Diane Coleman and Steve Gold in Seattle Times Story

Things are a little behind here, in terms of posting and commenting on news items.

On Sunday, September 16th, Diane Coleman and Steve Gold were quoted in a Seattle Times article titled “Some favor slower right to die for paralyzed.” Not the best title, but a predictable one. An alternative and accurate title might have read “Some want more time, deliberation and information to insure ventilator users who end lives through treatment refusal are truly informed decisions.” But that’s a little long and complicated when you can use a simple piece of jargon like “right to die” as shorthand.

The article resulted from the highly publicized decision Capt. Drew Jensen to end his life on a ventilator after a bullet wound inflicted in Iraq resulted in his total paralysis from the neck down.

Here are some of the comments from Gold and Coleman:

Statistically, spinal-cord patients are more likely to be young and male — hurt in sports, auto accidents or other trauma. Unlike older patients, who may come to be disabled more gradually, they are suddenly forced to imagine a life with grave limitations.

And, most likely, they’ve internalized stereotypes and negative attitudes about disability, said Diane Coleman, president of the national disability-rights group Not Dead Yet.

They and the medical providers who advise them often have had no exposure to paralyzed people who work as engineers, computer programmers or who operate
motorized wheelchairs, she said.

“Two, three months after an injury, you cannot be making an informed decision,” said Stephen Gold, a Philadelphia-area lawyer who represents disabled people. “You just don’t have the experience yet.”

More from Diane here:

Still, society and its influences must be considered, counters Coleman of Not Dead Yet. “I’m not wanting to judge [Jensen] or his family,” Coleman said. “I am wanting to judge our society, and I am prepared to question the medical people, and the people surrounding the actual case.”

In any case involving disabled people, there are issues about support, about finances, about the emotions and motives of patients and family that must be scrutinized, she said.

For example, limits on payments for in-home services, pushing some into unwanted nursing-home care, amount to “coercion,” Coleman said. Some in that situation have felt their only choice was to ask that life support end. “That’s not voluntary choice,” she said.

Disability advocates have long been excluded from discussions of medical-ethics policies, Coleman said. “We’ve only recently been yelling so loudly that they’re being forced to talk with us.”

This article skimmed the surface of a difficult issue with a complex history – a history that has often been distorted. For more information, please check out the following:

  • Unanswered Questions by Mary Johnson – discussion of the cases of Kenneth Bergstedt and Larry McAfee, both of whom were quadriplegic and dependent on ventilators. Both were at the center of battles about their right to have their vents shut off.
  • A bioethicist offers an apology by Howard Brody – discusses his rethinking of the criticisms of disability activists during a prominent vent-removal case involving David Rivlin in Michigan.

Rush to Judgment Ends Lives of Newly Disabled

I recently attended a medical ethics seminar held at the Rehabilitation Institute of Chicago that reaffirmed medical practice guidelines about brain injury. Doctors continue to agree that it is necessary to wait before they can predict brain injury outcomes with reasonable, though they also admit not total, certainty. For traumatic brain injury (e.g. car accidents), the waiting period is one year. For anoxic brain injury (e.g. stroke or heart attack), it’s three months.

Many people with disabilities know someone who beat the predictions and amazed the doctors. But those people may become increasingly rare. In fact, evidence is mounting rapidly that the accepted guidelines are not consistently followed.

In yesterday’s blog entry, several major stories involving “rush to judgment” cases were discussed. On an MSNBC blog entry related to the Jill Finley case, several people told stories involving similar scenarios – with “mixed” outcomes. We also get calls from families several times a year – families feeling pressured by doctors to remove the life support from a family member mere weeks or even days post-injury.

Discussing the medical advice in the Jesse Ramirez case, Dr. Steven Miles referred to early decisions to end someone’s life as “malpractice” and “unusual.” Between the news stories and the phone calls we get, I don’t think that these scenarios are “unusual” any more.

Dr. Joel Frader is the current president of the Chicago End-of-Life Care Coalition. Frader co-authored a 2004 article with James L. Nelson, a bioethicist at Michigan State University. The authors bemoaned the difficulty of predicting outcomes “at those times during the course of treatment when there may be a ‘convenient’ window of opportunity to stop interventions and allow a patient to die.” (Nelson and Frader, “Brain Trauma and Surrogate Decision Making: Dogmas, Challenges, and Response,” Journal of Clinical Ethics, Vol. 15, No. 4, 264-276.) “A convenient window of opportunity” to cause death by omission before someone objects or the individual shows “too many” signs that recovery is underway, though he or she may be permanently disabled to some extent? This suggests that the “better dead than disabled” philosophy may be gaining wider acceptance within the medical profession than the public has been led to believe.

Frader and Nelson also questioned what they call the “orthodoxy” of taking only the patient’s perspective into consideration in health care decision making, without also considering the burdens to family caregivers. This intentionally echoes the arguments and sentiments of philosopher John Hardwig, author of the infamous “Is There a Duty to Die?”. (Hardwig’s answer is “yes,” demonstrating that a communitarian ethical framework can be just as hostile to the lives of people with disabilities as utilitarian ones.)

The pressures seem to be mounting. In a recent New York Times article (Jane Brody, “The Solvable Problem of Organ Shortages”), Dr. Robert Steinbrook, a consultant with the New England Journal of Medicine, reportedly said “potential donors included patients on ventilators after devastating and irreversible brain injuries, as might follow a hemorrhagic stroke, as well as patients with high spinal cord injuries and terminal musculoskeletal diseases like ALS, for whom further medical treatment is deemed futile.” Like Ruben Navarro? Readers of this blog will hopefully recall that Navarro – five days into a coma – was enlisted as an organ donor under the NHBD protocol. He continued breathing after removal of his ventilator and a transplant surgeon is now facing multiple criminal charges for allegedly trying to “hasten” his death.

Brody went on to write, “These patients are technically not dead. But if they are considered suitable donors and the families agree to donation, life-support measures are ended. …If the heart does not stop within a reasonable time, planned donations have to be canceled, which occurs in about one in five cardiac deaths.” We can safely assume, though, that the deaths proceed as scheduled.

Isn’t it time for some open public discussion about how the medical profession is making these judgments, and how they should be made? —Diane Coleman

Miracles, Malpractice, Survivors and Recovery

Last week, during the national ADAPT Action here in Chicago, several people forwarded one of those stories that brought to mind Yogi Berra’s “This is like deja vu all over again.”

The story that provoked this “I’ve seen this before” feeling was about Jill Finley, who came out of a coma – 14 days after its onset and after her husband had ordered removal of life-support after some not-so-subtle nudges from the physicians:

Doctors wouldn’t come right out and say that the situation was hopeless, but they did say that only one to two percent of such cases recovered to live normal lives.

“It was grim,” Ryan told Vieira. “I’ll put it that way. Everything they told me was grim.”

Ryan Finley found his wife unconscious and unresponsive one morning and administered CPR he had learned many years earlier. They now know Jill has a condition that causes her heart to stop beating and now has a pacemaker to correct for the condition.

In the same story, Jill Finley told Meredith Vieira that it was a “miracle” for her to be alive and talking.

She might be right, but probably not for the reasons she’s thinking.

The past year or so has had stories of other people written off early after going into a coma. Back in June of this year, we had the story of Jesse Ramirez. He suffered traumatic brain injury in an automobile accident. His wife, acting on the negative prognosis given to her by physicians, ordered the removal of her husband’s feeding tube a little over a week after his injury. Other members of the family contested her action, which bought valuable time, time in which Jesse Ramirez started to recover:

His siblings and parents refused to give him up for dead, and today, Jesse Ramirez is alive and conscious.

Two weeks ago, he was the center of a family battling over of whether he should live or die.

Now, he can hug and kiss, nod his head, answer yes and no questions, give a thumbs-up sign and sit in a chair.

Some family members, quoted in media reports, called the recovery of Jesse Ramirez “a miracle.”

In an ABC News story attempting to explore the ethical implications of the Ramirez case, Dr. Steven Miles gave a frank assessment of apparent rush to end the life of Jesse Ramirez:

“This case is about a hasty clinical decision which should have never been made,” he says. “In terms of the process itself, stopping the feeding tube this close in time to the injury is actually pretty unusual.

“This is about malpractice, not about a persistent vegetative state.”

It’s gratifying to see Miles call the medical advice in the Ramirez case for what it is. However, I have to wonder if he really can support his assertion it’s “unusual” for doctors to be pushing for treatment withdrawal so soon after an injury. The Ramirez case only became public because of a legal battle between family members. His recovery was made possible because of the court order stopping the removal of the feeding tube.

It seems reasonable to assume that in most cases, family members reach agreement, and no one other than they and the doctors who gave them advice know about what happened. Cases like Jesse Ramirez and Jill Finley could be rare – or they could be the tip of a large iceberg.

There’s one more case that should be mentioned in this context. In January, 2006, a judge ruled that 11-year-old Haleigh Poutre should be entitled to “pass away with dignity.” The Department of Social Services had sued to end Poutre’s life-support less than two weeks after alleged abuse by her adoptive parents put her into a coma. Her physicians at Baystate Medical Center described her as “virtually brain dead.” One day after the judge’s ruling, verified reports came out of the hospital that Haleigh was conscious and responding to commands. She would never have had the time to recover without the suit brought by the person charged with abusing her, challenging the state’s authority to end her life. Her death and the decision that authorized it would have just been one more “end of life” case.

There was considerable fallout in the Poutre case, but most of it fell on the Department of Social Services. The physicians at Baystate Medical Center avoided being challenged by the press and the public. The same kind of failure we see in the kinds of things not being asked of the physicians who were in charge of caring for Jesse Ramirez and Jill Finley.

The next time you see a story like that of Finley, Ramirez, or Poutre, avoid thinking of them as “miracles” and think of them as survivors. And let’s ask their doctors how many other patients they’re treating aren’t quite so lucky. –Stephen Drake

ADAPT in Chicago: Blogs and Websites

By now, most of the out-of-town ADAPT activists have returned home. That means that after a day or two of recuperation – maybe – it’s time for everyone to get back to work again. That means follow-up and continuation of the advocacy for community-based services here in Illinois and in all other states as well.

NDY will be getting back to its usual work as well. There might even be an entry later today that’s back to the range of topics we usually cover here.

But we thought it would be a good idea post a list of links to visit for pictures, accounts and other info related to ADAPT and the protests in Chicago. This is not an exhaustive list. Apologies to anyone who was missed. If you want me to put a link up just email me and I’ll edit it in later, although it may be a few days.

First and foremost, you should visit and revisit the ADAPT Action Report – which currently features links to photos, youtube videos, reports, and the action blog, featuring daily accounts of Galen Smith.

Kay Olson has provided commentary, video links and photos at the Gimp Parade (and managed to figure out a way to fix a link I used that is kind of glitchy). Check here, here, and here.

Cilla Sluga, who writes at Big Noise, has returned after her first national ADAPT action. She was only able to stay one day and when she returned, she followed the comments on blogs in which the ADAPT action was being discussed. She “comments on the comments” in her entry Collectively They Are Pretty Spectacular.

Larry Wanger at the DisabilityNation blog has announced the audio magazine will feature coverage of the ADAPT action in Chicago. It’s scheduled to air on Sunday, September 16th. You can get more information on DisabilityNation and how to listen to the episodes offered by visiting the main website.

Donna Harnett joined ADAPT for the protest at AFSCME. She writes about it in the entry Wow, wow and wow! Donna and her family became important allies and friends during the protests launched by FRIDA during the “Ashley X” attack on people with disabilities.

Huffington Post blogger Robert Koehler writes about Martin and Donna Harnett – and why the fight she and ADAPT are fighting is important in Martin’s World.

Finally, my favorite comment from a member of the nondisabled public who whose plans were interrupted by the shutdown of the Thompson Center in downtown Chicago:

A blogger named Rudy hosts a blog that is titled the “Lager Beer Riot.” It’s explained on the blog:

Know-Nothing Mayor of Chicago Levi (great nephew of Daniel) Boone incited the Lager Beer Riots of 1855 when, in a conscious attempt to curtail German immigrants’ ability to associate and organize, he prohibited the beer gardens from opening on Sunday after church. He was voted out of office the next year. To those who would defend our inalienable rights of free association and worship, good government, and quality beer, I say, Prosit!

So please go read his account of being blocked from his planned visit to the Department of Motor Vehicles. It’s worth the visit.

Update: September 17 –

Second account by Cilla Sluga at Big Noise, this one titled March On, ADAPT.

Feminist Response In Disability Activism (F.R.I.D.A.) has a day-by-day account written by disability activist Amber Smock. It covers the preparations for the arrival of ADAPT activists coming into Chicago and Amber’s own accounts of the daily protests in Chicago in the FRIDA Report from the ADAPT National Action in Chicago.

Update: September 18 –

There are two ADAPT-related accounts on Mike Meiselman’s Magitator blog, AFSCME: Lost Its Way and The “Perils” of Being Inconvenienced.

ADAPT in Chicago – Day 3 of Protests

12:00 pm Central

For Immediate Release:
September 12, 2007

Contact:
Bob Kafka (512) 431-4085
Marsha Katz (406) 544-9504
Gary Arnold (773) 425-2536

ADAPT Visits AFSCME Offices, Demands They Stop
Trampling on the Rights of People with Disabilities and the Elderly

Where: 29 North Whacker Drive, Chicago IL 60606
When: Now

ADAPT has requested that the American Federation of State, County and Municipal Employees (AFSCME) endorse the Community Choice Act (formerly known as Micassa). Despite multiple meetings with the union’s leadership, AFSCME has refused to endorse the legislation or support the right of people with disabilities and the elderly to receive community-based services instead of being forced into a nursing home or other institution. In fact, AFSCME has undercut efforts of ADAPT and the disability community to address the institutional bias in long term services and supports by actively advocating for increased funding for institutions. AFSCME has even lobbied that institutions like Lincoln Developmental Center be reopened even though this proposal was vigorously opposed by the disability community.

AFSCME has repeatedly trampled on the human and civil rights of people with disabilities and the elderly. The union has sacrificed the freedom of people with disabilities and the elderly to increase their own membership and union dues, stealing lives to line their own pockets. This must stop.

ADAPT demands AFSCME immediately endorse the Community Choice Act and work with ADAPT to develop a strategy for the union to promote workers’ rights without sacrificing the rights of people with disabilities and the elderly. Right now, hundreds of disability activists have occupied the office building at 29 North Whacker Drive in Chicago. There is a negotiating team of local ADAPT activists on the 8th floor.

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Update 12:45 pm Central.

Pictures from AFSCME’s lobby here in Chicago:

The picture above shows about ten tightly packed activists lined in two rows against the wall, and look like they’re chanting.

The picture above is taken from the inner part of the lobby straight across the room toward a pretty bright window. It looks like it’s wall-to-wall activists in there!

Above is another shot of tightly-packed activists against one of the walls. In this shot, there’s a long banner hung behind them, which I can’t quite make out.

The shot above is taken by the receptionist in the lobby and looks out across the room, which is crammed with ADAPTers. A “Free Our People” Banner is strung across the windows facing out, so it can be read by people passing by.

Update 1:45 pm. Central

I heard from Marsha Katz. The negotiations look like they went absolutely nowhere.

Arrests have begun.

Earlier, AFSCME reps at Council 31 in Chicago suggested the signing of a joint statement that contained some of the elements contained in this excerpt from a statement that has been written up about today’s events by Council 31’s PR officer, issued on Council 31 AFSCME letterhead, with Director Henry Bayer’s name on it somewhere…

“We believe that people who want to be served and need congregate care should
receive that care. We believe that individuals who want to receive
services in their homes and can receive their services in that setting should be
allowed to do so. We believe that the federal and state governments should
appropiate sufficient funds to provide quality care in both settings.”

Here’s what it looks like now:

The picture above shows activists being processed by police, who have pulled them away from the doors to issue citations.

Above is another street picture with a long line of activists – mostly wheelchair users – being processed by police.