Tuesday, May 02, 2006

ANDREW LONGMAN TO DR. BEVERLY NUCKOLS CLAIM
THAT "TEXAS FUTILE CARE ACT" DOESN'T EXIST!!
columns@andrewlongman.com


Reasonable, Procedural, Justifiable

The reasonable and cogent doctor presents an entirely reasonable and
normative tone in her article "Texas Futile Care Act doesn't exist".
It is reassuring, level, seemingly decent and persuasive that nothing
is deeply wrong.

Unfortunately, this is like the bromides uttered by an MSNBC reporter
after meeting with Sadaam Hussein outside his palace.

The naivete and commitment to the party line is obvious and, indeed,
why not? Don't we all wish that the system and the doctors were
reasonable people, doing reasonable things, carefully following
thoughtful precept with dignity? And so the good doctor intones the
expectation of educated human beings: these doctors are not at all
monsters, they are just doing a reasonable effort towards making
reasonable things work. Sounds great except for the fact that this
is perpendicular to the facts in Andrea Clark's case.

It doesn't matter that the word "futile" isn't mentioned in the law.
It matters that the board considers people futile. It doesn't limit
the activity of monstrous doctors that some conscientious doctors
might not give CPR to someone whose chest would be crushed by it. It
is irrelevant that TADA allegedly doesn't give power to consider the
"quality of life" in determining whether to kill a living patient.
It matters only that now, post-TADA, doctors do it. It does not matter
that doctors and nurses we know wouldn't preclude taking in a patient
whom another hospital had rejected - nurses don't make those decisions,
administrators talking to insurance companies do. It does not matter
that the author thinks a "conspiracy" is necessary to get all the
hospitals in Houston, of which there are heaps within a stone's throw,
a literal stone's throw, of St. Luke's, to deny care; it happened and
it was easy and whatever the heck you call it, it's endemic,
institutional.

It doesn't matter that nice words are written in nice procedures.
It matters that when you give doctors power to kill people, they do it
and they ignore moral truth.

But what does matter can be seen in this, "Much more likely is that the
medical judgements of one doctor and ethics committee are trusted to be
valid by the other hospitals and that the other facilities would reach
the same conclusion..." and in it we can see how the "conspiracy" is
easily maintained: doctors have come to think that doctors are god.

I remember when Grandma was cantankerous. Uncle Bob would tell us that
all we had to do was get a doctor to say it and then in Granny's mind it
became law. Her devotion was cute. But doctors' devotion to the
principle that, since God is not legally in the room then they must be
god themselves, has reached a pandemic scale. The irrational gifts that
society has been bestowing on them - the ability to decide the life and
death of the innocent - is rushing so fast to their head they are in a
perpetual state of red out; blood blinds their consciousness.
And our friend writing says it well: one demi-god believes another.
When one says "she must die" they all defer. It was the same idiocy
with the legal cabal in Florida when Greer murdered Terri Schiavo slow:
Greer ruled "she must die" so we, the bar, all believed. After all, is
he not an infallible like unto us?

Indeed, conspiracies are easily sustained by collusion. They are
all sunk to the same music and unaware of a world outside their own
judgement. And that is why it is especially wicked for another doctor
or hospital not to review it. Such turns the decisions of the MD class
not into matters of science, but into matters of spiritist utterance.
Science is a matter of constant cross-examination, questioning, and
objective verification. Death sentences unchallenged are rites of human
sacrifice. Any doctor asked who wouldn't object and want to review
Andrea's case is a criminal-priest, not a scientist.

It is really amusing that the writer goes on to say that it just
isn't necessary to transfer Andrea to a hospital where they don't want
to murder her even a little bit. After all, the writer notes, if
another hospital can be found, the first hospital loses all legal right
to murder her. In light of the fact that the writer has just told us
that, due to professional deference, it is virtually assured that all
other hospitals are going to conclude the same as the first one, we
have to wonder what her goal is? All other hospitals will say she's
futile, there's no need to move her to another hospital because this
first hospital will protect her if another can be found, and no other
hospitals will be found because they will all agree with the first one.
So in asserting she doesn't need to be moved, the writer asserts there
is no reason to save her life because the judgement has been
professional.

But the self-referent madness spills out of this narrative. This doctor
who is writing, like all the others, are about, exclusively, preserving
the purview of authority for their profession and defending all
arbitrary increases of that authority. The new breed of doctors gets
high on the fact that, in a secularised society, they are the new
demi-gods, the ones with power over life and death of the innocent. So
here we have someone trying to protect this power. How distasteful.

The closing clause is highly indicative of this self-worship, this
concept that "we doctors are the only intelligent source of consequence
in the room". On discovering that Andrea reverses course, fails to
die, fails to allow herself to be killed, the doctor writes, "I would
sure want to reevaluate my earlier decision and celebrate if the care
given by myself and my colleagues had been more successful than we
predicted." The care from ME and MY COLLEAGUES! Ha! It had
NOTHING to do with ANDREA'S FIGHTING SPIRIT or GOD'S SOVEREIGN DECISION
eh? Of course maybe the doctor reflects on those as quaint
afterthoughts but certainly not as a matter of FIRST CONSEQUENCE.
The maxim holds: doctors are gods. All else is psychology. And note
that the only reason for reevaluating a decision to kill a woman is
that the woman accidentally recovers. Reevaluation has nothing to do,
again, with the fact that ANDREA WANTS TO LIVE AND HER FAMILY WANTS HER
TO LIVE AND HER FAMILY BELIEVED SHE COULD RECOVER. It's all "me"
focused: I believed I will reevaluate My diagnosis so I can learn
something and I will be surprised about how My treatment worked.

It used to be that medicine was patient focused. Now its all about
the free religious expression of doctors. And their religion is them.

Ultimately what all this does is attack society. A small and then
growing number of doctors will arbitrarily kill people. This will lead
to it becoming institutional. People will inevitably protest, slam the
doctors, just as I am now doing. The good doctors will protest, the
bad ones act offended. A natural split between doctor and patient will
grow until we are like the Netherlands: armed guards sitting at the foot
of the bed to defend the patient against the hospital staff. In time
this will result in open violence: a family member who has seen their
loved one murdered and who has no legal recourse will satisfy justice
via the vigilante. And this is the loss and break down of society.
We are seeing the similar loss of confidence in the judiciary.

All of this can be corrected and avoided by simply returning to
normative medical and judicial ethics. "Do no harm" is an excellent
place to start. In other words, doc, you care for them till the bitter
end and you let God be God - as though he knows when to take
one of his creatures home. We destroy our very fabric of social order
when we legally require doctors to abandon the Hippocratic oath. We
assault the institutions of government when judges or legislators may
decree that the innocent must be killed.

I would much rather hear this doctor issue a level, thoughtful, educated
review of how giving the power to murder to a physician is evil and
leads to social rupture and medical incompetence. Indeed, what does a
healer say about a healer who has turned to committed killing? What does
it lead to more and better of, healing or killing?

Killing.

1 comment:

LifeEthics.org said...

I'm the doctor accused of idolatry by Mr.Longman.

It would have been polite for Mr. Longman to discuss his criticism with me or to at least let me know that he was passing around such comments. Or for those quoting him to alert me or at least link to LifeEthics, so readers could judge for themselves. (It appears that Mr. Longman has attacked others before, and apologized for it).

Hopefully, those who read the blog will see that I, too, adamantly demand that medicine return to the First Principle of nonmaleficense, "First, do no harm." At least a link to the original article on LifeEthics might have shown an attempt to explain the art of medicine as a process of using what we know, what we can measure, and what others can and have reproduced and proven true and reliable in other situations. And that I didn't approve of removing the ventilator against the objections of the family.

Just to make it clear: the doctor assumed his actions were futile. If he assumed any patient to be futile, his priorities are wrong and they are as bad as this essay accuses.

There is one statement that is completely false, as I never "noted" any such thing:
After all, the writer notes, if
another hospital can be found, the first hospital loses all legal right
to murder her.


Again, I was trying to explain the law and correct often-repeated myths about it. The law does not require that a patient be transferred from the original hospital after the ethics committee rules on the treatment decision of the doctor. And, of course, the fact that Mrs. Clark is still at St. Luke's shows this to be true.

As to the comments on reevaluating: hopefully, a lot of people, including the original attending doctor, have learned important life lessons from Mrs. Clark and her survival at least a week longer than the doctor and hospital predicted. Unfortunately, it appears that Mrs. Clark's condition has worsened after the gallbladder procedure and that the assumption that the gall bladder was blocked was mistaken.