Saturday, March 03, 2007

Misconduct During Organ Harvesting & Futility?

This story is disturbing on many levels. A mentally retarded man was hospitalized for a critical illness. He was an organ donor whose organs were to be harvested after the removal of his respirator.

The problem was, he didn't die fast enough after the respirator was removed. This led to the physician to order and have administered massive amounts of morpine and sedatives. He still did not die and another dosage was ordered. In fact, he did not die until the next morning!

First, the hospital policies do not allow a physician who is going to harvest a patient's organs to administer treatment. The ordering of the morphine and sedatives were a treatment. There is an inherent conflict of interest when a physician, who desires to take someone's organs, to administer treatment. In this case, there is a question about whether the administration of these drugs were "treatment" in the usual sense--or a conscious attempt at euthanasia. I believe that a criminal investigation should ensue.

Further, given that the patient apparently started breathing on his own after being removed from the respirator, didn't the doctors have a duty to administer treatment to preserve his life?
He wasn't brain dead, after all.

I am also concerned about the fact that the man was mentally retarded. Did he have a surrogate making treatment decisions? Who was the surrogate? A family member? A state-appointed guardian?

Many mentally retarded adults living in long-term care facilities have no family or guardian. What was this man's situation?

What brought about the initial decision to remove care? Was it truly just his medical condition? Did his mental retardation play into any "quality of life" assessments? Was this a case of "futility" based on non-physiological reasons?

Finally, how often does this sort of thing happen in organ harvesting situations? How far away are we in this increasingly Godless country from situations like this?

(HT Dakota Voice Blog)

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Friday, January 26, 2007

Loving Levi

Here is a story about a little boy who might have been written off by futiliarians. Although Texas has been on the forefront of futility theory, this includes a story about a Christian Texas physician who saw Levi's worth.

Thursday, December 07, 2006

NPR Covers The Texas Futile Care Statute

Lanore Dixon, Andrea Clark's sister, and I were interviewed on NPR. The show aired last Tuesday. You may listen to it here.

Saturday, November 25, 2006

Sham Peer Review And Futility Protocols

In 1949, an article by Dr. Leo Alexander entitled Medical Science Under Dictatorship was published in the New England Journal of Medicine. Dr. Alexander participated, as a prosecution medical expert, in the trials of Nazi physicians at Nuremberg. He wrote the article, in part, to illuminate the reasons that German physicians participated in the euthanasia of incurables and the disabled as well as the commission of medical experimentation on human beings.

First, there was prepatory propaganda, designed to counter attitudes of compassion for the ill, directed to both physicians and the public. Second, influential scientists were allowed personal, career benefits due to their access to body parts for experimentation. Third, some were motivated by fear that their careers would be adversely impacted because they would be labeled traitors, communists or accomplices to acts against the State. As Dr. Alexander points out:

These cases illustrate a method consciously and methodically used in the SS, an age-old method used by criminal gangs everywhere: that of making suspects of disloyalty clear themselves by participation in a crime that would definitely and irrevocably tie them to the organization.


The important lesson here is that this motivation, with which one is familiar in ordinary crime, applies also to war crimes and to ideologically conditioned crimes against humanity---namely, that fear and cowardice, especially fear of punishment or of ostracism by the group, are often more important motives than simple ferocity or aggressiveness.

Of particular interest to me in this article was the successful resistence of the doctors in The Netherlands to the efforts of the Nazis to force them into the fold and to send their sick charges to the "death factories" or to euthanize them, themselves. The tactics used against the Dutch physicians included threats to revoke the physician's licenses to practice.

This brings me to "sham peer review", which has been described in the hyperlinked article as:

peer review done in bad faith for some purpose other than the furtherance of quality care

A recent case involving sham peer review so enraged a jury as to bring about a verdict of $366 million against the offending hospitals, although the Court reduced it to $22.5 million.

According to Dr. Lawrence R. Huntoon, sham peer review usually occurs like this:

A conscientious doctor reports a quality care problem or patient safety problem to the hospital administration. This might be anything from an anesthesiologist falling asleep during surgery to a malfunctioning piece of equipment which places patients at risk for harm.

Instead of fixing the problem, some hospitals misuse the peer review process to attack and silence the physician whistleblower.

The hospital administration and unethical physician collaborators then search for some pretext upon which to attack the physician whistleblower. This might involve the hospital bringing trumped up charges against the physician or it might involve bringing totally false and/or fabricated charges against the physician. The truth and the facts do not matter in a sham peer review in the hospital since the hospital controls the entire process.

The hospital then goes through the motions of providing a hearing to the accused physician, which they call;fair,8; yet the outcome of the hearing is predetermined. The physician's due process rights are often utterly trampled. At the conclusion of the process, the physician's privileges to practice at the hospital are terminated. The physician is reported to the National Practitioner Data Bank, and the physician's career is essentially over. Once a physician receives a negative report in the National Practitioner Data Bank, it is unlikely that physician will ever work in any hospital again anywhere in the nation.

Sham peer review is also being used by unethical physicians to attack other physicians so as to eliminate competition. It is a process which is being driven by money. As reimbursements to hospitals and physicians decline, sham peer review increases.

What has all this to do with futility protocols? One of the accusations that often brings about a sham peer review is that the physician is a "disruptive physician." How does one defend oneself against such a nebulous label? As Dr. Huntoon says,
;Those physicians who fail to pledge allegiance to the mainstream; viewpoint are at risk for being labeled disruptive physicians, which can lead to termination of a physician's career.

If there is pressure placed on physicians to trigger futility protocols, what better tool can there be to coerce compliance than sham peer review? There are no consequences for giving false testimony--the liar is given immunity, although there are some chinks in the armor of immunity developing. Also see: Bruce B. Feyz, M.D. v Mercy Memorial Hospital et al., Supreme Court of Michigan No. 128059 (June 24, 2006)
Due process protections for physicians during peer review are wholly insufficient. Does this sound familiar?

Do you disbelieve that peer review and abusive attention by a physician's licensing board can and is being used in cases where physicians wish to treat patients against the will of the hospital? If so, go read this.

Tuesday, November 21, 2006

"Futile" Care And Premature Babies

Wesley J. Smith blogs about the recommended guidelines adopted by a Bioethics think tank in Great Britain in light of the British Medical Society's coming out in favor of euthanizing disabled newborns. The good thing is that the think tank disagrees with the concept of euthanizing newborns. The bad part is this:

The Council also suggested that infants born at 22 weeks gestation or earlier not be given intensive care unless as part of medical experiments. At age 23 weeks, it urges that no intensive care be given unless insisted upon by the parents and doctors agree. At 24 weeks and above, the provision of intensive care would be the norm.

Wesley concludes:

I am not comfortable with such guidelines in that each patient should be evaluated and treated as an individual, not as part of a group. Of course, knowing the odds of survival at any given stage would be part of that agonizing decision making process. I also worry that futile care theory could seep into this process and that infants would be denied treatment because they would be disabled.

I agree. But, as you will note in the comments such things are already happening in the United States. Take the case of Baby Nathan Valor Jackson. Baby Nathan's mother had some pre-delivery complications which necessitated that she be in the hospital with her legs up. Then the trouble started:

Early that morning, Brian and Kathy were visited by the hospital’s social worker, who wanted the uninsured family to agree to take Medicaid and SSI. Brian refused, explaining that he could not in good conscience accept state welfare assistance because of his conviction that this was not the jurisdiction of the state. Brian expressed his intention to pay the hospital all it was owed, explaining his understanding that the Bible placed this responsibility for payment first on him, with extended family, the local church, and ultimately the church universal coming alongside to help him, if necessary. The social worker pushed hard for the Jacksons to change their position, but they remained firm.

This would not be the only point of contention. A few minutes after the talk with the social worker, the doctor treating Kathy hinted to the Jacksons that the hospital’s neonatologist might not try to save their son if he were born prior to twenty-four weeks. When the Jacksons pressed her for an explanation, she responded evasively. The Jacksons were quickly becoming alarmed at the direction things seemed to be going and called on Vision Forum’s General Counsel, Don Hart, for assistance. Mr. Hart agreed to represent the Jacksons and began to advise the Jacksons on how to proceed.

A few hours later that same day, Brian and Kathy were visited by the chief of staff of the hospital’s neonatology unit. Upon entering their room, he stated his name and began his remarks with this statement: “Let me paint you some pictures of what may happen if you go into labor right now.” The doctor then grimly described the problems a premature baby might face. He told the Jacksons that if their son was determined at birth to have been in the womb for more than twenty-four weeks, then all action possible would be taken to save his life. He then stated bluntly that if it was determined upon the child’s birth that he had been in the womb for less than twenty-four weeks, the baby would be made comfortable until he died.

The hospital official said these things to both Brian and Kathy with no apparent regard for how his comments might affect Kathy’s condition as she lay on strict bed rest, with her feet elevated, on medication directed toward stopping her contractions. Kathy was on the verge of going into the labor, which if initiated, would be—according to this doctor’s casual statement—signing her baby’s death warrant.

Fortunately, the General Counsel for Vision Forum Ministries intervened on behalf of the parents and the hospital gave the treatment to Baby Nathan and soon he was ready to be discharged. Then this happened:

The day began to approach when Nathan Valor could actually go home, but the challenges for the Jackson family were not over. Despite the high-ranking hospital staffs’ expression of admiration for the Christian convictions of the Jacksons in their stand on paying his bills privately (instead of allowing the taxpayers to cover them through welfare programs), the hospital decided to make another effort to pressure the Jacksons into taking Medicaid. And why? If the Jacksons submitted to this pressure, the hospital would receive its payment more quickly. Thus, the hospital elected to pull out all the stops to accomplish this goal.

The Jacksons were informed that if they did not change their minds and accept welfare assistance, their son would not be released to them. They were told that Texas Child Protective Services would be called in and would take custody of their child, since no medical providers could be expected to work with the Jacksons unless they were on welfare assistance. The hospital which had earlier fought to kill Nathan Valor if he was born too early was now threatening to kidnap him unless paid a ransom obtained through the welfare coffers.

After dropping this bombshell on the young parents, the hospital asked for a meeting with all interested parties to discuss Nathan Valor’s discharge. The Jacksons attended, accompanied (much to the chagrin of the hospital) by their attorney, Vision Forum General Counsel Don Hart. Upon learning of Mr. Hart’s presence at the meeting, the neonatal chief of staff refused to attend. When confronted with their unconscionable behavior in threatening to take the Jacksons’ son in order to extort payment via welfare, and when called to task for the absurdity of their feigned surprise that the Jacksons would seek legal assistance in the face of such actions, the hospital officials had little to say. Not surprisingly, the bully tactics stopped, and no mention of CPS involvement was ever made again.

What a disgusting display of aggression on the part of the hospital. When the hospitals and doctors fighting for the Texas Futile Care Statute make the claim that they are compassionate when dealing with families during the "futility protocols", I will remember Baby Nathan.

Go read the whole article at Vision Forum Ministries.

Friday, November 17, 2006

I'm Doing Talk Radio on Futile Care Theory

Today, I will be appearing on Voice for Life at 10 AM Pacific time to discuss Futile Care Theory and the Texas Futile Care Statue. The show is carried on Immaculate Heart Radio.

To listen live over the internet click here. Then, click on one of the streaming audio options. It will ask you to run an MP3 file, or something similar. Your media player should come up so that you can listen.

You can also listen to the replay Saturday at 3 PM PST or get by pod cast at the same link. You will probably have to check the archives section and it might not be available until next week.

Be sure to listen.

Sunday, October 22, 2006

You Gave My Generation Abortion. We Are Going To Give You Euthanasia.

Read about it here and here and here.