of structural preserved brain, particularly the cerebral cortex, basal ganglia and cerebellum. There is major damage to the corpus callosum and the brainstem, particularly the pons…corresponding to to the severe brainstem dysfunction that has been documented in her progress notes from St. Peter’s. 

By contrast, the relative integrity of the cerebral cortex no doubt underlies her ability to understand language and to make voluntary motor responses.

Shewmon doesn’t blame the original diagnosing doctors.

Clearly, Jahi is not currently brain dead. Yet, I have no doubt that at the time of her original diagnosis, she fulfilled the AAN diagnostic criteria, correctly and rigorously applied by the several doctors who independently made the diagnosis then…

She is an extremely disabled but very much alive teenage girl.

Shewmon doesn’t believe in brain death–not from a religious but a scientific perspective. That is a heterodox position, with which I disagree when the condition is accurately diagnosed.

But no matter. He is not an advocate but medical doctor and scientist with an excellent worldwide reputation.

This is the kind of evidence I said was necessary for this case to go forward. The heft of Shewmon and Machado’s reputation compel the case be reopened. 

Sometimes, we would be better heeding family observations than smugly assuming–as I have often seen in these kinds of cases–that they are only seeing what they want to see.

Good for Jahi’s family. Good for Bobby Schindler and the Terri Schiavo Life and Hope Network that went to their aid. And good for attorney Chris Dolan, who took a very unpopular case. 

Standing up to widespread scorn and derision is never easy–but so worth doing in the cause of what you see to be right.

 

 

Womb Transplant “Consumerist,” Not “Medical”



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The story of a successful birth post uterus transplant has been promoted understandably as a “feel good” saga of joy and the awesome power of modern medical science. But I have a different take.

Uterus transplants are “consumerist” procedures–as distinguished from “medical”–performed at sometimes great expense to enable lifestyle choices or help make dreams come true. As such, I believe they should be looked at differently than the usual healthcare.

But to the story. From the Telegraph report:

The parents of the first baby to be born from a transplanted womb have told of their delight. The boy’s birth took place in Sweden after surgeons at the University of Gothenburg performed the pioneering transplant procedure.

The baby was delivered by caesarean section in the 31st week of pregnancy. He weighed 3.9 pounds — normal for that stage of pregnancy – and both mother and child are now at home doing well…

British experts said that they were preparing to carry out a similar procedure next year. It could help 14,000 British women carry their own child.

Some would say that there nothing intrinsically different in transplanting uteri than hearts, livers or kidneys. They are all organs. 

Except there is.  Kidney, liver, heart, etc. transplantations are serious and very expensive, non-elective surgeries.  They are performed to save lives or restore essential functions. They also require expensive post-surgery drugs to suppress immune response–which also can carry some risks, deemed acceptable because of the urgent nature of the patients’ illnesses.

In contrast, transplanting a uterus is wholly elective, obviously performed to allow a woman to gestate and give birth. In other words, she has a bodily dysfunction, but is not sick. Indeed, her physical health is put at peril from the procedure, whereas doing nothing will not endanger her life or hurt her health. And given that the child is delivered early, there could be some risk to the baby.

This is a classic example of how on one hand we yell about out-of-control health care costs–and claim that shortages require that we ration care to the elderly, the disabled, the dying etc., based on quality of life judgmentalism. 

At the same time, we keep expanding the scope insurance or government-covered procedures intended to facilitate lifestyle choices or make dreams come true–even though they are not treating health-deteriorating illness or saving lives. Consider: If NHS covers potentially 14,000 transplants, what “medical” procedures will the technocrats decide not cover?

Finally, consider the paradox: If a woman wants a baby, we will allow womb transplants, biological colonialist exploitation of the destitute for their eggs or gestational capacities, one day, cloning, etc.. On the other, we slaughter tens of millions of fetuses each year–most killed for lifestyle facilitation purposes–and claim it is a fundamental right.

Meanwhile, countless children have no parents and desperately yearn to be adopted into loving homes.

I certainly hope mother and child do fine. And I get that the parents are very happy. But that shouldn’t be the only consideration.

So, sorry if I don’t ooh and aaah. But I don’t think this is a good trend. 

“Lethal Ageism” and Its Cure



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I delve into the deadly threats posed to our elderly loved ones by contemporary culture of death trends in my current First Things column.

I discuss some issues we have explored here at HE recently, such as the joint euthanasia killings of elderly couples in Belgium and Rahm Emanuel’s intention to die at 75 because after that, life isn’t much worth living–attitudes that are slipping into public policy.

Then, I get into the explicit advocacy among some in bioethics for a “duty to die.” From, “Lethal Ageism:”

Writing in the Hastings Center Report in 1997, bioethicist John Hardwig was even more explicitly lethal in his ageism, actually advocating that our venerable ones have a “duty to die” when they become dependent.

A duty to die is more likely when continuing to live will impose significant burdens—emotional burdens, extensive caregiving, destruction of life plans, and yes, financial hardship—on your family and loved ones. This is the fundamental insight underlying a duty to die.

A duty to die becomes greater as you grow older. . . . To have reached the age of say, seventy-five or eighty without being ready to die is itself a moral failing, the sign of a life out of touch with life’s basic realities.

Think about that. In essence, that is what Emanuel advocates between the lines. Hardwig is just more candid.

Next, I pivot to the potential cure. 

The antidote for lethal ageism is to assure our elderly at every opportunity that caring for them is an honor not a burden—a great gift not just a moral duty.

Sure, it can be tiring, but so what? We’ve all known people who cared for their elderly parents because it was the right thing to do, only to discover later that they were the prime beneficiaries. And we’ve known some who didn’t step up to the plate and later regretted their failure bitterly.

I quote a friend who left a successful career to care for his dying mother, and how that is the best thing he has ever done. Then, I conclude:

St. Paul put it this way: Love “bears all things, believes all things, hopes all things, endures all things. Love never fails.” We must love our elderly in just this way if we are to make them feel welcome and safe in an increasingly hostile world.

We are responsible collectively for our elderly worrying so deeply about being “burdens.” We also have the ability to undo the existential damage we have inflicted.

Texas Aborts Abortion



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The Texas abortion regulations have withstood federal appeal. From the Houston Chronicle story:

A divided federal appeals court ruled Thursday evening to allow Texas’s tough new abortion regulations to take effect, a decision that is expected to force all but seven clinics in the state to close…

The provisions require abortion doctors to obtain admitting privileges at a nearby hospital and abortion facilities to meet the standards of hospital-style surgical centers.

Is it not ironic that Planned Parenthood says only 3 percent of its business is abortion, yet closes its clinics en masse when the abortion going gets tough? What about all those breast exams they claim to be about?

Will the Fifth Circuit take it en banc? Don’t know. 

Will the case go to the Supreme Court if it survives the Fifth? I think so.  Will it survive the Supremes? Don’t know.

Could this case help lead to a pro-abortion reversal of Roe v. Wade? I think so. At least, that is where the pro abortion activists will now try to go.

Horrible Home Health Care in Province of Death



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I call it “Euthanasia Land:” When medicalized killing is advocated, it is always in the context of oh, so caring doctors, loving families, committed caregivers, and stalwart patients making “last resort” decisions.

Then, when real world care inadequacies are exposed–the actual context in which killing decisions are made–somehow, euthanasia never gets mentioned. It isn’t even a tickle in the back of the mind.

Example: Quebec has legalized a radical euthanasia bill, clearly not limited to the terminally ill–als requiring complicity from all Q-licensed physicians. Yet the Montreal Gazette writers ignore the killing agenda in an editorial rightfully decrying the shabby state of the province’s home health care system. From, “Homecare in Quebec is Profoundly Inadequate:

One bath a week. That is how low the standard of care has fallen for some elderly Quebecers in need of homecare, a publicly funded service that is supposed to allow ailing people to live at home with dignity so they don’t have to be institutionalized.

The office of Quebec’s ombudsman delivered another damning report last week, painting a dire portrait of health and social services, especially for seniors…Among the disturbing findings of the ombudsman’s report were regional disparities, lengthy waits for service even after need was determined, and levels of care being influenced by the presence of family members or the patients’ perceived resources.

Add to this a lack of quality control, widely diverging standards, insufficient evaluations — and in some cases a lack of time actually spent in patients’ homes by personnel

How does a major newspaper in the Canadian Province of Death square “profoundly inadequate” services for the elderly and medicalized killing? It doesn’t even try. Euthanasia Land.

Let’s connect the dots, people! Nous allons relier les points gens!

Yes, of course the Gazette editorialized in favor of the euthanasia law.

Claim: Jahi “Interactive” and “Responsive”



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I have read the petition filed on behalf of Jahi McMath’s mother to reopen the case and declare her daughter alive. Here is the gist:

Petitioner [Jahi's mother] is in possession of current evidence, including MRI evidence of the integrity of the brain structure, electrical activity in her brain as demonstrated by EEG, the onset of menarche…and her response to audible commands…demonstrating that Jahi McMath’s brain death was not “irreversible.”

This is a crucial contention. For brain death–or heart death, for that matter–to be “dead” the system failure must be irreversible. The contention here is that because some capacities returned, her condition was not factually irreversible, and hence, she is alive.

Back to the petition:

Petitioner’s experts will testify that Jahi may have, at the time of Dr Fischer’s examination, demonstrated evidence of brain death due to swelling of her brain…but, now that the swelling has receded, and she has had time to receive proper post incident medical care, she has demonstrable brain function.

Note, this isn’t evidence, it is an offer of proof. There also may be more evidence of brain function than listed in the petition.

At some point, I would expect sworn declarations under penalty of perjury from the experts claiming that Jahi is alive. If I can get them, I will describe here. 

This case should be heard and the evidence presented. But it had better be convincing. Too much is at stake societally for a claim of this nature to be made frivolously.

Or to put it another way: Jahi’s family deserves one bite of the apple. But only one bite.

By the way, the case should not be decided based on money, but whether Jahi is alive or dead.

HT: Thaddeus Mason Pope’s Medical Futility Blog.

Court Petition to Declare Jahi McMath Alive!



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According to the State of California, Jahi McMath has been dead since December 9, 2013, when she went into cardiac arrest after catastrophic side effects from throat surgery.

Oakland Children’s Hospital doctors insisted she was brain dead, that is, she had experienced total brain failure. Under California law, brain death is dead. 

When the doctors stated their intention to remove the life support from Jahi, her mother sued. A brouhaha ensued.

A judge appointed an independent physician from Stanford to examine the girl, and he too found she was dead. The judge declared her dead and the state of California issued a death certificate.

But the compassionate judge also pushed the parties into a settlement that released Jahi to the coroner–still on a ventilator–and thence to her family. She was taken out of state.

At the time, I wrote here and elsewhere that I thought she was dead. But I also said that if her body did not deteriorate–as almost all brain dead bodies do–my eyebrows would be raised. Over the last few months my eyebrows have migrated past my receding hairline.

I also wrote that if she was found to not actually be dead, there would be “hell to pay.” That bill may be coming due if the McMath attorney Chris Dolan, succeeds in having the state declare her alive. From the San Francisco Chronicle story:

Nearly 10 months after doctors found that Oakland teenager Jahi McMath was brain dead, an attorney for her family has petitioned an Alameda County judge to have her declared “alive again.” “I have medical experts, including world-class experts on brain death, who will testify she is not brain dead,” attorney Chris Dolan said Wednesday, calling a judge’s refusal last year to compel a hospital to care for her “a grave injustice.”

Oakland Hospital has been just abysmal in its PR in this case–and that maladroit insensitivity continues:

Hospital officials did not return our call seeking comment. However, in their court filing, attorneys for Children’s said Grillo’s ruling upholding the death declaration was “well-supported in fact and law.” What’s more, they said, Dolan missed the deadline to request a rehearing by seven months, and therefore the court no longer has jurisdiction to hear it.

Dolan argues that the court does have the legal authority to rule “in the interests of justice, which are literally those of life and death.”

Good grief. This isn’t about legal procedure. If evidence exists that she is alive, the hospital should be supporting that data coming out.

If evidence exists that Jahi is alive, it needs to be heard! That’s what we do in death penalty cases, after all: Permit new evidence even after procedural deadlines have passed.

Dolan is a well-respected lawyer. He is not saying that Jahi’s mother believes she is still alive, or that family members have detected interactivity in their deep love for her. He is not contending that the California law on brain death is wrong.

He is saying objective medical tests demonstrate that she is not brain dead. Or to put it another way, Dolan apparently believes that he can prove to the court, based on evidence, that Jahi McMath has positive brain function. If so, she is not dead.

Please note, this isn’t the same thing as saying she is awake. A persistently unconscious person is alive. A brain dead person isn’t in a coma, but deceased.

If Dolan successfully proves the case, there will be much hell to pay. There will be consequences.

Fasten your seat belts: This is going to be a bumpy ride!

 

Dutch Shrinks Kill More Mentally Ill Patients



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Dutch euthanasia rates keep rising, and the killable caste continues to expand. From, the DutchNews.nl story:

There were 4,829 official cases of euthanasia in the Netherlands last year, an increase of 15% on 2012, according to the annual report of the regional monitoring committees…

In total, there were 42 reports of people who underwent euthanasia because they suffered severe psychiatric problems, compared with 14 in 2012 and 13 in 2011.

Dementia was the reason behind 97 cases, mainly early stage dementia in which patients were able to properly communicate their wish to die.

And let’s not forget the elderly “tired of life,” experiencing social/financial difficulties, or living in a nursing home.

Then, after reporting the increased lethality and expanding categories, the story throws in the usual ridiculous bromide:

Euthanasia is legal in the Netherlands under strict conditions.

Ow! My stomach hurts from laughing so hard and so bitterly.

Hear me now or forget me later: Once a society determines that killing is an acceptable response to human suffering, there are virtually no limits to the kinds of suffering that qualify for killing.

The Cowardly God Complex of Transhumanism



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Ah, those paradoxical transhumanists: They disdain human exceptionalism–and then assure that human ingenuity will enable us to live forever with the powers of a superhero. 

And talk about hubris and delusions of grandeur. Maybe that’s why Psychology Today published Zoltan Istvan’s “Three Laws of Transhumanism.” 

Why, Wesley, what are the TLofT? I am glad you asked:

1) A transhumanist must safeguard one’s own existence above all else.

Really? Over one’s own children? If it means pushing people out of the lifeboat on the Titanic to save oneself? That’s a prescription for cowardice.

2) A transhumanist must strive to achieve omnipotence as expediently as possible–so long as one’s actions do not conflict with the First Law.

God complex alert! Sorry. No human being–or post human, should one ever come into being–will ever be omnipotent. Or omniscient, for that matter. And even uploading one’s mind into a computer won’t make one omnipresent, although I admit Google comes close.

3) A transhumanist must safeguard value in the universe–so long as one’s actions do not conflict with the First and Second Laws.

So, if necessary we can destroy planets, wipe out civilizations, and make species extinct, if that is required to save post-humans or give them the illusion that they can achieve omnipotence?

Like I always say, I am not worried about transhumanism succeeding in the creation of post humanity. But its values: Those are very worrying.

Istvan’s piece is just one small example why.

 

Darwinist Denies Human Exceptionalism in NYT



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The New York Times is consistently anti-human exceptionalism, never missing an opportunity to publish articles that seek to reduce humans to just another animal in the forest.

Today, the Sunday Review section has University of Washington biology professor, David P. Barash, bragging that he works to destroy faith in his classes (“The Talk”), insisting to his students that science and religion are incompatible.

That kind of ideological indoctrination is par for the disturbing course in universities, but not an issue with which I grapple. However, I would be remiss not to point out that this learned scientist–as so many of his ilk–also engages in profound reductionism by denigrating the unique moral value of humans beings. From, “God, Darwin, and my College Biology Class (my emphases):

Before Darwin, one could believe that human beings were distinct from other life-forms, chips off the old divine block. No more. The most potent take-home message of evolution is the not-so-simple fact that, even though species are identifiable (just as individuals generally are), there is an underlying linkage among them — literally and phylogenetically, via traceable historical connectedness.

Moreover, no literally supernatural trait has ever been found in Homo sapiens; we are perfectly good animals, natural as can be and indistinguishable from the rest of the living world at the level of structure as well as physiological mechanism.

Except we are. Human exceptionalism doesn’t rely on provable “supernatural traits,”–not sure what he means by that.  But we alone are creative. In the 1 billion years of life on this planet, no other species has created a sonnet or drawn even the most rudimentary picture on a cave wall or rock outcropping.

No animal has created philosophy. No animal comprehends right and wrong, good and evil. No animals fashion moral codes. 

These are distinctions with a huge moral difference regardless of whether we evolved into these natural human capacities through random means, design, or creation.

Indeed, Barash invokes those very moral concepts with regard to suffering–the driving impetus for anti-human exceptionalists:

But just a smidgen of biological insight makes it clear that, although the natural world can be marvelous, it is also filled with ethical horrors: predation, parasitism, fratricide, infanticide, disease, pain, old age and death — and that suffering (like joy) is built into the nature of things.

The more we know of evolution, the more unavoidable is the conclusion that living things, including human beings, are produced by a natural, totally amoral process, with no indication of a benevolent, controlling creator.

But these aren’t ethical horrors at all in the natural world. Indeed, without death and its many causes, natural selection could not operate.

“Ethics” only come into play when the actions or consequences that Barash invoke involve human agencyIndeed, why is it only humans take such offense at these issues? Why do only we make moral judgments about any of this?

Because we are exceptional. 

And what other species works so empathetically to mitigate suffering? Perhaps that’s a spark of something indefinable that Barash chooses not to see.

The other day, a friend and I were playing a round of golf and came upon a downed deer, a juvenile male and had clearly been severely injured in a rutting fight. If I had a gun with me, I would have shot the suffering, dying animal. 

We stopped golfing and urgently waved down a grounds keeper to get help.  He took one look and immediately called the clubhouse, assuring us help would be called. He later told us the deer expired before an animal control officer could arrive.

I mention this not because what we all did was special, but because–for humans–it wasn’t! Any other species coming upon the dying deer would have either eaten it or ignored its travail.

That’s a huge difference, the importance and meaning of which Barash’s oh, so rational mind appears unable to comprehend.

No matter. I always get a chuckle out of ideologues, who so smugly claim the mantle of defender of objective science to push their anti-human exceptionalism (and often, as here, anti-religious) views: They always invoke aspects of our intrinsic uniqueness they huff and puff to deny.

P.S. The Times carries another column about how we are supposedly responsible for mass extinction, and what we can do to save endangered species. One question: If we are not exceptional, how could we cause such a thing–and moreover, why would we care? 

Who Decides the Harm in “Do No Harm?”



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Medical futility disputes often involve the question of harming the patient. Family/patient believe they should decide what constitutes “harm” in these cases, and that for the patient/family, the greatest harm would be death.  Hence, they insist that efficacious treatment to extend life continue–as the way to avoid harm. That is, after all, a fundamental purpose of medicine when staying alive is wanted.

Bioethicists and some doctors believe that they get to decide what constitutes “harm.” Thus, if a patient is unlikely to recover or ever lead a “meaningful” life, they insist on being able to stop wanted treatment. 

Religion is also a large factor in many of these situations. The secularist view sees suffering as the worst harm. Many religions, particularly more traditional approaches to Catholicism, Islam, and Judaism, death. Thus, forcing treatment to cease is often viewed as disrespecting freedom of religion.

At the same time, many futilitiarians believe in judging “harm” on a the macro level. They look beyond the patient to perceived emotional harm to the family–and the morale of the reluctant medical team–as well as financial harm to society by “investing” resources on the patient supposedly more wisely spent elsewhere.

So who gets to decide the meaning of “harm” in a particular situation–the patient/family or the technocrats?

Canada has established a bureaucratic board to make these decisions when doctors/bioethicists and patients/families disagree. From the Toronto Star story:

In Ontario, intractable, life-and-death disputes between physicians and patients’ families sometimes end up before a unique provincial body charged with wading into complex issues of medicine, ethics and faith. The little-known Consent and Capacity Board (CCB) — the only one of its kind in North America, perhaps anywhere — is a working laboratory for the most pressing issue facing Canada’s healthcare system: the end of life.

When a physician’s treatment proposal is challenged by a family member whose loved one can no longer communicate their wishes, doctors can make an application to the CCB. The Board then convenes a hearing within seven days, often in hospital board rooms, headed by a lawyer, a public member and a medical professional, typically a psychiatrist.

The panel’s job is a mix of legal arguments and character analysis. It must ultimately determine an incapacitated patient’s “prior wishes” or “best interests.” The panel must then issue a binding order within 24 hours of the hearing’s conclusion — a remarkably fast and economical process relative to the courts.

It seems to me that these futility cases are so relatively few and far between that coercion should rarely–if ever–be used.

These are subjective decisions. Establishing bureaucratic boards would sow mistrust for the system and validate the concept of “death panels.”

And talk about the potential for abuse of power. Why should strangers to the patient be given so much authority,in effect, empowered to impose their values over those of the family?

No. Education and continual mediation should be the watchword. Doctors should be brutally frank about the consequences of continuing care. But barring very rare circumstances, the patient/family should have the final word.

Children Support Parents’ Joint Euthanasia



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If this doesn’t scare you, nothing will.

A doctor has agreed to murder euthanize a healthy elderly Belgian couple who don’t want ever to live apart–and their three children approve. One even procured the death doctor. From the Daily Mail story:

Their son, John Paul, 55, approached their doctor to request their euthanasia – which was legalised in Belgium in 2002 – but the doctor refused because there were no grounds for it. John Paul found another doctor willing to perform the killings in an unnamed hospital in Flanders, the Dutch-speaking part of Belgium in which 82 per cent of euthanasia cases are performed.

Francis said he and Anne were grateful for the arrangement. ‘Without our son and our daughter, it would never have succeeded,’ he said. ‘We are not sad, we are happy,’ he continued. ‘When we were told we could leave life together smoothly we were on a little cloud. It was as if we had spent all that time in a tunnel and suddenly we came into the light again.’

The couple’s daughter has remarked that her parents are talking about their deaths as eagerly as if they were planning a holiday. John Paul said the double euthanasia of his parents was the ‘best solution’. ‘If one of them should die, who would remain would be so sad and totally dependent on us,’ he said. ‘It would be impossible for us to come here every day, take care of our father or our mother.’

Imagine knowing your children don’t want you depending on them–because that is really what is being said.

If I told my mother I supported her euthanasia at 97, it would make her want to kill herself! Good grief.

The story is wrong that this would be the first joint euthanasia in Belgium of elderly couples–which I have covered here at HE at least twice before. It has also happened in Switzerland.

But that’s the way euthanasia rolls. Culture of death, Wesley? What culture of death?

Assisted Suicide as “Last Resort” Fantasy



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Many supporters of assisted suicide are well-meaning, really thinking that it would only be done in the proverbial “last resort” scenario. But that’s a fantasy, as we will discuss below.

The bioethicist, Art Caplan, is one such last resortist. He used to oppose assisted suicide but now believes it can work under “strict guidelines”–such as waiting periods and terminal illness–and then, only as a last resort. From his, “Physician-Assisted Suicide: Only as a Last Resort,” published on Medscape:

The other restriction I would look for with respect to assisted suicide is to first offer people palliative care, hospice — options that do not involve taking the person’s life. If they say, “I’m in pain”; if they say, “I’m spiritually upset,” then we ought to try to address that first before we say, “Here’s a pill; goodbye.”

It does seem to me that good palliative care and good hospice care are crucial as fundamental components of what assisted suicide should be about. We do not want to encourage people toward assisted suicide. We may want to include it as an option but absolutely the option of last resort…

Assisted suicide may work but only with adequate protections, adequate controls, adequate oversight, and adequate regulation to make sure that people do not think, “I better do this because I am a burden to others” or “I am going to do this because nothing else out there can help me with my pain, suffering, or depression.” Those are not adequate ethical circumstances to support someone ending his or her own life.

Sorry. Assisted suicide is never practiced only as a “last resort.” Consider:

1. “Offering”hospice is not a “last resort” measure. Some who would be helped might turn it down and get assisted suicide anyway.

2. Suicide prevention is an essential hospice service. Denying that intervention no different ethically than denying pain pills.

3. Most assisted suicides in Oregon and Washington do not involve “last resort” situations in which a patient is in intractable pain for which nothing can be done to eliminate suffering.

4. The laws don’t require “last resort,” application only.

5. There is no “adequate oversight” by regulators in Oregon. The law relies almost entirely on physician self-reporting and the Oregon Health Department, which oversees the law, has no budget or authority to conduct investigations if the guidelines are violated.

6. The only real requirement in Oregon, Washington, and Vermont is diagnosis of terminal illness reasonably likely to cause death within 6 months. Some people last for years with that diagnosis. A few never die of the diagnosed condition at all.

7. The most common reasons for committing assisted suicide in Oregon/Washington are not wanting to be a burden, worrying about losing the ability to engage in enjoyable situations, etc..These existential issues are very important and certainly need attention of caregivers–but they are not “last resort” problems, at least as that term is commonly understood.

8. Oregon rations health care on Medicaid, such as life-extending (as opposed to curative) chemotherapy, but always pays for assisted suicide. Two cancer patients even received letters refusing chemo but assuring that assisted suicide would be paid.

9. Studies show how impersonal the death bureaucratic process can be. Example: Kathleen Foley–perhaps the nation’s palliative care doctor–and suicide expert, the psychiatrist Herbert Hendin, revealed the paper-thin protection Oregon’s guidelines provide. From their ignored-by-the-media study published in the Michigan Law Review:

He [the prescribing death doctor] stated that after talking with attorneys from the Oregon Medical Association and agreeing to help aid Joan in death, he asked Joan to undergo a psychological examination. The doctor reported that…”I elected to get a psychological evaluation because I wanted to cover my ass.”

The doctor and the family found a cooperative psychologist who asked Joan to take the Minnesota Multiphasic Inventory, a standard psychological test. Because it was difficult for Joan to travel to the psychologist’s office, her children read the true-false questions to her at home. The family found the questions funny, and Joan’s daughter described the family as “cracking up”over them. Based on these test results, the psychologist concluded that whatever depression Joan had was directly related to her terminal illness, which he considered a completely normal response… [Me: Can we say “rubber stamp?]

The psychologist’s report in Joan’s case is particularly disturbing because without taking the trouble to see her, and on the basis of a single questionnaire administered by her family, he was willing to give an opinion that would facilitate ending Joan’s life. The physician’s attitude toward the consultation surely played a part in his receiving a report that did not meet professional standards.

Assisted suicide is sold as “last resorts” to a wary public. Some, like Caplan, even believe it. 

But it is not applied that way in the real world. Moreover, once society widely accepts killing for suffering, the outcome is Belgium. That hasn’t happened here yet. But if the country generally swallows the hemlock, it will.

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