Good and Bad News

Wednesday, November 5, 2008
A victory for reason.

A defeat for equality.

31 comments:

John the Scientist said...

Well, I'm not surprised at Prop 8, but I think the right will be back in some form, soon.

I'm boggling at Prop. 4. I'm responsible for the health and well-being of my minor kids in every respect, as well as being legally liable if they do something wrong. A clinic better damn well inform me before performing an abortion on my daughter.

It won't be an issue in my house, because I will know if she gets pregnant, but if I have to sign off on chemo for my kid why the HELL don't I have to sign off on surgery of that nature? If the kid is unconscious in, say, an automobile accident at a later date, I need to know the whole medical history in order to make an informed decision. Otherwise, emancipate the kid at 16, and send them out into the world on their own.

Janiece Murphy said...

John, we're going to have to agree to disagree on Prop. 4. Your position makes the assumption that everyone parents their children in a responsible way (as you do), and unfortunately for all concerned, that is simply not the case.

You also assume that your daughter will grow into the person you want her to be. And while that is every parent's hope, there are no guarantees.

The Mechanicky Gal said...

Yes, John, unfortunately there are just parents out there that don't. Parent, that is. (Just out of curiosity, how would you know if she got pregnant? If she didn't tell you herself?)
It seems that South Dakota has turned down their abortion restrictions also. Good news there.
But, Florida has screwed not only same-sex couples but also their issue has denied hetero-sexual couples domestic rights also.
Way to go Florida.

John the Scientist said...

Bad parenting on the part of some is no excuse to deny good parents the chance to parent. Under any system someone is going to get screwed. It's an unavoidable part of human nature. The system should not screw responsible people on purpose, however.

Notification is not the same as permission, and chance for judicial review in the case of disagreement between parent and child is fine - but no notification is NOT. Look, Jehovah's witnesses have some really goofy ideas about medical care, but if their kid is in an auto accident, I don't advocate not notifying them. Where does the encroachment of the Government into parenting stop.?

Like I said, be consistent. Let 14 year olds make all their own medical decisions and see where that leads.

Jeri said...

John, I know of some parents, unfortunately, that upon notification of an abortion that would 1) batter and/or virtually imprison their daughter to 'prevent' such an event, or 2) kick the daughter out of the house, leaving her on the streets.

You and all of us in the UCF are good parents. Level headed, critical thinking, idealistic but practical. This law is to protect teen girls against the significant percentage of those that aren't good parents, the ones that should be required to get a license before conceiving a child.

:( :( :(

Janiece Murphy said...

What Jeri said.

Because while I recognize that John makes a good point in terms of punishing responsible parents unfairly, I'm more interested in protecting the young girls who are unfortunate enough to be born to nutbar parents.

Because in my view, government encroachment into parenting shouldn't stop if the well-being of the child is at risk (as in Jeri's example).

Carol Elaine said...

I'm not a mother, so I know parents will take what I say with a grain of salt, but while my instinct is say that parents should be told what their children are up to, especially when it comes to something as serious as abortion, I also have to agree with points of the ladies who have thus far weighed in. I also fear for those girls who would not just be imprisoned by their families or kicked out, but would also be beaten, possibly even killed. Because I assure you, that WILL happen. And for it to happen to only one or two girls is for it to happen to too many.

Not to mention pregnancy by the girls' own fathers. Which may occur only rarely, but it does occur. Do you want the daughters of these sick fucks to be forced to bear the children of their fathers? I wouldn't.

I know we can never make it a zero sum outcome, but we can certainly do our best.

As for Prop 8, I am deeply saddened by its passage. Well, now I know what I'll be working on, now that Obama will be moving into the White House (yea!).

The Mechanicky Gal said...

Janiece, you said it on an earlier post.
Legal, safe, and rare.
Lets keep education out there, keep a full curriculum in the schools, and work to make the need for parental notification a rare event.

Jeri said...

As for good news, Washington's Initiative 1000, our "Death with Dignity" act, passed by a solid margin. It was a well-crafted initiative, modeled after Oregon's successful model. Not surprisingly - I'm for it.

Janiece Murphy said...

Jeri, I did a paper on the Oregon model for my Ethical Decision Making class.

I'm all for it.

Go, Washington!

Jerry Critter said...

Prop 4 really doesn't affect the good parents. "Good" parents establish communication with their children. A pregnant child goes to a "good" parent and together they decide what is best. Prop 4 protects the child from the "bad" parent.

Parents that worry that their children will go behind their backs for an abortion better take a good look in the mirror. Your child is afraid of you because...

John the Scientist said...

Jerry, you've never had a kid do something monumentally dumb behind your back not because they were afraid of you, but because it was the easiest option?

Random Michelle K said...

Lemme know when y'all wanna debate about assisted suicide.

Cuz I'm opposed to it.

That was my semester project for my medical ethics class. :)

Tania said...

John, I have a family with members that have a background of sexual abuse/incest/rape. Now that I think about it, a couple of friends*, too.

So, yes. "Sneaking" behind daddy's back to get an abortion (which is something that is pretty fucking hard to get in most of the USA) might be the first real act a girl takes to admit to the abuse situation. Parental consent would not be an option, as mommy would probably not believe her and/or tell her that she's a whore that is bringing it on herself and the mind boggles at the things daddy would come up with.

Middle-class and above kids are ALWAYS going to have options and choices for how to deal with an unwanted pregnancy. Laws like this are meant to stick it to people who are already in a remarkably fucked up situation.

Having had to spend my kidhood dealing with shit like this, and the resultant fall-out, this is one of topics I on which I will publically state an opinion.

*At my HS we had a very quiet pass the hat fundraiser so one of our classmates that had been assaulted by a family member could go to Anchorage and get things taken care of. Because that was the only reasonable option.

Jeri said...

Michelle - I can't debate the global ethics of assisted suicide. I can only say that it's an option I want for myself when it's my time and I'm facing those circumstances. If I need it, and it's not legally available, then I'll find some illegal option - because it's my life and my choice.

Eric said...

John, I'm a little astonished if you consider abortion the "easiest option" for a teenage girl.

The "easiest option," historically and even after Roe v. Wade has been for the kid to hide her pregnancy, not seek appropriate medical care, give birth in a restroom, abandon the newborn or stillborn infant there, and then to get criminally charged by self-righteous pricks. At least those are the stories that keep showing up in the national news.

Y'know, my gut instinct is to agree with you, is the thing. A kid can't get her ears pierced without a parent, you'd think a medical procedure would follow the same standard. But intellectually, I've gotta say my gut is 100% wrong on that score. Aside from the real horror stories--e.g. the girls for whom getting parental consent for an abortion means getting permission from their rapist--the sad reality is that there are some girls for whom an abortion ought to be the easiest option, because carrying to term is worse for everybody.

------

PS

I believe a right to suicide is consistent with a belief in fundamental human dignity and self-determination. I grapple more with the question of if or when suicide should be prevented than I do with whether a rational person--say one suffering from a terminal illness--ought to have the right to control how they exit the world.

Random Michelle K said...

Well see Jeri (and Eric), assisted suicide isn't just about you.

It's not even about your family. Much.

It's about medical professionals going against their Hippocratic oath.

It's about quality of life and who makes the determination as to what qualifies.

It's about the fact that medical technology currently exists so that no one should have to be in pain at the end of life.

We're not talking about Advanced directives. We're not talking about removing oxygen and feeding tubes. We're not talking about DNR orders. We are talking about physicians actively ending a patients life.

We're talking about the abuse of that power that has occurred in countries where PAS is legal and regulated--where patients are pushed by the family and by their physicians into ending their lives.

No one should be able to force someone to end their life against their will. No one should be allowed to actively take the life of patients who cannot make such decisions for themselves (by this I mean patients who are not, and never have been, mentally competent)

Unfortunately, when PAS becomes broadly legalized, you see individuals at the margins of society being forced into that choice by their physicians, who want to free up bed space, or by family members who are tired of spending time or money to care for a dying individual.

Death is a process, a part of life. NO ONE should have the right to force others to end that process early or against their desire. And legalizing PAS does precisely that.

Eric said...

Gee, Michelle, that's the exact same case some conservatives have been making for allowing pharmacists to "opt-out" of providing contraception, and in particular the so-called "morning-after pill," to customers.

The exact same argument can also be applied to abortion: it's not about the woman's right to choice at all, or even about the fetus (very much)--it's about forcing (or even allowing) a doctor to violate his Hippocratic Oath by performing a surgery that terminates an (arguably) human being. The terms of the post-Roe debate have been wrong all along: everyone should have been talking about the doctors' perspective.

I agree that nobody should be forced to end their life in spite of their desires. On the other hand, I don't think anyone should be forced to live if they have legitimate reasons not to. And pain-relief, frankly, is a dog that won't hunt: if I am a decaying, dying, terminal shell in my last days, it is absolutely no consolation that you can pump me full of painkillers until I don't notice how gone I am, killing whatever is left of my brain and consciousness. I am far less afraid of dying itself than I am of dying slowly in a drugged-out stupor, thanks.

Your argument fails to consider that maybe I don't want to live past certain points.

Which reminds me: I probably need to set up a living will, don't I?

Random Michelle K said...

Eric,

I'm actually anti-abortion. So that argument doesn't work well with me.

I believe that all life is sacred across the spectrum (remember the whole don't eat mammals thing?). I'm anti-abortion except for the life and health of the mother (please note that caveat. Self-defense is allowed; how far self defense stretches, I'm not sure), anti-death penalty, and anti-PAS.

However, I strongly believe that the solution to the abortion problem is making it unnecessary.

But to get back to the original point.

The violation of the Hippocratic oath is only one tiny and rather insignificant part of my argument.

The greater part is the fact that PAS is and will continue to be abused when legalized.

As far as the right of an individual to end their own life, that is entirely different from PAS. All patients have the right to refuse treatment of any sort. They also have the right to refuse food, as well as hydration if that is their wish (and no, these deaths are not painful. When a patient is terminally ill, their body begins to shut down and often intake of food and in come cases hydration, actually causes suffering rather than relieves it. The patients do not, in fact, starve to death as the healthy would see it. They don't feel hunger and do not suffer from hunger.)

They also have the right to request terminal sedation, even in the case where such sedation would hasten death.

But the right of doctors to administer death to patients goes against the greater good for all terminally ill patients.

Just as I believe that even the death of one innocent man on death row is unacceptable, so I believe that coercing even one patient to end their life early is unacceptable.

And that does happen with PAS.

Janiece Murphy said...

I agree with Eric on this one.

While I have no doubt that the abuses Michelle describes do occasionally take place, I am unwilling to give up my own self-determination on this matter, or that of my family members.

As for the Hippocratic oath issue, doctors are not forced to participate in PAS against their personal moral code, anymore than doctors are forced to perform abortions. There's a choice for them, too.

Random Michelle K said...

And yes, you should set up advanced directives.

And like I said earlier, this isn't about you or Jeri. It's about protecting those who would be forced into an early death because they they are expensive or inconvenient.

Jeri said...

I think this comes down to the same three issues - whether it's death with dignity, abortion, or gay marriage.

First, there's the intersect between private needs and public policy. Like I said, I know what I want should it happen to me - but I don't presume to extend that into some sort of public policy for people in that position.

Second, there's the need to respect the wishes of the responsible majority of patients, parents, & loved ones while restricting or regulating the irresponsible or abusive minority.

And finally, there's the need to allow the competent decision maker the right to self determination, while protecting those who, for medical reasons may not be in a position to make such decisions.

And in those gray areas, the intersect of those decision points, is where we all get stuck - and can logically and validly come up with different answers to the same question. Public policy, and the law, seeks to do the same, even more imperfectly because there are no good answers.

Still, for me and mine, I'll argue for self determination, privacy and personal choice every time.

Random Michelle K said...

The problem with PAS, as opposed to gay marriage, is that it involves a vulnerable population.

Just as we have stricter laws regarding children, because they are a vulnerable population, so must we require stricter laws regarding the infirm and dying.

Like children, they have no voting block, and many are not held competent to speak for themselves. They are completely at the mercy of their caregivers, be they medical personnel or family members.

And although doctors may be a worry as far as end of life care, family members are a far greater problem.

Elder abuse is a huge and invisible problem in the US. I mention this because the parallels with the dying are similar. They are often at the mercy of their families, unable to act on their own due to physical decline.

Add to that the stress of caregiving that often brings out long repressed arguments, feelings, and hostility.

We've all heard stories of families fighting at a funeral over the dispersion of material goods. The fights can be far more intense when a parent is dying, and there is dissension among the caregivers as to how the dying should be treated.

And often the needs and wishes of the dying individual are lost in these battles.

And elder or a dying patient can be easily influenced by the spoken and unspoken wishes of their caregivers, and even reading ideas and feelings where none exist. I have experienced this myself, with my grandmother randomly insisting she is a burden upon me, and no matter how we reassure her, those doubts creep back.

How easy must it be for those doubts to appear unbidden into the minds of the dying. They *are* a physical burden upon their families and they recognize this fact. Is it a surprise that they may come to believe that ending their lives would be the best for their families?

The lives of the dying and the elderly are already devalued. PAS increases the belief that we have nothing to learn from those who are sick, elderly, and infirm.

Yet we have plenty to learn from those at the end of their lives, be they WWII veterans who liberated the concentration camps, or Stephen Hawking continuing to provide theories and ideas about the universe.

As I said previously, end-of-life care has progressed immeasurably in recent years. It is becoming unacceptable for individuals to die alone in sterile hospital environments hooked up to too many tubes and machines to count.

The knowledge of hospice care and end of life care is slowly spreading, and is becoming a field of study in many medical schools. Until then patients must be their own advocates to have the death they want--without resorting to PAS.

Janiece Murphy said...

And often the needs and wishes of the dying individual are lost in these battles.

Just another reason I'm glad to be a member of my family.

Yikes.

Michelle, I do understand what you're saying. While members of my family have not (and would not) behave in such a fashion, I'm not unaware that such things happen.

Like abortion, I consider this an ethical dilemma. But I value the right of self-determination, and I'm not willing to sacrifice it.

Random Michelle K said...

See, this is where ethically we digress.

I believe that individuals must make sacrifices for the greater good, and this is one of those instances.

One unwilling death, one innocent death, is unacceptable.

Janiece Murphy said...

Michelle, I agree that individuals must sacrifice for the greater good. I'm not a "big L" libertarian, and the ethics of PAS is certainly the crux of the matter. The disagreement comes in your second assertion - that this is an instance where the sacrifice is warranted.

In this case, I don't believe it is, while recognizing that the opposing view makes valid points.

I also don't think the system is perfect. The Oregon/Washington model has safeguards in place, but I would be willing to support additional safeguards if they were executed for the benefit of the patient and did not unduly curtail their rights.

Jeri said...

Something you mentioned, Michelle, slipped by me earlier.

I believe, in the Oregon and Washington model, that the physician does not administer the terminal medication, whatever that is, a la Kevorkian. They are simply allowed to prescribe terminal sedation to a patient, and the patient and family can do with it what they will.

You mentioned earlier that terminal sedation was something you feel a patient could request.

That sort of sedation is still open to abuse, but perhaps not so egregiously as physician administered medication.

Random Michelle K said...

Providing a patient with a prescription--under strenuous circumstances--makes it the patient's choice. I'm not thrilled with the idea, because depression is undertreated in the elderly and the dying, but it's different from PAS, where the physician the lethal dose of medication.

TO clarify on the term terminal sedation...

Terminal sedation (which is allowed by the Catholic church, for those who see religion as a moral ruler) is where, at the end of a patient's life, especially in cases of lung cancer or other illnesses that cause pain and distress, the patient is aggressively treated with pain killers and sedated to relive them of the pain and anxiety of their illness.

[Such patients are most likely already off food and hydration (hydration actually causes distress in many patients suffering from terminal lung disease).]

Although terminal sedation may in many cases hasten the death of the patient, through decreasing respiratory and pulmonary function, the goal of the physician is not to cause death, but to relieve suffering.

The doctor is not providing medications to end the patient's life; the doctor is allowing the patient to end their life in peace and without suffering.

It is the intent that is the important distinction.

Janiece Murphy said...

Thanks, Jeri, for pointing out that important distinction.

I support the Oregon/Washington model, not the Kevorkian model.

I apologize if I didn't make that clear.

Eric said...

If you're concerned about a vulnerable population, then incorporate some form of judicial review as a compromise, as has been done in some states with regard to young girls seeking abortions.

I personally don't feel that it's consistent to say "life is sacred" and that an individual's choice and dignity must therefore be sacrificed for the greater good--I'm not saying you're being inconsistent or hypocritical, Michelle, I'm saying that I can't get my ethics around that. An intelligent, aware, mentally capable person with a painful and humiliating physical condition decides he's done with life, and the state is going to tell him he can't act on it because it's bad policy (and anyway maybe somebody can still learn something from him while his brain is being leached out by painkillers and his organs are failing)? I can accept making this person go through an extra bit of process if there's a concern he's not of sound mind (and denying him full exercise of his rights if he's not competent--that's routine in our society), but I can't accept a flat "no, you can't."

Furthermore, Michelle, the elephant in the room is that self-suicide remains illegal in many states and is considered grounds for involuntary commitment in all. Having a willing doctor prescribe an overdose in supervised conditions means you can have supervision, determination of capacity, and a review process (judicial or otherwise), with many judgments being brought to bear. Outlawing PAS doesn't do anything to prevent a terminal patient from attempting to kill himself--it simply means he (and possibly family members willing to risk being charged with murder) must make a go of it on his own and face further medical problems and/or institutionalization should his judgment of what's lethal be less-accurate than a doctor's might have been.

I'm skeptical, to be honest, that there's an epidemic of doctors murdering their elderly patients, or that there would be if a state passed a soundly-written PAS statute that allowed for external review and required documentation of patient requests and doctors' rulings, etc. (I have no idea whether the Oregon statute or any other involves these things, but if I were drafting a law these are things I'd implement). That's basically the horror you're describing, Michelle, and I'm not saying families don't murder their unwanted members in various ways (sometimes they're even caught at it and prosecuted, you know), but it seems a little implausible to me that there will be a sudden rash of children scurrying off to persuade their parents to be killed and their doctors to help.

Indeed, in reading the news this morning, I find a somewhat parallel situation in which a hospital in Washington is seeking to end life support for a twelve-year old in an apparently irreversible coma despite the objections of the child's parents. Without having an opinion as to the rightness of the hospital's views, it is a reminder that many families are likely to want a family member to remain alive despite all else. If it isn't hard to imagine some degenerate trying to talk his senile grandfather into just ending it, well, it's no harder to imagine some well-meaning person trying to talk his tack-sharp grandmother into not going through with it, making her difficult (but well-thought-out) decision harder. Such are the ethical dilemmas that crop up when we talk about life/death issues--nobody said it would be easy or simple.

Indeed, that's why you have ethical rules and it's also why you have an institution that's established for the purpose of having a neutral arbiter settle close calls.

Finally, I'd point out that a lot of this discussion has been focused on the elderly, but PAS isn't just an elderly issue. We're not merely talking about the rights of "unloved and unwanted" people in nursing homes, but also of twenty-somethings and forty-somethings and sixty-somethings who are looking at quality-of-life issues that might well extend to decades of suffering and misery.

Jeri said...

Eric, that latter, very thorny issue is specifically excluded by current legislation, which is addressed to patients who have been diagnosed by their doctor with a life expectancy of six months or less.