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End of life discussions are hard enough

I posted this several years ago. I think that it is worth posting again.(Besides, I don’t know what to make of Rick Santorum.)

When Sarah Palin wrote, “the America that I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death penalty’ so his bureaucrats can decide, based on a subjective of judgment of their ‘level of productivity in society,’ whether they are worthy of healthcare. Such a system is downright evil,” I got physically nauseated. The only reason that former Governor Palin said this was to derail healthcare reform and to try to elevate her own status in the conservative movement. The statement had no basis in reality. My nausea stems not from a lie, but from this person unknowingly making my job harder. Speaking with real patients about real end-of-life issues is incredibly difficult.

The following is an example of an end of life discussion. It has been fictionalized to protect patient’s privacy. A 80-year-old man presented after a fall at home. The patient had been in declining health for some time. He has an abnormal heart rhythm and congestive heart failure. He is on blood thinners because he is at increased risk of developing clots in his heart. The patient is awake and alert on arrival. A CT scan is obtained of his brain which reveals blood between the brain and the skull — subdural hematoma. The patient is admitted to the intensive care unit for observation. Medications are given to reverse his blood thinners. The patient does well overnight in a repeat CT scan (standard practice) performed to see if anything new has shown up. The patient has a new contusion (bruise) on his temporal and frontal lobes.

The patient, who was lucid throughout the night, is now somewhat confused. He is having some problems finding his words. His son, who is an orthopedic surgeon, had been with the patient through the night. The son is now extremely concerned. He wants to know what happened. I review the CTs with him and point out that the contusion is in the area of the speech center of the brain. This should explain his difficulty finding words.The son wanted a repeat CT scan, in spite of the fact that the second scan was only completed four hours ago. I asked whether, if we find a surgical lesion (something that can be operated on), he would like me to call a neurosurgeon. I asked if he wanted his father to undergo brain surgery if it is necessary.

I think this question is more than reasonable. Thankfully, the son never had to make that decision. The repeat CT scan was the same as the second scan. Neurology was consulted. Over the next several days, the patient slowly improved and was able to be discharged to a rehabilitation center.

You know our society is in trouble when a physician has not thought about end-of-life issues concerning his 80-year-old father who has a bad heart. From a medical standpoint, I just want to do what is right for the patient, which is to follow that patient’s wishes. Yet so very few families have talked about end-of-life issues. You don’t want to be in the position of the son where you’re having to make a decision while looking at a CT scan in the middle of an ICU. Instead, you would like to be able make decisions in the privacy of your physician’s office.

I deplore any politician that makes this situation harder. Emotions are overwhelming when families are faced with these types of decisions. Exploiting end-of-life issues for political gain should get those politicians a special place in Dante’s Inferno.

By |2012-02-08T05:57:03-04:00February 8th, 2012|Congress, Healthcare|Comments Off on End of life discussions are hard enough

Let’s look at the death penalty again

I have been bothered by the death of Troy Davis. What the hell? There was an opportunity for those who love life… I keep thinking about this case. Why did this guy “have to” die? Where was the governor of Georgia? Could Mr. Davis been pardoned? Where was the president? No one could have saved this man?

From NYT Editorial:

As the unconscionable execution of Troy Davis in Georgia last week underscores, the court has failed because it is impossible to succeed at this task. The death penalty is grotesque and immoral and should be repealed.

The court’s 1976 framework for administering the death penalty, balancing aggravating factors like the cruelty of the crime against mitigating ones like the defendant’s lack of a prior criminal record, came from the American Law Institute, the nonpartisan group of judges, lawyers and law professors. In 2009, after a review of decades of executions, the group concluded that the system could not be fixed and abandoned trying.

Sentencing people to death without taking account of aggravating and mitigating circumstances leads to arbitrary results. Yet, the review found, so does considering such circumstances because it requires jurors to weigh competing factors and makes sentencing vulnerable to their biases.

Those biases are driven by race, class and politics, which influence all aspects of American life. As a result, they have made discrimination and arbitrariness the hallmarks of the death penalty in this country.

For example, two-thirds of all those sentenced to death since 1976 have been in five Southern states where “vigilante values” persist, according to the legal scholar Franklin Zimring. Racism continues to infect the system, as study after study has found in the past three decades.

By |2011-09-29T12:07:26-04:00September 29th, 2011|Legal|Comments Off on Let’s look at the death penalty again

It Is Time to Rethink Capital Punishment (Update)

Currently it’s 10 PM on Wednesday, September 21, 2011. Troy Davis was scheduled to be executed a little over three hours ago. His execution has been delayed by the United States Supreme Court. The question that looms is whom the state should execute. When do you institute the death penalty? Right now, the Troy Davis case hangs over this country. No matter what you think of this case, there are a few undeniable facts. First, nine eyewitnesses initially testified that Troy Davis shot and killed off-duty police officer Mark MacPhail in 1989. Since then, seven of the nine eyewitnesses have recanted their testimony. There is no physical evidence that I know of. The weapon used to shoot Officer MacPhail was never found. So, is this a case in which the death penalty should be instituted?

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Interestingly, Lawrence Russell Brewer was executed in Texas tonight. He died at 7:21 EST. Mr. Brewer was convicted of dragging James Byrd, Jr. to death. This was a famous case at the time, a terrible race-based crime. Interestingly, the family of James Byrd holds no animosity toward Mr. Brewer. They actually petitioned the court not to execute him.

As I mentioned earlier, I think that somebody like Timothy McVeigh should have been executed. So, once again, should we consider using the death penalty much more narrowly than ever before? Should it be something that is used rarely, maybe once or twice a year across the United States? Will it be possible for us to have a serious debate over the death penalty or will it turn into a media circus, like every other major issue that we have discussed over the last 10 years?

Update: The U.S. Supreme Court has denied Davis’ motion for a stay of execution. I suspect that My Davis will be executed later on tonight. So sad, so very sad.

By |2011-09-21T22:50:18-04:00September 21st, 2011|Domestic Issues, Legal|Comments Off on It Is Time to Rethink Capital Punishment (Update)
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