Final Exit Network Starts Billboard Campaign

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Many readers of this blog are probably already aware that the Final Exit Network (FEN) has put up a promotional billboard in San Francisco.  The group promises to erect more in New Jersey and Florida. 

There hasn’t been a great deal of attention paid to the group and the billboard as of yet, but what little there is shows clearly the advantage FEN has in managing the information about themselves, as can be seen in this SFGate blog entry:

According to its site, FEN provides support, information and counseling, and doesn’t physically help people end their lives. But authorities believe the group played an active role in the death of a cancer-stricken man in Georgia and have charged four network members with assisted suicide, evidence-tampering and racketeering, reports Time. They were indicted by a grand jury in April.

 Interestingly, the blog links to a story in the last sentence of this paragraph that gives a lot more detail – and contradicts the claims made by FEN that are otherwise unchallenged in this report.  Here’s an excerpt from the MSNBC article in the link above, referring to two of the defendants in the Georgia case, Thomas Goodwin and Clair Blehr:

Goodwin and Blehr were with Celmer when he died, each holding one of his hands, according to court records. Afterward, investigators said they removed a helium tank and hood Celmer wore to help him suffocate. Investigators say Egbert and Sheridan evaluated him before his death and gave the OK for his suicide.

FEN members also cleaned up the scene, removing the helium tank, plastic hood, etc.  As for “holding” hands, the allegations of the Georgia Bureau of Investigation are stronger than that:

The death had been planned for months, authorities say. Two helium tanks were purchased, along with an “exit bag,” or hood to be placed over the suicidal man’s head.

Thomas “Ted” Goodwin, 63, formerly of Kennesaw, and Claire Blehr, 76, of Atlanta, would observe the death of the man they were told suffered from pancreatic cancer. In truth, the man was a Georgia Bureau of Investigation agent conducting a sting operation at a residence in Dawson County.

On Wednesday, authorities say, Goodwin walked the undercover agent through the steps that would have killed him. He demonstrated how he would hold down the undercover agent’s hands to prohibit him from removing the “exit bag.” (Emphasis added.)

I’ll be writing more about FEN, and some reactions (past and present) from different parties and what it can tell us about the broader “right to die” movement. I think we’re getting to the point where groups like “Conflation & Con Jobs” AKA “Compassion and Choices” can’t accuse us of being fearmongers when we accuse their movement of following “incrementalist” or “slippery slope” strategies.  –Stephen Drake

New Guidelines for Determining Brain Death – But Will Hospitals Actually Follow Them?

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From USA Today – “When is someone brain dead? Experts revise guidelines“:

Determining brain death is a complex process that requires dozens of tests to make sure doctors come to the correct conclusion.
With that goal in mind, the American Academy of Neurology has issued new guidelines — an update of guidelines first written 15 years ago — that call on doctors to conduct a lengthy examination, including following a step-by-step checklist of some 25 tests and criteria that must be met before a person can be considered brain dead.
The goal of the guidelines is to remove some of the guess work and variability among doctors in their procedure for declaring brain death, which previous research has found to be a problem, said guidelines co-author Dr. Panayiotis Varelas, director of the Neuro-Intensive Care Service at Henry Ford Hospital in Detroit.
According to the U.S. Uniform Determination of Death Act, brain death occurs when a person permanently stops breathing, the heart stops beating and “all functions of the entire brain, including the brain stem” cease.
While no one disagreed with that description, a 2008 study that included 41 of the nation’s top hospitals found widespread and worrisome variability in how doctors and hospitals were determining who met the criteria, said Varelas, co-author of the 2008 review.

Dr. James Bernat elaborated on the findings of the 2008 review, the implications and the intent of the new guidelines.

Dr. James Bernat, a professor of neurology and medicine at Dartmouth Medical School, said the new guidelines will help to remove some of the variability in how doctors determine brain death.
“The 2008 study disclosed rather surprising and disturbing variations in determining brain death, and in some cases there were practices that were just plain wrong,” Bernat said.
The main risk is that a patient will be declared brain dead who really isn’t, Bernat said.
“The authors of this (new) study are experts in their field and have done an evidence-based, authoritative review,” Bernat said. “They are saying, ‘This is the way it ought to be done.’ The goal is to improve the uniformity and the quality of neurological practice.”

Maybe I’m missing something, but I don’t see how this will have a great impact on current practices.  These new guidelines are recommended guidelines, just like the old ones. In fact, when I read the 2008 study, it seemed clear to me that the biggest problem wasn’t a lack of specificity in the guidelines, but a virtual guarantee of widely varying practices built into the Uniform Determination of Death Act. Here’s a relevant excerpt from the abstract of the study:

In accordance with the Uniform Determination of Death Act, guidelines for brain death determination are developed at an institutional level, potentially leading to variability of practice.

So, again, unless I am missing something, individual hospitals still get to set their own practice standards in making a determination of brain death.  I don’t see them hopping up and embracing the new, detailed standards here, frankly.  From what I can see, the trend has been for hospitals to move toward standards that broaden the types of medical professionals that can make the determination, as was recently done in Virginia in a way that makes it possible to have a determination made without the involvement of a physician in a neurologically-related specialty. In the link above discussing Virginia, there is also information on a 2006 attempt by medical organizations in New Jersey to expand the range of professionals allowed to make a determination of brain death and dropping the two-physician requirement at the same time.

It seems – and not for any sinister reasons – that hospitals want to be able to make those determinations more quickly and with which ever medical professional is handiest.  They’re looking to save money and time – and time may be important when organ donation is a consideration.

I don’t see how – unless the Uniform Determination of Death Act is rewritten – these new guidelines will have much impact, especially since even one of the authors seems to be engaging in a bit of denial over what the widely varying practices have meant in life-and-death terms:

“We found no credible report of anyone who was brain dead and who woke up and survived,” Varelas said.

I have two issues with this statement.  First of all, any individual who is being evaluated for brain death is obviously in dire straits.  It’s highly unlikely that many would survive the removal of life support, even if they were capable of recovery – and obviously those who might have gotten falsely diagnosed as “brain dead” who were organ donors had no chance to recover at all.

Which brings me to the second issue.  In 2008, 21-year-old Zack Dunlap was determined to be brain dead in an Oklahoma hospital following an ATV accident.  As luck would have it, one of the two friends who accompanied him to be prepped for organ donation had some medical training – and got a “feeling” that Dunlap didn’t look “ready.”  The friend did some simple test for reactions to scraping his skin – and got them.  Organ harvesting was called off and he was evaluated further.  Dunlap eventually made close to a full recovery.

I don’t know what to make of the statement Varelas made.  The report on Dunlap was very credible.  Maybe Varelas would claim that Dunlap was never really brain-dead, so he doesn’t count.  That would be beside the point, though.

Because no matter how thoroughly or sloppily the determination was made, once Zack Dunlap was declared “brain dead,” he was corpse in the eyes of the State of Oklahoma.  And he stayed a corpse until the hospital realized it made a mistake (although they called it a “miracle” rather than a “mistake”).

So – someone tell me, please.  What good are the new guidelines if hospitals don’t have to follow them? –Stephen Drake

Next on the Kevorkian Promotional Tour: Larry King Live

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The promotional tour of Kevorkian – with his new and improved “packaging” – continues on CNN.  According to the CNN site, he’ll be appearing on Larry King Live on Friday, June 18th.  This should be real nausea-inducing.

Why would I think that?

Well, for starters, Larry is the “King” of softball interviews and it’s why people love to come on his show.  They won”t get asked any hard questions and King will treat them with an attitude ranging from warm geniality to open adoration.  That’s the normal mode for the Kingster.

However, as noted in this blog, Kevorkian has already gotten softball treatment from both Anderson Cooper and Sanjay Gupta.  It’s gonna be real hard for even the master of fluffy interviews to go softer than his two colleagues.

I figure the only place he can go is to use the ten questions always used by James Lipton on Inside the Actors Studio:

  1. What is your favorite word?
  2. What is your least favorite word?
  3. What turns you on?
  4. What turns you off?
  5. What sound or noise do you love?
  6. What sound or noise do you hate?
  7. What is your favorite curse word?
  8. What profession other than your own would you like to attempt?
  9. What profession would you not like to do?
  10. If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates?

 Those questions could fill a lot of time and manage to out-softball Anderson and Gupta – barely.

FWIW, you can submit questions for the show at this link.

As an exercise in futility, I submitted one.  I asked why Kevorkian was lying about his motivation in helping people commit suicide.  Right now, he’s saying it’s all about relieving suffering.  But in his 1991 book “Prescription: Medicide” he told a potential “client” that his primary goal was the “prospect of making possible the performance of invaluable experiments or other beneficial medical acts.”

My guess is that King will ask Kevorkian what kind of animal he’d like to be reborn as rather than ask something of substance like the question above.  But submit questions anyway.  Then King and his staff won’t have ignorance as an excuse for sticking with mush in terms of content.  –Stephen Drake

Long Discussion on Kevorkian and Related Topics with Stephen Hand

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On Saturday Morning, I was a guest of Stephen Hand on his show on blogtalkradio.  It was a long discussion that covered topics such as the recent positive media attention being given to Jack Kevorkian, mostly being stage-managed by HBO and CNN, which are both properties of Time-Warner.  We also talked about Peter Singer, bioethics and Edwin Black and his book War Against the Weak.

Stephen Hand comes from a different perspective than the secular one of NDY, and there are definitely some issues we wouldn’t see eye to eye on.  But we’re very much in sync when it comes to euthanasia, assisted suicide and related issues.  Steve and his family are very much part of the disability community – his wife has lived with multiple sclerosis for about twenty years; their son was gravely injured many years ago and – thanks to their resistance to medical pressure – survives and enjoys life with disability.

Unlike most media interviews/discussions, this one was very relaxed – less of an interrogation (as some tend to be) and more like an exploration of some areas of mutual concern.  The time flew by amazingly quickly.

The show is available for listening at this link

I want to thank Steve Hand for 90 minutes I felt were spent well.  I hope that he and his listeners felt the same way.  –Stephen Drake.

Addendum: Coincidentally, Edwin Black has an op-ed out today on The Cutting Edge – you can read Mendoza Legislation AB 2072 Nudges California Back to Eugenics here.

CNN’s Sanjay Gupta Fawns Over Kevorkian in Pre-HBO Documentary PR Blitz

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HBO will be airing a documentary on Kevorkian on June 28th.  It will undoubtedly be a soft and positive take on Kevorkian.

This morning, in what was no doubt the first in several media gigs stage-managed by CNN, Sanjay Gupta gives a stunningly shallow and fawning account of a day spent with Kevorkian.  Not that we in the disability community expect much from Sanjay Gupta – last year, he grossly misreported the facts on the Community Choice Act, and has so far not bothered to apologize for his error or to correct the record.

Sanjay Gupta’s report on his visit with Kevorkian can be read here.  There is a “comment” section – I’ve already done so and invite others to do the same.  –Stephen Drake