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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Tell Me Again How There’s No War on Women…

While I am on the subject of women’s rights, I see that the thoroughly despicable Chris Christie has vetoed a New Jersey bill that would have required businesses to pay men and women equally when they are performing the same tasks.

On average, women in New Jersey make 80% of what men make for substantially similar work.

Christie called the bill “nonsensical” and said it would make New Jersey “very business unfriendly.”

Christie is currently stumping for his former nemesis Donald Trump, who holds a 70% unfavorability rating among women.

Forgive me if I am uncharitable, but the only justification (if one can call it that) for this veto is as part of a pathetic effort to be The Donald’s running mate. I mean, let’s face it–Christie is massively unpopular in New Jersey where, on those rare occasions when he has visited the state he governs, his “accomplishments” have consisted mainly of lowering the state’s bond rating and closing a bridge.

There are a lot of things that people like Christie (and Indiana’s Mike Pence) believe make a state “business unfriendly.” Laws requiring employers to pay a living wage, or give bathroom breaks or sick leave, for example. Or laws against wage theft. (Do you know what would make a state really attractive to business– “business friendly” in the Pence/Christie model? Slavery! It would be great; you wouldn’t have to pay workers at all!)

To Christie–and Pence–“business friendly” measures include right to work laws (often called “right to work for less laws,” because they make it difficult if not impossible for employees to bargain effectively with their employers), and low taxes (although lots of research suggests that the low quality of life that accompanies low taxes is a big turnoff to businesses looking to relocate).

Add to those “business friendly” measures laws making it perfectly acceptable for employers to pay women less than they’d pay a male worker. After all, we women are just incubators, necessary only to produce the next generation of voters and workers, and ultimately beholden to the un-self-aware “mansplainers” and bullies like Christie. Why should we expect wages equal to those of a man?

Come to places like New Jersey and Indiana,  “business-friendly” states where you can hire women and save money!

I’m sure Trump approves. And I’m sure Pence is taking notes….

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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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Why Am I Not Surprised?

The Governor steps in it again.

Gov. Mike Pence is using a recent Indiana Supreme Court decision to argue that he should not be required to release documents that have been deemed by law to be public records.

The Indiana Supreme Court ruled April 19 that it won’t compel lawmakers to release their emails to the public, even though it said the Access to Public Records Act applies to the General Assembly. The court said the separation of powers in the Indiana Constitution means the courts should not tread on lawmakers’ turf.

Now, Pence wants that same logic applied to him.

Of course he does. He also wanted to operate his very own “news bureau,” so that “news” would portray him in a favorable light.

The Indiana Supreme Court’s decision in the recent Koch case dismayed the legal community, for a number of reasons. The Court cited separation of powers–saying that it lacked the authority to overrule the legislature’s own interpretation of the law requiring disclosure.

In the Koch case, Citizens Action Coalition and two other groups the tried to get access to emails between utility companies and Rep. Eric Koch, R-Bedford, who is chairman of the House Energy Committee. The Supreme Court found that determining whether those documents counted under the APRA as legislative work is a “non-justiciable question,” meaning a matter it cannot adjudicate.

In the immigration case, Groth requested the contract the governor entered into with Barnes & Thornburg, who sued for the state instead of Indiana Attorney General Greg Zoeller, as well as copies of firm’s invoices. He also sought emails between the Texas Attorney General, who led the suit, and Pence’s office.

But the documents Groth received back were “heavily redacted,” he said, so he complained to the Public Access Counselor and ultimately filed the suit.

What is at stake here is a basic tenet of good government: are citizens entitled to information about contracts that their elected officials have entered into? Information about the expenses involved? The usual answer is: yes. That’s what is meant by transparency–an important aspect of democratic governance.

If voters cannot access information about the way their government works, they lack important information on which to base their votes. We call that sort of information “accountability.”

Public access advocates say their fears about the recent Indiana Supreme Court decision are already coming true.

Kerwin Olson, executive director of the Citizens Action Coalition, said he was worried the Supreme Court case would have negative, far-reaching implications, and this appears to be one of them.

“The Pence administration is already citing Koch as an additional authority to deny releasing government documents,” Olson said. “it’s quite astonishing and troubling. It further shuts the door to accountability and transparency in government when we should be going the opposite direction.”

The Indiana Supreme Court’s ruling is troubling, and not just because it is an open invitation to Mike Pence and the legislature to shield their actions from the voters. As Steve Key, executive director of the Hoosier State Press Association, noted

“If the judiciary takes this position, it would eviscerate the Access to Public Records Act because every agency would argue that a judge shouldn’t judge whether a document should be released under an APRA request if the agency’s position is that the record is part of its internal operations,” Key said. “The public’s ability to hold government officials accountable would be greatly hamstrung by such a policy.”

Ya think?

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Interim Report on an Interim Committee

As some readers of this blog know, I was appointed to a Special Interim Study Committee on Redistricting, convened by the Indiana Legislature. Yesterday was our second meeting;  we heard three presentations and took public testimony.

The first presentation was… interesting. It was offered by Jim Bopp.

For those who don’t know of him, Bopp is an uber-conservative Indiana lawyer on the wrong side of pretty much everything: he was the architect of –and won–Citizens United, and he has argued against same-sex marriage, reproductive choice….He’s pretty infamous in Indiana but until he appeared before the committee, I was unaware that he had any background in redistricting.

Actually, if his testimony reflected his knowledge of the issue, he probably doesn’t know much about it; he just favors anything that keeps Indiana Republicans in control. (In a later presentation, former Indiana Supreme Court Justice Ted Boehm–an expert on the law of redistricting– noted that Bopp had made several assertions that were factually inaccurate.)

Bopp’s basic argument for keeping redistricting in the legislature was straightforward, if bizarre: Since all choices inevitably have partisan consequences, establishing an independent commission to draw district lines would not be any better than the system we have now. (I am not making this up.)

When Senator Lanane asked him if having elected officials draw their own districts wasn’t an inherent conflict of interest, he disagreed, offering a convoluted argument that allowing lawmakers to choose their voters is no more self-interested than letting people vote for a representative whose policies will benefit them. ( I couldn’t make that up!)

I asked Bopp whether he was familiar with the academic literature suggesting that public trust in the legitimacy of the system improved in states that adopted nonpartisan redistricting. He dismissed the public’s opinion as an artifact of a biased media. I wasn’t sure I’d understood his response, so I asked him a follow-up, “Do I understand you to be saying that the public’s attitude is irrelevant?” and his answer was “yes, because the public’s attitude is the result of propaganda, and is wrong.”

So there.

The other presentations were markedly more substantive and informative. Tom Sugar presented his “No Politics Plan” modeled on the redistricting system used in Iowa. (It can be accessed here.) Judge Boehm led us through the thickets of current constitutional law on the issue. (Most of what he presented is included in my paper on Electoral Integrity: How Gerrymandering Matters, which he was kind enough to review for me a while back.)

When it came time for public testimony, we heard from citizens ( some of whom had come from as far away as South Bend), and representatives of statewide civic organizations. Not surprisingly, all of the public testimony urged reform of the current system.

I am convinced that if the Interim Study Committee acts, it will be because so many citizens turn out every time there is a hearing. This one was on a Thursday afternoon, after relatively short notice, and the hearing room could not hold them all; an equal or larger number was in the hall, watching the proceedings on a television. The message was unmistakable: Indiana citizens want change. They want competitive, meaningful elections. They want trustworthy democratic institutions.

Unlike Jim Bopp, they don’t think the players should get to be the umpires.

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