The Onion: Financial Planner Advises Shorter Life Span

humor, Our News & Commentary Blog

The news these days is mostly cruddy. We’ll get into that in the days to come. In the meantime, leave it up to The Onion to show us that no situation is so horrible that it can’t be laughed at – even if it’s pained laughter.

Financial Planner Advises Shorter Life Span

TUCSON, AZ—After reviewing his client’s income, assets, and personal budget Tuesday, Morgan Stanley financial adviser Henry Dalton determined that Jason
Hutchinson, 43, could make the best use of his portfolio by dropping dead at the age of 62. “Taking account of inflation and the rising cost of living versus the projected direction of the economy in the coming decade, I told Mr. Hutchinson that he could significantly reduce his spending by simply living less,” Dalton said. “After looking at his investments, I calculated that he really shouldn’t live a day over 62—or 59 if he wants a funeral.” In order to help his client plan for his financial future, Dalton presented Hutchinson with several of the company’s comprehensive suicide packages.

New Study in BMJ Indicates People with Clinical Depression Getting Lethal Prescriptions in Oregon

assisted suicide, Oregon, Our News & Commentary Blog, policy, reality check, research

Hot off the press, first from an article from today’s US News & World Report, carefully titled “Oregon’s Assisted Suicide Law May Overlook Depressed Patients“:

WEDNESDAY, Oct. 8 (HealthDay News) — Oregon’s physician-assisted suicide law may not adequately protect the one in four terminally ill patients with clinical depression, a new study says.

The Death with Dignity Act was passed by the state in 1997, and there’s been intense debate about the extent to which potentially treatable psychiatric disorders may influence a patient’s decision to hasten death, according to a news release about the study, published online Oct. 8 by the British Medical Journal.

The act does contain several safeguards to ensure patients are competent to make the decision to end their life, including referral to a psychologist or psychiatrist, if there’s concern that a mental illness may be impairing a patient’s judgment. However, depression is often overlooked in mentally ill patients.

In 2007, none of the 46 people in Oregon who used physician-assisted suicide were evaluated by a psychologist or psychiatrist, the news release said.

For the new study, researchers at Oregon Health and Sciences University checked for depression or anxiety in 58 terminally ill patients who’d requested physician-assisted suicide or had contacted an assisted death organization. Fifteen of the patients met the criteria for depression and 13 for anxiety.

By the end of the study, 42 patients had died. Of those, 18 received a prescription for a lethal medication, and nine died by lethal ingestion. Of those who received a prescription for a lethal medication, three met the criteria for depression. All three died by lethal ingestion within two months of being assessed by researchers.

The article in question is freely available online. Here’s the conclusion from the abstract of the article:

Although most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.

This is a very restrained conclusion. A closer look at the data in the paper reveals that levels of anxiety and depression were reported in an even larger number of participants, even if the levels didn’t reach the standard for clinical depression.

Given the larger context, namely that no one obtaining a lethal prescription in 2007 was referred to a psychologist or psychiatrist, it’s fair to question just how much care and support these individuals are given when thinking about suicide.

The study authors also note that “in 2006 Compassion and Choices gave information to or attended the deaths of three quarters of patients who choose aid in dying.” I’m going to take a leap here and assume that Compassion and Choices has its own list of doctors it sends people to – doctors who don’t tend to be too concerned about giving patients any kind of support other than a lethal prescription. (i.e. Could anxiety and depression be reduced in these individuals, making them less likely to want to kill themselves? Do the doctors care?)

Predictably, Compassion and Choices has already come out and put its “spin” on the study.

On the left side of its main page, under “top stories” is the headline:

“10.7.2008 New Study: All Patients Using Oregon Death with Dignity Act Were Mentally Competent to Make Informed Choice.”

The “spin” in the comments on the Compassion and Choices website is provided by two medical professionals with a long history of advocating euthanasia and assisted suicide. Compare their comments against the article in the BMJ.

I find it curious that this study was published in the BMJ rather than an American publication. I don’t know what – if anything – to make of that. –Stephen Drake

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

california, media coverage, Oregon, Our News & Commentary Blog, professional accountability

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