Category Archives: Personal Autonomy

Right to Die

Those of us who listen to public radio are familiar with Diane Rehm, the raspy-voiced hostess of a respected public affairs program. Recently–in the wake of her husband’s terminal illness–Rehm has become a spokesperson for an individual’s right to decide how and when he will die.

Rehm said she decided to write the book because she was frustrated by the way her husband died.

“People need to talk about this issue,” she said. “Doctors need to be taught about this issue. The whole idea of doctors being taught about helping to keep people alive, but not being taught how to listen to those who are ready to die — that seems to me sad and misguided.”

One doctor who has come to agree with Rehm is my cousin, Morton Tavel, a cardiologist whom I often quote on this blog. He recently analyzed the issue thusly:

As a physician, I originally supported the dictum that death should be prevented at all costs. But more recently, I have come to realize that perhaps we should also consider suffering as well as dying.

These thoughts have directed my attention to the so-called “aid in dying” laws that are in force in the U.S. states of Oregon, Washington, Montana, Vermont, and California. They are sometimes referred to as “Physician-Assisted Suicide”. These examples often require that a patient’s death be expected within six months, and they compassionately offer a voluntary, self administered end to suffering at an individual’s own preferred time. Since 2014, aid-in-dying bills have been introduced in Washington, D.C. and several states. Canada is also considering such a bill. Other countries, including Switzerland and Belgium, allow aid in dying for people who are not even terminally ill. All these laws provide freedom for a physician to prescribe a lethal drug to a patient for self administration. At present, such a practice is unlawful in 46 states, including Indiana..

In the example of Oregon, which has had such a law in effect since 1997, subsequent study has uncovered no abuses, and, interestingly, about a third of patients who receive medication to end their lives never actually use it, meaning that many are likely reassured by the simple knowledge that they will be able to end their lives at any time of their choosing.

What people want, often, is knowledge that they can control their own lives and deaths.

Tavel recognizes the potential for abuse, and the need to ensure that people do not terminate their lives because they are depressed, or in pain that could be alleviated with proper medical intervention, but he insists that such issues can be addressed.

Laws addressing such issues should be clearly defined. First, I believe a specific time for life expectancy need not be spelled out, for misery without hope doesn’t necessarily conform to a distinct number of days or months. For instance, someone suffering from a severe progressive neurologic disease such as Lou Gehrig’s disease (ALS) can continue suffering for many months prior to death. On a personal level, I witnessed the suffering and death of a patient/friend of mine from a similar neurologic disorder called progressive supranuclear palsy (PSP), a disease that claimed the life of actor Dudley Moore, which is an uncommon progressive fatal brain disorder that affects movement, control of walking (gait), balance, speech, and many others.Given the choice, and if it were legal, he would have gladly opted to end his life by assisted suicide. Even various terminal cancers can behave for variable durations, but also cause prolonged pain and suffering.

In Oregon, for example,the attending physician and a consulting physician have to confirm the patient’s diagnosis and prognosis and determine whether the patient is capable of making and communicating health care decisions for him/herself. If either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder (such as depression), the patient must be referred for a psychological examination.

If this and the other safeguards of the Oregon law are satisfied, the prescription may be written.

In most cases, the drug used for this purpose belongs to a group of so-called “barbiturates”, commonly used in lower doses for the induction of normal sleep. In large doses, however, death is painless, peaceful, and will occur within a matter of minutes to hours.

A death in this fashion is usually far better than other, less desirable, alternatives. Thus I might conclude with a simple question: Isn’t it more humane to deal with one’s own species in a manner at least as appropriate as the smooth and painless exit we provide to our beloved animal pets?

What is the justification for over-riding individual autonomy, and insisting that a terminally-ill person suffer?

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Your Religion, My Body–Happy Mother’s Day

It’s Mother’s Day–an appropriate time to think about human reproduction.

So…let me suggest a science fiction scenario.

We’re 25 years into the future. In reaction to massive population growth, NoNo, a religion encouraging ritual sterilization, has become the majority religion  in the U.S.  Practitioners believe (sincerely and devoutly) that God wants humans to avoid reproduction. (This religion’s conception of Diety is noncommittal on sex–it’s just making babies She is discouraging.)

As this religious community has grown, it has come to control the majority of the nation’s hospitals; well over 60% of them have become part of a national network of medical facilities run by and faithful to NoNo principles.

Our protagonist is not a NoNo, but she lives in a small town with only one hospital, and it is part of the NoNo network. She suddenly becomes ill. She is taken to the hospital in her area, where she is diagnosed with a treatable condition that will require minor surgery–and she’s told that, according to the tenets of NoNo, she will also be sterilized during the procedure. She objects–she’s only twenty, has never had children and desperately wants to be a mother–but her objections are deemed irrelevant. She is deprived of her control over her own body and any chance of having biological children.

Far fetched? Not if you switch the text.

The California Medical Association is seeking to join the ACLU of Northern California in its lawsuit against a Catholic hospital system over one of its facilities’ refusal on religious grounds to allow a doctor to perform a tubal ligation after a planned Cesarean section….

The suit stems from a case at Mercy Medical Center in Redding, one of Dignity Health’s 29 hospitals across the state. Mercy Medical says its refusal to perform the procedure was based on the Ethical and Religious Directives for Catholic Health Care Services, written by the U.S. Conference of Catholic Bishops. The Directives – followed by all of California’s 35 Catholic hospitals – prohibit birth control, abortion and, in most cases, sterilization.

The California Medical Association says hospitals should make decisions that are medically appropriate–and should not make medical decisions that are contrary to best practices for reasons of religious dogma, especially when the patient does not accept that dogma.

Civil libertarians–in this case, the ACLU–say individuals should not have to cede control over their bodies and beliefs in order to receive medical care.

Over the past quarter-century or so, Catholic hospitals have assumed control of a significant percentage of the nation’s hospitals. What the courts need to decide is whether the merger of these hospitals entitles the Church to dictate medical decisions that would at best be considered “non-standard” or at worse would constitute malpractice.

Because God.

Suddenly, my “science fiction” scenario doesn’t look so far-fetched. As I’ve said before–a government with the power to prohibit abortion (or birth control) is a government with the power to require it. As a friend used to put it, poison gas is a great weapon until the wind shifts.

Unless the courts rule otherwise, hospitals with a monopoly on medical care can impose their own rules. Based upon their religious beliefs. No matter which way medical science’s winds blow.

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Losing the Wedge

Oh Ted! I hate to break it to you, but tapping a female culture warrior as your VP–even one who manages to be nearly as repulsive as you– isn’t going to get you the nomination.

Not even close.

There have been a number of signs during this unending primary season that the GOP’s “old reliable” tactic of focusing on social issues is no longer the sure-fire bet it was when George W. Bush won his second term with the help of fear of/hate for “the gays.” Part of the reason is demographic: fear of LGBT folks, hatred of immigrants, belief that women should stay in the kitchen (barefoot and most definitely pregnant), even racism are all attitudes more plentiful among older, whiter Americans–and they’re dying out.

Partly, of course, the lack of focus on social issues this time around is the flip side of the 24/7 focus on the strange orange candidate. Donald Trump doesn’t fixate on social issues. Or any issues, actually–he mostly focuses on himself, and his YUGE business ability. And large “hands.”

Actually, Trump is preferable to Cruz, in much the same way that a merciful death is preferable to an agonizing one….At any rate, according to the Boston Globe, Cruz is counting on a re-invigorated appeal to social conservatives in Indiana and elsewhere:

Over the past month, as the primary wove through Wisconsin, New York, and the socially moderate states that voted on Tuesday, the GOP candidates focused on issues like trade, jobs, and the economy. But the next contests on the calendar are in Indiana, West Virginia, and Nebraska, where evangelical voters make up more of the Republican electorate. That trend might even continue in California, which awards most of its large number of delegates by congressional district, some of which are very conservative.

It’s the first time social issues — such as abortion, gay marriage, and transgender rights — could take center stage in the primary since early March, when a swath of Southern states voted in the primary. That’s mostly good news for Cruz, who has already touted his social conservative credentials on the stump in Indiana, which holds its primary on Tuesday.

I may be wrong (wouldn’t be the first time!), but I think it’s too late for “fear of God” wedge issues. America has had same-sex marriage for a year now, and the apocalypse hasn’t occurred. Young people are more irate about their student loans than about who’s peeing in the next stall. The population keeps moving into cities, where there tend to be gay people and black people and brown people, and women in executive positions, and Americans have gotten used to the idea that the diversity is sort of nice.

Cruz isn’t going to win Indianapolis, for sure (and if he thinks Carly on the ticket is a great idea, he’s even nuttier than I previously thought), but he may win Indiana. In our more rural precincts, culture war wedge issues can still be pretty salient. And he is running against the Donald.

If Cruz does win the state, however, I really, really, REALLY need to move.

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Periods for Pence

I’ve posted previously about Indiana’s latest–and most intrusive–anti-abortion legislation.

In the wake of the Governor’s “prayerful” signature of that measure, it seems that a group of Hoosier women has formed “Periods for Pence.” The concept is simple enough: since the Governor is so …interested…in our “lady parts,” Hoosier women are calling his office to report on the particulars of their monthly menses.

Evidently–and hilariously– the Governor’s office is being inundated with snarky “reports” about the details of women’s periods. (Readers who want to get in on the fun are encouraged to go to the group’s Facebook Page.)

Excellent as this trolling is, however, political theater really is no substitute for competent political leadership.

The Pence administration has been an unmitigated disaster for Indiana, not just because  the Governor’s emphasis on social issues at the expense of actual governance has given us a decaying infrastructure and interfered with educational progress, among other things, but because it has been very, very bad for business.

When Georgia’s Republican Governor vetoed that state’s RFRA, observers noted that the Governor wanted to avoid the damaging economic repercussions that Indiana had experienced in the wake of Governor Pence’s very different decision in Indiana.

As I have written elsewhere: even Georgia doesn’t want to be Indiana.

But as this latest assault on Hoosier women demonstrates, it goes well beyond RFRA. This Governor has undone years of efforts to position Indianapolis and Indiana as welcoming, business-friendly venues.

Remember “Hoosier Hospitality”?

Under Mike Pence, Indiana garnered negative headlines for refusing to allow a single family of Syrian refugees to resettle in our “hospitable” state. His ongoing assault on the Superintendent of Public Instruction (elected, inconveniently, with more votes than Pence garnered) has given us a black eye in the national education community.

And now, in the wake of Pence’s “prayerful” signing of the nation’s most punitive and restrictive abortion law, national media is once again portraying Indiana as anything but hospitable.

The New York Times ran a scathing editorial. A banner in Salon.com was accusatory: “Mike Pence’s sadistic abortion law: Indiana passes draconian anti-choice bill geared towards humiliating and bankrupting women who have abortions.” Slate noted that “Indiana’s HB 1337 is So Extreme Even Republicans Don’t Like It.” Other headlines referred to the bill as “extreme,” “chilling” and “most restrictive in the nation.”

These latest headlines add to the national impression that Indiana is a state hostile both to LGBT individuals and women’s autonomy. And whatever one’s position on these issues, that image spells nothing but trouble for the state’s economy.

The business community has opposed these culture war eruptions for a very good reason: the message they send is terrible for business.

It’s hard enough recruiting top-flight talent—the sort of employee who is in high demand—to a state with no mountains, no oceans, a middling-to-poor quality of life (poor public transportation, ill-maintained parks, struggling schools), without adding a reputation for homophobia and chauvinism.

I’ve lived in Indianapolis all my life. I’ve been involved, over the years, in a number of efforts to “sell” our city. I still have fond memories of my time in the Hudnut Administration, when Bill Hudnut–a Mayor with a very different understanding of both Republicanism and Christianity than our Governor—talked about building an inclusive and welcoming “City on the Hill.” People in that Administration, and several that followed it, worked tirelessly to garner “good” PR for Indianapolis.

We knew then that a positive image wouldn’t just generate convention business, important as that is for the city and state’s bottom line, but that being seen as a welcoming and inclusive and vibrant city would encourage businesses to locate here, and those already here to expand.

We wanted to encourage all kinds of people to join us in building our local economy; not just those who went to a particular church or subscribed to a particular version of Christianity.

A lot of people have worked hard and spent a lot of money over the years, promoting Hoosier Hospitality. Too bad we elected a Governor who seems determined to undo it all.

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UnAmerican Activities–War on Women Edition

Several readers have asked me why I haven’t written anything about Indiana’s horrific House Bill 1337.

To be honest, words fail. Once again, national news outlets are using Indiana as an example of right-wing extremism untempered by even a hint of compassion or common sense.

As Salon noted, if it is somehow upheld, this measure–on Mike Pence’s desk for a signature that is a foregone conclusion–will end virtually all abortions in the state.

The legislation authorizes an entire menu of grotesquely unconstitutional anti-choice TRAP(Targeted Regulation of Abortion Providers) laws, as well as new forms of authoritarian, misogynistic devilry, each of which could be defined as reproductive Jim Crow laws. Put another way, the new Indiana bill is in keeping with a series of laws that don’t outright ban abortion, but which makes it really, really difficult to have a safe and legal abortion.

The bill is a mashup of grisly, gratuitous measures having no purpose whatsoever other than to punish women who choose to exercise their constitutional right to terminate a pregnancy.

The bill itself is an abortion. It requires burial of the fetus–a funeral for what in most cases is little more than a microscopic clump of undifferentiated cells. It mandates fetal ultrasounds. It requires the woman to listen to the fetal heartbeat (despite the fact that, in many if not most cases, the procedure occurs too early to allow detection of a heartbeat).

The fetal heartbeat screening and the ultrasound procedure have to be conducted 18 hours prior to having an abortion. What makes this waiting period particularly vile is that previous TRAP laws have closed most of Indiana’s abortion clinics, leaving just four counties out of 92 with abortion facilities. In other words, if you choose to terminate, you’ll likely have to travel not-insignificant distances in order to find a clinic. From there, you’ll have to bed down at a hotel or elsewhere while your 18 hour waiting period winds down. Yet another expense on top of the abortion itself.

There’s much more, but by far the most offensive provision–in a bill filled with offensive provisions–requires a woman to carry a pregnancy to term if the motive for the abortion is that the fetus is deformed or disabled.

Think about that. The men at Indiana’s General Assembly have decided that they know best whether a woman who finds herself pregnant with a profoundly damaged fetus has the financial and/or emotional resources to spend the rest of her life caring for a disabled child. These legislators know better than the woman and her husband–who may have desperately wanted the pregnancy–the emotional toll of giving birth to a child who cannot live more than a few hours or weeks after birth.

And don’t get me started down the legal rabbit-hole of determining a pregnant woman’s “real” motive for aborting.

As one ob/gyn observes, this bill is just another assault in social conservatives’ dogged and persistent war on women’s autonomy. It is all about control. There is nothing medical about it.

The truth is, these legislative fights over reproductive choice aren’t really fights about the decision to abort. They are fights about who gets to make the decision. 

Giving government the right to decide whether an individual woman should carry a pregnancy to term is no less dangerous than giving government the right to dictate her reading material or religious affiliation. The Bill of Rights rests on the Founders’ belief that—although individuals may certainly make bad or dangerous choices—empowering government to make those choices for us is far more dangerous.

The government that can prohibit abortion today can require it tomorrow. Ask the Chinese.

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