UK National Health Service

[Umfriend]

If #5, 6 and 7 are true, why isn't he in jail? Well ok, why isn't he at least removed as, uhm, what's it called, not "trustee" but erhm, shit, darnit, what's it called again? He was appointed as her [fill in blanks here].

Anyway, being her [...], should he not have regards for her best interests? At least re- and now better diagnosing her would serve that, no? Why was not his control lifted when her parents asked for it?

On the other hand, IF these new diagnostic research would indicate she is indeed brain dead, beyond any recovery, would her parents let her go then?

[James_D]

legal guardian?

[Umfriend]

That's the idea, yes.

Dr. M.: Could you shed any light as to how misinformed I am about the AMA?

[EnglandJoe]

I haven't read every long post here, and I have every bit of sympathy for your friend.

However it irks me when people complain about the NHS. People that don't like the care the NHS provides should get medical insurance.

[Dr Mordrid]

Um

The AMA is less a union than a professional association/lobby group. As such its influence is limited to its political influence, and even then the competing interests of other (often) opposed groups also limits its control.

The AMA has far less control over its membershkp than you think, and admittance to the profession is not controlled by the AMA but by the individual states medical boards. Get your MD degree and pass the boards of the state where you live and you can practice unhindered by the AMA if you so desire.

As for Mrs. Shiavo there was an interesting interview today with Dr. William Hammesfahr (neurologist and Nobel Prize nominee). He spent several hours with Mrs. Schiavo and stateed emphatically that she is NOT in an irretrievable vegetative state and could be trained to feed herself and perhaps speak. IMO his opinion is a bit better than her current doctor, who has 5 malpractice suits pending in Florida.

Here is the text of his report to the Florida Supreme Court (one that the court totally ignored);

http://libertytothecaptives.net/hammesfahr_dr._report.html

Dr. Mordrid

[KvHagedorn]

Ahh.. just read your comments on the first page, Doc.. my questions answered about why hubby doesn't just leave. Slimeball.

[Brian Ellis]

People that don't like the care the NHS provides should get medical insurance.

That is extremely arrogant. This guy is just 65 and his income is essentially his OAP. He was forced into early retirement about 6 or 7 years ago and his savings were swallowed up paying back the remainder of his mortgage, that he had planned on finishing paying back at 63. How, in the name of all that is holy, do you think he could afford private medical insurance? And, having paid into the NI for all his working life, do you really believe he is not entitled to reasonable medical care, not left for cancer to metastasize? Or perhaps you believe it is a deliberate ploy to kill people off early as being cheaper than keeping them alive an extra 10 years?

[KvHagedorn]

You know, the same thing happens in the US to people who have medical insurance. The insuror often decides whether or not they will pay for a procedure. If they don't want to hurt their bottom line, they don't have to pay for those expensive tests to determine if he has cancer. It happens all over.. it's called GREED and INCOMPETENCE.

[cjolley]

...
Anyone but me find these situations a bit fishy and convenient?

IMO what's necessary is that Mrs. Schiavo needs to have a court appointed attorney act as her agent, independend of both sides and who'll be HER advocate and willing to persue the true state of her status.

Dr. Mordrid

http://slate.msn.com/id/2115124/

Let's be clear: The piece of legislation passed late last night, the so-called "Palm Sunday Compromise," has nothing whatever to do with the rule of law. The rule of law in this country holds that this is a federalist system—in which private domestic matters are litigated in state, not federal courts. The rule of law has long provided that such domestic decisions are generally made by competent spouses, as opposed to parents, elected officials, popular referendum, or the demands of Randall Terry. The rule of law also requires a fundamental separation of powers—in which legislatures do not override final, binding court decisions solely because the outcome is not the one they like. The rule of law requires comity between state and federal courts—wherein each respects and upholds the jurisdiction and authority of the other. The rule of law requires that we look skeptically at legislation aimed at mucking around with just one life to the exclusion of any and all similarly situated individuals.

And what is the overwhelming constitutional value that supersedes each of these centuries-old legal notions? Evidently, Congress has a secret, super-textual constitutional role as the nation's caped crusaders—its members authorized to leap into phone booths around the world and fly back to Washington in a single bound whenever the "culture of life" is in peril. Republicans acknowledged this weekend that their views on "the sanctity of life" trump even their convictions about federalism. Or, as Tom DeLay put it, when asked how he reconciles this bill with conservative calls to keep the federal government out of state matters, "We, as Congress, have every right to make sure that the constitutional rights of Terri Schiavo are protected, and that's what we're doing."

This congressional authority to simply override years of state court fact-finding brings with it other superpowers, including the power of gratuitous name-calling: Members of Congress unable to pronounce Schiavo's name just last week are denouncing her husband as an adulterer and common law bigamist who withheld proper medical care from her. I wonder what they'd say about my parenting—or yours—if they decided to make a federal case out of every domestic-custody dispute currently resolved in state court proceedings.

Members of Congress have apparently also had super-analytical powers conferred upon them, as well. Senate Majority Leader, and heart surgeon, Bill Frist felt confident last week—after reviewing an hour of videotape—in offering a medical diagnosis of Schiavo's condition, blithely second-guessing the court-appointed neurologists who evaluated her for days and weeks. His colleagues are similarly self-appointed neurological experts. Years of painstaking litigation, assessment, and evaluation by state courts are dismissed by Tom DeLay as the activist doings of a "little judge sitting in a state district court in Florida." Only the most extraordinary levels of congressional hubris could allow a group of elected citizens to substitute their personal medical, legal, and ethical judgments for those of the doctors, judges, and guardians who have been intimately involved with this heartbreakingly sad case for years.

PS Sorry for the OT post Brian

[Umfriend]

Hé, he started it!

[cjolley]

Also from that article:

Take a peek into any chat room (or this Fray in 15 minutes) and you will find hundreds of individuals who personally know that Terri Schiavo is—despite voluminous testimony by her doctors and her guardians ad litem and the findings of multiple judges—capable of laughter and responsiveness and a full recovery. How do they know these things? The same way their elected representatives do: They watched a video clip. And because anyone who disagrees with the video is a murderer and torturer, the state court judge in this case requires constant police protection: The standard-bearers of the "culture of life" keep threatening to kill him.

[cjolley]

http://seeingthedifference.berkeley.edu/schneiderman.html

...
Now, just a brief lesson in neurology. You have in your brain the cerebral cortex, which is actually a very thin structure on the outer surface of your cerebral hemispheres. Four to six minutes of anoxia, lack of oxygen, destroys that completely. The rest of your brain, particularly the brain stem, can survive for fifteen or twenty minutes without oxygen. That disparity accounts for what we now see in as many as 30,000 to 40,000 people being kept alive in permanent unconsciousness. Usually the cause is failed CPR, or occasionally a stroke or a motor vehicle accident of some sort. What happens is that that part of the brain, the cerebral cortex, which is us, our personality, who we are, how we think--our capacity to experience, see, hear, think, emote--that may be permanently destroyed. Whereas the rest of us, the brain stem, which gives us the ability to breath, digest, all the organ functions, that could be kept alive, and in many cases has been kept going for decades. And so that has given us this condition which was first diagnosed in 1972. It's really interesting, that that's a very new disease as far as medicine is concerned, and, in fact, it's an iatrogenic [doctor-created] disease. Vegetative state is the condition, as we call it, but persistent or permanent is what we do to keep that condition going. So in a sense, that's a very important notion.

Now, all of us who do ethics consultations, have had the experience, and I've had several, where families have insisted that their loved one be kept alive in a permanent vegetative state, permanently unconscious. And this is a clinical diagnosis. If someone, for example, has persistent vegetative state, where their eyes may open and close and they have all sorts of reflex capacities, that's because that part of the brain stem, the reticular activating system that's responsible for sleep/wake may be temporarily impaired, but then recover. And so they're unconscious. Their eyes may open, and they sleep, but they're completely unaware. Families will sometimes demand that physicians keep such patients alive--and it's very simple, a feeding tube and good nursing care will do it. There's nothing more that has to be done, if that's the condition we're talking about.
...

[cjolley]

In case I'm not making myself clear

http://www.salon.com/news/feature/20...ohn/print.html

"This has nothing to do with the sanctity of life"
The Rev. John Paris, professor of bioethics, says Terri Schiavo has the moral and legal right to die, and only the Christian right is keeping her alive. - - - - - - - - - - - -
By Andrew Leonard

March 22, 2005 | The decision on whether to allow Terri Schiavo to die has sparked endless controversy over what is legal and ethical when patients are unable to make their own wishes. One observer who brings both legal and moral authority to the debate is the Rev. John Paris, the Walsh Professor of Bioethics at Boston College.

Paris has served as an expert witness on numerous cases involving patients who were being kept alive by artificial means. He is equally capable of discussing the legal details of the Schiavo case and the Catholic Church's view of it. According to Paris, every relevant legal issue has already been decided; the only thing keeping the case alive is the fact that the Christian right has made Schiavo a cause célèbre.

Paris did not serve as an expert witness in the Schiavo case. However, when the case was reviewed by the Florida Supreme Court, he signed an amicus brief on behalf of Michael Schiavo, who wants to take his wife off life support. Salon spoke to Paris by phone on Monday morning. "This case," he says, "is bizarre."

Why is the case bizarre?

In most cases, the court has a theory, you have an appellate review, and that's the end. But this case, the parents keep coming back with new issues -- every time that they lose, they come in with a new issue. We want to reexamine the case. We believe she's competent. We need new medical tests being done. We think she's been abused. We want child protective services to intervene. Finally, Judge George Greer denied them all. He said. "Look, we have had court-appointed neutral physicians examine this patient. You don't believe the findings of the doctors but the finding of the doctors have been accepted by the court as factual." There have been six reviews by the appellate court.

What did the appellate court find?

The Florida Court of Appeals found four very interesting things. And it found them by the highest legal standard you can have -- clear and convincing evidence. The appellate court said that Judge Greer found clear and convincing evidence that Schiavo is in a well-diagnosed, persistent vegetative state, that there is no hope of her ever recovering consciousness, and that she had stated she would not ever want to be maintained this way. The court said we have heard the parents saying she didn't [say that], and we heard the husband say she did, and we believe the husband's statement is a correct statement of her position. The court also found that the husband was a caring, loving spouse whose actions were in Terri's best interests. The court said, "Remove the feeding tube," and the family protested. Of course, the family has the radical, antiabortion, right-to-life Christian right, with its apparently unlimited resources and political muscle, behind them.

So what do you think this case is really about?

The power of the Christian right. This case has nothing to do with the legal issues involving a feeding tube. The feeding tube issue was definitively resolved by the U.S. Supreme Court in 1990 in Cruzan vs. Director. The United States Supreme Court ruled that competent patients have the right to decline any and all unwanted treatment, and unconscious patients have the same right, depending upon the evidentiary standard established by the state. And Florida law says that Terri Schiavo has more than met the standard in this state. So there is no legal issue.

Are there any extenuating circumstances?

The law is clear, the medicine is clear, the ethics are clear. A presidential commission in 1983, appointed by Ronald Reagan, issued a very famous document called "Deciding to Forgo Life-Sustaining Treatment." It talked about the appropriate treatment for patients who are permanently unconscious. The commission said the only justification for continuing any treatment -- and they specifically talked about feeding tubes -- is either the slight hope that the patient might recover or the family's hope that the patient might recover. Terri Schiavo's legitimate family -- the guardian, the spouse -- has persuaded the court that she wouldn't want [intervention] and therefore it shouldn't happen. Now you have the brother and sister, the mother and father, saying that's all wrong. But they had their day in court, they had their weeks in court, they had their years in court!

Isn't the underlying social issue here one that says the law doesn't have authority over this kind of life-or-death matter?

Let me give you a test that I've done 100 times to audiences. And I guarantee you can do the same thing. Go and find the first 12 people you meet and say to them, "If you were to suffer a cerebral aneurysm, and we were able to diagnose that with a PET-scan immediately, would you want to be put on a feeding tube, knowing that you can be sustained in this existence?" I have asked that question in medical audiences, legal audiences and audiences of judges. I'll bet I have put that question before several thousand people. How many people do you think have said they wanted to be maintained that way? Zero. Not one person. Now that tells you about where the moral sentiment of our community is.

Where do you think this case is headed?

It's headed to federal court today. I cannot imagine what the federal question is. Congress said, "All we are doing is asking to have a federal court examine this." I don't know what they thought the courts were doing in the last eight years. They are saying, "We're asking a court to review this, to be certain that due process has not been violated." I don't think there is a case in the history of the United States that has been reviewed six times by an appellate court. Remember, the United States Supreme Court refused to review this.

[cjolley]

cont....

As a priest, how do you resolve questions in which the "sanctity of life" is involved?

The sanctity of life? This has nothing to do with the sanctity of life. The Roman Catholic Church has a consistent 400-year-old tradition that I'm sure you are familiar with. It says nobody is obliged to undergo extraordinary means to preserve life.

This is Holy Week, this is when the Catholic community is saying, "We understand that life is not an absolute good and death is not an absolute defeat." The whole story of Easter is about the triumph of eternal life over death. Catholics have never believed that biological life is an end in and of itself. We've been created as a gift from God and are ultimately destined to go back to God. And we've been destined in this life to be involved in relationships. And when the capacity for that life is exhausted, there is no obligation to make officious efforts to sustain it.

This is not new doctrine. Back in 1950, Gerald Kelly, the leading Catholic moral theologian at the time, wrote a marvelous article on the obligation to use artificial means to sustain life. He published it in Theological Studies, the leading Catholic journal. He wrote, "I'm often asked whether you have to use IV feeding to sustain somebody who is in a terminal coma." And he said, "Not only do I believe there is no obligation to do it, I believe that imposing those treatments on that class of patients is wrong. There is no benefit to the patient, there is great expense to the community, and there is enormous tension on the family."

How do you square that with the pope's comments last year, which seemed to indicate that people in Schiavo's situation should be kept alive?

The bishops of Florida did it very nicely when they said, "There is a presumption to use nutritional fluid, unless the continued use of it would be burdensome to the patient." So it's not an absolute. That statement is a recognition that the Vatican is inhabited by the same cross section of people that inhabit the United States

What do you mean?

I mean there are some radical right-to-lifers there, and they got that statement out. But it has to be seen in the context of the pope's 1980 declaration on euthanasia, and the pope's encyclical on death and dying, in which he repeats the long-standing tradition that I just gave you. His comment last year wasn't doctrinal statement, it wasn't encyclical, it wasn't a papal pronouncement. It was a speech at a meeting of right-to-lifers.

Again, this issue is not new. Every court, every jurisdiction that has heard it, agrees. So you'd think this issue would have ended. I thought it ended when we took it to the Supreme Court in 1990. But I hadn't anticipated the power of the Christian right. They elected him [George Bush]. And now he dances.

- - - - - - - - - - - -

[cjolley]

Say, how about those English doctors?
Sorry again Brian.
This one just turns my crank one cog too tight.