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Archive for February, 2010

Ahead of Newsweek

There’s an article in this week’s Newsweek called “The Snitch in Your Pocket” on the same topic as my debut blog. Umm… try and keep up Newsweek. (Check it out here: http://www.newsweek.com/id/233916)

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In Summer 2008, I was faced with one of the saddest moments of my life. I had to put my baby girl Miko to sleep. She was not actually a baby anymore at 17 years, but this cat was my favorite thing in the world. She had been part of our family since I was 9 years old! But Miko was very sick. That January, she was diagnosed with both hyperthyroidism and severely worsening kidneys, which negatively affected each other. She lived a pretty good life for several months, but the last two weeks she had been deteriorating at a fast pace. A Maine Coon breed, she had once been easily 16 pounds and had dwindled down to 6. She was nothing but fur. In her final week, she took to sitting in the bathroom—a very odd choice, but then, that is what happens. (Because my parents were on a trip, Miko was staying with me at my apartment rather than at my parents’ house, the only home she’d ever known. I was hoping she could make it until they returned.) One Saturday night / Sunday morning, she woke me up crying. She was uncomfortable. She had not eaten all day. She got in the bathtub, and that is when I had no doubt that it was time for her to go. She was asking me to do something about the pain she was in, so I did. At 5am I took her to an emergency pet hospital and I let her go. I have never cried so much in my life!

Because our pets just don’t live as long as we do, this is an all-too-common experience. We know that ending our beloved pet’s suffering is the right thing to do. We say that euthanizing them is “humane” (interesting word, considering). It is without question fair and right to put them out of their misery. They should not have to endure pain. Why, then, do we not afford humans that same policy?

The Catholic Church strictly forbids euthanasia as a “crime against life.” Also, apparently Islam “categorically forbids all forms of suicide and any action that may help another to kill themselves” (from Wikipedia), so some people must be seriously misinterpreting the Koran. Protestantism and Judaism also disagree with euthanasia, but many denominations are divided on smaller points of the issue.

People can be against euthanasia for humans for many reasons. Obviously, there are theological reasons. Or perhaps a person thinks of euthanasia as murder or suicide and is simply against it morally. Some may feel that euthanasia can be voluntary only if the patient is conscious, and clearly sometimes they are not. Some may hold out hope that some other medicine or treatment will help, even when all options have been exhausted.

The practice is often divided into three sub-types: passive, non-aggressive, and aggressive. Passive is most accepted and involves simply withholding medication (such as antibiotics) that would prolong life. Non-aggressive is withdrawing life support. Aggressive is administering drugs or actions that will end the life. (Even these definitions are somewhat disputed, however.)

Some forms of euthanasia are legal in Belgium, the Netherlands, Switzerland, Luxemburg, and some Australian states. In the United States, Oregon and Washington are the only two states that allow assisted suicide. (The Supreme Court rejected in 2006 an effort by the Justice Department to block Oregon’s law, which had taken effect in 1998.) In Montana, a state judge ruled in December 2008 that doctor-assisted suicide was legal under the state’s Constitution, but the state appealed that decision. The Washington and Oregon laws allow terminally ill patients who are at least 18 and have been found mentally competent to self-administer lethal drugs under the prescription of a doctor.

I am interested to know how people feel about this. Do you accept euthanasia for animals? What about for humans? If a person wants to die, should that be a basic right?

One of the most common practices in end-of-life care is palliative sedation—the practice of relieving distress in a terminally ill person in the last hours or days of a dying patient’s life, usually by means of a continuous intravenous or subcutaneous infusion of a sedative drug. For sedation, typical drugs include lorazepam, midazolam, phenobarbital, and, in the intensive care unit only, sodium thiopental. For pain, typical drugs include morphine, methadone, and fentanyl.

Doctors tend not to see administering these drugs as assisted suicide, and responsible use of them is legal. The American Academy of Hospice and Palliative Medicine has endorsed “palliative sedation to unconsciousness,” and in 2008, the American Medical Association issued a policy statement supporting palliative sedation, except when it is used primarily for emotional distress. Certainly there is a difference between terminal sedation and what Jack Kevorkian did in providing a cocktail that he knew would end life right then, but I don’t think the difference is all that grand. Anemona Hartocollis writes in the New York Times,

The medical profession still treats its role as an art as much as a science, relying on philosophical principles like the rule of double effect. Under this rule, attributed to the 13th century Roman Catholic philosopher Thomas Aquinas, even if there is a foreseeable bad outcome, like death, it is acceptable if it is unintended and outweighed by an intentional good outcome — the relief of unyielding suffering before death. The principle has been applied to ethical dilemmas in realms from medicine to war, and it is one of the few universal standards on how end-of-life sedation should be carried out. (Full article)

Many doctors insist on drawing a line between terminal sedation and euthanasia, but to me the primary difference is time. The intent is nearly identical.

I will say that one of my grandmothers passed away from liver cancer, and in her last days she was given morphine. I was not present at the time, but it’s my understanding that one of her daughters knows that she gave the fatal dose and must live with the conflicting feelings that invokes. In the end, though, I think everyone was at peace with how my grandmother was allowed to pass away.

But back to the types of euthanasia that are unlawful. I can understand where opponents of euthanasia are coming from. It would be hard to avoid people taking advantage of the right and ending a life before it is necessarily warranted. Some critics fear that physician-assisted suicide will pressure people with terminal illnesses who have low incomes or are disabled to end their lives to avoid becoming a financial burden to loved ones. And there could be instances where doctors, lawyers, and even family members choose to hasten the process for any number of reasons—scheduling, money, and so on.

One of the most common complaints, however, is that it is God’s will when we die; therefore, we should not try to schedule death. Well, I suppose that is fair. But I could argue that God’s will is violated not when the feeding tube is removed, but when it is inserted. Or that God’s will is violated not when the respirator is turned off, but when it is turned on. And what role should God’s will play in a decision by the government anyway (that is, in making laws)? And for that matter, what role should law play in this personal decision?

On the original and overarching point, I still wonder why there is a disconnect between ending suffering for animals versus ending suffering for people. Awhile back, I read an interesting take on the debate, though it is still religiously based. The argument was that people will disagree on the matter depending on who they see as in ownership of their body. A pet’s body, many will argue, is owned by the person who it lives with and who feeds it and who has registered it to the county. A person’s body, on the other hand, is owned by God, and therefore the decision to end a person’s life is up to only God. Well, I would argue against this on the basis that a pet’s body is just as owned by God as any human’s (we are all God’s creatures!), but oh well. I just wanted to offer one opinion on why there is a divide.

So, what do you think? Do you support euthanasia for pets? What about for people? What’s the difference? Do you think euthanasia will ever become a widespread right in America? Do you consider it “mercy killing” or just killing? Share what you think!

Note: The title of this blog is from a 1935 Horace McCoy novel in which a woman asks her partner in a bizarre dance marathon to shoot her to put her out of her misery during the Great Depression, and he obliges.

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Conscience v. conscience

Fresh into office and riding a tidal wave of support, the Obama administration started making promises to the American people about all the ways they were going to overturn Bush policies. Guantanamo? We’re shutting it down! The Mexico City policy? Reversed! That eleventh-hour conscience rule? We’re going to void it!

In late February 2009, merely a month after being sworn in, the administration revealed via a post to a federal website their plans to void the so-called Conscience Rule. Predictably, the announcement drew relieved praise from some and condemnation from others. But what has happened since then? Has the law actually been voided? In a word, no.

I’ll back up for a moment for anyone who is not familiar with this piece of legislation. The Provider Refusal Rule took effect on the last day of Bush II’s presidency (January 20, 2009—actually a half-day for him), and it allows health care professionals to refuse to participate in actions they find objectionable for moral or religious reasons. The law accomplishes this by withholding or revoking federal funds from recipients found coercing or discriminating against people who exercise their conscience rights. Under the rule, workers in healthcare settings—from doctors to janitors—can refuse to provide services, information, or advice to patients on subjects such as contraception, family planning, blood transfusions, and vaccine counseling if they are morally against it.

To be clear, there are already federal and state laws in place that allow healthcare workers to refuse to participate in abortions. Those laws are not under consideration, and I don’t think they should be. But Bush’s conscience law takes limiting access to health care to a whole new level, and I am disappointed that Obama’s promise to void the rule has not been fulfilled.

There are two scenarios commonly relayed when discussing how this rule affects patients. The first is: a woman walks into a pharmacy with her legitimate prescription from her legitimate doctor, and the pharmacist refuses to fill that prescription. In the second scenario, a rape victim walks into a hospital and is administered the standard rape kit but is not offered emergency contraception. In both instances, the healthcare worker makes a decision for the patient to deny legal options. They take away the patient’s choice.

When this happens in the real world (and it is more common than you might think), the easy answer is that the patient can just go to another provider. There is a CVS, Walgreen’s, or Rite Aid on nearly every corner in cities and suburbia. But what about in small towns? What about the places in the lesser-populated areas of America that only have the mom and pop pharmacy and only have one hospital within a considerable radius? Where are they supposed to go for their emergency contraception? Not everyone has a personal vehicle, the time to travel elsewhere, or the money to take a bus trip to a larger city where someone will agree to provide the care. It’s easy to say that finding another provider would be convenient enough, but that is not always the case.

And at what point do the moral and religious justifications become preposterous? I completely understand laws protecting workers who don’t wish to help perform abortions. But the Provider Refusal Rule is so overly broad that it extends to anything a worker wishes to deny based on moral beliefs. There are those special people out there who believe in using prayer rather than science to heal wounds and cure diseases. No, these people aren’t likely to be doctors, but they could be nurses or any other participant in the industry. Young people have died because their parents refused to seek medical attention, instead choosing to believe in the healing power of prayer. Imagine if someone who believed this way was making unilateral decisions for you about your healthcare options! While it might sound like a stretch, that seems to be perfectly legal under this clause. The same goes for people who object to blood transfusions and vaccines. End-of-life care is affected (maybe DNR is against someone’s morals, or turning off the machines). Your dentist could object to numbing your gum during oral surgery. The possibilities are endless.

These are the gatekeepers of legal health care, and when my body is the one in question, their conscience should not trump mine. Yet that is what it boils down to. Whose conscience is more important here? Your Catholic pharmacist, who believes taking birth control pills is wrong, or you, who may believe that having a child before you are ready is wrong? I think it has to be the patient’s conscience that overrules. Would you think it fair for a pharmacist to tell you that you must take birth control pills in order for him or her to serve you? Of course not. And there isn’t much difference in that and in one telling you that you can’t take them. The point is, it’s your decision, not your pharmacist’s.

Though the rule certainly affects more than reproductive issues, abortion is the central element in the argument. This baffles me even more because so many of the medicines or treatments these “moral” people want to deny are available specifically to avoid the need for an abortion. They are biting off their nose to spite their face.

But if the Obama administration promised to void this law within a month of assuming the country’s reins, why has that pledge seemed to die? I think it has a lot to do with the raging debate in Congress about healthcare reform. Limiting abortion rights came up as a bargaining chip last fall to try to build support from conservatives and help push through a reform bill. So, if the liberals were willing to reach out that far to conservatives to find an agreement, naturally Obama didn’t want to stir the pot by officially revoking the conscience rule. That whole idea of adding abortion limitations into the public health option blows my mind, but I’ll reserve comment on it for now. As for the motion to rescind the conscience rule, it went to a 30-day public comment period that ended April 9, 2009, and that’s the last we have heard.

I understand that this is a complicated issue. I don’t know what I would do if I were asked to compromise my beliefs for my job, but my gut tells me that I would find a different job. If you don’t believe in contraceptives, you’re probably better off choosing a profession other than pharmacist, as I imagine birth control pills are an enormous share of the business. But for those who do work in the healthcare industry and hold strong beliefs against care that is legal, I imagine they struggle with it mightily. I can’t help but conclude, however, that their struggle cannot trump the patient’s choice. If John Q feels bad about handing Jane emergency contraception, I think that’s a better option than forcing Jane to bear a child she doesn’t want and can’t afford.

What do you think? Whose conscience is more important?

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Don’t look now, but the government knows where you are. They also know where you’ve been—that is, if they want to know these things and have “reasonable grounds” to obtain the information from your cell phone provider.

There’s a federal appeals court case that began February 12 in Philadelphia that more people should be paying attention to. Essentially, the government wants relatively free access to the locational information your cell phone keeps, and civil liberties groups (including the Electronic Frontier Foundation, the Center for Democracy & Technology, and the American Civil Liberties Union) are arguing that a search warrant should be required.

It’s not because I am doing anything wrong and it’s not because I have watched Will Smith in Enemy of the State a few too many times (though true), but I think giving law enforcement and the government such broad access to this information is  one colossal invasion of privacy.

Think about it. You carry your cell phone with you just about everywhere, and your phone can pinpoint your location (recording the data about once every 7 seconds!), effectively making it a tracking device. It knows when you went to the grocery store, that you were in Miami for the Super Bowl, that you visit your mother on Sunday afternoons, that you were out at the bar until 3:30 am and slept somewhere other than your home, and so on.

Of course, for a lot of people, this information is useless and not pertinent whatsoever to the government and law enforcement. But the government can ask for the locational information from days, months, and even years ago, so who is to say what kind of mess you’ll find yourself in over the years and what kind of information, while not illegal, will help build a case against you (innocent or otherwise).

People might want their movements private for any number of reasons. Location can reveal what religious services a person attends, involvement in political protests, evidence of marital infidelity, financial hardships, visits to Alcoholics Anonymous meetings or rehabilitation clinics, and other activities that most people deem incredibly personal.

I, for one, thought it was creepy enough that the government can track your vehicle’s movements through the EZ Pass system on toll roads. But this case brings it to another dimension.

The question in this federal appeals case is not whether the government should be able to use cell phone records to track the movements of suspected criminals. I certainly agree that this is a wonderful technological advance to help find and prosecute dangerous criminals. What is in contention in Philadelphia is what legal standard should apply to government requests for the locational information. The government is arguing that they should only have to show “reasonable grounds,” while civil liberties groups want to require the more strict “probable cause” to obtain a warrant, as guaranteed in the Fourth Amendment.

A little backstory: In late 2007, the United States applied for court permission to obtain information about the location of an individual’s cell phone, without showing probable cause that tracking the individual would turn up evidence of a crime. A magistrate judge denied the government’s request and a district court upheld that decision in September 2008. The government is appealing the ruling in the U.S. Court of Appeals for the Third Circuit. The hearing will represent the first time a federal appellate court has heard arguments on the legality of the data-collecting methods.

The Obama administration has argued that warrantless tracking is permitted because Americans enjoy no reasonable expectation of privacy in their—or at least their cell phones’—whereabouts. U.S. Department of Justice lawyers say that “a customer’s Fourth Amendment rights are not violated when the phone company reveals to the government its own records” that show where a mobile device placed and received calls. But so far, the court has disagreed, concluding “that law enforcement’s investigative intrusions on our private lives, in the interests of social order and safety, should not be unduly hindered, but must be balanced by appropriate degrees of accountability and judicial review” (read the court’s opinion here).

Are Americans really apathetic to giving up their right to privacy and limiting the Fourth Amendment, which protects against illegal searches and seizures? In George Orwell’s 1984, the citizenry of Oceania live in the perfect totalitarian state, and the state is almost completely enabled by technology that erases privacy. The main character, Winston, must worry about even his own thoughts:

It was terribly dangerous to let your thoughts wander when … you were in any public place or within range of a telescreen. The smallest thing could give you away. A nervous tic, an unconscious look of anxiety, a habit of muttering to yourself—anything that carried with it the suggestion of abnormality, of having something to hide. In any case, to wear an improper expression on your face (to look incredulous when a victory was announced, for example) was itself a punishable offense. There was even a word for it in Newspeak: facecrime, it was called. (Book 1, chapter 5)

I’m not arguing that the United States is becoming like Oceania, but you have to admit that it’s a slippery slope. Winston Smith knows that “the smallest thing could give you away,” and I think that has to include a log of a person’s specific whereabouts over months and potentially years. The government can learn a lot about a person’s thoughts by knowing where they have been.

But the government does have one argument to reassure anyone worried about this potential power, arguing that “one who does not wish to disclose his movements to the government need not use a cellular telephone.” Gee, thanks.

What do you think about this case? Are people who are worried about the potential abuse of power just overreacting, or would this be an unconstitutional invasion of privacy? Either way, this should be a landmark court decision.

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