Wednesday, February 8, 2012

Life & Death: A Perfect Storm in 2012

I recently read about a Seattle hospital's merger into a company that followed the moral teachings of the Roman Catholic church in its policies, most notably with regard to life’s beginning and ending.
Along with Oregon, Washington is one of two states in the country where voters have sanctioned the legalization of physician-assisted suicide for the terminally ill, a sanction that couldn't be honored in a Catholic-run hospital. But can a hospital refuse treatment voters have approved?
A similar hospital merger in Louisville was stopped by Kentucky Governor Steve Beshear in late December over concerns that included restrictions in reproductive services. "In my opinion,” the governor said, “the risks to the public outweigh the potential benefits."
According to USA Today, in Troy, NY, a maternity ward was created, free from Catholic restrictions and separately licensed, on the second floor of a secular hospital taken over by a Catholic system. And to ease concerns about affiliating with a Catholic system, Swedish Medical Center in Seattle agreed to fund a Planned Parenthood office next door. 
“In the past few years, proposed mergers between Catholic and secular hospitals in Louisville, Ky., and Sierra Vista, Ariz., have collapsed in part because of concerns about the church's bans on abortions, in-vitro fertilizations and sterilizations,” USA Today reported recently.
San Francisco-based Catholic Healthcare West, its growth prospects compromised, is ending its Catholic affiliation and changing its name -- to Dignity Health, not to be confused with Dignity 2012, the organization promoting physician-assisted suicide in Massachusetts.
I recalled these scenarios this week as I read about the staunchly Catholic GOP candidate Rick Santorum’s primary night sweep; criticisms by Santorum, House Speaker (and Catholic) John Boehner and others of President Obama’s controversial new contraceptive policy; and the state Supreme Court declaring unconstitutional Georgia’s ban on advertising assisted suicide. (The practice of assisting in suicide isn’t actually illegal in the state, only the advertising of it.)
Throw in California's newly overturned Proposition 8, and the separation of church and state is becoming a perforated line at best, or perhaps a rift.
In the Georgia ruling, the court suggested the state could formally legalize assisted suicide, and perhaps that is what Georgia legislators will do (NOTE: See correction in attached Comments). Meanwhile, in Massachusetts (39 percent Catholic in 2008), the question of legalizing physician-assisted suicide will be put to the voters in November.
Life, death, faith and choice are in for a profound going-over this election year. 


  1. Life, death, faith, and choice are assumed to be "good" things - with implied moralities and ethics where "should" arises. We should preserve life, we should postpone death, we should have faith, and we should have free choice. And as soon as the "shoulds" are personalized, when the discussion focuses on whose life, whose death, whose faith, and whose choice, then it gets polarized and polarizing.

    To my mind, we should preserve life but that can still mean reproductive choices; we should postpone death but not prolong the suffering of someone actively dying; we should have faith in a God who is merciful and forgiving but recognize He has not manifested Himself to everyone; and we should have the freedom to make choices but knowing they are limited to the extent we live with others who are affected by our choices. It's the "buts" that limit the "shoulds" . . .

    And that is where politics and health policy collide with real people in real pain. I don't think the government should enlist caregivers to aid someone to die. I don't think the government should tell a religiously based institution how to conduct its affairs. I don't think you can legislate morality. I think morality comes from a changed heart - an alchemical change wrought by Spirit upon flesh. It's a community of people with changed hearts that should then go forth and put life, death, faith, and choice in their proper perspective - it is all a gift of immense proportion. We should, as a result, be merciful. How you legislate that, I do not know.

  2. The "quaint" notion of separation of church and state seems to be optional if you listen to the political debate of today. If I want an abortion I don't go to a Catholic hospital....I think we all get that . The current problem has to do with fair and adequate health care coverage (INSURANCE BUSINESS) for employees of religious institutions, many of whom do not share the beliefs of the institution. Freedom of religion does not equal the enforcement of your beliefs on someone else.

  3. Just a little tweak here in terms of accuracy. This blog post states

    "In the Georgia ruling, the court suggested the state could formally legalize assisted suicide, and perhaps that is what Georgia legislators will do."

    That is NOT what the court suggested. This is what the court had to say on the subject:

    (this is an excerpt from a news article, but it's an accurate quote from the ruling which can be accessed at this url:

    "Had the state truly been interested in the preservation of human life ... it could have imposed a ban on all assisted suicides with no restriction on protected speech whatsoever," the ruling said. "Alternatively, the state could have sought to prohibit all offers to assist in suicide when accompanied by an overt act to accomplish that goal. The state here did neither."

    So the court gave advice on how to outlaw assisted suicide rather than how to legalize it.

  4. I accept and appreciate the tweak, Stephen. The point worth making, from my perspective, is that the court told the legislators if they want to deal with assisted suicide, to deal with it directly, and not do this silly (and unconstitutional) dance around it. I could have made the point more clearly and accurately, but think you've taken care of that here. Glad you're paying close attention to this, and hope to see more of your input here in the future.

  5. As I have been thinking about Physician Assisted Suicide (PAS) these past weeks, I think back to a comment from a recent community ethics committee meeting on this subject - that we probably can’t decide this topic on a moral basis but rather have to consider it from a choice perspective. I think that sums up where I am at this point. While I’m not sure I can say whether PAS is morally “right” or “wrong”, I think it is important for people to have the option. In fact, if I consider PAS as a treatment option for extreme existential pain or fear in an individual with a terminal illness, I could make many of the arguments we made in favor of continuous deep sedation until death (CDS) in favor of PAS. For example, we acknowledge in the end of our CDS report that “It is probably fair to say the goal of everyone is a “good death” – one in which the dignity of the person is maintained, when pain is well-managed and familial and community supports are in place.” For some people with a terminal illness, this argument would support the option of PAS. While it’s true that in the absence of legalized PAS, anyone can commit suicide, I hate to think of someone who is already facing the difficult battle of a terminal illness and their own mortality having to resort to such a conflicted end – secretive, guilt-inducing, and distressing for loved ones. I prefer to think of someone having the peaceful option of a “good death” - taking a medication at their chosen time and place, with family and friends present, if desired, and facing death on their own terms and with dignity – however they choose to define that.
    I do think CDS is an important option for many people facing intractable pain at the end stage of a terminal illness, as we argued in our report. It is interesting, though, to look at the data from Oregon and Washington on their experience with PAS. The biggest concern people choosing PAS cited for their choice was the loss of autonomy, followed by less ability to engage in activities making life enjoyable, and then the loss of dignity. None of these would be addressed by continuous deep sedation, rather they would be exacerbated by CDS. Only about a quarter of individuals reported a fear of inadequate pain control as a reason for choosing PAS. This suggests to me that PAS and CDS are both important options for individuals facing a terminal illness.
    As I think about all of the different elements of PAS, I have to keep the context in mind, as I did with CDS – these are options for people who are terminally ill/imminently dying. Neither is a choice between life and death but rather a choice for how one chooses to face the dying process.
    Finally, I think we often think of death as an evil thing. Maybe focusing/reframing death as the natural end point that it is in the progression of the life cycle would take some of the evil/fear out of it and indeed, depending on one’s religious views, allow more people to embrace the process and seek out the best, most dignified end for themselves. Those who choose PAS seem to have come to this point – I think the ability to follow-through with PAS requires a tremendous amount of courage, conviction, and peace with the dying process. The fact that over 90% of individuals choosing PAS in OR and WA died at home and over 80% were enrolled in hospice suggests to me that these individuals were able to orchestrate a peaceful, well-supported, dignified death.

  6. I seriously think that more voices should be added to making medical ethics. There are so I don’t understand and don’t agree with. Please after all the meetings on the ethics please hire the for a professional documentation. It can save a lot of lives.