The Latest From Clem
November 25, 2009 11:57 AM
The Manhattan Declaration
September 29, 2009 10:33 AM
Reflections on the Struggle to advance the Culture of LIfe
August 27, 2009 10:42 AM
A comprohensive Primer on Stem Cells
August 4, 2009 04:42 PM
Catholic World Report on Health Care
The following information-- which is not my own work, but the work of astute friends in Washington, DC-- provides all you need to know about the Obama White House plans regarding abortion and health-care reform:
Phil Lawler Catholic World Report
From the latest polls:
•51% of Americans self-identify as pro-life (Gallup Poll, June 2009)
•61% of Americans say abortion is an important issue and 52% think it is too easy to obtain an abortion in America (Rasmussen Survey, June 2009)
•62% of Americans want more limitations placed on abortions and only 36% believe abortion should be generally available (CBS Poll, June 2009).
Elections have consequences:
1) One of President Obama's funding requests, the Financial Services Appropriations bill, allows publicly funded abortion in the District of Columbia. This overturns a 13-year ban on taxpayer-funded abortions in the nation's capital. Amendments to restore the ban were either blocked or defeated by the majority. Currently, over 41% of pregnancies in DC end in abortion, giving the capital city the highest abortion rate in the nation.
2) Senator Durbin's amendment to the Financial Services Appropriations bill cleared the way for taxpayer-funded abortions through the Federal Employee Health Benefits Program, which covers 8 million federal employees. The FEHBP has been repeatedly discussed as an example of what a government-run health care system could be.
3) The House of Representatives voted against the Pence Amendment to the Labor/HHS/Education Appropriations bill. The amendment would have prevented Planned Parenthood or any business doing abortions from receiving taxpayer funds. Last year Planned Parenthood performed over 300,000 abortions. The Guttmacher Institute, the research arm of Planned Parenthood, reports that abortions increase by 30% when taxpayers foot the bill.
4) Through an amendment offered by Senator Lautenberg, the Senate has permanently reversed the Mexico City Policy, which banned taxpayer funds going to international agencies that perform or promote abortions. This gives the existing policy of funding international abortion services-- set by President Obama's Executive Order on January 23-- the force of law. Future presidents will be unable to re-establish the funding ban.
5) Following President Obama's instructions, Congress has completely defunded abstinence education and has designated a minimum of $164 million for contraceptive-only comprehensive sex education. In addition, the Secretary of HHS has a $640 million fund which can be used for family-planning services, if pro-Planned Parenthood Secretary of HHS Kathleen Sebelius so desires. A Zogby poll found that 80% of parents want more abstinence education. Studies prove that abstinence education is more effective in delaying the onset of sexual activity in young people than is comprehensive sex education. CSE has demonstrated no effect on teen behavior. (And do you find that surprising?)
6) President Obama is supporting the United Nations Convention on the Rights of Persons with Disabilities which, through its affirmation of "sexual and reproductive health," recognizes an international right to abortion. He is urging the Senate to ratify the treaty, which sets up an international committee to decide whether the United States complies with the treaty's provisions. If ratified, the treaty would take precedence over all federal and state laws dealing with the disabled. The Vatican objects to the inclusion of the phrase "sexual and reproductive health" because it "may be used to deny the very basic right to life of disabled unborn persons." Like CEDAW (the Committee on the Elimination of Discrimination Against Women, which contains an international mandate for access to abortion services) and CRC (the Convention on the Rights of the Child, which interferes with parental rights over their children) which Obama also favors, this is a treaty that the United States should not ratify.
Heath-care reform:
1) The House version of the health care bill creates an "Advance Care Planning Consultation" for Medicare patients to be counseled on end-of-life decisions. Such consultations would take place every five years, or more frequently if there was a significant change in the individual's health. Two pro-life Congressmen state that "This provision could create a slippery slope for a more permissive environment for euthanasia, mercy-killing and physician-assisted suicide because it does not clearly exclude counseling about the supposed benefits of killing oneself."
2) Senator Mikulski (who identifies herself as a Catholic) offered an amendment to the Senate health-care bill that would provide for any service deemed "medically necessary or medically appropriate." When pressed by Senator Hatch, she admitted this would require the coverage of abortion services by health-insurance companies.
3) As currently written, both the Senate and House health care bills would allow federal officials to require the inclusion of abortion coverage in virtually all health plans, as well as taxpayer funding of abortions, and would expand the number of abortion providers in most parts of the country. Abortion services have been defined by legislatures and courts as being included in the term "essential health care." Because abortion would be "essential," it would be necessary to provide access to abortion, thereby mandating subsidizing the practice with taxpayer monies and increasing the number of abortionists and opening more abortion facilities in areas of the country that now do not have them. Catholic health-care professionals would be required to participate in abortions or run the risk of being charged with "patient abandonment," which could mean the loss of their license to practice.
4) The Capps Amendment to one of the health-care reform bills, presented as a compromise, is not: the government-run health plan offered in every region of the country will include whatever abortions are eligible for public funding and will include all abortions if so approved by the HHS Secretary.
5) A provision of the health-care bills establishes the Agency for Healthcare Research and Quality which would do comparative effectiveness research-- that is, it would determine the most cost-effective treatment for a specific medical condition and would override the doctor's decision for his patient. A government bureaucracy dictating health care decisions has, in England, led to rationing of health care, selection of inappropriate or ineffective treatments for individual patients and premature deaths. When a pro-life Senator offered an amendment in committee to prevent rationing of health care services for the old, the infirm and the chronically ill, it was voted down by the majority. President Obama said recently that "the chronically ill and those toward the end of their lives are accounting for 80% of the total health care bill."
6) The health-care bills call for a new health-benefits advisory committee whose task it will be to define benefits for all health plans in the United States. As it will be an unelected committee named by the Secretary of HHS, there will be no accountability to the citizenry for what the committee determines will be the necessary components of health coverage.
7) Under the current health-care reform bills, there is no conscience clause allowing an individual or an organization with a religious affiliation to opt out of health plans that include an abortion component. The Senate bill contains a very weak conscience clause for those religions that, as a tenet of their faith, do not seek medical care (they would not be required to carry insurance coverage). Catholic institutions and organizations with Catholic affiliations would be forced to offer abortion coverage in their employee health insurance package.
8) The Senate health care bill contains a hidden provision that matches the provisions of the Freedom of Choice Act; it would preempt any state law hindering a woman's access to "essential health services"-- again, a phrase that includes abortion services. Federal health care legislation would overturn the following state laws:
•42 states have physician-only laws that limit the practice of abortion;
•32 states follow the funding limitations of the federal Hyde Amendment (no taxpayer funding of abortions);
•27 states have abortion clinic regulations to protect the health of women;
•30 states have informed-consent laws (women receive information about fetal development, fetal pain or the causal link between abortion and breast cancer; or are offered an ultrasound exam);
•24 states require a 24-hour waiting period before an abortion;
•36 states require some kind of parental involvement: either parental notice (11 states) or parental consent (25 states);
•at least 5 states have funded abortion alternatives (pregnancy centers, prenatal assistance, adoption promotion).
9) The Hyde Amendment cannot take care of the abortion issue in the various health care bills. Abortion must be explicitly excluded from coverage. Access to abortion also must be explicitly excluded or taxpayer funds will be used to fund abortions and the expansion of abortion services and facilities. This means there must be language in the actual legislation that excludes abortion in "medically necessary or medically appropriate" and "essential" health care.
10) The health-care system in the United States accounts for 14% of our economy. (It equals the size of Great Britain's entire economy.) Any plan to revamp that large a piece of any economy requires thoughtful decision-making, not a rush-to-completion with a majority of the Congress not even reading the legislation. Congressman Conyers said: "What good is reading the bill if it's a thousand pages and you don't have two days and two lawyers to find out what it means after you've read the bill?" It should be noted that lawyers make up 54% of the Senate and 36% of the House of Representatives.
Authors
Dr. Jeff Mirus (204)
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August 4, 2009 01:57 PM
Statement of Catholic Medical Association on Health Care
Statement on Health Care Reform
The Catholic Medical Association (CMA) calls upon President Obama and Congress to “hit the reset button” in their attempts to address the serious problems in the nation’s health-care financing and delivery systems. The CMA is concerned that the bills that have emerged from House and Senate Committees to date are too flawed, and the process too rushed, to provide meaningful reform.
“While health-care reform is more important than ever, existing legislation in the House and Senate—combined with President Obama’s push for hasty action—could make our current, flawed system even worse,” said Catholic Medical Association representative R. Steven White, M.D., in a statement released on July 29, 2009. “Sound reform must be based on sound ethics and economics; but so far, the House and Senate bills meet neither standard.”
The CMA is particularly concerned about two significant ethical issues (1) respect for the conscience rights of health-care providers; and (2) a mandate to finance and provide abortion.
According to the CMA’s executive director, John F. Brehany, Ph.D., the conscience rights of health-care providers are not adequately addressed in any current legislation. “The House Tri-Committee bill does not even mention the topic of conscience rights of health-care providers, and Democrats on the Senate H.E.L.P. Committee voted against an amendment that would have prohibited forcing health-care providers to perform or participate in abortion,” stated Brehany. Brehany continued, “This issue is very timely, since the department of Health and Human Services canceled a Conscience Protection Rule earlier this year and has not announced what will replace it. Yet polls show that patients want physicians who are committed to ethics and who share their values. Coercing health-care providers to deny their deepest values and ethical commitment to patients’ well-being will harm the medical profession and undermine trust in the provider-patient relationship.” Brehany concluded, “In a July 2 interview, President Obama promised a ‘robust conscience clause.’ We think it is time to deliver the text of that conscience clause and make conscience protection an integral part of any health-care reform legislation.”
Abortion is another key ethical concern for the CMA and for most Americans. CMA President Louis C. Breschi, M.D., is alarmed that White House officials and the Senate H.E.L.P. Committee have refused to exclude abortion from health-care legislation. The House Tri-Committee bill never mentions the word “abortion, but most analysts think that, without explicit exclusion, abortion will be mandated by the Secretary of HHS and/or by the courts. According to Breschi, “Few people realize that, as things stand, abortion could be a required benefit in all health insurance plans, and it would be subsidized not only in health-care premiums, but also through taxation. This unjust mandate must be excluded.”
Apart from ethical concerns, the CMA finds significant shortcomings in the economic and clinical aspects of current legislation. First, as the Congressional Budget Office points out, the legislation does nothing to reduce long-term costs. Rather, current legislation increases costs by hundreds of billions of dollars even after tax increases and creative accounting measures. Second, the bills’ attempts to control costs and increase access rely on heavy-handed government control that is antithetical to the rights of patients and physicians, and to good clinical care. Dr. White commented: “Unprecedented powers are entrusted to the Secretary of Health and Human Services (as evidenced by over 1,120 references to the ‘Secretary’ and his/her powers in the House bill) and to a new authority—the ‘Health Choices Commissioner.’ Moreover, a Federal Coordinating Council on Comparative Effectiveness was created and funded, without adequate debate, by the Stimulus Bill; and there are valid concerns that the FCCCE could soon start regulating medical treatments based not only on clinical, but also ‘economic’ criteria.”
This heavy-handed federal control is made worse by two additional provisions. First, House bill regulations make it almost impossible for any current health insurance plan to survive in a new government-controlled regime. This would break President Obama’s repeated promise that Americans could keep their doctors and health-care plans—and remove the means for people to choose insurance which accords with their values and priorities. Second, House and Senate bills plan to extend health insurance coverage to millions of people by moving them onto the Medicaid rolls. However, the flaws of Medicaid are well-known—its costs have run out of control in most states, and 40% of physicians are compelled to refuse Medicaid patients because Medicaid’s low reimbursement rates do not even cover the overhead cost of office visits. Adding millions of people to this flawed system will not constitute meaningful health insurance coverage.
These problems would be exacerbated by a “public option” plan which would “compete” with private health insurance, as called for in the House Tri-Committee bill. But there is no way that private companies can fairly compete with the federal government. The government can establish below-market rates for insurance premiums and provider reimbursement and shift costs onto private companies. The government also can increase taxes or the federal deficit to absorb losses. The result is that everyone, sooner than later, will be forced to become participants in the “public option” plan and fully subject to the costs and regulations of government health care. When this happens, the American people will have lost the freedom to make important decisions about their life and health.
The Catholic Medical Association supports health-care reform that increases access and quality, and respects the values of providers and patients. These goals can best be achieved by legislation that empowers people to own their health insurance policies (as contrasted with government- or employer-controlled health-care insurance), and using targeted measures to help people who cannot afford the entire cost of their insurance premium. Legislation addressing some of these goals already has been introduced into Congress and should be reviewed to either improve or replace the current House and Senate bills.
In the meantime, current bills require such substantial amendment that it would be better to scrap them and start again. According to Dr. Breschi, it is critical for Congress to take the time necessary to address the complex economic and ethical issues involved, and to give the American people an opportunity to review any proposed legislation. Health-care reform encompasses both individual rights and the common good, ethical issues surrounding life and death, and economic issues ranging from taxes and property to economic competitiveness. It is essential that Congress first “do not harm” and then enact measures that can respect all of these complex goods.
About the Catholic Medical Association: Founded in 1932, the Catholic Medical Association is the largest association of Catholic physicians in North America. The mission of the CMA is to assist physicians in upholding the principles of the Catholic faith in the science and practice of medicine and in witnessing to these principles within the medical profession, the Church and society at large. The CMA also publishes The Linacre Quarterly, the oldest continuously published journal of medical ethics in the United States. For more information, go to www.cathmed.org.
CONTACT: John F. Brehany, Ph.D., S.T.L.
215-877-9099 (JavaScript must be enabled to view this email address)
June 26, 2009 05:03 PM
In defence of the Vatican statement on Hydration and persistent vegetative state
This issue of Ethics & Medics offers two replies to the recent statement of the Consortium of Jesuit Bioethics Programs, the first reply by the ethicists of The National Catholic Bioethics Center, and the second by a distinguished group of Catholic scholars interested in issues of bioethics. At stake is whether the Ethical and Religious Directives for Catholic Health Care Services, authored by the United States Conference of Catholic Bishops, should be revised in light of recent statements from the Vatican on the provision of food and water for patients in a persistent vegetative state. These changes would affect the end of the introduction to Part V of the Directives, “Issues in Care for the Dying,” and directive 58, concerning the administration of medically assisted food and water. The members of the Jesuit Consortium have argued against any revision.—Ed.
The Consortium of Jesuit Bioethics Programs, a group of seven bioethics programs at Jesuit universities in the United States, has published a critique of papal teaching on providing food and water to patients in a persistent vegetative state (PVS). Their article “Undue Burden? The Vatican and Artificial Nutrition and Hydration,” was printed in the February 13, 2009, issue of Commonweal.
In the article, they make a wide range of claims about the March 2004 address of John Paul II on life-sustaining treatments and the vegetative state, and about the August 2007 response from the Congregation for the Doctrine of the Faith (CDF) to questions from the U.S. Conference of Catholic Bishops concerning artificial nutrition and hydration (ANH).(1) The Consortium claims, for example, that the Vatican now mandates percutaneous endoscopic gastrostomy (PEG) tubes for a broad class of patients; that many patients will be deprived of the benefits of hand-feeding; that Church teaching will impose heavy financial burdens on patients and their families; and most significantly, that the Vatican has infringed on patient autonomy.
In this brief response, we show that these claims are false and that the authors of the Consortium have not properly understood the documents in question.
General Observation
The purpose of these two Vatican documents was to address the moral obligation to provide food and water to patients in a PVS. These are patients who cannot decide such matters for themselves and so must rely on loved ones and health care workers to make the proper decisions for them. Given the tendency of some to argue that patients in a PVS should be deprived of food and water, it was not surprising that the Vatican would wish to speak to the moral aspects of this issue.
The provision of food and water to patients who are in a vegetative state and who are otherwise healthy is morally obligatory, but this does not mean that ANH is mandatory for all patients who are having difficulty eating and drinking. Although it should be expected that other patients who are not in a PVS but suffer similar cognitive disabilities should also receive food and water as needed, the Consortium’s claim that John Paul II’s address “defines ANH as ordinary and obligatory” (Commonweal, 14) is simply false.
Is Tube-Feeding Now Preferable?
First of all, and most importantly, the 2004 address and the 2007 response both allow for the administration of food and water by either natural or artificial means. When the U.S. Conference of Catholic Bishops inquired whether the administration of food and water “by either natural or artificial means” was morally obligatory for patients in a PVS, the CDF’s response stated that the provision of food and water is necessary “even by artificial means.” The phrase “even by artificial means” presupposes that natural means of providing food and water are preferable whenever they are possible. The Consortium, however, asserts that the Vatican, in these two documents, holds that artificial means of feeding are required not only for patients in a PVS, but for all terminal patients whatsoever.
In many cases, patients can still feed themselves at the end of life. Those who cannot may still be effectively hand-fed. Because tube-feeding remains a measure of last resort, hand-feeding may continue for some time even if it does not provide the patient with full nutritional requirements. Among those who cannot be hand-fed and who are near death, a simple intravenous line often proves to be the best means of providing comfort. The Vatican documents do not declare tube-feeding to be mandatory for all patients at the end of life, nor do they abandon the commonsense view that the simplest and most humane way of feeding patients is the best.
Given the false premise that the Vatican now “defines ANH as ordinary and obligatory,” various absurd conclusions follow. One is that many patients will be deprived of the benefits of hand-feeding under Church teaching.
The authors ask us to believe that the Church no longer supports the hand-feeding of patients. The authors state, “Although hand feeding takes more time, we urge families and health-care workers to provide hand-feeding as an alternative to ANH whenever nutritional needs can be met equally well in this manner” (14). This is proposed as if it were a course of action that is preferable to what is advocated in the Vatican documents, but in fact, there is nothing in the 2004 address or the 2007 response that suggests opposition to hand-feeding. When faced with the choice of natural or artificial means, the natural means of hand-feeding is preferable in almost every case where it is possible.
The Consortium also states that an accurate reading of recent Church teaching requires patients with end-stage Alzheimer’s to be tube-fed, even though scientific evidence suggests that such patients would not live longer by using this method than if hand-fed. We would only note that if it is true that patients with Alzheimer’s do not live any longer when they are tube-fed instead of hand-fed, and if tube-feeding offers no other benefits or advantages to such patients, then it should be obvious that they ought to be hand-fed when that is possible. The claim that the Church would object to such an approach, and demand that patients be placed on tube-feeding even though it would provide no benefit, is disingenuous.
Are There Enormous New Costs?
Yet another misleading claim is that a great many families, now compelled to use tube-feeding, will be burdened with enormous costs. Although the estimated annual cost of caring for a loved one on a PEG tube at home ($9,000 to $25,000 a year) and in a professional setting ($60,000 a year) can seem high, this problem affects any patient who has suffered an incapacitating medical event, whether it requires tube-feeding or not. The costs arise not so much from the tube-feeding itself (which is generally inexpensive and covered by insurance), but from the custodial care required to meet the patient’s basic needs.
In a society as wealthy as ours, it is reasonable to expect that these basic human needs should be met. As already noted, the Church allows for the provision of food and water through either natural or artificial means; it does not mandate the artificial over the natural. In the vast majority of cases, the natural means of feeding will be appropriate. At other times, an intravenous line will be sufficient. If there are genuine cases of fiscal hardship because of the need for extended custodial care, they will be what the CDF calls physical impossibilities, and thus not obligatory.(2) But such cases would not be expected to occur with any great frequency in the United States. We should change the law on medical reimbursements, if that is necessary, rather than abandon these patients.
The Consortium’s concern about the high costs of tube-feeding is inconsistent when we compare it to what they say about hand-feeding. The Consortium states that we should prefer hand-feeding, whenever possible, even though it is more expensive than tube-feeding. If the authors object to tube-feeding because of its attendant custodial expense, what prompts them to favor a method that is even more expensive?
Has Patient Autonomy Been Infringed?
Finally, we come to what, according to the Consortium, is the most egregious error in recent Church teaching: Patients who previously could refuse burdensome interventions are no longer allowed to do so because “the papal address defines ANH as ordinary and obligatory—regardless of the patient’s judgment” (14). We have already pointed out that the first half of this claim is false. Church teaching does not require ANH, but it does require that patients receive food and water by either natural or artificial means.
In connection with this error, the Consortium states that even “though John Paul II explicitly maintains that providing ANH is not a medical act, the reality is that within the fields of medicine and law, the practice generally is viewed as a medical treatment” (14). John Paul II certainly understood that the insertion of a PEG tube is a medical procedure. The suggestion that he was uninformed on this point is unfair. In his address, the Holy Father did not say that the provision of ANH “is not a medical act”; he said that the provision of food and water is not a medical act. (3) Again, there is a great deal of difference between these two statements. The provision of food and water is a part of ordinary care.
If medical treatment concerns the cure or amelioration of a pathological condition, then food and water are not medical treatments. They do not cure or ameliorate hunger and thirst; they satisfy these desires, which are natural to the human condition. We will never be without these needs. Food and water are like blankets, clean surroundings, physical movement, and human contact—they form the basic elements of care that are necessary for all those who suffer illness.
Every patient has the right to direct his or her own course of treatment and care. There are no new restrictions on this freedom. The CDF’s commentary on their response specifically states that anyone who experiences “excessive physical discomfort” may abandon even food and water if it becomes too “burdensome.”(4) This will be a decision of the patient, or of the designated health care proxy, but given modern methods of palliative care, the experience of this kind of suffering typically can be resolved or significantly minimized. The implication that Church documents sanction the harming of patients through the imposition of misguided and unwanted “care” is mistaken. The best interest of the patient always takes precedence in Church teaching on medical ethics.
Care is a moral duty that we owe to every patient—indeed, to every human being, whether sick or healthy. Unlike treatment, there can be no “extraordinary” care. If care does not fulfill its purpose of either preserving life or providing comfort, then its use is unjustifiable and must be discontinued.
Most patients will remain the best judge of what truly constitutes care in their own case, but this freedom obviously cannot include the decision to commit suicide through an arbitrary refusal of food and water. Patients who are in a debilitated cognitive state cannot direct their own care, not because the Vatican has taken that decision away from them, but because they are incapacitated. Those who care for these patients are similarly constrained from bringing about their deaths through the arbitrary removal of food and water.
Not a Helpful Intervention
The Consortium’s misunderstanding of John Paul II’s address and the CDF’s response is not helpful in providing guidance to those charged with establishing policies and protocols for Catholic health care ministry. It is particularly unfortunate that their interpretation of the documents in question leads to the appearance of a division between magisterial teaching and the provision of sound health care.
The Ethicists of The National Catholic Bioethics Center
John M. Haas, Ph.D., S.T.L., K.M.
Rev. Alfred Cioffi, S.T.D., Ph.D.
Edward J. Furton, M.A., Ph.D.
Marie Hilliard, J.C.L., Ph.D., R.N.
Stephen Napier, Ph.D.
Rev. Tadeusz Pacholczyk, Ph.D.
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1. John Paul II, Address to the participants in the international congress on “Life-Sustaining Treatments and the Vegetative State: Scientific Advances and Ethical Dilemmas” (March 20, 2004); and Congregation for the Doctrine of the Faith, “Responses to Certain Questions of the USCCB concerning Artificial Nutrition and Hydration” (August 1, 2007), reprinted in Ethics & Medics 32.11 (November 2007): 1–3.
2. CDF, “Responses to Certain Questions,” 3.
3. “I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”
4. CDF, Commentary on “Responses to Certain Questions of the USCCB Concerning Artificial Nutrition and Hydration” (August 2007), reprinted in National Catholic Bioethics Quarterly 8.1 (Spring 2008): 123–127.
