Terri Schiavo rant

[Edited. I didn't realize when I first posted it that MS Word had put a whole batch of odd stuff in it. My apologies. I'm not sure it's 100% clean, but it's cleaner than it was. --Liam]

I plan to write a more humorous essay on my opinions in the "right to die / do not resuscitate / no extraordinary measures” debate, but this one’s been eating at me since the decision was made last week to remove the feeding tube, so I have to rant for a bit.

My problem is that once again, I fall somewhere in the middle of the story, and it’s hard to know how to feel about this SPECIFIC case, because we don’t have all of the details. I haven’t followed the case as closely as I should have, so some of the "facts" as I understand them may not be, and if you know something to be different, please post a comment or e-mail me and correct me.

That said… There are a lot of issues here. There’s money involved. There are the wishes of the woman in question. There’s morality.

The thing that makes it difficult for me is that we don’t KNOW the wishes of Terri Schiavo. She did not leave a living will behind, nor a health care directive. Even had she, I’m not sure how clearly applicable it would be to this case. But the point of the case is that we have only her husband’s word and her parents’ as to what she "would have wanted".

I do not believe in the sacredness of life, when life is technical only. If Ms. Schiavo was in a non-responsive coma, with so little brain function she could not even keep her own heart beating or lungs breathing, then I do not believe any favors are done for anyone by keeping her alive, because she clearly would not be, except in the barest of medical technicalities. That case does not apply here. We’ve all seen the video (shown in endless exploitation on the news shows) of her sitting up, visibly conscious, even smiling. She’s not, by any stretch of the imagination, dead. Which means even had she left a health care directive, I’m not sure it would be clear that this is a case of “permanent vegetative state”.

The argument has been made by co-workers of mine that withholding a food/water tube is only different "by degrees" from mechanically keeping a heart beating and lungs pumping, but I see a clear distinction. If your brain is damaged so badly that not only are you not conscious and non-responsive, you can’t even sustain minimal life signs in your own body, you are pretty clearly beyond any reasonably hope for recovery. However, the brain does some amazing things, retraining itself to do things in working parts of itself which used to be handled by damaged parts. It seems to me that if Terri Schiavo is capable of being conscious and mildly responsive (such as smiling), and her brain is capable of maintaining basic life functioning, starving her to death (or more correctly, dehydrating her) is murder, not particularly different than smothering her with a pillow.

Which is not to say that, given her state, that might not be what she would have wanted, but let’s call it by it’s real name. Some of the same people who don’t have a problem with removing her feeding tube would be incensed if we were to suggest that she be given a fatal dose of morphine to end her suffering. I do not object to right-to-die, I do not even have a moral objection to suicide (although I do think as a society we should do our best to help people who are suicidal to solve their problems so they do not need to resort to it). But euthanasia always bothered me, because it carries with it a certain implication of making that decision FOR the patient, different from murder only in that in a murder case, the decision is made for a wholly functional human being. But would we feel justified in denying basic biological needs to the functionally retarded? Because that’s what (my impression of) Terri Schiavo is: functionally retarded.

On top of everything else, my understanding is that there’s a large medical malpractice settlement riding on this case. Again, I don’t have all of the facts, but the story as I’ve heard it is that her doctor was successfully sued because he didn’t recognize the vitamin deficiency that led to the event that led to her condition… even though she never divulged to him that she had an eating disorder. If these really are the facts, then it’s a travesty that this doctor was expected to recognize the results of a disorder he was not informed was extant. This is tantamount to going to the doctor because you stepped on a nail, never mentioning to the doctor even so much as “My foot hurts”, and then suing the doctor because your foot gets gangrenous and must be ultimately amputated. But again, I may not have all of the facts.

The point is, though, this settlement is in a fund to pay for the care of Ms. Schiavo, and is being eroded by paying FOR it. When she dies, whatever is left goes to whoever her primary guardian and legal care giver is at the time. To me, this is a heck of an incentive for her husband to want her allowed to die. Convince yourself that there’s no chance for any kind of recovery (admittedly, after 15 years, probably a pretty good bet), and so you’re not doing anything to Terry, she’s already dead. Then I can see wanting to at least get your hands on the money, both while she’s still your legal responsibility AND before it’s been eaten up paying for medical bills.

So in Solomonic solution, let’s remove it from the equation. Have a court declare that that money stays in a fund to pay for her continued care, goes to HER (for her loss) if she comes around enough to legally be responsible enough to take custody of it, and goes to charity (perhaps brain function research?) if she dies without being able to take custody of it and form a will providing for other disposition of it. Then let’s see if her husband is so certain that “Terri wouldn’t have wanted to live this way.” Let’s see if her parents aren’t hoping her husband will divorce her so he can marry his (now) girlfriend, thus leaving that money to THEM.

I’m not saying that money IS the motivating factor on either side, I’m just saying that it very well COULD be, and it’d be nice to know. (Of course, even if we remove the money, at this point there’s face to be saved, so it is doubtful that either side would change their story publicly, but perhaps they’d stop spending as much effort to argue their side of it, if money really is their prime motivation).

But it all comes back to three things: Do you support euthanasia? Is Terri Schiavo so far gone as to be functionally dead and beyond reasonable chance of even partial recovery? And if so, what would she have wanted?

For me, the answers are No (not without a patient directive or clear knowledge of the patient’s wishes), No (there’s too much basic functioning, even basic consciousness, to believe that all hope is lost) and I have no idea. Given these three answers, I can’t support what amounts to murder, be it by introduction of fatal doses of medication, smothering with a pillow, or merely forced starvation and dehydration.

--Liam.

(And let me say again, I really do want to hear if you believe the facts are other than I understand them, or if you have a different take on the matter.)

Copyright © March 22, 2005 by Liam Johnson. http://www.liamjohnson.net

Yeah, THIS makes sense....

How wonderful. Our country's Senate has just passed legislation to allow drilling for oil in the Alaskan Wildlife Refuge.

I can't begin to tell you how many things about this smell rotten, not in Denmark, but right here at home.

First off, before anything else... It's a wildlife refuge. It's been set aside as a place to be untouched for the indigenous wildlife. That's not supposed to be "as long as it's convenient", it's supposed to mean that the animals in this one of very few small corners of the planet can safely live their lives, undisturbed by the various evils Man inflicts upon the Earth.

Also, there are the tactics. Not that it should surprise me, but this bill is attached to a vital budget bill, in a rider, making it harder for Senators to oppose in it’s own right. The rider system is fundamentally flawed in this country, in that it allows completely unrelated things to be lumped together in one vote. Want a new perk for your state? Get the bill attached to something that no one in their right mind can vote against, like anti child abuse legislation. The Senate has on several occasions (although I am not aware of any perpetrated by the CURRENT Senate) slipped through pay raises for themselves by attaching them as last minute riders to other bills with overwhelming support. But the worst of it is that by attaching this particular rider to this PARTICULAR bill, they take away one of the few weapons left in the minority’s arsenal. You may not like the filibuster, but it has been used to great effect down through the years, and to make a bill like this filibuster proof abuses the system.

But the real kicker is that expert opinion says that if we were able to harvest ALL of the oil to be found under ANWR, we could only meet 6 months of this nation’s demand. Now, granted, 6 months on top of what already exists is a nice bonus, but to argue (as they have) that this will somehow loosen the grip foreign oil companies have over our nation is ludicrous. Estimates are that it will take 7-10 years before we can possibly see any of this oil. 7-10 years of destruction of home for caribou, polar and grizzly bears, snow geese, golden eagles, as well as sacred ground for at least one of the native "eskimo" tribes.

And the hypocrisy of it all is that this same congress refuses to increase fuel efficiency standards on automobiles. Why conserve, when we can just make more? What are the needs of a few million animals, compared to the profits of automobile and oil companies, which might be threatened if they were forced to put money towards developing more efficient vehicles? I drive a Toyota Prius, I know it is possible to make a mid-sized car which can get (in warm months) 55-60 MPG, and in winter, around 40. Let’s push the companies to all go that route. There are a number of new technologies which show promise, not the least of which is hydrogen fuel cell technology. Let’s develop that and COMPLETELY eliminate the foreign dependency on oil. Oh, right, our leader’s corporate friends in the oil industry wouldn’t like that one bit.

We don’t really want to reduce our domestic dependency on oil, we just want to find a way to make it OUR oil, instead of someone else’s. Can it be any clearer that the almighty profit margin, and not the American People, is the master to which our government bows?

Copyright (c) March 16, 2005 by Liam Johnson. http://www.liamjohnson.net

Minor Rant

(So minor, I probably won't index it).

I'm trying to figure out the best way to post my essays. In order to make sure there's a steady stream of them, I post one per week, on Friday, as regular readers know. (I may post rants and such at other times, but the humorous (or at least, intended to be humorous) columns which are the bread and butter of this blog).

However, I find that sometimes I have nothing to write for a few weeks, and then a whole batch at once, so I queue them up. Right now, there are three all written, just waiting to post over the next three weeks (for those who like hints, you get to hear about my car, my bald head, and my take on religion&politics, not necessarily in that order).

Now, the question is, do I post them in the order I write them, or in order of how funny I think they are? And if the second, do I post the funniest first, or do I save the funniest ones, in case the ones I write later aren't as good?

All in all, a much better problem to be dealing with than, say, writer's block, but if any regular readers wish to weigh in on the matter, I'm open to suggestions.

(The only thing I'm not open to is posting them all as I write them. I really want this blog to grow in popularity, and in order to keep readers, I can't go for long periods with no activity, or people will tend to go elsewhere. As a result, I kind of think having a backlog is a good thing, so if I have a bad couple of weeks, I don't leave y'all hanging, or drive you off to more prolific sites...)

Liam.

Response Rant

(This began as a response to a comment on my previous rant, but it quickly turned into a rant on it's own, and so I'll post it new.)

The problem with the hypocratic oath is that our legal system likes to interpret that as "Doing nothing is OK, as long as you don't accidentally do something HARMFUL."

When we hear about high profile malpractice suits, they're usually because the doctor DID something which (according to the suit) "caused" some bad result, or failed to cure the condition. The suit against a doctor because he DIDN'T do something is rarer (or at least, gets less press).

I think it's horrific what passes for "proof" in our courts. There are several classic examples. Dow Chemical's trials with breast implants, for one. The famous "McDonald's is liable because they served HOT coffee" is another.

In the first, a classic false "proof" was used: Testimonials. A certain percentage of the population is going to come down with any known disease, and with breast implants as prevalent as they are, there is going to be some cross over. If one person in a hundred (1%) of people come down with XYZ's disease, and one person in a hundred who has breast implants also comes down with XYZ's disease, then statistically, the implants had no effect. But if you gather up 50 or 100 of those people (skipping over the other 4999 or 9999 who DIDN'T get the disease), and parade them one after another in front of the jury, it's human nature to eventually start to believe the testimonials.

Let's put this another way: If I put label 10 ping-pong balls 1 through 10, sterilyze them and put them into a bag, and then ask 10,000 people to pick one out of the bag and remember their number, some small percentage of those people will get a headache in the next day or so (and would have gotten one, whether they'd picked the ball out or not). Now imagine that I ask all of the people who picked 3, and gathered up the 50 or so who'd gotten a headache.

Now I parade them in front of you one after another, to testify that "I picked #3, and less than a day later, I had a headache". After enough of them testified, I might be able to convince the jury that the number 3 was evil and actually caused headaches. Never mind that there are roughtly 950 people who picked 3 who did NOT get headaches, and nevermind that there are about 50 people who picked each of the OTHER numbers who also got headaches. The jury is never presented with this information.

We fall for this same tactic every time we see an add for some "food supplement" on television or on line. If you pay close attention, rarely do they quote any scientific double-blind study proving efficacy. No, they just parade about 5 people past who say "I took Dr. Ultra's Miracle Pill and within 3 weeks, my toenail fungus was completely cleared up!" It's very possible that each of these people would have been spontaneously cured WITHOUT the miracle pill, certainly there are few diseases which do not OCCASIONALLY spontaneously go into remission (or "cure"). The key is to take the population of people who took "Dr. Ultra's Miracle Pill" and the population of people who experienced spontaneous remission of the disease in question, find the intersection of the two sets (however small), and only present THOSE cases to the judging body.

Back to the examples of "proof", there's the famous case of the McDonald's coffee that was "too hot". We've become so lawsuit happy that a company such as McDonald's can't do it right. They're damned if they do and damned if they don't. Why, you ask? Well, consider the two options.

1) Drive-thru windows are not SUPPOSED to encourage eating while driving. Although we all know this is not how it happens, the intent is supposed to be "I'll buy my food at the drive through, take it to where I'm going, and eat it there". As a result, you're going to want to serve the coffee just as hot as you can, so that the coffee is still warm when the destination is reached. Hot coffee is good, iced coffee is good. Tepid coffee is gross.

2) On the other hand, you have the case as it exists, someone who "didn't expect the coffee to be that hot", spilled it on herself, and then sued for pain and suffering.

Now, given both of these options, before the case in question came up, which would you think the better choice: serve your coffee hot because who expects someone to complain because coffee is hot, or serve your coffee warm and hope no one gets into an accident and then sues on the grounds that "The coffee is never hot enough, I had to drink it before I got home, or it would have been gross!".

So unfortunately, although I don't like the behavior of the "bad apples" among the medical community, I can certainly UNDERSTAND the annoying "ass covering" maneuvers perpetrated by most. When we have a legal system that actively hostile to doctors, is it any wonder most doctors aren't willing to take any risks or accept any but the standard accepted course of treatment for a disease, even when it doesn't seem to be working?

Copyright (c) March 10, 2005 by Liam Johnson. http://www.liamjohnson.net

A Rant for a Sunday Afternoon

I'm lying in bed with the flu, today, and feeling kind of grumpy. My wife is feeling stir-crazy because we haven't gotten out of the house, but in truth all of the energy I have is going into typing. Walking upstairs from the TV to my bed is about all of the "out-and-about" I can handle today. I was perusing cpaptalk.com (as is my wont) and I just wrote a version of this in response to something on the site, and felt like expounding some more on the point...

The discussion in question was about doctors as authority figures, not to be questioned. One user had a doctor who made a statement decrying a feature of treatment designed for COMFORT as having no therapeutic benefit. My opinion is that comfort is almost as important as efficacy, because without comfort, there is a higher probability of non-compliance with directions, and without proper compliance, the most effective treatment in the world will have no good result. (You can buy the best, most effective exercise equipment in the world, but if you never USE it, it’s never going to have any effect on your flabby buttocks.) Comfort features are VERY important, and for a doctor (and supposed specialist in his field) to pooh-pooh them as marketing gimmicks indicates no real interest in his patient’s well-being.

But the part that really galled me was that the quote by this doctor went on to cite his various degrees and certificates and insist that one should not "question authority". In my opinion, (some *) doctors need to get it through their heads that they are NOT in positions of authority. They are in positions of expertise, which is different. Who do they think pays their salary? They work for us, not the other way around. When I go to a doctor, I’m there to consult upon his expertise, not paying him (or her) to be some sort of dominatrix. I’m not into that.

Similarly, when I go to a car repair facility, I ask the mechanic what is wrong, but if he comes back and tells me that my car needs new brakes when the problem is that it won’t start, there’s no reason at all why I should just do what he says. I paid him for a consultation on his expertise, I’m free to accept or reject what I get from him, as easily as I am free to accept or reject an apple I purchase, when I get home and find it not particularly tasty. I paid for it, it’s mine to do with as I wish.

My opinion is that true experts in a field do not get defensive about being questioned. If you REALLY know your stuff, you have no reason to feel threatened by someone questioning something you say. We’re all human, we all make mistakes occasionally or jump to conclusions before we know all of the facts. I’m considered an "expert" on the Oracle database within my company, but that doesn’t mean that it’s a direct or personal attack any time someone suggests that my way of doing something may not be always right. Because it isn’t always right. As the "expert", it’s right more often than it’s wrong (at least, I hope so, or what are they paying me for?), but I’m not infallible. I’m not a god among men.

The problem began, in my opinion, when the medical establishment decided to start naming everything with complex Latin names, with the intent of keeping their art mysterious and unknowable by the masses. When coming out of the doctor’s office after having sustained an injury, are you more likely to panic if he tells you that you have a "bruise" or a "subcutaneous hematoma"? They’re the same thing, but for quite a number of years, the medical establishment urged the use of the second over the first.

It was this level of "we’re just regular people, we couldn’t POSSIBLY understand the subtle complexities of the physician’s art" which allowed some of the travesties which are now public knowledge to be foist, in secret, upon the populace. Illicit tests of LSD on patients who thought they were being prescribed other medications. Intentional infliction of syphilis on men of the lower classes to see how long they would live without treatment. Doctor-supervised tests of the effects on soldiers of exposure to nuclear bombs (from a distance, of course, we know the immediate effects of an up-close nuclear bomb).

When we allow any part of society to be elevated to the rank of "god among men", we forget that all men (and women) make mistakes, and we forget that power corrupts. I’m sure many of the doctors involved in some of these illicit experiments felt that they were helping humanity. By inflicting trouble upon the few, data could be gained which would allow treatment of the many. This level of detachment is only possible when you feel honestly superior to your unwitting test subject. Who among us would not be HORRIFIED at the intentional infliction of various painful conditions upon test subjects, with the intention of trying one or more treatments on some, and leaving others as "control groups", if those test subjects were humans instead of rats and monkeys and other "sub human" populations?

The problem has gotten better. Ready availability of information on the internet to research drugs which have been prescribed for us has helped to make it better. Public outcry when some of the experiments like the ones I listed above were discovered has helped to make it better. Breaking of the doctor’s code (so that a non-doctor such as myself knows what a "subcutaneous hematoma" is) has helped to make it better.

But we still need to be vigilant, and we need to be active participants in our own health care, and if we are not, we are putting power into the hands of someone who, at best, will use it benignly, and with normal human potential for error. At worst, someone who may care more about his money or her prestige or his research or her paper than they actually care whether you get any better.


(* My own doctor, Mark Splaine, is wonderful in this regard, and so I do not wish to paint all doctors with one brush. I find Dr. Splaine to be as open about what he DOESN’T know as about what he does, and to be perfectly open to my being a PARTNER in my heath care, not a customer or servant. Good doctors do exist, I’m not even certain they’re rare. But as in any field, the bad apples can cast a pall over the rest, unfair as that is.)

Copyright (c) March 5, 2005 by Liam Johnson. http://www.liamjohnson.net

Experimental Column #1

It's time I settled into the "once a week" column style of posting I said I was going to try to maintain. That way, all of my loyal readers (both of you) can get used to checking the blog once per week. I may still post random rants when something strikes me, but as to the humor columns, I'm going to post a new one each weekend ("weekend" defined as Friday if I have one done, and late Sunday night, if I get lazy). I've actually already written this week's column, but it's not Friday yet, so you'll have to wait.

In the mean time, however, I've decided to try the first of the "topical" columns that I talked about trying last week. Initially, this was intended to be the funny column for this week, but I'm not convinced that it's funny enough, so instead this is today's rant.

We'll start with: FCC indecency rules. It seems that the FCC, in its ongoing quest to facilitate communications, has decided that the best way to do this is to up the penalties on some forms of actual communication. A year ago, Janet Jackson's right breast was bared during the Super Bowl. If this is a surprise to you, then frankly I'm surprised you're aware there is an internet, or have found this blog. Anyway, the breast was bared and apparently our society crumbled under the strain. Clearly the half second flash completely warped the minds of our children. The re-airings of that half second (sometimes in slow motion, or freeze frame), often shown repeatedly in a single program, were news and in no way damaging. But clearly our children have never seen a breast before and must be protected. It's a good thing those things don't provide something necessary to the young or anything.

Anyway, in order to protect us from seeing a part of the body that WE ALL HAVE (women larger than men, but still...), the Senate is raising the fines on television stations for airing "indecency". And the part of this I find the most insane is that every time one of our elected or non-elected officials comments on the proposed change in the law, they stress that "nobody wants censorship, we just want to enforce a certain standard of decency". Clearly, these people have not ever, in the course of a life in public service, come across a DICTIONARY. The definition of the word "censor" is "to examine in order to suppress or delete anything considered objectionable."

But the thing is, they're punishing the wrong people. The stations which aired the superbowl had no idea that boobs were a scheduled highlight of the program. As far as I've been able to determine, the stations, the network, the National Football League and even MTV (producers of the event) had no idea it was planned. And while the "wardrobe malfunction" line is a bit suspect from Mr. Timberlake and Miss Jackson (what can I say, I'm nasty), it seems clear that no one else knew it was planned. So how do these increased fines solve the problem?

Obviously, what is needed is: a boob tax. That's right, tax boobs. Put the money into a fund to help pay for therapy for any poor, injured soul traumatized by a glimpse. It's the price we pay for being allowed to have such a damaging body part. This should be a "progressive" tax, so that the larger and more noticeable a breast, the higher the tax. For example, the average man would pay $50/year. Weight lifters perhaps $100/year. Most women as well as fat guys such as myself, $500/year. And "dancers" with names like "Candy", "Bambi" or "Misti" could help us to pay down the national debt in under a decade.

As part of this discussion, there is talk about applying this new fine to cable networks as well, completely ignoring such facts as:

• You have to subscribe to cable channels, they don't come into your house unbidden.
• Most cable companies can block individual channels that the subscriber finds objectionable.
• I pay good money to see boobs on Cinemax.

The fact is, the only real reason for the existence of the FCC is to regulate the use of a limited resource: Broadcast channels. There are only so many frequencies and lots of uses for them, and so there is a need to regulate over-the-airwaves content, or else anyone could broadcast anything at any time, and no one would ever get a clear signal to their home. Then again, watching this year's UPN lineup of shows, I'm not so sure that would be a bad thing.

I think it's time we, as a nation, admitted something to ourselves: We LIKE boobs. If we didn't, there'd be no need to keep them off of the airwaves. You'll note that the majority of people do NOT like viewing open heart surgery, and as a result, there's very little attempt on television to show it. The reason tv and radio stations keep "pushing the envelope" is because it gets ratings. Ratings are the ultimate in free market economy. We decry the level to which network television has sunk, and yet at the end of the day, many more of us turn on "Fear Factor" (today's episode: using a straw as suction during open heart surgery) than PBS (showing tonight: part 27 in a series on the growth of bread mold).

If we, as a society, didn't WANT boobs on the air, Howard Stern would be selling insurance somewhere. Don Imus would be a cattle rancher. Geraldo Rivera would be... well, he'd pretty much be doing what he's doing now, but walking the streets of Manhattan instead of in front of a camera with a mic in hand. You may not like that Janet Jackson's bare breast was seen on national television, but admit it: You were one of the millions of people who downloaded close-up shots of it the next day, trying to figure out what that decoration thing was.

And if you're saying to yourself "I did no such thing", note that you are NOT saying "What decoration thing?"

We are adults, we do not need protection from ourselves, and we should be responsible for protecting our children, not the FCC. If we don't like what's on, we should turn it off.

Now if you'll excuse me, there is another "Janet" with boobs which are calling me.

Copyright (c) March 3, 2005 by Liam Johnson. http://www.liamjohnson.net