Bioethics, healthcare policy, and related issues.
Jill Stanek has masterfully body-slammed the pro-choice community with a logical maneuver so powerful it would be irresistible if it happened to make any sense or involve actual facts, which, sadly, it does not. As usual, she is wrong in virtually everything she says, but is enjoying a wave of anti-choice congratulations over her latest clever obfuscation.
It is a tedious necessity, but I suppose we ought to take a closer look at what she’s saying, and what is actually true about what she’s saying (which are two very different things).
Art Caplan has written several times on the need for regulations banning drug use and other performance enhancements by athletes. I have criticized some of his positions before. Recently, though, he came out against regulations banning another form of enhancement, regarding them as too intrusive, or perhaps arbitrary.
I don’t think he can make these positions consistent.
There is much buzz about a just-released report in the clinical journal Neurorehabilitation, which reports a case study of three patients, reportedly diagnosed with long-term persistent vegetative state, who were returned to full consciousness for a number of hours with doses of zolpidem, the medication in the sleeping pill “Ambien”. Clinicians and ethicists are warily interested; the “pro-life” blogosphere, of course, is uncritically beside itself over the news:
End the Madness: PVS is reversible or misdiagnosed [Pro-Life Blogs]
PVS is reversible and often misdiagnosed [HyScience]
Important News: Drug ‘Reverses’ Vegetative State [BlogsforTerri]
Rise and Talk [Premature Terminal Delivery]
Holy Cow! Patients in PVS Awakened by Sleeping Pill [Wesley J. Smith]
etc.
The Terri Schindler Schiavo Foundation has already demanded a moratorium on terminations of treatment for all patients in PVS on the strength of this report, as has their easily-misled former spokesperson, Pamela Hennessy.
One persistent feature of right-wing objections to fairly ordinary healthcare procedures is the unapologetic ignorance they display. The bizarre distortions of the debate over intact dilation and extraction abortions were just the most effective such example; from the Catholic Church’s completely false characterizations of condoms as a bulwark against AIDS, to the familiarly bogus claims about “the abortion/breast cancer link”, “post-abortion trauma syndrome”, and most recently James Dobson’s non-existent “detachment and differentiation” as the cause of homosexuality, the far right seems to suffer from a persistent and universal failure of reading comprehension, as well as a gasping lack of basic factual knowledge. And, worse, the use it to their advantage, often it seems deliberately.
The latest example is Pamela Hennessy’s screed against an end-of-life-decisionmaking bill in New Hampshire. She grounds a panicky call to arms on an obvious misreading of the plain text of the bill, then somehow manages to paint “ethics” itself as some sort of conspiracy (of the Party of Death, no doubt). You rarely see that much weirdness appended to one paragraph of legal text, but Hennessy – for years a Schiavo Foundation spokesperson (ahhh . . . now I understand . . .!) – manages it.
The AP is carrying a story on the increasing popularity of hormonal birth-control regimens that provide round-the-cycle protection and do away with monthly menstruation. Women love them, and nobody understands why The Pill hasn’t always been this way.
In particular, the AP article makes no mention whatsoever, and the author is apparently completely unaware of, the reason a monthly period is built into birth control pills. The answer has nothing to do with women’s health or with increased contraceptive effectiveness. The answer, as with so many forms of interference in women’s sexual health, is the Catholic church.
I just came across an old post on Feministe, responding to a conservative woman who explained why she supports Bush (guns, public funding for private schools, the “war on terror”, and because America just gives wa-a-a-a-y too much back for what it receives from the rest of the world). The comment thread, as such things do, quickly turned to a general libera-vs.-conservative slagfest, particularly on the subject of abortion.
One of the commenters came up with a strong statement of the autonomy-based defense of abortion that I thought was as good a job of putting it in a nutshell as I had seen, and which makes an interesting and useful analogy between autonomy over pregnancy and the unquestioned autonomy rights even conservatives recognize over other bodily invasions. It’s worth noting.
There is a Costco about a mile from my new apartment in Brooklyn, so I paid $45 for membership privileges there when I moved in, anticipating making it back in all the savings I would reap on their low-priced goods. I never seem to have time to shop there, though, so today, when I was nearby and dropped in for the first time, a few things hit me: I am unlikely to recoup my $45 there; the reason is that I am not a Costco person; furthermore, leaving aside the $45, which I now regret, I have no desire to be a Costco person.
That, of course, makes me evil in the eyes of the “we know what’s best for you” right wing.
I don’t have much interest in or concern for The Da Vinci Code in any of its manifestations, and even less for the predictable special-interest Catholic whining that accompanies almost any artwork touching on their preferred view of the world. However, one complaint about the newly-released film caught my attention. Fans of the book or movie will not be surprised, but I was not previously aware that one of the chief villains in the story is an assassin monk who has albinism. (What? No dwarf?) This makes approximately the gazillionth “deformed” villain in the history of movies, stage, and novels, and the albinos in particular – a polite but feisty bunch – are getting pissed about it.
(more…)
As a follow-on to the below post on PIGD in England, Pro-Life News reports on the same story and then comments (complete with misspellings and scare quotes):
Doctors tested embryos created by the woman and her “partner” using in-vitro fertilisation (IVF) methods for the cancer gene. Only unaffected embryos were implanted in her womb, the newspaper said. But it is not reported how many babies the so call “doctors” killed in the screening proucess.
It will surprise no one, I’m sure, that this makes not the slightest sense.
Glen McGee reports on this development in genetic diagnosis: England’s HFEA (national assisted-reproduction policy-making body) has finally agreed to authorize pre-implantation genetic diagnosis (“PIGD”) for some known cancer-linked genes (apparently BRCA1 & 2), but the genes in question are patented by a commercial corporation, Myriad, who flatly refuse to license the testing. So the regulatory barrier has been removed, but it is still illegal to perform tests which, presumably, patients want, and that could give them knowledge of a child’s predisposition to breast or ovarian cancer, because a commercial license-holder has decided unilaterally not to allow it.
I have blogged previously on the dangers of patents for ordinary genome sequences; this seems to be as stark an example as you could ask for. Basic information about people’s health status and prognosis is being withheld from them, deliberately, by an uninvolved third party acting under property rights law, of all things. Are people’s values and freedom ever going to be taken seriously in the healthcare arena?
Psychologist David Barash makes a welcome, and very overdue, point in an interesting Op-Ed in the LA Times: the well-documented decline in birthrate, and the rise in voluntary childlessness in Western cultures, not only does not conflict with a theorized evolutionary-psychological drive to reproduction, but is an expression of the fundamental freedom from evolutionary pressures that gives human nature its unique qualities.
In traditional evolutionary theory, reproductive success is all; those who die with the most kids win. Evolutionary psychology and sociobiology put this in more complicated perspective – altruism, kin selection, and all that – but it was still understood that getting your gametes over the hump, as it were, was the goal of life. This makes voluntarily non-reproductive lifestyles – whether homosexuality, delayed reproduction (with its risk of failure), or plain “childlessness by choice” – seem positively unnatural, and thus, in the naive fallacious naturalism that so often characterizes the right wing, that much more immoral. “Contracepting”, or not having kids by whatever means, becomes not merely religiously irritating to those of the familiarly thin skin, but somehow perverse, an attack on the species imperative to survive and prevail. Or so it may seem.
Barash defends sex for its own sake (a stance the more pathetic for its boldness in this benighted day):
For more than 99.99% of their evolutionary history, humans haven’t had the luxury of deciding whether to reproduce: simply engaging in sex took care of that, just as eating solved the problem of nutrition. But then something quite wonderful arrived on the scene: birth control. Because of it, women (and men) can exercise choice and, if they wish, save themselves the pain, risk and inconvenience of childbearing and child-rearing, indulging themselves rather than their genetic posterity.
This study is getting some play, purporting to show that a large percentage of medical-malpractice tort suits are ill-grounded. According to these reviewers, 40% of all malpractice suits filed are “frivolous”, and some actually come from patients who were not even injured! Commentators are already touting it as the smoking gun for malpractice “tort reform”. I think the reasonable conclusion is exactly the opposite.
The bioethically-oriented religious right has a strange history of inventing imaginary disorders with which to accuse or disparage people whose lives or behavior they disapprove of – or to scare others out of behavior they might choose if left to their own devices. Examples include the pretended “post-abortion trauma syndrome”, as well as the repeatedly-disproven “link” between abortion and breast cancer. There is also the bizarrely counter-factual harping on the dangers of contraception and abortion, never presented in comparative context, which would demonstrate them both to be vastly safer than an unwanted pregnancy. And there is a lot of weird nonsense heard about pornography, masturbation, television shows, magazine covers, and whatever other source of titillation pushes the right’s always-armed sex-panic buttons.
Beyond abortion and women’s sexuality, though, without doubt the one issue that prompts more purely delusional pseudo-scientific spewing is the question of homosexuality – its source, its practice, and its consequences. “Answers” to the befuddling question what “causes” homosexuality are legion. It will surprise no one to discover that James Dobson, purveyor of so much amusing right-wing bloviating, has discovered yet another such theory – one he claims is “being discussed in the child development clinics and in the universities throughout the country and around the world”, none of which seem to have heard of it.
[This is the first post in an irregular series of reviews and discussions of fiction and non-fiction books relating to bioethics or concepts in the field.]
Robert J. Sawyer is a hugely creative sci-fi author (Hugo, Nebula multi-nominee and winner, slews of other awards) with a fascination for issues touching on human personhood and human nature. He has a widely-read series that posits a parallel universe in which H. neanderthalensis evolved to become the dominant species, with a distinctly different human nature from that of H. sapiens, and a number of similar books in which human nature and the science/religion conflict are examined from a perspective slightly removed – by the license granted to science fiction – from our own. His most recent book is Mindscan, an examination of the possibility of cognition “uploads” – the copying of memory and thought from the human mind into a permanently-rebuildable (hence immortal) synthetic substrate. The fact that the copying process does not destroy the original – that it creates two cognitively-identical minds housed one in its original organic body and the other in an indefinitely long-lived synthetic one, which then vie for recognition as the “real” person – gives the plot its tension.
APeticola has an interesting post at the always-challenging Health Care Renewal, on the tendency for diagnostic “thresholds” to decline over time – that is, the fact that certain conditions will tend to be seen, and treated, in more and more patients as those conditions acquire greater salience in the medical community.
In the news recently was someone or other’s recommendation that less severe degrees of obesity than morbid obesity be also treated by gastric bypass. This should surprise no one. There are constantly “discoveries” that it is better to be more and more aggressive with blood pressure, cholesterol, blood sugar targets; etc.; and thresholds for treatment are generally lowered with each new series of recommendations.
Diagnostic and treatment thresholds ratchet ever downward. It’s definitely good business. But is it good medicine?
Good question, certainly. And Peticola does a good job laying out some of the problems that this phenomenon may generate:
As treatment thresholds move downward, medical expenses move upward. And something else occurs: as thresholds are lowered for treating various risk factors, the benefit/risk ratio changes markedly.
But I wonder if there’s a point being missed here.
A group of occupational-medicine physicians has released a white paper on the issue of disability certifications for impaired workers, holding that doctors often keep workers off the job too long after an injury or illness and that the specialty should adopt a “Stay at Work/Return to Work Process” as its fundamental organizing model for treating disability. That process seeks to minimize the time workers spend off the job, which, the authors assert, would be beneficial in many ways:
We know that much work disability is not required from a strictly medical point of view. We see devastating psychological, medical, social, and economic effects caused by unnecessarily prolonged work disability and loss of employability. We also see wasted human and financial resources and lost productivity.
Finding better ways of handling key non-medical aspects of the process that determines if an injured or ill person will stay at work or return to work will improve outcomes. Until now, the distinct nature and importance of the stay at work and return to work process (SAW/RTW) has been overlooked. Improvements to that process will support optimal health and function for more individuals, encourage their continuing contribution to society, help control the growth of disability program costs, and protect the competitive vitality of the North American economy.
This may all be true, but it causes concern nonetheless. Without comment, these authors introduce multiple factors into their outcome evaluation which are not related to, and in fact may conflict with, patient welfare. They say explicitly here, and throughout the paper, that the benefits of encouraging workers to take less time off the job for disability-related reasons include, among other things, harm to the “economy” (GDP, presumably), “contribution to society”, reduced costs of disability treatments, and worker productivity. In other words, among the major drivers for doctors to determine the course of individual patients’ care are the contributions those patients can make to overall economic goals valued by their employers, third-party healthcare payers, or “society”, not the patients themselves.
To put that another way, these authors are openly encouraging doctors to admit external economic values (in addition to the many that already impact treatment decisionmaking) to directly influence their decisions regarding their patients’ recovery from illness or injury – values that run directly counter to the patients’ own. There may be a problem there.
This story from England strikes a familiar chord: a doctor has assisted a woman well beyond the typical age of fertility to undergo an IVF pregnancy; critics claim he should not have done so because it smacks of “selfishness” and because “it would be extremely difficult for a child to have a mother who is as old as a grandmother”. Art Caplan said much the same thing in a column about a year ago: “it was wrong because there was a terrible price to pay for using reproductive technology [in the case he discusses].”
I’m uneasy about this, in a lot of ways.
I’ve been following the dustup over Caitlin Flanagan’s self-absorbed and whiny rant that nobody appreciates her for trying to turn back the clock on women’s rights. (Primo examples here, here, here.)
Contrary to her assertions, it’s not her lifestyle liberals object to. (Contrary to her delusions of grandeur, nobody really cares how she lives her life – they just wish she would stop telling them how to live theirs.) It’s her enthusiasm for “little-helpmeet” misogyny that drives them to consider her an enemy. See if you can tell why:
[P]ity the poor married man hoping to get a bit of comfort from the wife at day’s end. He must somehow seduce a woman who is economically independent of him, bone tired, philosophically disinclined to have sex unless she is jolly well in the mood, numbingly familiar with his every sexual maneuver, and still doing a slow burn over his failure to wipe down the countertops and fold the dish towel after cooking the kids’ dinner. He can hardly be blamed for opting instead to check his e-mail, catch a few minutes of SportsCenter, and call it a night.
Ahhhh . . . . So, if all that is what is wrong with women, what would it take for them to be right?
Aside from the familiar, dreary 50s drudgery of it and the cheerfully creepy rape-positivism (she can’t initiate sex, she can’t refuse it, and she must not have sexual desires of her own – but she is obligated to satisfy her man on his whim no matter what), what’s inescapable is that women of the Flanagan mold must not have any self-directed lives of any kind, nor any “philosophical inclinations” to think their own interests and values matter; they exist for the sexual gratification of, and personal service to, their husbands, and are judged (by Flanagan) on how well they perform those functions.
Where have I seen this before . . .?
Oh, yeah. Now I remember. (more…)
LifeSiteNews, a right-wing online news outlet with somewhat dubious standards of reportorial accuracy and a never-failing slant on even the most straightforward stories, offers this shocking headline:
Chinese Military Doctor Witness to over 60,000 “Involuntary” Organ Donations – most from Falun Gong
That’s gut-wrenching. The fact that it’s almost certainly false, however, only detracts from the serious issue of telling the truth about Chinese organ-transplant abuses and repression of the Falun Gong.
Canada is slowly being invaded by the US’s culture of right-wing grousing about other people’s liberties. The Canadian courts, however, have remained a bulwark for its citizens, and in a recent case not only made a powerful and important distinction regarding the rule of, and role of, law, but in doing so set what the opponents of liberty themselves refer to as a “precedent”. Let’s hope the courts take them at their word, and build on this example.
The case, like so many of America’s most important cases on liberty rights, hinges on an issue deliciously guaranteed to trip the right-wing’s sex-panic hairtrigger. The question was the Constitutionality (under Canadian law) of bans on sex clubs and “swinger” clubs. The Court properly found no good reason to be against them, and struck down the law. And the howling began.
Jay Sennet posts his “Trans[sexual] Political Agenda” – a cri du coeur on the subject of outsiders’ cluelessness about the lives of those with non-normative gender status or identity.
A criminal category for prisons and mental health institutions that stop hormones of inmates.
He do like to stir shit up.
Paul Root Wolpe, a highly respected bioethicist, was working awfully hard at the UPenn Bioethics Conference last weekend to picture the Schiavo case as a glass half full. Bioethics.net quotes him:
The real truth – the one hidden in the invective and hostility that infected so much of the debate over the case – is that both sides were right. Terri Schiavo found herself in a medical limbo that left her person and nonperson, severely damaged yet not really suffering, awake and moving yet not perceiving or feeling. That is precisely what makes these cases so tragic. . . .
If we conduct [these debates] without bitterness, assuming our opponents’ good faith, and in a spirit of working toward solutions, perhaps it won’t be quite so hard to die in America.
Good luck with that, Paul.
William Saletan has been on a tear recently, repeatedly offering his now-familiar argument that the pro-choice community has to find some way of appeasing anti-choicers in whatever guise, and whatever venue, he can find. There was a celebrated spat between him and Katha Pollitt in Slate not long ago. When it was over, he didn’t seem to have heard that the things he keeps saying – essentially, that women should settle for whatever they can get and “put Roe behind them” – are infuriating to women who want the rights and freedom they’re entitled to, and not just whatever slips under the right wing’s RADAR.
Yesterday, in a Seattle Times Op-Ed, he went on the same kick, urging pro-choicers to “move beyond Roe” by “making it irrelevant”.
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