Wednesday, May 30, 2018

Medical Bias? Oppose It

This is the fourth in a five-part series contrasting the ways our society could handle end-of-life care moving forward.

Medical bias is real, and it could affect anyone. What happens when medical bias is paired with a seemingly cheap and simple solution: doctor-prescribed suicide or euthanasia?

In a perfect world, a doctor examines a patient, finds the underlying cause of the problem, and uses the best treatment available for that particular patient. However, our world is not even close to perfect.

Every patient is different. Every individual has their own unique health circumstances, and they come from different races, cultures, sexes, classes, etc. Not only do each of those groups have their own unique health concerns, but our medical system has been proven to treat them differently, often without being aware of it. Medicine is not like building a car in a factory with a set of unchanging instructions; personal interaction between patients and caregivers often determines whether a health problem is even identified.

Some health problems are not well-understood, and some remain essentially mysteries. Sometimes an underlying health problem may be misunderstood or ignored, leading to a wrong diagnosis or no diagnosis at all.

The best treatment is not always obvious. Individuals may respond differently to the same treatment.

When you add culture, the human body, and flawed and unique individuals together, you get an extremely complex situation. The opportunities for even subtle bias from well-meaning physicians to effect outcomes is large. Unlike cases of employment or housing, mistakes due to bias in medicine costs lives.

We can't fix such a complex system overnight. We can strive to be aware of medical bias and to work to fix it the best we can. The one thing we shouldn't do is ignore or even exacerbate medical bias. Doctor-prescribed suicide and euthanasia make medial bias harder to confront, and even provide an excuse to ignore or embrace it.

We must face several critical questions if we accept taking life as an acceptable practice of medicine. In dealing with a patient a doctor or nurse explicitly or implicitly sees as unworthy of their effort or perhaps even life itself, it's tempting to just shut the patient's file and encourage cheap, lethal drugs as the easy choice.

Studies show minority patients often have worse health outcomes. When deciding if a patient should be recommended for suicide, will our medical system treat patients of each race equally? Will patients feel confident that they can trust their caregivers when taking their life becomes a legal option? Women also have poorer health outcomes, will they be able to confidently trust their caregivers as well?

Women attempt suicide more often than men. Men have much higher rates of successful suicide. Will doctors be cognizant of the complex nature of suicide risk and be aware that many requests for suicide stem from depression or despair, or will they just encourage every patient to get it over with? Will they nudge a person from the brink of despair into the abyss, because it's easier than solving a complex problem? Based on how few people in states with legalized doctor-prescribed suicide receive counseling before receiving lethal doses of drugs, we can be confident about the answer to these questions.
Will poor patients have insurance companies in their corner for expensive treatments, or will they be refused care and offered the cheapest treatment as the only alternative? Will wealthy patients be pressured into suicide by their family members, especially if those family members will financially gain from a quick death?

We already know the disabled are marginalized by a society that often sees them as life unworthy of life. When ending their life becomes a viable option, their level of care will continue to suffer.

Nobody should feel safe from medical bias. Treating difficult cases asks the most of our medical system, while encouraging suicide via lethal doses of drugs is a cheap and easy shortcut. Which way helps us confront medical bias?

Tuesday, May 29, 2018

Ireland votes for abortion for no good reason

Image courtesy of the Life Institute
Sadly, the people of Ireland voted to strip recognition of the equal right to life of children in the womb from their constitution on Friday, May 25.

While most countries in Europe have stricter abortion laws than the United States, many of those are generally accepting of abortion. There are a few notable exceptions, including Poland and formerly Ireland.

Despite their prolife history, including a public vote to add constitutional protection for children in the womb in 1983, the final tally showed 66.4% of Irish voters stripping away the right to life.

Why did they do it?

If you look at the reasons most often used to justify abortions, they simply don't apply in Ireland.

Irish women aren't dying in "back alley abortions." Despite their law essentially banning all elective abortions, Ireland has significantly better maternal mortality statistics than the United States. With our country's extremely permissive abortion laws, pregnant women are nearly twice as likely to die in the U.S. than in Ireland.

The European Union's European Institute for Gender Equality shows Ireland to be above the European average in their measures of equality between the sexes. Ireland's score is 69.5, right behind the neighboring United Kingdom at 71.5. Which country scores the worst? Greece, at 50, with abortion there totally legal before 24 weeks.

What about poverty? The Irish poverty rate is nearly half that of the United States. Their gross domestic product per capita is the envy of most of the world, more than $10,000 more per person than the United States or Sweden, making them one of the richest countries per person among large European countries.

Overpopulation? Did Ireland need to "cull the herd," to put it bluntly? Ireland's population density is below countries like Iraq and Ukraine, and most other large European countries. Ireland has a higher birth rate than other European countries, but their total fertility rate is below two children per woman, meaning their population will shrink in the future.

Looking at the facts, it seems Ireland is a better place to live than most everywhere else, including just about every country with permissive abortion laws. So, if abortion is a necessary evil, where is the necessity? Well, there is no "need." Ireland didn't need abortion to thrive; they are doing just fine without it.

So, why did Ireland want to legalize abortion?

There seems to be three reasons:
  1. The unique history of Ireland and the Catholic Church has led many Irish citizens to become resentful of anything that seems remotely Catholic. By voting for abortion, many voters thumbed their nose at the Catholic Church.
  2. Ireland wanted to join the European club. Most countries considered progressive allow abortion, so many voters thought it was time for Ireland to "get with the program." For years international institutions pressured Ireland to remove legal protection for children in the womb.
  3. Irish voters bought the talking points. Even though the statistics show Irish women are doing as well or better than their European sisters in other nations, and that Ireland's abortion ban isn't killing women, they still bought into the rhetoric that abortion is somehow a necessary evil, even though Ireland was the strongest example that proved that it wasn't.
There were celebrations in the streets as Ireland voted to allow the brutal killing of children in the womb. Why do these children need to die? Purely out of spite and envy, it seems. Ireland will not be a better place by taking their lives of their own sons and daughters; abortion is a chosen evil, not a necessary evil.

Look to Poland as the next major target of the international abortion industry. After restoring protection for unborn children in the wake of the fall of the Soviet Union, Poland has also proved than abortion is not a necessary evil, and their country has growing prolife views. Will they weather the storm of those obsessed with bringing death to their nation's children?

Tuesday, May 22, 2018

President Trump to divert Title X funding from Planned Parenthood

UPDATE: The rule change has been formally proposed. We'll have further analysis next week after Memorial Day. Here's the full proposed rule.

Late last week President Trump announced that the U.S. Department of Health and Human Services Department will be introducing a policy that will remove Title X family planning tax funding from health-care providers that perform or refer women for abortions, shifting it to providers that don't.

Known as the "Protect Life Rule," this policy has yet to be officially written down and proposed through the federal government's rule-making process. While we don't have the fine-print details yet (and enforcement is always a challenge), this policy is another high-profile demonstration that the Trump Administration is committed to making sure that no federal tax dollars fund abortion.

This is not the first time a policy like this has been proposed. President Reagan proposed something similar while he was in office. Just like now, pro-abortionists were clamoring that the policy will hurt women. A judicial challenge to the Reagan-era policy reached the U.S. Supreme Court, where in 1991 the court ruled in favor of the legality of Reagan’s policy in Rust v. Sullivan. Unfortunately the incoming pro-abortion Clinton Administration quickly dropped the rule.

Both the Reagan-era rule and the Protect Life Rule have similar language and goals, which could be helpful if the new policy is challenged in court. Even more importantly, Justice Anthony Kennedy was on the Supreme Court when they made the 1991 decision in Rust v. Sullivan—the likely swing vote in this case has already spoken.

Title X Family Planning Program was created in 1970 to provide grants for family planning and health care to families in need. The law was never written or intended to pay for abortions. Unfortunately poor legal interpretations have resulted in accounting gimmicks being the only separation between tax dollars and abortions, violating the spirit of the law.

The policy change has the abortion industry very upset, because Planned Parenthood receives tens of millions of dollars in Title X funding every year. If the policy goes through as announced and is strictly enforced, some Planned Parenthood affiliates may have to restructure or even close due to their dependence on both abortion income and tax funding hand-in-hand.

While Planned Parenthood and others may claim women are at risk, not a single penny of Title X money will be cut. The only thing at risk is Planned Parenthood's profit margin, which often exceeds the amount of Title X funding they receive in a year.

Stopping our tax dollars from helping to pay for abortions has long been the goal of the prolife movement, because we are firmly committed to conscience rights. This policy could make a significant dent in the hundreds of millions of dollars that Planned Parenthood receives every year out of your pocket, courtesy of the IRS.

Abortion is not healthcare and tax dollars meant for health care shouldn't be wasted on ending lives, directly or indirectly.

Wednesday, May 16, 2018

Doctor Prescribed Suicide? Oppose It

This is the third in a five-part series contrasting the ways our society could handle end-of-life care moving forward.

 “That was the one thing my doctors didn't give me: hope. Not at all.”

 “It will only prolong the inevitable.”

“You predicted a miserable and very low quality of life.”

“We know they are not going to be given any hope. Almost everyone we talk to has a negative story.”

“They were not happy with me because I didn't do what they wanted me to do. They thought I was in denial.”

We’ve heard these words and many more like them. Far too many in our medical system seek the easy way out rather than adequately responding to patients’ needs as human beings. Make no mistake, there are mountains to climb when it comes to health challenges. Some mountains are just too tall to climb, but many are not, and some want to give up before even starting.

It can be tough being a doctor or a nurse. Often you see people at their worst, and eventually many of your patients die. You often see caregivers at their worst, too, struggling to take care of a terminally-ill child, or a parent with dementia, or many other tragic conditions. It can be tempting to embrace despair.

Some in our medical system sadly internalize that despair, and it infects their role as healers. Some even let it control their professional judgement, giving patients and their family unrealistically bleak prognoses or even trying to pressure or coerce patients and caregivers into giving up. Perhaps they believe they are doing those patients a favor.

Despair is badly failing patients, however. Countries and states that legalize doctor-prescribed suicide run roughshod over concerns about how it really affects patients. Instead of despair, patients should be offered realistic views centered on hope and life.

Sometimes diagnoses are wrong, including terminal diagnoses. When patients express hope to overcome their disease, they should be given accurate information, including about risks of treatments, and then their decision should be respected, whether it’s deciding they no longer want to receive medical care they believe is burdensome, or they want to try to continue their fight. They should not be overridden in secret or bombarded with offers of lethal doses of drugs.

Some patients know they are going to die, but have not prepared themselves for it, or have some unfinished business, or simply enjoy life and want to have a few more months of it. They shouldn’t be told their quality of life makes those last few moments less important or unworthy of care than others.

Other patients succumb to despair. This isn't merely deciding the time is right for their terminal condition to take its course, but truly the same despair that afflicts others in the prime of life and leads them to attempt suicide. We should not look at one person and say, “you have so much to live for!”, and at the other person and say, “do it!” That mode of thought degrades the value of life and will quickly metastasize to other issues.

Often caregivers can become exasperated. The persons they care for may be unable to express their own wishes. Sometimes medical decisions fall on them, with no clear instructions from their loved ones. They should be given advice in line with the best interest of the patient, not offered euthanasia as a solution to their own struggles, or even having their loved one passively euthanized in secret—supposedly to spare them grief.

Despair is often short-lived. When patients and caregivers get the care and support they deserve, they are often able to continue on with dignity—for however long life allows or it.

Robert Salamanca was one such person. Suffering from ALS (Lou Gehrig’s disease), Bob wanted to die. In fact, he wanted to travel to Michigan to die here; at the time Jack Kevorkian was working to end the lives of as many people as possible here. But suicide is not what Bob really wanted; he was facing the dark pit of despair. Thankfully, Bob had family and friends in place to pull him back from the brink. Bob was able to spend the end of his life with his family, learning new skills, and indulging his great love of boxing as a quadriplegic (watching on cable, of course). He passed away peacefully in his sleep.

Others are not as blessed as Bob with such a great support system. Before his death, Bob wrote an article in the San Francisco Chronicle about how advocacy for euthanasia and doctor-prescribed suicide fed his despair rather than offering him hope.

If physician-assisted suicide is legally available, the right to die may become a duty to die. The hopelessly ill may be subtly pressured to get their dying over with — not only by cost-counting providers but by family members concerned about burdensome bills, impatient for an inheritance, exhausted by care-giving or just anxious to spare a loved one further suffering.

In my view, the pro-euthanasia followers’ posture is a great threat to the foundation upon which all life is based, and that is hope. I exhort everyone: Life is worth living, and life is worth receiving. I know. I live it every day. 

Too often our hospitals and our society see challenges and pressure people into just giving up. Instead of despair, we must offer people a realistic view focused on hope and life.

Tuesday, May 15, 2018

2017 Michigan Abortion Report

Last week the Michigan Department of Health & Human Services (MDHHS) released their latest abortion statistics report for the state of Michigan. In 2017, 26,594 abortions occurred in the state: 97% of those abortions were done on Michigan residents. The overall number is sadly slightly up 0.8% from 2016, with 26,395 abortions reported that year.

Even with the heart-breaking news of a slight increase instead of a massive decrease—as we work and hope for ever year—overall abortions in Michigan are down 45.6% since 1987.

There were several key trends to take note of in the 2017 report.

52% of Michigan resident women who received an abortion were receiving their second or more abortion. This repeat abortion figure has been slowly increasing annually. 65% of women having an abortion had carried a previous pregnancy to term. 90% of women who had abortions were not married.

Medical abortions using the RU-486 abortion pill regimen continue to trend up as the cheapest method for the abortion industry to use. In 2017, RU-486 accounted for 35.5% of abortions, up from 30% in 2016. Seeing this trend shows us how important it is that we continue educating women about abortion pill reversal. We will never know how many of the women would have changed their minds if they knew that was an option, but we do know many women have instantly regretted their abortion decision, and some have been able to use abortion pill reversal to save their child’s life.

Black abortions saw a tiny decline, from 12,794 to 12,789 abortions. Any decline is welcome, however, as Black abortions remain high despite the decreasing overall abortion rates.

Teen abortions once again saw a decrease. In 1987, women under 20 accounted for 28.5% of abortions in Michigan. Today they account for 9%. Recently there has been an aging trend with abortion. In 2017, the 25-29 age group had the highest percentage of abortions, 31%. Women 30 and older had 29.3% of abortions and women 20-24 had 30.6%.

After reading through the 2017 report, there were some very odd numbers noticed this year. A huge chunk of abortion data was missing and uncategorized. Despite this, abortions with missing data were still used to calculate overall percentages in the report. Right to Life of Michigan staff had to spend extra time combing through the data and recalculating the numbers from the MDHHS to make sure that the statistics above were accurate.

For example, the repeat abortion rate according to the report’s summary is 55%, but the MDHHS included 1,720 abortions in that calculation for which they have no idea if the woman had a previous abortion or not. Using some simple math, we discovered the correct known repeat abortion rate is actually 52%, what we included above.

While none of the numbers were extremely off, bad statistics are bad statistics, and Right to Life of Michigan doesn’t do bad statistics. Also, abortion clinics are required to report these statistics by law. Right to Life of Michigan doesn’t look the other way on that, either.

It could be discouraging to see this slight uptick in numbers, but it should be an indication of how much harder we have to work to see an end to abortion. We have seen huge prolife victories the past year and a half with the election of President Trump, and with the nomination of Justice Neil Gorsuch to the Supreme Court. With upcoming elections in August and November, we have to make sure we elect prolife officials at all levels so we can pass more life-saving legislation and ensure our laws are being properly enforced.

Now is not the time to get complacent; long-term abortion declines only continue when we work to continue them.

Thursday, May 10, 2018

Still on That Journey: New Video Series

The Right to Life of Michigan Educational Fund has developed a series of four new 3-minute films for our continued multicultural outreach efforts.

In our "Still on that Journey " series, prolife advocate Christina Marie Bennett, herself almost aborted, explores feminism, black history, and the barriers that often exist between the mainstream prolife movement and the African American community.

The films were produced by artist film studio Minus Red and award-winning director Jim Hanon, who has done such an excellent job with many of our other ads.

Christina will be speaking at our annual Conference on September 27. Save the date so you can hear more from her!

Watch a 30-second preview of the short films below. Visit our YouTube Channel to see all four short films!

Wednesday, May 2, 2018

Right to Die? Oppose it

This is the second in a five-part series contrasting the ways our society could handle end-of-life care moving forward. 

The right to die is an odd concept. Everyone will inevitably die. Many people fear what sort of condition they may be when they are older or suffering from a terminal disease. Some people express that fear in these exact words: "I don't want to be hooked up to all of those machines."

Patients certainly have a right to refuse unwanted medical treatment. But when people speak of the "right to die," they don't mean allowing someone at the end of life to let life take its natural course. People have had that right for a long time, even before the advent of modern palliative care and adequate pain control. No, the "right to die" means euthanasia or suicide: the right to kill a suffering person or to kill oneself.

Autonomy is given as the reason we need to have a "right to die," but embracing a "right to die" quickly ends with sacrificing patient autonomy. "I don't want to be hooked up to all of those machines" turns into, "You shouldn't be hooked up to all of those machines."

It's a slippery slope. Some accuse people who refuse to embrace euthanasia of committing a logical fallacy by saying it's a slippery slope. It's not a fallacy, however, and real world experience backs up the simple observation that people will often take the easy way out instead of the right way through a problem.

The Alfie Evans case is a prime example. Courts in Britain thought that death was preferable to Alfie living, despite his loving parents' decision to let his life continue with palliative care. The court ordered he must die now, because of his "quality of life." Alfie's autonomy, as expressed and protected by his parents? Ruled irrelevant, not in his best interest, in the opinion of a judge who never has to visit Alfie's grave.

In countries that have embraced a legalized "right to die," a "duty to die" is quickly taking hold. In the Netherlands and Belgium, involuntary euthanasia—we call that "murder" here—is a significant proportion of euthanasia deaths. Efforts to prosecute doctors who decide to kill their patients—for their own good they say—fail. The autonomy of patients who want to live but are killed anyway? Unprotected, of little value.

Here in Michigan, we know of cases where patients who request medical treatments have them denied in secret and have secret orders placed into their charts, because the doctors believe the patient is better off dead. Imagine the horror of learning a hospital has placed a do-not-resuscitate order in your file, even though you expressed your wishes for life-saving care. What can you do when your life depends on those who think you need to die? The autonomy of those with the will to live? Not just ignored, but undermined in secret.

As we pointed out in part one, what happens when health insurance costs combine with a "right to die"? Patients find themselves being encouraged to exercise their cheaper "right to die" than their right to life. The autonomy to choose your own medical care? Rejected, some rights are apparently better than others (and cheaper).

A society that protects patient autonomy and gives them the compassionate care they deserve simply cannot be a society that embraces suicide or killing as a solution for the sick and disabled. They don't go together, today or in the future. Caring for the sick and disabled can be hard and places demands on the healthy and able. It's cheap and easy to lethally inject someone or give them a lethal dose of drugs. The "right to die" gives moral window-dressing to taking the easy road at the expense of the good road.

Patients deserve protection, from food and water to the right to refuse unwanted medical treatment. Killing patients isn’t a right, however, it’s wrong.

Tuesday, May 1, 2018

The impact of Alfie Evans

Photo source: Daniel Evans
The story of Alfie Evans in the United Kingdom shocked and captivated an international audience. His death on April 28 was tragic, leaving his parents and countless people across the globe heartbroken, including his devoted online advocates in "Alfie's Army."

Many things happened during his case. The medical details are complex, with Alfie perhaps suffering from a unique disease.

While the details may be hard to follow, the controversy over Alfie is really quite simple: Alfie's medical care was forcibly removed from him because of his quality of life. This was a fight about imposing "quality of life" judgements on the unwilling.

If you didn't follow all of the ups and downs of his story the last few months, you really ought to care about how he died, because it could very well impact you soon, or a loved one.

Here's all of the important points you need to understand, and this might be all you need to read:

1. Patient choice matters. Parents are responsible for children who can't express their own wishes.
2. Subjective "quality of life" concerns are dangerous for the sick and disabled.  
3. Courts took away Alfie from his parents entirely based on their opinion of his "quality of life." His parents were doing nothing wrong or abusive.
4. There was no evidence that Alfie was suffering other than his being alive with a disability.
5. Courts should not take children away from their parents because judges believe death is preferable to disability.

Some people are having difficulty grasping the above points, however, or disagree, especially on the first two statements.

If you want to read more about Alfie's case, please do so. There are a lot of important issues that deserve discussion. The source of the controversy, however, was the legal fight to force the hospital's care plan over the objection of Alfie's parents, forbidding them to even take him home to die. The purpose of that care plan was to let Alfie die on the hospital's terms because the hospital did not believe his life was worth living anymore.

Alfie was only a toddler, unable to express his wishes about what level of care to continue to receive, so instead his parents were responsible for determining his care. They decided it was in Alfie's best interest to stay alive. They made a decision for Alfie that many adults legitimately make for themselves. Alfie's case appeared to be terminal, but that doesn't make it morally wrong or abusive to live out as much life as possible in his parents' care. Medical miracles happen and doctors can be wrong about a diagnosis.

How a patient views their health is important, but it's a very subjective value. Unfortunately many doctors, hospitals, academics, and government officials have come to believe that many forms of disability are so insufferable that a person is objectively better off dead. "I wouldn't want those tubes hooked up to me" is quickly turning into, "You shouldn't have those tubes hooked up to you." Even subtle bias in treatment decisions can have deadly effects.

Many terminal patients decide to forgo exceptional treatments, and that's their right to do so. Many do not, but more and more those choices are being frowned upon, or quietly or actively blocked. It's one thing to have a broad discussion about good end-of-life decision-making on the frontier of new medical advances, but it's an entirely separate thing to legally coerce someone into dying.

You may have decided on a different care plan for Alfie based on the medical facts. But you are not Alfie, nor are you his parents. Neither were his doctors, or the UK courts.

Theoretically there could have been good reasons to remove Alfie from his parent's care. Alfie could have been older and communicated that he didn't want to remain on a ventilator. His parents could have been abusive or been keeping him alive for financial interest. Alfie's medical care could have been actually futile. Alfie could have been suffering. None of those were true. The courts simply decided they knew better about what Alfie needed than his parents, and that need was death.

This was not a case where Alfie's medical care was futile. Alfie was still able to digest food and fluids. Alfie was not brain dead, obviously proven when he continued breathing on his own for days after the ventilator was removed. The hospital took away his efficacious care so that he would die quickly, and they were clearly shocked when Alfie refused to die. It took the hospital nearly a day to begin feeding Alfie again, and his parents had to beg to have him allowed oxygen. Either the hospital was hoping to speed along his death, or they were shockingly incompetent in delaying proper care.

Alfie's case is another dangerous precedent, like the recent Charlie Gard case. Alfie and Charlie are not alone. There was a bone-chilling case where authorities started a manhunt for parents who sought care for their critically-ill son, Ashya. The child survived, proving doctors and authorities heinously wrong. There's been other cases as well. It's encouraging, however, that Charlie's parents are helping to revise laws in the UK so that quality of life values are not just imposed on children.

One huge obstacle, however, is the unshakeable faith of those who believe that imposing quality of life views on patients is a good thing, even if the patient expresses their will to live. In commenting on Alfie, Prime Minister Teresa May said it was a great tragedy, but ultimately said medical experts should decide on patient care, not patients or their parents: "It's important that decisions about medical support that are given to children and to others are made by clinicians, by those who are expert in that matter..."

Were the experts who launched an international manhunt to nab Ashya's parents humbled after radiation treatment abroad left him cancer-free?

The people who took away Alfie are likely utterly convinced they did the right thing. The sinister nature of a "quality of life" ethic is that those who believe people are better off dead feel completely morally justified in the death of human beings. They are blind to the dangers of their beliefs. Removing care or giving people lethal doses of drugs is cheap, whereas caring for the sick and disabled can be very difficult. People have a habit of taking the easy route, sometimes even if it harms other people. Now the easy route has a worldview justifying even causing death as compassionate.

Restoring a belief in the fundamental value of human life is what the prolife movement is all about. We'll continue to fight for it, in memory of Alfie, Charlie, and others like them.

Alfie's aunt, Sarah, left this final tribute to her nephew on the Alfie's Army Facebook page:

"Our beautiful soldier, your stubbornness will carry on through your beautiful Mum Kate, your strength you found from your hero your Dad: Both sides of the family are shattered. Never has there been a boy so beautiful special and precious as you are. Hearts are broken all over the world. Your cousins miss you so much. The tears that are shed are for the love we all have for you. It’s never goodbye, its until we all meet again. We love you Alfie we do, we love you Alfie we do, we love you Alfie we doooooo oh Alfie we love you."