To view Part 1, go here
Saturday, December 21, 2013
Beware of Vultures: Senator Jennifer Fielder on Compassion & Choices
"I found myself wondering, 'Where does all the lobby money come from?' If it really is about a few terminally ill people who might seek help ending their suffering, why was more money spent on promoting assisted suicide than any other issue in Montana?"
By Senator Jennifer Fielder
As we wrangled through the budget this spring, the beautiful state capitol began to feel like a big, ripe carcass with a dark cloud of vultures circling about.
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| Senator Jennifer Fielder |
The magnitude of money in government attracts far more folks who want to be on the receiving end than it does those who just want fair and functional government. Until that ratio improves, it may be impossible to rein in unnecessary regulation and spending.
Special interest groups spent over $6 million dollars on lobbyists to pressure Montana legislators during the 2013 session. Seems like a lot of money, until you compare it to the billions of taxpayer dollars at stake. Does the average taxpayer stand a chance against organized forces like that?
As your Senator one of my main duties is to sort out who wants your money, or a change in a law, and why. Getting to the bottom of it takes work. It would certainly help if well-intentioned citizens would do a little more research before clamoring onto any particular bandwagons as well.
We have to be careful not to be fooled by catchy slogans, shallow campaign propaganda, biased media reports, or plays on our emotions which, too often, conceal a multitude of hidden agendas.
For example, it seems odd that the top lobby spender in Montana this year was Compassion and Choices, a “nonprofit” group that spent $160,356 advocating for legalization of assisted suicide. The second biggest spender was MEA-MFT, the teachers and public employees union who spent $120,319 pushing for state budget increases.
I earned a reputation for asking a lot of questions. I certainly didn’t take this job to rubber stamp anything. It's my duty to determine whether a proposal relates to an essential, necessary service of fair and functional government, or if it is motivated by piles of money to be gained from ill-advised government decisions.
You see, there is so much money in government that almost everything in government is about the money. The usual tactic is to disguise a ploy as “the humane thing to do”. . . .
Some groups work very hard to provide factual information about their issue. Others stoop to the lowest of lows to invoke heart wrenching emotions, twisted half-truths, or outright lies. You really have to look carefully for all the angles.
Assisted suicide is another issue that can be highly emotional. There are deep and valid concerns on both sides of this life and death debate. But I found myself wondering, “Where does all the lobby money come from?” If it really is about a few terminally ill people who might seek help ending their suffering, why was more money spent on promoting assisted suicide than any other issue in Montana?
Could it be that convincing an ill person to end his or her life early will help health insurance companies save a bundle on what would have been ongoing medical treatment? How much would the government gain if it stopped paying social security, Medicare, or Medicaid on thousands of people a few months early? How much financial relief would pension systems see? Why was the proposed law to legalize assisted suicide [SB 220] written so loosely? Would vulnerable old people be encouraged to end their lives unnecessarily early by those seeking financial gain?
When considering the financial aspects of assisted suicide, it is clear that millions, maybe billions of dollars, are intertwined with the issue being marketed as “Compassion and Choices”. Beware.
Public issues are not easy, and they are not always about money. But often times they are. If we want fair and functional government, we need to look deeper than most people are willing to look.. . .
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Published as Communication from Your State Senator, "Beware of Vultures," by Montana State Senator Jennifer Fielder, Sanders County Ledger, http://www.scledger.net, page 2, 6-4-13. Senator Fielder lives in Thompson Falls MT, representing Montana State Senate District 7.
Thursday, December 19, 2013
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-Choice is an Illusion.
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-Choice is an Illusion.
Euthanasia: Where there's a Will, there's relatives
By Dee Burton (excerpt)
I liken the death experience to birth when talking to the elderly people I work with - it can be so hard to go through, yet is inevitable.
None can know for absolute sure what, if anything, lies on the other side. Euthanasia promoters make some assumptions about 'nothing' or 'peace', Christians talk of hell for those who have rejected a loving God who lives in heaven.
My biggest concern however is something we do know about - relatives who are keen to get their hands on what is left behind. We've all seen and heard of the acrimony and greed of relatives and lawyers and the pressure they can put on the execution of the Will.
My fear is that legalising of euthanasia will have that pressure put on the dying relatives, and it is so obvious that this will occur.
"I was afraid to leave my husband alone"
When my husband was seriously ill several years ago, I collapsed in a half-exhausted heap in a chair once I got him into the doctor's office, relieved that we were going to get badly needed help (or so I thought).To my surprise and horror, during the exam I overheard the doctor giving my husband a sales pitch for assisted suicide. 'Think of what it will spare your wife, we need to think of her' he said, as a clincher.
Now, if the doctor had wanted to say 'I don't see any way I can help you, knowing what I know, and having the skills I have' that would have been one thing. If he'd wanted to opine that certain treatments weren't worth it as far as he could see, that would be one thing. But he was tempting my husband to commit suicide. And that is something different.
I was indignant that the doctor was not only trying to decide what was best for David, but also what was supposedly best for me (without even consulting me, no less).
We got a different doctor, and David lived another five years or so. But after that nightmare in the first doctor's office, and encounters with a 'death with dignity' inclined nurse, I was afraid to leave my husband alone again with doctors and nurses, for fear they'd morph from care providers to enemies, with no one around to stop them.
It's not a good thing, wondering who you can trust in a hospital or clinic. I hope you are spared this in Hawaii.
Kathryn Judson, Oregon
Published in the Hawaii Free Press, February 15, 2011.
To view as published, click here and scroll down towards the bottom of the page.
Wednesday, December 18, 2013
"But Doctor, I Want To Live": The Other Side Of The "Dignified Death" Debate
http://www.forbes.com/sites/davidshaywitz/2013/12/18/but-doctor-i-want-to-live-the-other-side-of-the-dignified-death-debate/
The emerging narrative about “Do Not Resuscitate” (DNR) orders is that they are not utilized frequently enough.
Doctors, it is said, are reluctant to have this discussion with patients, and patients are typically unlikely to
initiate such a
conversation with their physician. As a result, there are dreadful
stories of dying patients who suffer excruciating, highly-medicalized deaths rather than one with the dignity the sufferers might have preferred. Such deaths, policy experts note, would also seem to constitute a regrettable waste of healthcare resources.
This is a powerful storyline because in many cases, it’s unfortunately true. Many patients have experienced precisely the sort of end-of-life care they never would have wanted. In some cases, these patients never formally codified their wishes, in other instances, patient wishes were tragically, at times incomprehensibly disregarded by the healthcare system.
Many have also complained (I’m one of them) that an ACA provision that would have allowed Medicare reimbursement for a proactive doctor-patient conversation about end-of-life care was withdrawn due to the misguided uproar ignited by some vocal critics.
But there’s another perspective as well, one highlighted by a recent experience I just learned about, involving the mother of a friend.
The patient in question is a 97 year old crusty Italian lady who had been living on her own, in generally good health, for a long time. A month or so ago, her primary care doctor diagnosed her with anemia, and transfused her but didn’t initiate a workup, apparently assuming it wouldn’t be indicated in a patient of this age. Shortly thereafter, the elderly woman presented to the emergency room with more severe anemia, and evidence of a GI bleed.
The woman was stabilized with transfusions, and as usual, entirely lucid. The doctors told her they assumed she wouldn’t want a workup or any interventions, and would prefer to be made comfortable.
No, she said, I’m OK with interventions.
Then, the topic of DNR: interventions might be dangerous in a patient of her age, the doctors told her. If an intervention occurs, and something goes wrong, we assume you wouldn’t want extraordinary measures?
No, that would be OK too, she told them.
Really? You realize how violent and painful these might be, they asked, employing the same scare tactics I remember from my medicine residency, when overworked surgical consultants would occasionally try to talk a patient out of getting a procedure like a sinus tap.
That’s OK, she said. I want to live.
In the end, the woman was scoped and discovered to have an easily-treated lesion (an arterial-venous malformation), which was quickly cauterized. The woman tolerated the procedure well, is recovering nicely, and is slated to return home shortly.
This story deeply resonated with me, evoking my own experience with my Uncle Marvin – see here and here. It also doesn’t strike me as all that unusual or exceptional, and highlights with unusual clarity the potential hazards of the push towards DNRs.
The big concern is that virtuous physicians – perhaps intending to do good for the patient, perhaps (in the context of “parsimony”) intending to conserve societal resources and do good for the world at large – will undervalue a patient’s will to live or right to live.
Unfortunately, it’s probably not all that uncommon for a doctor to pressure a patient into making a decision the doctor earnestly believes is best; some would say it happens every day.
Both my uncle and the elderly lady profiled above were able to resist unreasonable physician pressure and successfully exert their autonomy. What about the many other patients who are persuaded –bullied? — by their doctor into declining treatments they might actually desire?
I appreciate the importance and virtue of proactive DNR conversations between patient and doctor, and recognize the good that can, should, and must emerge from these essential conversations.
What worries me, however, is the righteousness driving some of the doctors who are leading these discussions – a deep-seated conviction that they’re better positioned than patients to know what’s the right choice for patients, and perhaps even “ethically” obliged to guide patients in this direction.
It’s arrogance masquerading as virtue, and endangers patient autonomy.
Doctors, it is said, are reluctant to have this discussion with patients, and patients are typically unlikely to
 |
| David Shaywitz, MD |
This is a powerful storyline because in many cases, it’s unfortunately true. Many patients have experienced precisely the sort of end-of-life care they never would have wanted. In some cases, these patients never formally codified their wishes, in other instances, patient wishes were tragically, at times incomprehensibly disregarded by the healthcare system.
Many have also complained (I’m one of them) that an ACA provision that would have allowed Medicare reimbursement for a proactive doctor-patient conversation about end-of-life care was withdrawn due to the misguided uproar ignited by some vocal critics.
But there’s another perspective as well, one highlighted by a recent experience I just learned about, involving the mother of a friend.
The patient in question is a 97 year old crusty Italian lady who had been living on her own, in generally good health, for a long time. A month or so ago, her primary care doctor diagnosed her with anemia, and transfused her but didn’t initiate a workup, apparently assuming it wouldn’t be indicated in a patient of this age. Shortly thereafter, the elderly woman presented to the emergency room with more severe anemia, and evidence of a GI bleed.
The woman was stabilized with transfusions, and as usual, entirely lucid. The doctors told her they assumed she wouldn’t want a workup or any interventions, and would prefer to be made comfortable.
No, she said, I’m OK with interventions.
Then, the topic of DNR: interventions might be dangerous in a patient of her age, the doctors told her. If an intervention occurs, and something goes wrong, we assume you wouldn’t want extraordinary measures?
No, that would be OK too, she told them.
Really? You realize how violent and painful these might be, they asked, employing the same scare tactics I remember from my medicine residency, when overworked surgical consultants would occasionally try to talk a patient out of getting a procedure like a sinus tap.
That’s OK, she said. I want to live.
In the end, the woman was scoped and discovered to have an easily-treated lesion (an arterial-venous malformation), which was quickly cauterized. The woman tolerated the procedure well, is recovering nicely, and is slated to return home shortly.
This story deeply resonated with me, evoking my own experience with my Uncle Marvin – see here and here. It also doesn’t strike me as all that unusual or exceptional, and highlights with unusual clarity the potential hazards of the push towards DNRs.
The big concern is that virtuous physicians – perhaps intending to do good for the patient, perhaps (in the context of “parsimony”) intending to conserve societal resources and do good for the world at large – will undervalue a patient’s will to live or right to live.
Unfortunately, it’s probably not all that uncommon for a doctor to pressure a patient into making a decision the doctor earnestly believes is best; some would say it happens every day.
Both my uncle and the elderly lady profiled above were able to resist unreasonable physician pressure and successfully exert their autonomy. What about the many other patients who are persuaded –bullied? — by their doctor into declining treatments they might actually desire?
I appreciate the importance and virtue of proactive DNR conversations between patient and doctor, and recognize the good that can, should, and must emerge from these essential conversations.
What worries me, however, is the righteousness driving some of the doctors who are leading these discussions – a deep-seated conviction that they’re better positioned than patients to know what’s the right choice for patients, and perhaps even “ethically” obliged to guide patients in this direction.
It’s arrogance masquerading as virtue, and endangers patient autonomy.
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