Washington Post: Saletan on “Redefining Life and Death”

bioethics, life-ending decisions, media coverage, medical decisionmaking, Our News & Commentary Blog, reality check

I’m a little late on this, but William Saletan, national correspondent for Slate.com, wrote a pretty thoughtful analysis of the current medical debates regarding the definition of death. First published as an essay on Slate, “The Doctors Who are Redefining Life and Death” was published in the Sunday, Oct. 5th edition of the Washington Post.

Saletan shares a some of the debates raging in medical circles in regard to defining death. He makes it clear that the driving force behind the efforts to expand the definition of death is the desire to obtain more viable organs for harvesting and transplantation.

From the essay:

Robert Truog, an ethicist who supports the Denver protocol, says this redefinition of death has gone too far. Let’s accept that we’re taking organs from living people and causing death in the process, he argues. This is ethical as long as the patient has “devastating neurologic injury” and has provided, through advance directive or a surrogate, informed consent to be terminated this way. We already let surrogates authorize removal of life support, he notes. Why not treat donations similarly? Traditional safeguards, such as the separation of the transplant team from the patient’s medical team, will prevent abuse. And the public will accept the new policy since surveys suggest we’re not hung up on whether the donor is dead.

But down that road lies even greater uncertainty. How devastating does the injury have to be? If death is vulnerable to redefinition, isn’t “devastating” even more so? The same can be asked of “futility,” the standard used by the Denver team to select donors. Is it safe to base lethal decisions on the ebb and flow of public opinion, particularly when the same surveys show confusion about death standards? And can termination decisions really be insulated from pressure to donate? Even if each family makes its own choice, aren’t we loosening standards for termination precisely to get more organs?

Saletan has zeroed in on the questions that “experts” like Truog would like to pretend aren’t relevant. Saletan is to be credited for this amount of analysis, since he doesn’t seem to be aware of just how much evidence there is that the pressure to obtain organs is already impacting life and death decisions.

What evidence?

It’s good to see Saletan turning his attention this way. He’s a thoughtful analyst that isn’t someone easily pigeonholed as “liberal” or “conservative” in his approach. I hope to see more from him on this and related topics in the future. –Stephen Drake

NOTE: Anyone interested in reading more by Saletan should check out the Human Nature section on Slate.

How many states does it take before we’re not “blown away” by nursing board scandals?

crime and punishment, media coverage, Our News & Commentary Blog, professional accountability, Ruben Navarro

Yesterday’s post discussed the LA Times article revealing that dozens of nurses in California with criminal convictions have valid licenses to practice in the state. One expert said they were “blown away” by the information, meaning she was surprised, I guess.

Turns out my suggestion that similar stories could be waiting in other states is all too true. A quick search this morning revealed there was a similar study in Texas earlier this year with even worse results.

WFAA-TV in Dallas, TX was able to come up with some very disturbing results with a few hours of research:

News 8 compared names and dates of births of every currently licensed nurse against the Texas Department of Public Safety criminal database.

The result revealed that thousands of Texas nurses have arrest records. In fact, one in 20 of them have records.

More than half of those work in hospitals and nursing homes. Some have charges as serious as arson, attempted murder and deadly conduct.

But what seemed even more remarkable was that the Texas Board of Nursing didn’t know about many of the arrests since its own background checks won’t be complete until 2012, according to the Board’s Director of Enforcement Tony Diggs.

So why do we care about this? Well, first there is the concern that some of the people in hospitals and other facilities may be people we wouldn’t want to entrust our lives to if we happen to end up there.

But it also relates to the debate about assisted suicide, euthanasia and other forms of medical killing. Advocates argue that strict safeguards will prevent any abuse, slide or spread of medical killing beyond what is allowed in the law.

The news in California and Texas shows us that the public’s faith in meaningful oversight of the medical profession is misplaced. And it’s not just these states – Oregon had its own scandal regarding its statewide nursing review board.

That’s three states out of fifty. I hope people will understand my inability to be surprised if stories like these pop up in more states. –Stephen Drake

LA Times and ProPublica: Dozens of Calif. Nurses with Felony Convictions Fully Licensed to Practice

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Over the weekend, an anonymous reader of this blog tipped me off to an important investigative piece published in the Los Angeles Times, in collaboration with ProPublica, ” an independent, non-profit newsroom that produces investigative journalism in the public interest.” To many readers, the following article might have been shocking:

Dozens of registered nurses convicted of crimes, including sex offenses and attempted murder, have remained fully licensed to practice in California for years before the state nursing board acted against them, a Times investigation found.

The newspaper, in a joint effort with the nonprofit investigative news organization ProPublica, found more than 115 recent cases in which the state didn’t seek to pull or restrict licenses until nurses racked up three or more criminal convictions. Twenty-four nurses had at least five.

In some cases, nurses with felony records continue to have spotless licenses — even while serving time behind bars.

Here’s a partial listing of some of the individuals they encountered still in good standing with the Nursing Review Board in California:

Among the cases in which the board acted belatedly or not at all:

* An Orange County man continued to renew his nursing license for years even after he was imprisoned for attempted murder.

* A Redding nurse was convicted 14 separate times from 1996 — a year after she was licensed — through 2006 on charges including several instances of driving under the influence, driving with a suspended license and drug possession.

* A San Pedro man amassed convictions for receiving stolen property, as well as possession of cocaine and burglary tools, before the board placed him on probation. He subsequently was arrested two more times, for possessing cocaine and a pipe to smoke it.

In response, the board extended his probation.

There’s more, but you probably get the picture. The article is easily accessible at both the LA Times link given above and at this URL for ProPublica.

In the article, btw, an “expert” on California Licensing Boards says she’s “blown away” by the findings in this article.

Frankly, I don’t see how anyone could be that surprised by this – in California or any other state. In California, for example, many medical professionals participated in the alleged attempt to rush Ruben Navarro’s death in a botched organ harvesting attempt. One transplant physician was the subject of criminal charges, but the other nurses and doctors in the room were exonerated by their respective review boards.

In Oregon, after a series of embarrassing investigative articles, a governor’s inquiry led to the resignation of the top two members of the Nursing Review Board in that state. The Governor’s investigation found that the board did “not protect the public as effectively as it protects a participant’s license to practice.”

So it’s not that surprising to hear of something like this coming from California. I’d be willing to guess that there are similar stories waiting to be written in many states by reporters willing to follow in the footsteps of the journalists in this latest story of professional review boards acting as a smokescreen for a laissez faire reality in the world of medical practice. –Stephen Drake

Biden Introduces “Crime Victims with Disabilities Act” – but isn’t putting the word out at his Senate Website

Our News & Commentary Blog, policy, politics

At first, I was really excited when I received email announcing Senator Joe Biden’s introduction of the Crime Victims with Disabilities Act – which reportedly occured yesterday, October 1st.

Unfortunately, except for the attached word document I received, and an email copy of a press release from the Association of University Centers on Disabilities (AUCD), I couldn’t find anything on the web anywhere documenting the introduction of the bill. (AUCD is one of several prominent disability groups that have endorsed the bill)

I called Biden’s Senate office and they did confirm his introduction of the bill and directed me to the description of it at Thomas.gov – you can see S.3668 here. The text of the bill isn’t there yet, but probably will be there by next week. The staffer I talked to seemed oddly unenthusiastic and nonresponsive to my questions about posting any info about the bill on Biden’s Senate website.

This bill is a version of one he introduced last year, which I wrote about in an earlier entry. It looks like a good bill that recognizes that people with disabilities are especially vulnerable to crimes of violence – and that the criminal justice system hasn’t been doing a very good job of helping people even when perpetrators are charged.

It seems odd to me, on the day of the Vice-Presidential Debates, that Biden wouldn’t go a little out of his way to remind people in the disability community that he is attuned to at least one part of the lived reality of Americans with Disabilities.

After all, Sarah Palin, who has a young child with Down syndrome, created a huge stir among parents of all political persuasions when she said (to parents of “special needs children”):

“I pledge to you that if we are elected, you will have a friend and advocate in the White House.”

So far, she hasn’t said anything about or to people with disabilities themselves.

This would have been Biden’s chance.

Tip to Biden and staff: Next time, when you do a good thing, let people know. –Stephen Drake

Update: Haleigh Poutre and the Strange Priorities of Massachusetts Legislators

"end of life", haleigh poutre, life-ending decisions, medical killings, Our News & Commentary Blog, policy, Surrogate Decisions & Guardianship, update

Wesley Smith has an update on Haleigh Poutre, who apparently – and hopefully – will be spared having to testify in the trial of her stepfather, Jason Strickland. Haleigh Poutre narrowly escaped the death planned for her by medical professionals at Baystate Medical Center and publicly-appointed guardians from Massachussets DSS. These professionals all signed off and went to court to seek removal of both ventilator and feeding tube from Haleigh Poutre just 8 days after her admission to the hospital. Poutre was in a coma, the result of injuries allegedly inflicted on her by her adoptive mother and stepfather, Jason Strickland. (NDY issued a press release calling for a larger investigation than actually happened)

Poutre’s adoptive mother committed suicide. Strickland, quite probably to avoid being charged with murder, fought the DHS in court, seeking to have Poutre’s life-support maintained.

In a case of incredible irony, the case took enough time to allow Haleigh to improve. In fact, news reports that she was awake and responsive emerged just one day after a judge approved the removal of Haleigh Poutre’s feeding tube.

If you’re looking for a hero in this story, you can stop now. There aren’t any.

And, under the radar, the legislative response is far from encouraging.

Back in March, for example, almost no coverage was given to the inaptly named “Haleigh’s Amendment” that was introduced – and passed into law:

‘Haleigh’s Amendment’

During debate last week on legislation pertaining to the abuse and neglect of children, which is intended to strengthen the Commonwealth’s oversight of children under the charge of the State, an amendment written by Sen. Scott Brown, R-Wrentham, was passed unanimously. The amendment protects victims from those who have been charged with their abuse or neglect.

Brown filed “Haleigh’s Amendment” in response to the tragedy of the Haleigh Poutre case in Westfield in 2005. Haleigh had been hospitalized as the result of alleged abuse at the hands of her adoptive mother and stepfather who had burned and beaten her into a coma with a baseball bat. While on life support, Haleigh’s stepfather attempted to obtain guardianship of her even though he was suspected of the abuse.

This amendment would prohibit an individual from being appointed a guardian or medical proxy if they have been charged with assault and battery, or neglect of the incapacitated child. In this case, the amendment would have removed any ambiguity as soon as the stepfather was charged.

Currently, the court may appoint a guardian for a person who is unable to make or communicate informed decisions due to physical incapacity or illness.

Please re-read the above with the circumstances of Haleigh Poutre’s near-brush with death in mind.

If this law had existed when she was admitted to the hospital, she’d be dead now.

That’s right. She’d be dead. Jason Strickland, motives aside, would have had no standing to challenge the DSS-appointed guardians in court. Haleigh Poutre’s death would have proceeded smoothly, efficiently and – most important of all – quietly.

It’s easy to see how this prevents the State from being embarrassed in a similar way in the future. It’s less easy to see – using Haleigh Poutre’s story as the rationale – how this is seen as furthering the “best interests” of children.

And, while the abuse of Haleigh was especially horrific, this bill strips all rights in medical decisionmaking from parents who haven’t actually been convicted of anything – and the bill strips those rights even from those charged with any level of neglect.

To be fair, though, the legislature finally got around to passing some other measures that seem to actually attempt to add some protections to children in situations like Haleigh Poutre’s, but it wasn’t on a fast track like the first bill.

According to Thaddeus Pope at the Medical Futility Blog, this legislation, which would require written second opinions and an approval from an ethics committee, is still pending.

Pope also refers to these pieces of legislation – relevant to situations such as Haleigh Poutre’s – as “end of life.” I guess he’s making assumptions about the outcome or just not bothering to reflect on the irony of using the term in this context.

I haven’t had a chance to read this pending legislation yet, but I’m not confident an ethics committee at Baystate would have gone against the medical recommendations to end her life. Similarly, if written second opinions are to really mean something, they should come from a qualified medical professional outside the original one.

In short, it looks like Massachusetts has made significant steps in making sure that a case like Haleigh Poutre’s never comes to light again. They have yet to make steps to make sure that medical railroading and abandonment don’t actually occur. It’s clear from where I sit which was more important to the legislature – avoiding future embarrassment or actually protecting children. And what I see doesn’t make them look very good. –Stephen Drake