There is some sense to calling Pentecost the birthday of the Church, but it can be somewhat glib.
You might say that the Church was born when Christ was born, or when water and blood, Baptism and Eucharist, flowed from Christ’s side on the Cross. You might even say that the Church was born with Adam and Eve and came to maturity when Jesus, the new Adam, and his mother Mary, the new Eve, greeted each other in the unrecorded instant before the break of Easter dawn. What we can say with precision is that on Pentecost the bond of love between the Eternal Father and the Eternal Son filled the Church. When Christ prayed the night before he died, he spoke of that unifier which is the Holy Spirit: “I made known to them your name, and I will make it known, that the love with which you loved me may be in them and I in them” (John 17:26).
The Year of Faith proclaimed by Pope Benedict XVI is to put to work the Seven Gifts of the Holy Spirit, which are given in Confirmation: wisdom, understanding, counsel, fortitude, knowledge, piety, and fear of the Lord. They give life to the Seven Holy Virtues and defeat the Seven Deadly Sins. He who has never been tempted by those sins would be an oyster or a rock rather than a human.
Perhaps the most underestimated sin is sloth. It is not simple laziness: sloth is spiritual apathy that dampens ardor for serving God in our short lifespan. An example of this is an individual who recently complained about Pope Francis canonizing the 813 martyrs of Otranto,[ who were killed by Muslims ] since it might be taken as an affront to Islam. We cannot pretend that they were martyred by wild Methodists brandishing water pistols, but the real problem is that slothful souls cannot understand why anyone would give one’s life for Christ.
Rather, Pope Francis said, “As we venerate the martyrs of Otranto, let us ask God to sustain those many Christians who, in these times and in many parts of the world, right now, still suffer violence, and that he give them the courage and fidelity to respond to evil with good.”
In our corner of the Church, which is New York, sloth is more subtle than heresy or blasphemy or wrath. Notwithstanding all the good things in our archdiocese, it is significantly below many other areas of our nation in attendance at Holy Mass and in priestly vocations. This is not what one would expect of a people filled with the Holy Spirit. With the beauty of worship in our parish, and the springtime of vocations exemplified by two of our young men being ordained this month, we too may risk becoming smug, a condition as ugly as it sounds, forgetting that there is much more to do. “Come Holy Spirit. Enlighten the hearts of your faithful people.”
Kermit Gosnell may be behind bars, but his deadly legacy lives on. Just when the abortion lobby thought it could turn the page on the PR disaster of the Women’s Medical Society, a new “house of horrors” is making headlines–this time in Texas.
There, the eye-witness accounts rival those of even Gosnell’s clinic, as three former employees described a staggering amount of violence, which would, on occasion, involve Douglas Karpen twisting off the heads of newborn babies. It was a routine procedure, Deborah Edge said of the born-alive killings–which usually involved cutting babies’ spinal cords or gouging them in the skull.
“I thought, well, it’s an abortion you know, that’s what he does, but I wasn’t aware that it was illegal… Most of the time, we would see him where the fetus would come completely out, and of course, the fetus would still be alive.” Asked how often the babies would be delivered before they were murdered, Edge responded, “every morning… on several occasions.”
In one of the more heart-wrenching parts of the interview, Deborah described how babies would be born “too soon” and would be “alive, moving, and breathing.” She said that sometimes Karpen would deliver the babies “feet first with the toes wiggling until he stabbed them with a surgical instrument.” At that moment, she explains quietly, the toes “would suddenly splay out” in excruciating pain “before going limp.” The process was so sickening and so messy that she recalls “the whole floor dirty. I’m talking about me drenched in blood.”
While Texas officials investigate, Congressman Trent Franks (R-Ariz.) took the opportunity yesterday to press Attorney General Eric Holder on whether the DOJ is turning its back on this grisly trend. “In 2002,” Franks said, “Congress enacted the Born-Alive Infant Protection Act that provides that all federal protections–including from your office, sir, for persons apply to every infant born alive. So will you enforce the Born-Alive Infant Protection Act as Attorney General and will you consider carefully what’s happening in clinics across the country like happened at the clinic that Kermit Gosnell ran?”
Holder, whose wife has her own ties to the abortion industry, insisted that he shared Franks’s concerns and acknowledged his responsibility to “enforce all the laws that Congress passes.” Yes, said Franks, but “have you ever enforced this law even one time?” “I don’t know,” replied Holder. “I just don’t know what the statistics are.” Enforcement, after all, is a relatively new concept at the Justice Department (see U.S. marriage and obscenity laws). Still, if there had been prosecutions, he would know about it.
With a web of underground killing fields in New York, Pennsylvania, Arizona, Maryland, and now Texas clinics, this is no longer a hypothetical question of children’s safety. It’s a pervasive practice that had obviously gone undetected for years–until Gosnell trial’s and Lila Rose’s undercover videos.
Her discoveries will be the subject of a special webcast edition of “Washington Watch” next Tuesday, May 21, at 5:00 p.m. (EDT). Together with congressional leaders like Rep. Marsha Blackburn, we’ll explore Live Action’s “Inhuman” campaign and explain how you can be involved in ending the Gosnell-type violence in clinics across America.
Updated: 11:23 a.m. Friday, May 17, 2013 | Posted: 10:54 a.m. Friday, May 17, 2013
A bitter and increasingly nasty split within the anti-abortion movement and like-minded organizations helped derail legislation seeking to resolve disputes that arise when family members oppose a doctor’s order to halt treatment and allow a seriously ill patient to die.
The bill, intended to balance patient rights against a doctor’s ethical obligation to do no harm with end-of-life treatment, was approved by the Texas Senate but will not get a vote in the House Public Health Committee because of deep divisions among House Republicans, said Rep. Lois Kolkhorst, R-Brenham.
“
There are vast differences between members” on the best approaches to take on end-of-life care, said Kolkhorst, chair of the committee. “It’s a judgment call by a chairman. It was not a judgment call made without a lot of prayer.”
Among a wide range of advocacy groups and religious organizations, there is near-unanimous agreement that Texas laws governing end-of-life care must be changed to better protect patient rights.
But for a decade, attempted fixes have fallen short in the Legislature amid fractures among groups that typically work toward the same goals.
Those fractures erupted into hostility and discord this session as accusations flew over lying, political posturing and bad-faith negotiating.
Much of the dispute surrounds hospital ethics committees. In Texas, if doctors believe continued treatment would inhumanely extend suffering, they can overrule family wishes by asking the ethics committee for approval to halt life-sustaining care — which can include withholding dialysis, ventilators and food and water administered via tubes.
If the committee — often comprising uninvolved doctors, social workers and clergy — agrees, treatment can be halted in 10 days.
The process is intended to shield doctors and hospitals from wrongful death lawsuitswhile protecting the rights of patients, the vast majority of whom are unresponsive and represented by family or other surrogates.
But in practice, according to hours of testimony at legislative hearings, families can be left scrambling in an unfamiliar system, with an impractical deadline, to find a caregiver willing to take the patient.
Senate Bill 303 by Sen. Bob Deuell, R-Greenville, would give families 21 days to find alternate care. It would also give more time to prepare for the ethics committee meeting — seven days instead of two — and require hospitals to provide care throughout the process.
Also under the bill:
• If a patient or surrogate objects, a doctor cannot place “do not attempt to resuscitate orders,” known as DNARs, on a patient’s chart without ethics committee approval.
• The hospital must supply a liaison to help the family navigate the ethics committee process.
• Up to five family members can be in the meeting, and medical records must be supplied without charge.
At Kolkhorst’s request, Rep. Susan King, R-Abilene, this week drafted a revised version of the bill, focused on banning secret DNARs and requiring water and nutrition to be provided to patients. The hope was to find something that could pass the committee without opposition, but even that version proved to be “too complicated,” Kolkhorst said.
Opponents, led by Texas Right to Life, have labeled ethics committees as “death panels” and say Deuell’s bill puts all the power into the hands of hospitals and doctors — charges Deuell has called distorted and wrong.
Right to Life supports a practice known as “treatment until transfer,” requiring hospitals to provide care until an alternate provider can be found, no matter how long that takes. End-of-life choices belong with the family, not hospital bureaucrats, they say.
Doctors object, saying treat until transfer amounts to government-imposed care that forces physicians to violate their ethics. Heroic, life-sustaining treatment frequently has painful consequences, including infections, they say.
Deuell hammered out a pre-session compromise with doctors, hospitals, religious leaders and the Texas Alliance for Life, which opposes abortion. The Senate voted 24-6 to approve the bill. All opponents were conservative Republicans.
King picked it up in the House and added language ensuring that “no patient is discriminated against based on disability, age, gender, ethnicity or financial or insurance status.” The change was intended to address concerns by disability rights groups, who complained that they were not invited to previous negotiations, King said.
All 13 Catholic bishops in Texas support Deuell’s bill, signing a letter saying it “respects the natural dying process.” It was countered by a letter from leaders of Eagle Forum, National Right to Life and almost 20 affiliated groups who criticized the bill, saying it improperly allows doctors “to make value judgments on the lives of these ailing patients.”
Deuell has said that defeating his bill, negotiated with the powerful lobbies including doctors, hospitals and religious leaders, would doom any future attempts to beef up patient protections. A similar compromise effort in 2007 passed the Senate but also died in the House.
Treat to transfer, he noted, isn’t a viable option. Treat-to-transfer bills have not gotten out of committee in either house during the past four legislative sessions.
This story has been updated to correct the name of a legislative committee and the bill number.
This is the SEVENTH of a series on human organ donation/transplantation I will be posting on this blog. Why will I be doing this? Because I am convinced that the transplantation of human organs is BIG BUSINESS. While it illegal to buy and sell human tissue and human organs for transplantation, it is legal for individuals to donate their tissue and organs to be transplanted into other persons who desperately need such transplanted tissue and organs in order to live a better life and in many cases, such transplanted tissue and organs are necessary for the recipient to stay alive.
While it is illegal to buy and sell human tissue, donated tissue and organs when transplanted in recipients produce a lot of money for the doctors making the removal or the insertion of tissue and organs and for the medical facilities, hospitals or clinics. Transplant operations can cost hundreds of thousands of dollars. Obviously then it is not unreasonable to describe the medical practice of removal and/or transplantation as BIG BUSINESS.
According to Transplant Living, the average total cost of a single heart transplant in 2007 was $658,800. This figure includes the cost of obtaining a donor heart, at an average of nearly $90,000, about $23,000 in evaluation fees, $40,000 for doctor’s fees, $383,000 in hospital costs, $93,000 in post-operative care, and over $29,000 for immunosuppressive prescription medications. Transplants that involved both a heart and a lung cost an average of $874,800, while heart and kidney combination transplants cost an average of $758,700.
Donors of tissue and organs act out of compassion. The same cannot be said of the health care industry. Example: last year the Chinese government brought charges against local officials in the western region of China who were systematically putting political dissidents in prison and then executing them in a mobile medical facility where their tissue and organs were removed and shipped throughout China where wealthy Chinese paid hundreds of thousand dollars for organ transplants. That practice is not confined to China but is present more or less in many countries.
While such a violation of human rights probably does not occur in the United States, there is illegal trafficking in tissue and organs. What immediately concerns me is the suspicion that the interest of the health care industry and tontos utilespromoting legislation such as the currently pushed Texas Senate Bill 303 and the Texas House Bill 1444 is that such legislation promotes the ‘third way’ for passive euthanasia. Simply put, it is so easy for trained health care personnel to have a naive patient check off boxes on a document like a POLST document that both authorizes withdrawal of treatment (including nutrition and hydration) and the donation of the patient’s organs. George Orwell is probably nodding his head when he hears some proponents of ‘palliative care’ push their agenda; he warned us to look behind the meaning of words.
When any patient dies, the hospital is required to contact the local Organ Procurement Organization (OPO). A member of that organization then determines if you are a designated donor or a potential donor and whether your organs are candidates for donation. Your family is contacted about donation, asked for consent if you didn’t register as an organ donor and asked about your medical history.
If it’s determined that your organ can be used, it’s removed, carefully packaged and delivered to the transplant hospital. If the transplant hospital is in the same geographic area as the location of your body, a representative from the OPO transports your organ in a cooler. However, if the organ’s destination is farther away, a contracted team from that hospital or OPO will fly to the organ, take possession of it and deliver it to the transplant hospital. Your organ will then be transplanted into the waiting recipient.
Though you won’t be paid for a living donation, the National Living Donor Assistance Center helps people who can’t afford the expenses they may incur when donating. This isn’t done as an incentive or payment for the donation itself but rather to remove financial obstacles for interested donor candidates. Available assistance includes reimbursement for travel costs and certain nonmedical expenses (such as lodging or meals). Assistance isn’t provided for cases in which expenses have been or will be paid by any other state or federal agency, insurance policy or the organ recipient. The organ recipient carries some expectation of compensation for the donor’s expenses. However, if the recipient’s income is under 300 percent of the federal poverty guidelines or if hardship can be determined on a case-by-case basis, the program will compensate the donor. Additionally, in some states it’s possible to receive a state income tax deduction for lost wages.
Living donors must strive toward good health get regular medical checkups to stay on top of any potential side effects that may develop from donation. And living donors continue to be at financial risk well after the expenses affiliated with donation are paid off. Most health and life insurance companies will not change rates for a donor, although a living donor may encounter higher rates if seeking to change policies or insurers. Additionally, health conditions resulting from organ donation may not be covered by insurance companies. If a living donor ever needs an organ donation himself or herself, the United Network of Organ Sharing (UNOS) will designate the person with points for more immediate attention. While this provides some preference toward the donor, he or she will still have to wait behind more pressing cases.
If you’re short on this month’s rent, the next section might be of interest to you.
Handouts and Hand-backs
Not all organ recipients are happy with their new body parts. In 1998, New Zealander Clint Hallum became the first person to ever have a successful hand transplant, and in 2001, he became the first person to have a transplanted hand surgically removed by request. Hallum stated he was “mentally detached” from the hand, which, although functional, was much larger than his left hand, a different color and covered in flaky skin
.
In 2006, a Chinese man became the first successful recipient of a transplanted penis after losing his own in an accident. Shortly thereafter, the man asked to have it removed because it was causing him and his wife psychological problems
This is the SIXTH of a series on human organ donation/transplantation I will be posting on this blog. Why will I be doing this? Because I am convinced that the transplantation of human organs is BIG BUSINESS. While it illegal to buy and sell human tissue and human organs for transplantation, it is legal for individuals to donate their tissue and organs to be transplanted into other persons who desperately need such transplanted tissue and organs in order to live a better life and in many cases, such transplanted tissue and organs are necessary for the recipient to stay alive.
While it is illegal to buy and sell human tissue, donated tissue and organs when transplanted in recipients produce a lot of money for the doctors making the removal or the insertion of tissue and organs and for the medical facilities, hospitals or clinics. Transplant operations can cost hundreds of thousands of dollars. Obviously then it is not unreasonable to describe the medical practice of removal and/or transplantation as BIG BUSINESS.
According to Transplant Living, the average total cost of a single heart transplant in 2007 was $658,800. This figure includes the cost of obtaining a donor heart, at an average of nearly $90,000, about $23,000 in evaluation fees, $40,000 for doctor’s fees, $383,000 in hospital costs, $93,000 in post-operative care, and over $29,000 for immunosuppressive prescription medications. Transplants that involved both a heart and a lung cost an average of $874,800, while heart and kidney combination transplants cost an average of $758,700.
Donors of tissue and organs act out of compassion. The same cannot be said of the health care industry. Example: last year the Chinese government brought charges against local officials in the western region of China who were systematically putting political dissidents in prison and then executing them in a mobile medical facility where their tissue and organs were removed and shipped throughout China where wealthy Chinese paid hundreds of thousand dollars for organ transplants. That practice is not confined to China but is present more or less in many countries.
While such a violation of human rights probably does not occur in the United States, there is illegal trafficking in tissue and organs. What immediately concerns me is the suspicion that the interest of the health care industry and tontos utilespromoting legislation such as the currently pushed Texas Senate Bill 303 and the Texas House Bill 1444 is that such legislation promotes the ‘third way’ for passive euthanasia. Simply put, it is so easy for trained health care personnel to have a naive patient check off boxes on a document like a POLST document that both authorizes withdrawal of treatment (including nutrition and hydration) and the donation of the patient’s organs. George Orwell is probably nodding his head when he hears some proponents of ‘palliative care’ push their agenda; he warned us to look behind the meaning of words.
Organ donation is a very complicated and well-coordinated process. At any given moment, organs become available, and a series of individuals, groups and organizations must swing into action. Organs cannot be stored, and most die within 4 to 24 hours of being removed from the human body. In order to maintain a streamlined, efficient and lawful process, several nonprofit entities have been established to facilitate organ donation.
Organ Procurement Organizations (OPOs) are federally designated, nonprofit local entities throughout the United States. They’re responsible for organ donor awareness, donor recruitment and evaluation, organ removal and its subsequent transportation. Each state has its own OPO, often with a central location as well as satellite offices throughout the state. When a patient dies, hospitals are required to contact the local OPO. A representative determines whether the person is registered as an organ donor and if his or her organs can be used. If consent is given — either by the patient prior to death or by the next of kin after the patient’s death — the OPO collects the donor’s relevant medical history and arranges to have the organ or organs removed from the body in the operating room, packaged and shipped to the receiving hospital.
The United Network of Organ Sharing (UNOS) is responsible for placing donated organs as well as maintaining the national waiting lists for them. It’s based in Richmond, Va., and is open 24 hours a day, 365 days a year. On an average day, organ placement specialists at UNOS find 15 recipients for organs, match 12 organ donors with local OPOs and take 350 phone calls relating to organ donation and transplantation logistics.
In 1984, the Organ Procurement and Transplantation Network (OPTN), a unified transplant network, was established. UNOS is responsible for administering the OPTN. The OPTN collects organ donation and transplantation data, drafts organ transplant policies and maintains a national computer network that matches donors with recipients. The OPTN maintains organ waiting lists, determines who has priority on the lists in each individual case and contacts the appropriate transplant hospitals.
The Scientific Registry of Transplant Recipients (SRTR) is a statistical database for organ transplant information. The SRTR maintains data on every facet of the donation and transplantation process that it collects from hospitals, the OPTN and local OPOs. This information is used by researchers, analysts, doctors and policy-makers to determine priorities and possible improvements in the organ donation process. The database is maintained by the Arbor Research Collaborative for Health in Ann Arbor, Mich.
Continue reading to find out the exact route your donated organ will take once it’s removed from your body.
Donation Firsts
1668: Bone graft from a dog’s skull successfully attached to a human’s head
1905: Slices of a rabbit kidney inserted into a child, improving kidney function though the child dies shortly thereafter of pulmonary congestion
1905: A cornea is transplanted to the damaged eye of a laborer, restoring sight
1906: A pig kidney is unsuccessfully transplanted into a human
1911: First vein transplant
1920: Monkey testicles successfully implanted into human
1923: Recipient of lamb kidney survives for nine days
If you want to experience the Middle East, you only have to travel as far as Dearborn, Michigan. This western suburb of Detroit has a population of close to 100,000. Over 40,000 of them are Arab or of Arab descent, giving Dearborn the distinction of having the largest Muslim population of any city in the United States.
The Muslims have been taking over many of the cities elected positions and have instituted many Muslim friendly ordinances. In fact the Muslim influence is so strong in Dearborn that the local high school held a girl’s only prom, since their religion does not allow girls and boys to dance or socialize together. If any other school in America did something similar based on Christian or Jewish beliefs, the ACLU and other groups would be circling the school waiting their turns to file lawsuits for violation of church and state. But these legal groups were nowhere to be seen in Dearborn.
Every year around June, the Muslim community holds an annual Arab Festival. For several years, some of the Christian pastors and their followers have stood outside the festival trying to hand out water bottles and tracts as they witness to the lost. A number of the Muslims have responded with violence, throwing garbage, rocks and other items at the Christians. When the police showed up, they made arrests, but it wasn’t the ones carrying out the violence that were arrested, it was the Christians.
A number of lawsuits have been launched against the city and although a couple were actually won by the Christians, that didn’t stop the violence against them. When they did win, the city appealed and most of the rulings were overturned.
Several of the Christian pastors filed a lawsuit against Wayne County, the Wayne County Sheriff’s Department and two of deputies for refusing to protect them from the Muslims that were attacking them. The deputies not only refused to protect them, they threatened to arrest them for disorderly conduct if they continued talking about Jesus and the Bible in the presence of the Muslims. Such talk was deemed to be offensive to the Muslims who felt justified in responding with violence.
On Tuesday, US District Court for the Eastern District of Michigan Judge Patrick J. Duggan dismissed the lawsuit when they granted the county’s motion for a summary judgment. The American Freedom Law Center argued the case before Duggan and also asked that the court bar the sheriff’s department from violating the Christian’s First Amendment rights of free speech and religion by interfering with their right to gather on public property outside the festival. In typical liberal fashion, Duggan refused to the motion.
In his ruling, Duggan stated:
“The Court finds that the actual demonstration of violence here provided the requisite justification for [the Wayne County sheriffs’] intervention, even if the officials acted as they did because of the effect the speech had on the crowd.”
In other words, the Christians were at fault and that the violent reaction of the Muslims was justified and the cops acted appropriately in arresting the Christians.
Robert Muise, Co-Founder and Senior Counsel for the American Freedom Law Center commented on Duggan’s dismissal saying:
“The First Amendment was dealt a severe blow today as a result of this ruling. Indeed, this ruling effectively empowers Muslims to silence Christian speech that they deem offensive by engaging in violence. And pursuant to this ruling, the Christian speakers are now subject to arrest for engaging in disorderly conduct on account of the Muslim hecklers’ violent response to their speech. In short, this ruling turns the First Amendment on its head.”
David Yerushalmi, another Co-Founder and Senior Counsel for AFLC said:
“This fight for our fundamental right to freedom of speech does not stop here. We have filed an immediate appeal of this ruling to the U.S. Court of Appeals for the Sixth Circuit. While Judge Duggan may have been the first judge to rule on this issue, he won’t be the last. Indeed, we are prepared to take this case to the U.S. Supreme Court if necessary because it is imperative that our free speech rights not be subject to mob rule. This is the United States, not Benghazi.”
Since when does anyone’s speech justify acts of violence? Where in the Unites States Constitution or Bill of Rights does it say that speech of any kind, especially religious speech can be stopped because someone or group of people are offended?
Time and again I see where the rights of Christians are being violated because someone else is offended. The saddest part in all of this is that many Christians are just rolling over and letting their rights be stripped away. When will Christians wake up and start fighting for their actions? When will Christians start filing lawsuits against Muslims or gays because of what they say and do is offensive to us?
Christian students are being bullied and harassed by teachers because they wear a Christian message on their t-shirts. Shouldn’t we be offended when we see t-shirts with an evolution or atheist or Muslims message on it? Then why aren’t we standing up and turning their own weapon against them?
Christians need to stop listening to Peace in the Valley and start listening to Onward Christian Soldier. Like it or not, we are in a war and right now we are losing that war big time and it’s our own fault.
Let me ask you a question. Is there anything in your life that you feel is worth fighting for? Our nation? A loved one in danger? Your property? How much more valuable is your Christian faith? So why aren’t you fighting to save it? I hope you realize that the only one you have to blame for losing your Christian rights and freedoms is you, because chances are you haven’t done a single thing to fight for them. Shame on you!
It’s time you make a decision here and now. Either stand up and fight for your Christian faith and freedoms or accept the inevitable persecution that’s coming if you don’t. The choice is yours.
No Due Process, No Justice for a Patient: SB 303 Only Makes TADA Worse; Representative King’s Amendments Do Not Remedy the Problems
By Kassi Dee Patrick Marks, JD
1. The recently passed SB 303, even with Rep. King’s amendments, does not address the fundamental problems inherent in the Texas Advance Directive Act (TADA) and creates entirely new problems. This committee should not set a vote for it at all. In the event a vote is set, this committee should vote against it.
2. At the outset, one must begin this analysis with questioning why any doctor would believe it is so necessary to have enshrined in law an ability to withdraw care from a patient rather than just say, “I don’t want to treat you, here’s a referral to another doctor” and have that followed with treatment until transfer. The proponents of SB 303 assume all doctors would have the same opinion or that such a doctor is infallible. Instead ofthat more balanced approach that would err on the side of life, proponents of SB 303 would further set into our law and insist on a (as in one) treating physician having the RIGHT according to CONSCIENCE to determine DENIAL of any further care for that patient and have a hospital “ethics” committee rubber stamp that after a kangaroo court. It simply makes no sense and makes a mockery out of any claim to “do no harm.” SB 303 changes nothing about the current law which does just this. What SB 303 does is codify this same result with regard to Do-Not-Attempt-to-Resuscitate Orders (DNARs). There is no rebalancing of powers here; there is no justice; there is no due process. There is a patient being handed a death warrant by a doctor and “ethics” committee without any recourse to court. TADA is bad law. SB 303 only makes it worse.
3. Patients[1] (or their family members) in Texas should have a right under the law to determine whether a DNAR is put in their chart at all. If they choose not to have a DNAR in their chart, that should be entirely respected. With regard to continuing life-sustaining treatment, patients should have the right to dictate their destiny. If a doctor no longer wants to treat the patient, then the doctor should tell that to the patient, give a list of referrals to the patient, and thenrecuse himself. Another doctor should then oversee treatment until transfer to either another doctor within that facility, transfer to another facility entirely, or the patient goes home with home health care arrangements made.
4. One particularly avid supporter of SB 303 wrote me recently and stated that SB 303 “vastly improve[s] protections for families to be able to protect their loved ones at the end of life. It does this while preserving the dispute resolution process so that physicians are not required by law to provide harmful, unethical, or futile procedures indefinitely.” What is missing from this statement is any concept giving the family and patient ultimate authority over what treatments are desired and what are not and deferring to their judgment, their moral beliefs, their decisions. Catholic moral teaching on this issue does not support the language in this bill despite what some may say. The concepts of justice and equity do not support what the current law allows or what SB 303 would allow if passed.
5. An analysis of just a couple of sections of SB 303 makes it quite clear that patients and families have little to no actual rights under this bill, which thereby maintains the status quo under the current law but extends it to DNARs. This may explain why disability advocates and patients’ rights groups do not support SB 303, including Bobby Schindler, brother of Terri Schiavo. Proponents, who initially used Schiavo’s name to promote SB 303 until her family objected, initially claimed that SB 303 would prevent another Schiavo. After her family objected to the use of her name, proponents changed tactics and said that Schiavo’s situation would not occur here because it was a legally different matter that a judge ordered her death at the request of her estranged husband. Schiavo is an appropriate analogy to TADA and SB 303 because life-sustaining treatment in the form of artificially administered nutrition and hydration was removed and a she died. That is allowed under current law. That would continue to be allowed even with SB 303.
Do-Not-Attempt-Resuscitation (DNAR) Orders
6. Supporters claim that: “Secret DNARs are not possible. If the patient or surrogate can be reasonably reached, they must be notified.” They further state that if the patient/surrogate objects to the DNAR in writing, it cannot go into effect for the duration of the review process.
7. Look to the language itself. DNAR would be an entirely new section, Section 166.012. The relevant subsections are 166.012(b) and (c) which state in their entirety[2]:
(b) Before placing a do-not-attempt-resuscitation (DNAR) order in a patient’s medical record, the physician or the facility’s personnel shall inform the patient or, if the patient is incompetent, make a reasonably diligent effort to contact orcause to be contacted the surrogate. The facility shall establish a policy regarding the notification required underthis section. The policy must authorize:
(1) the notification to be given verbally by a physician or facility personnel; and
(2) any request under Subsection (d) to be given verbally by the patient or surrogate or surrogate if the request is:
(A) witnessed, in person or telephonically, by two facility personnel; and
(B) documented by the facility personnel in the patient’s medical record.
(c) The DNAR order takes effect at the time it is written in the patient’s chart or otherwise placed in the patient’s medical record.
8. Immediately the problem here is that the patient is not asked whether he wants a DNAR. That life and death decision is made for him, a decision he may or may not be aware of as there are a number of undefinedterms to navigate. Beyond this insurmountable problem, the language is vague and ambiguous, which gives both power and cover to the health care provider. What is a “reasonably diligent effort” is all that is required to “contact” or “cause to be contacted the surrogate.” What is a “reasonably diligent effort”? What does “cause to be contacted” mean? Neither of these terms indicate that contact must actually be made. Therefore, without actually having made contact, a DNAR order could be placed in the file of the patient without the patient’s or surrogate’s knowledge. Therefore, the result is a “secret” DNAR. Supporters may say this could never happen. Is that what the law should be in Texas? How hard is it to actually require contact be made? Why not take all uncertainty out and draft a better piece of legislation? Others have already noted that if contact is made the discussion need only be verbal. Others have noted that the witnesses are paid personnel of the facility, thus creating one of many conflicts of interest.
9. What happens if the patient or surrogate disagrees with the order? What recourse do they have? That is found in subsection (d); in pertinent part:
If the patient or surrogate disagrees with the DNAR order being placed in or removed from the medical record, the patient or surrogate may request in writing or as provided by Subsection (b) and is entitled to a consultation or a review of the disagreement by the ethics or medical committee in the manner described by Section 166.046, with the patient or surrogate afforded all rights provided under that section, and with the physician afforded all protections from liability provided under section 166.045(d).
10. Note that the request must be in writing. Keep in mind that this will be a time when the patient is either feeble or weak because they are in the hospital for some illness, and the family or surrogate is busy seeing to their needs. Yet, the health care provider, through the Legislature mandates that the patient or surrogate step away from caring for their loved one to go write out a request that the DNAR decision be reviewed.
11. Supporters will note that the DNAR must be removed from the file from the moment the review process is requested. That’s cold comfort, for if the ethics committee agrees with the physician, there is no additional recourse. Note again that there is immunity from lawsuit and no cause of action is created or liability possible against a physician acting under this Section. Indeed, lack of liability and/or immunity is mentioned no less than three times in just this one Section.
12. Note also there are exceptions in subsection (f) where the notice provisions, such as they are, in subsection (b) do not apply. These exceptions are full of undefined, subjective terms such as “reasonable medical judgment”, “imminent”, “medically ineffective”. What do these terms mean? How will they be applied? It also requires the physician to predict the future. One exception states that notice is not required for a DNAR if the physician’s “reasonable medical judgment” is that that despite attempted resuscitation the patient’s death is imminent. See Section 166.012(f)(1). Another exception is that if the physician’s “reasonable medical judgment” is that resuscitation will be medically ineffective, subsection (b) does not apply. How can the physician know this? See Section 166.012(f)(2).
13. A word of caution about the term “surrogate” is in order here. That is a new definition under Section 166.002(16). A “surrogate” means a legal guardian, an agent under a medical power of attorney, or a person authorized under Section 166.039(b) to make a health care or treatment decision for anincompetent patient under this chapter.” “Incompetent” is defined (sort of, there is rather broad language used and the term “reasonable medical judgment”), but who makes that determination and when is not set forth. Further, under 166.039(b), “If a patient does not have a legal guardian or an agent under a medical power of attorney, the attending physician and one person, if available, from one of the following categories, in the following priority, may make a treatment decision that may include a decision to withhold or withdraw life-sustaining treatment:
(1) the patient’s spouse;
(2) the patient’s reasonably available adult children;
(3) the patient’s parents; or
(4) the patient’s nearest living relative.
14. Note that the surrogate is the physician AND one of the above, if available, if one does not have a legal guardian or agent under a medical power of attorney. Section 166.039(b) is existing law and is now part of the formal definition of surrogate that hasbeen added to the definitions section of the bill.
15. But the analysis of the DNAR issue should begin and end withthe fact that when it comes to one’s health and medical treatment, that should be the patient’s decision or made on his behalf by his surrogate (which should not include the doctor).
Artificially Administered Nutrition and Hydration (AANH)
16. The same enthusiastic SB 303 supporter also noted that: “AANH cannot be involuntarily denied, except if one or more of the four conditions are met. See Sec. 166.046(e),…”. . . except that artificially administered nutrition and hydration must be provided unless, . . .[except with the conditions].” (Emphasis by supporter.) This one may be the most troubling section.
17. Section 166.002(2) already has a definition for artificial nutrition and hydration which has been tweaked only slightly to be worded “Artificially administered nutrition and hydration” which is defined as “the provision of nutrients or fluids by a tube inserted in a vein, under the skin in the subcutaneous tissues, or in the stomach (gastrointestinal tract).”
18. Section 166.046(e) states in full:
If the patient or surrogate is requesting life-sustaining treatment that the attending physician has decided and the ethics or medical committee has affirmed is medically inappropriate treatment, the patient shall be given available life-sustaining treatment pending transfer under Subsection (d). This subsection does not authorize withholding or withdrawing pain management medication, medical procedures considered necessary to provide comfort care, or any other medical care provided to alleviate the patient’s pain. The patient is responsible for any costs incurred in transferring the patient to another facility. The attending physician, any other physician responsible for the care of the patient, and the health care facility are not obligated to provide life-sustaining treatment after the 21st calendar day after the written decision required under Subsection (b-1) is provided to the patient or the surrogate unless ordered to do so under Subsection (g), except that artificially administered nutrition and hydration must be provided unless, based on reasonable medical judgment, providing artificially administered nutrition and hydration would:
(1) hasten the patient’s death;
(2) seriously exacerbate other major medical problems not outweighed by the benefit of the provision of the treatment;
(3) result in substantial irremediable physical pain or discomfort not outweighed by the benefit of the provision of the treatment; or
(4) be medically ineffective in prolonging the patient’s life.
(Emphasis added.)
19. To be clear, this is the situation where the patient or surrogate is requesting that life-sustaining treatment be continued but thephysician disagrees and the ethics committee at the hospital has affirmed that disagreement (“Medically inappropriate treatment” is another undefined term). “Life-sustaining treatment” is defined to include “artificially administered nutrition and hydration” among many other things. See Sec. 166.002(10). If the patient or his surrogate has gone through the review process and lost (See Sec. 166.046), there is no further recourse, and their treatment may only continue 21 days at this facility. The only hope is that another facility will take them within that time period.
20. If you need more time for the transfer, you may make a motion to a court, but that court will only give you more time “if the court finds, by a preponderance of the evidence, that there is a reasonable expectation that the patient or surrogate may find a physician or health care facility that will honor the patient’s or surrogate’s health care treatment or decision if the time extension is granted.” See Sec. 166.046(g). But here’s the kicker, once you read through the “except” and the “unlesses” if the physician determines that “based on reasonable medical judgment” one of those four exceptions applies, AANH does not have to be continued even during this court-ordered reprieve! Note also that the underlying decision cannot be challenged. That is, the fact that the physician or ethics committee has determined that the patient is no longer entitled to receive care or his wishes will not be honored, is not part of Subsection (g) or any part of Section 166.046 at all that one may have recourse to courts to challenge the ethics committee’s decision.
21. The preceding was analysis of just a couple of sections of this bill and just one part of the definition of life-sustaining treatment, specifically AANH. The process for an “appeal” to the ethics committee is fraught with difficulties, allows for the hearing without the family being given all the information they need in a timely fashion, and, again, provides no recourse after the ethicscommittee makes its decision.
22. Proponents argue that more process has been given to the patient and there are more days provided, records given, people allowed in the committee hearing. But that is form without substance. Ultimately, if the medical ethics committee agrees with the doctor, and given the inherent conflict of interest in having that committee made up ofpeople from within the same facility where the doctor practices, that is highly likely, the patient has no further recourse. This is not due process, this is not a balanced or equitable process or result.
23. Even on the basis of “incrementalism,” this bill is too flawed to support that argument. In the final analysis, the convicted felon has more due process rights and guarantee to a conflict of interest free proceeding, which might actually change the ultimate finding of his guilt, than the sick patient in a hospital once a physician has determined that continuing care for that person violates his “conscience” and is futile. That is not right, just, or equitable. Texas can do better. Patients deserve better. And doctors whose consciences prevent them from caring further for a patient can assuage their consciences simply by “firing” the patient, not mandating his death. Amending the Advanced Directives Act (AKA the Futile Care Law) is something that is certainly needed. However, it needs to be done correctly and with full understanding of the results of such amendments. As it stands now, this bill must be opposed. The stakes are too high, indeed, they do not get any higher than life and death, to make another mistake with regard to TADA’s language.
[1] Whenever “patient” is used herein, it is meant to include the family or surrogate if the patient is unable to make those decisions for himself. A surrogate is meant to be a family member or person closest to the patient and NOT surrogate as that is currently defined to include, in some situations, the doctor AND another person.
[2] References are to the bill as it has been amended by Rep. King as of Friday, May 10, 2013.
