posted
Yesterday, I gave a speech at a Catholic ethics conference here in Chicago.
It's unusual for anyone from my organization to get invited to speak at any ethics conference. We're at odds with a lot of what is happening in ethics, including some aspects of the Catholic variety.
I tried something new yesterday. I decided to warn the audience about who I am and what they could expect to hear:
quote:Part of the reason disability activists get excluded is that, frankly, we’re annoying. We’ve been known to disrupt conferences and events, and to use rude language in giving voice to some of our points over the years. It’s not like we’re less annoying on those rare occasions when we’re invited into events like these – we offer a viewpoint and critique that is in direct conflict to the way in which you not only see yourselves, but the way in which you present yourselves to others. We challenge your commitment to healing, justice, fair and open debate – we even challenge your claim to objectivity.
I wish I could tell you today is going to be different. Instead, I can guarantee that I will end up saying things over the next half hour or so that will annoy almost every single one of you in the audience. So my biggest challenge to you is for you to consider how you intend to handle that annoyance. When someone gets under your skin is that a time to stop listening? Or is it maybe a time you should be paying extra close attention?
Here's the weird part - many people came up to me after conference for the specific purpose to tell me that they thought I had failed to annoy anyone.
Of course, neither the Cardinal nor the particular Catholic ethicist in the audience I critiqued by name was in that crowd.
Anyway, I'm still trying to puzzle out the reaction. Did I actually manage to reduce the level of annoyance at what I had to say by setting people up in the beginning? Or was it just a fluke and a particularly good and lucky day?
posted
Maybe they were being nice. Seriously, though, I think such a warning would put a different frame on what they were hearing, so the first twinge of discomfort did turn to self-examination instead of defensiveness.
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posted
Thanks for the comments - I suspect that it worked along the lines I was thinking. I hadn't really thought it all the way through.
Part of my approach was dealing with the "elephant in the living room." Attendees who were connected to the "end of life" community here in Chicago had probably heard some unpleasant things about us (I acknowledged this - I said the the image they had of us was "the barbarians at the gate."). I wanted to acknowledge our reputation and get it out in the open. So everyone would know that yes, I know I can be annoying.
But I'll probably try variations on this in the future and see how it flies with other audiences.
Also, people did come up to me to talk about a lot of other things I covered in my talk. It was a good time.
To Bob: For crying out loud, I compared the ethical writings of a priest in my audience to those of Peter Singer's. I tried, I really tried. And, for the record, I think he was pretty annoyed. I can live with that. Posts: 4344 | Registered: Mar 2003
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posted
I think it worked because you had them prepared probably (mentally) for much worse than it is.
such as, if you were going into see a doctor, and he said, "now this procedure is really going to hurt bad, but just for a little while" you kinda get yourself mentally ready for it. Then when it is performed, it turns out to not hurt as MUCH as you were expecting (it still hurts, but you were prepared for much worse). So they you say, "Well, that didn't hurt!"
When in fact, it would have felt much worse if he hadn't prepared you first.
posted
I think it was because you refrained from using your annoying "Jerry Lewis" voice through out your speach, just saving it for those really special, deeply religious moments.
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posted
I liken it to expectations of a movie. When I've been told a movie is really funny, I rarely find it all that funny. I was expecting it to be funny, so the few jokes that do work, don't seem like such a big deal. However, when I've heard nothing about a movie, I'm occasionally surprised, because I wasn't expecting a good movie. I figure if I've never heard of the movie, it must not have been all that good. Sometimes, I'm wrong.
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I think you are saying things close to what some of the serious people here have been saying. Setting up expectations - if they don't expect me to offend them and I do, they end up being really offended. If I say I will offend them and I only offend them a little, I've come in under the expectation I myself set. Yes?
As for less serious people:
quote:I think it was because you refrained from using your annoying "Jerry Lewis" voice through out your speach, just saving it for those really special, deeply religious moments.
*ahem* I, of course, don't have any of those deeply religious moments, so no occasion to use the voice.
By a strange coincidence, a good friend of mine is the founder of Jerry's Orphans, a group of ex-poster kids (now adults) that protest the telethon. Diane, my S.O., was one of the group's first members.
posted
This type of exploitation is especially insidious because the label of ingratitude is applied to anyone who refuses to be the tool on which someone else demonstrates their compassion.
Not only "aren't I such a good person for granting you this boon" [subtext: this is not something which is yours by right, but mine to give by fiat], but also "aren't you the miserable/petulant/brattish little freak for not understanding your place and being grateful for the scraps I throw your way."
Lord save us from the professional do-gooders. Their livelihood depends on the existence of a need for charity, even when that need is artificially imposed.
Reminds me a lot of my Aunt Purple, but that's another story.
Thank you - the issue is definitely not unique to disability. It's the "charity trap."
And, I hope you know that I really want to hear the story about Aunt Purple. But I can wait patiently until you have the time and are in the mood to tell it.
Briefly, I come from a huge family of practicing old-world Catholics (as in, I have more than 140 first and second cousins sort of Catholic). Convents and monasteries figure prominently in our lives, even for my generation. "Christ-like" is a much-sought appellation, as it always has been. We take our do-gooding seriously.
I ran away from home to go to college and avoid the convent at Ferdinand, Indiana, but that's a whole 'nuther story.
Forceable charity has a strong tradition in the family. My Great-great Aunt Verona went her whole life by the name "Purple," due to her habit of always wearing the penitential purple that was originally required during Lent. She was known for getting up well before the crack of dawn to light the fires at both Catholic churches in the area, walking from one to the next, and then -- after attending mass and feeding her family -- she would set out to do Good Works for the Poor.
I'm sure she was an inspiration to many lives. I am also sure she was a burden to many of the poor, as it later became known that they would shut their curtains and pretend not to be at home.
My generation in the family now calls insisting on one's promotion of an unwelcome charity to be "pulling an Aunt Purple."
Some other time I'll tell you about the latest time someone in my family pulled an Aunt Purple on me. It has to do with a wealthy relative offereing to open up the church donation site so I could find used clothes to wear to my mother's funeral. (Mind you, Stephen, I always shop second-hand anyway. But the context of this made the offer a deliberate offense, unlike, say, the offer of other relatives to loan me one of their black dresses. *sigh It's a long story, but it was definitely an Aunt Purple.)
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posted
sndrake, I know you don't like to mix Hatrack with work, and you don't really know me either, so this might be a bit out of the blue...
But if you had some spare time in the future, could I ask you some questions about what you do? I've recently been thinking about it myself, and it might be nice to talk to someone who's already there...
Anyhow, thanks either way! Posts: 2849 | Registered: Feb 2002
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CT graciously replied to my subtle request for a story:
quote:My generation in the family now calls insisting on one's promotion of an unwelcome charity to be "pulling an Aunt Purple."
We loves stories. And the metaphors we get from them.
"Pulling an Aunt Purple" now joins a list of honored metaphors in my household:
"The Princeton gambit" "The Jerry Lewis School of Dignity and Respect" "Like riding a bicycle" (means something very different in my household) "When the walls fell" "His eyes uncovered!"
Forgot to add: "Fire bad. Tree pretty."
Eaquae:
It's not that I don't like to mix Hatrack with work. I just don't want work to swallow the Hatrack part of my life - which is what has happened to most other parts of my life.
I'm not really that scared of that any more. After close to a year here and closing in on 900 posts, I don't think I have to worry about being a "one-note" kind of person.
And if I didn't occasionally bring up the stuff I do on Hatrack, I'd be leaving out a huge chunk of who I am - personally, politically and professionally.
That's a long way of saying it's fine with me to discuss whatever aspects of my work you want to, either here - or via email. My email is open and listed in my profile.
quote:It's unusual for anyone from my organization to get invited to speak at any ethics conference. We're at odds with a lot of what is happening in ethics, including some aspects of the Catholic variety.
This sentence has intrigued me since I read it. Do you have a good link that summarizes the disputes with "ethics of the Catholic variety?" I don't know a lot about Catholic bio-ethics (beyond the obvious) and am wondering what areas might be problematic. I'm really just curious in learning more about this issue in general, since all my knowledge is peripherally derived from my knowledge of the abortion issue.
posted
Claudia Therese, are Aunt Purples only charitable things that are deliberately offensive? Or does it apply to well-meaning oblivious acts of offensive charity as well? Aunt Purple is almost an archetype, isn't she?
sndrake, I am dying to know the stories behind each of those phrases and what they mean.
I love stuff like that. In my family we call Aaron Copeland's Appalachian Spring "Grocery Store, Chinese Food", and Stravinsky's Petroushka is "Oh, my name is Mr, Pig". Taking something away to be fixed and never bringing is back is known as "honeysuckling" it, and so on. I love things like that!
posted
See why I'm not worried about my work swallowing my identity here?
Dag, I couldn't find a site that summarizes some of the problematical areas, and if I can't find one, I'll summarize some of the areas myself with links, etc. so the source material can be read. Most of the problematical areas have to do with "withdrawal or withholding of treatment." As I've said, I'm not a Catholic, but doctrine is somewhat ambiguous - the broadest and most extreme interpretation ("extreme" meaning endorsing these situations as ethical) is being promoted by both some prominent Catholic ethicists and Catholic medical organizations.
Some of the material I need (like archived email) is at home.
aka,
A couple of the quotes refer to STNG - specificlly the episode "Darmok." I'll tell at least one of the more personal stories before the thread runs out. Haven't decided which one yet.
As for "Fire bad. Tree pretty." You don't watch Buffy, do you? Posts: 4344 | Registered: Mar 2003
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posted
Thanks, sndrake. I'd be very interested in reading those. We've had to deal with withholding and withdrawel of treatment cases twice since I started law school and I've had to stay out of both discussions because I've been tempted to stand up and scream, "This is a person we're talking about!"
quote:VATICAN CITY -- Pope John Paul II said Saturday the removal of feeding tubes from people in vegetative states was immoral, and that no judgment on their quality of life could justify such "euthanasia by omission."
John Paul made the comments to participants of a Vatican conference on the ethical dilemmas of dealing with incapacitated patients, entering into a debate that has sparked court battles in the United States and elsewhere.
The pope said even the medical terminology used to describe people in so-called "persistent vegetative states" was degrading to them. He said no matter how sick a person was, "he is and will always be a man, never becoming a 'vegetable' or 'animal.'"
My conference-related paper is already in for publication. I'm going to call the director on Monday to see if this can be put in as either an end note to my own article or as a separate piece in the publication. I'm really tempted to email this directly to a couple of Catholic bioethicists who have been front and center on sanctioning these practices in the name of Catholic doctrine and ask what they intend to do now.
It's a little too appealing on a nasty level for me to go ahead and do it without a little bit of reflection first, though. Posts: 4344 | Registered: Mar 2003
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quote:The pope said even the medical terminology used to describe people in so-called "persistent vegetative states" was degrading to them. He said no matter how sick a person was, "he is and will always be a man, never becoming a 'vegetable' or 'animal.'"
That brought tears to my eyes. The word "vegetable" has always, always offended me.
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I was a bit confused how Catholic ethicists could justify the removal of feeding tubes. I mean, this isn't even extraordinary measures here. Not by a long shot.
EDIT: And I'm glad to see JPII coming out against the word "vegetable." I hate that word.
posted
Thanks, Belle. Me too. The word was used by a doctor a long time ago to describe me or what he thought I'd be like. The important issue about the word - for me - was his intent in using it. He was using it to steer the conversation toward the question of withholding medical treatment of me do I would die. Fortunately, that didn't happen.
Clarification: the conference I mentioned in reference to my paper is NOT the Vatican conference, but the conference held in Chicago a few weeks ago that was mentioned in the beginning of this thread.
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posted
sndrake, doctors told my family my grandfather was in a vegetative state and his brain damage was so severe he would never respond to anyone. And yet, he reached toward my baby daughter and said "I want to hold the baby" and held her and smiled at her. And when we prayed with him, he closed his eyes and bowed his head.
He was a man, all the way until the end, not a plant, not an animal.
Those words are often used to influence families, by putting a distance between the family and the sick person. "Oh, it's not your loved one anymore, it's just a vegetable that looks like him."
No, that was my grandfather who held my little girl and smiled at her.
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I wish I could tell you that what your doctors told you about your grandfather was an unusual story. Unfortunately, I can't. It appears to be very common.
I also wish I could tell you that the response of you and your family was a common one. I don't think it is. People with a lot of serious neurological damage generally take a lot of persistence and attention on the part of familiar people to get responses. And even when you don't get a response, the only thing you can really be sure of is the lack of response - we can never really know for sure what someone else's internal state is. We base our judgments on the external evidence.
It's important not to mistake "best guess" for "knowing."
posted
I worked in hospice for a brief period of time. As part of the training I recieved before working there, I was given some literature on the process of dying. One of the points that I recall, and have observed personally many, many times, is that when a person is dying, they stop eating. From what I remember of the literature, and again this is backed up by my own experience, when people stop eating, it puts them in a kind of fugue state that makes the process of dying 'easier'.
I mention this not to contradict what sndrake is saying, but more of a response to the quoted comments by the pope. The key difference between what sndrake is saying and what I'm talking about is that one person is dying even with a feeding tube, the other is not. I just want to point out that the word 'immoral' is something of a grey term and that sometimes we can appreciate that helping people die with dignity; when they are, say, dying and in immense pain and feeding them either exacerbates that pain or will just extend it for another day or two, and helping them to die in comfort and in dignity is not a bad thing.
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Ideally, the person doing the dying would get to decide. Hopefully they'd have given instructions prior to becoming incapacitated -- which is often the case with cancer sufferers (sort of Hospice's main clientel, I believe).
Someone who is unable to communicate...that's a tough call and I think doctors have a mindset that says life ends when there's nothing more THEY can do for the patient.
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posted
sndrake, something that disturbs me immensely is when a feeding tube is witheld, the person becomes dehydrated (if an IV is not in, which in my grandfather's case there was no IV) and weak from lack of food. Confusion is a common side effect. How can you expect the person to respond to you, when they've had nothing to eat or drink? Their low blood sugar alone could cause the confusion.
I'm not denying my grandfather suffered brain damage from lack of oxygen, he did. But, he was not a "vegetable" or "brain dead" He recognized some of us, calling my aunt by name. With time, and patience, good nutrition, and care I think he would have come to be more alert and aware. Unfortunately, we didn't get that time, pneumonia claimed him.
Witholding nourishment from someone who can breathe on their own is criminal. I don't understand how its anything beyond torture.
There is one thing to honor a person's living will that states they don't want to be kept alive by artificial measures (i.e., ventilator), it's quite another not to feed them.
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posted
Just to be clear, the Pope's statement reflects nothing new in Catholic teaching. I was taught this in my senior year of high school in post-confirmation classes.
Those bioethicists you were talking about were just plain wrong from a doctrinal perspective. I'm glad JPII spoke up to clarify things.
Dagonee Edit: Was this the root of the disagreement you had with the Catholic ethicists that you mentioned earlier in the thread?
posted
Stephen, I think you should find a way to include it, and then just send a copy of the article to the folks you want to make sure see it. It doesn't need any twisting of the knife accompanyment. Just send it with a nice note about how much you enjoyed the time at the Chicago meeting.
quote: Ideally, the person doing the dying would get to decide.
The problem is that you do find people who try and push food on the dying person. It's easy to say 'let them decide'. Not so easy when you are that person's family, or are responsible for their care. There are also mitigating factors of pain and pallative drugs and dementia that make it difficult for a person to think and that make it difficult and unclear how to best follow a person's wishes, even when they can communicate. But when someone can't communicate other than to weep and shreik and moan, what then? You know they are in immense amounts of pain and that their condition is terminal. Is it most ethical to let them suffer until the very end or to end their suffering as soon as possible, perhaps by withholding nutrition?
Again, this has little to do with what sndrake has, in general, been talking about and everything to do with the Pope's comments.
Let me point out that there are other issues that haven't been discussed. Patients who are in persistive 'vegetative' states cost a lot to take care of. I seem to recall something on the order of, on average, around five times what it costs to take care of other patients in LTC facilities. (Anyone feel free to correct me on this.) The funds that a society has to take care of individuals are limited. Again, I've experienced this myself. Many patients in nursing homes have teeth that are rotting in their heads because they can't afford a trip to the dentist, or they are unable to get dentures; or cannot see because they don't have the money to get prescriptions for their glasses, or cannot continue to pay for certain drugs that might help their quality of life. What of them? When you keep someone alive, you are also paying for a host of other things that might be better spent on people who are definitely able to experience and feel and do things. It's just basic medical triage.
I recognize that I am in way over my head here. I'm sure CT or Theca or Suneun know way more about this than I do. But they haven't said anything. So, I am, since it is something that I have some pretty strong feelings (as opposed to educated opinions) about and this thread has given me a chance to voice them.
posted
My personal feeling is that someone who is alive, regardless of mental condition, deserves at least the basic necessities of food/nutrition and shelter. Then they should be provided with medication and/or treatment as appropriate to keep them comfortable if recovery is not possible and they are not able to otherwise specify their own wishes.
And thanks, aka, now I have a name for one of my quirks. I am a pathological honeysuckler.
posted
Let's try to get a few points clear (I'll probably try to do complete replies on some things tomorrow):
The statement by the pope isn't about "dying" people. That's not really an area of concern for me either.
Let me illustrate: Diane's father died of bone cancer. In the final stages, his desire to eat and drink lessened. He'd already decided that he didn't want food and water via tube, but they would have pushed for the same thing even if he hadn't made his wishes clear. For a very simple reason: His organs were shutting down and they couldn't process fluids or nutrients any more. It would have increased his suffering without doing much of anything to lengthen his life.
That's a very different situation from a physically healthy person who is unable to communicate or eat by mouth. I realize there's a lot of confusion over that, but that's largely because there are an awful lot of people in the medical and ethics communities conflating the situations.
It's amazing to me how much difference context makes. In the past week, news stories about two disabled people starved to death have come into my mailbox. One was a 15-year-old with cerebral palsy here in the Chicago area. Another was a guy in the Pittsburgh area with quadriplegia and brain injury.
In both cases, the relatives are being charged with neglect, manslaughter, the works. No one is writing about how dignified starvation is or how maybe the relatives knew best what they wanted.
And yet, in both cases, if the relative had taken them to a hospital and then asked to have tube feeding withheld, it would have been supported. It would be defended as "death with dignity." And any number of professionals would tell us how peaceful it is to starve to death.
(I think I am feeling another op-ed coming on)
*Sigh*
Dag, this does touch on some of the issues I was referring to. I have a paper prepared of my remarks that might be helpful, but I'm thinking I already might need a new one.
Bob, I know, I know.
It's just that it's so gratifying to think about doing the knife approach. What's cured me of that is that I've learned that in the long run the high road is often the cruellest. Posts: 4344 | Registered: Mar 2003
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posted
Actually, sndrake, the pope didn't make the distinction of whether the person was dying--at least in your article. That's why I responded the way I did. Let me also repeat that I did say that, by and large, I was responding to what the Pope said, not you.
I believe that the official doctrine of the Catholic church, please correct me if I am wrong, is that suicide and 'murder' for any reason are always wrong. If this is so, then it would be consistent with doctrine for the Pope to say that removal of of a feeding tube is always wrong.
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I intend to reply to other parts of your earlier posts tomorrow, but the pope's statement was made in the context of a conference on issues surrounding the vegetative state. The church has some official statements about the issues of "burden," and avoiding prolongation of dying through extroardinary means. Trouble is, the statements were so fuzzy, they've come to mean almost anything anyone wants them to. This is a clarification about tube-feeding and hydration when it comes to people with cognitive disabilities.
posted
I should have just waited for the expert to reply. Thanks for keeping us posted on all this, sndrake. I can't think of another issue where the vocabulary itself has become so one-sided. At least in other areas where vocabulary is being used to define the controversy away there is some vocal opposition from the other side being heard. Anytime this issue comes up, the press mangles the other side very badly.
quote: Storm, the quoted portion refers to "persistent vegetative states," which by definition means not foreseeably terminal.
After rereading the article, it's clearer to me that you are right. I was responding to
quote: VATICAN CITY - Pope John Paul (news - web sites) II said Saturday the removal of feeding tubes from people in vegetative states was immoral, and that no judgment on their quality of life could justify such "euthanasia by omission."
where they didn't say persistent, and
quote: He said no matter how sick a person was, "he is and will always be a man, never becoming a 'vegetable' or 'animal.'"
where I thought he was saying that the person should never have the feeding tube removed, no matter what, because they were men.
Thanks for the clarification.
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posted
If anyone's interested, there's an online article that has a Q&A with me on the issue of advanced directives that talks about a lot of these issues. It was published on my birthday in the Reno Gazette-Journal:
quote:1. Do you support advance directives? Why or why not?
We support detailed advance directives in regard to people’s treatment preferences. In the current climate, we stress it’s probably more important to make it very clear what kind of medical treatment you do want, since the default assumption seems to be switching to that of non-treatment for incapacitated persons in the health care system. For example, the University of Pennsylvania Hospital has announced it will no longer admit people with a label of “persistent vegetative state” or “minimally conscious state” to Intensive Care unless they have an advance directive saying that is what they would have wanted.
2. How could advance directives be abused?
One of the greatest dangers is over-interpretation. Someone who states on a form they don’t want measures such as a ventilator or tube-feeding may be thinking in terms of not wanting these as a permanent measure. Regardless of what they might have meant, a directive that specifies neither of these measures can come into effect even if their use is expected to be short-term. It can even be true if there is a possibility that the individual might regain communication ability in the future.
Another area of abuse stems from people’s “blind faith” in medical labeling. Most people are probably under the impression that a “vegetative state” is a simple diagnosis. In fact, several studies have indicated that the misdiagnosis rate of persistent vegetative state runs as high as 43 percent. An error rate like that is serious in and of itself -- it’s even more serious when someone’s life hangs in the balance.
I think it’s fair to say that people need to take into account the fact that physicians are increasingly directive in urging nontreatment if they think the prognosis is unsatisfactory Numerous studies indicate medical professionals grossly underestimate the quality of life of people with disabilities compared with what we ourselves report. The same professionals are also more likely to regard certain disabilities as “worse than death” than are the public or families of people with severe disabilities.
quote:The funds that a society has to take care of individuals are limited. Again, I've experienced this myself. Many patients in nursing homes have teeth that are rotting in their heads because they can't afford a trip to the dentist, or they are unable to get dentures; or cannot see because they don't have the money to get prescriptions for their glasses, or cannot continue to pay for certain drugs that might help their quality of life. What of them? When you keep someone alive, you are also paying for a host of other things that might be better spent on people who are definitely able to experience and feel and do things. It's just basic medical triage.
Storm,
First of all, "triage" is a practice that is supposed to be applied to extreme crisis situations. Applying it to society at large has a less than respectable history.
It's a similar argument being used right now against immigrants - legal and illegal - and the resources they "sap" from the citizens of this country. It's similar to attacks on special education - pointing to how the money could be better spent on "normal" students who don't have enough to get decent textbooks.
Lifeboat arguments like these look more like scapegoat arguments from where I sit.
To save myself some time and trouble (and thinking - it's early), here's what I said in the article I linked to about economics:
quote:If we’re going to start a debate over economics and health care, we don’t accept singling out people like Terri Schiavo and others as having too little value to justify expenditure of resources. If we’re going to debate economics, let’s look at the whole picture -- for example, the role that advertising, marketing and profiteering by the pharmaceutical industry plays in burgeoning health care costs.
On the other hand, it’s clear that for at least some people, the desire to limit care and end the lives of people like Terri Schiavo is an economic issue. There are probably even more bioethicists and advocates who feel the same way but aren’t willing to be honest about it. We feel that if people want to use economic considerations to end the lives of people like Terri Schiavo, let them be frank about it instead of hiding the motivation behind terms like “compassion,” dignity,” and “choice.”
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Whether you like it or not, the resources of any individual or society are limited. They are only able to recieve the care that they are able to pay for. When you bring publicly funded care into the picture, that helps somewhat, but you still must make a choice as to who gets what procedures and how much you (society) are willing to pay. For most people in the US, care is always limited, either by their insurance plans, or their finances. I understand Terri Schiavo's parents were/are going to pay for her care. That's great. They're going to have to decide what they can afford to pay for and what they can't until they run out of money, which they will because LTC care is expensive, at which point it goes to the state to decide. Triage. This isn't scapegoating, these are just economic facts.
As is well known, this country is heading into a period where there are going to be large numbers of people retiring and relatively few people working, bringing in income. After that, it will be large numbers of people in LTC facilities. All these people are going to need to recieve some level of care. I'm not arguing they shouldn't. What level of care they are going to recieve on the public dime is going to be a huge debate, it's going to have to be weighed in terms of quality vs. quantity of life for healthy and sick members of society. That's just the way it works when everyone must compete for the same public funds.
posted
Stormie, I've been following along, but I still am gathering my thoughts. For one thing, I believe this is an important issue, and for me, the importance of thinking through a matter is directly proportional to the time and care that should be spent on doing it right. I don't speak off the cuff about matters like this.
Even more importantly, though, I have noted that my assessment of how these questions arise is different from sndrake's. While he finds that the rhetoric is shifting towards encouraging removal of support, from my perspective, it is the reverse. I see physicians and nurses even less likely to discuss these matters, much less act on them, usually for fear of legal action.
But I don't think that this is disingenuousness or falsehood on either my part or Stephen's. I suspect that those outcomes we fear will be those that we see and remember, and I expect that -- as a physician -- my biases are to fear what I do not wish to deal with. And I suspect that what we are least likely of all to see is that which we have done, but yet are ourselves unable to admit.
I can recall only one time in my medical career that I made a decision not in the best interests of my patient. After 36 hours without sleep, I delayed ordering an abdominal x-ray on a neonate because I didn't want to have to be up to read it. I wanted to sleep first. For various reasons, it didn't affect the care of the patient, but I know that was not foremost in my mind when I made that choice.
And here's the kicker: I take that record to be evidence not of my worth as a physician, but as evidence of my own lack of awareness about something I fear. Objectively, I know that this self-assessment is not accurate -- it can't be. And I know, then, that my own good qualities shine clearly in my eyes while I do not see that which I wish not to see.
So, given that Stephen has made the study of these issues his life work, and given what I know about myself, I would do him a disservice and disrespect if I didn't try to sort through my own thoughts more clearly, as well as get more familiar with what data is out there, before I jumped in willy-nilly. There is a tendency for physicians to assume they are experts on everything, and that their opinions are desperately needed in every discussion. That's nonsense.
So I'm working on it, Stormie, but I haven't much to say yet. When I do, I promise to chime in.
posted
Hrm. Once again I am reminded of what a spectacularly bad writer I am.
I wasn't making a jab at you by saying you and Theca or Suneun hadn't said anything. You, in particular, have said things in other threads. So, it would be pretty silly of me to accuse you of, uh, ignoring the issue. If that's what you're saying.
I'm more than happy to discuss these issues with Mr. Drake, but I'm afraid I'm not just going to accept his opinion as the right one simply because of his expert status. As an expert, he should be, and has shown that he is, more than able to address my own uneducated concerns. This doesn't mean that I am going to agree with him on everything, though, or that I won't have questions. I'm sure he respects that.
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