Terri Schiavo

I think that there is a law somewhere stating that all bloggers must comment on Terri Schiavo, so here I go.

On the moral issue, I don't think we have enough accurate information. Can she respond? Did she talk to her brother? Is she in a PVS? A MCS? The answers to those questions comes down to her parent's word vs. her husband's. I do think that there can be times when allowing someone to die is the most obedient decision. Newsweek has an interview with a Jesuit bioethicist who states this case. Here is money quote:

Here's the question I ask of these right-to-lifers, including Vatican bishops: as we enter into Holy Week and we proclaim that death is not triumphant and that with the power of resurrection and the glory of Easter we have the triumph of Christ over death, what are they talking about by presenting death as an unmitigated evil? It doesn't fit Christian context...
But is anyone arguing that for Schiavo to die would be an "unmitigated evil"? They just don't want her death to happen unnecessarily.
It's not happening unnecessarily. It's happening because her heart attack has rendered her utterly incapable of any future human relationships.

I don't know if she is, in fact, incapable of any future human relationship, and I think there are reasons to question the way that both the husband and the parents answer this question.

There are certainly political questions raised here, and nobody should be surprised that I find the actions of the congressional Republicans to be unethical and hypocritical. As in Bush v Gore, the conservative are intervening in a situation strictly for political reasons AND they want to claim that their intervention should not set a precedent for future cases. If the intervention was the right thing to do, then why not set a precedent?

The hypocrisy abounds. You have Republicans judge shopping, looking for the federal government to overturn the decision that the state courts have consistently made, trying to intervene in the sanctity of marriage.

When I hear Republicans in Congress expressing their concern for creating a culture of life, I am amazed. These are the politicians who are advocating tort reform that protects insurance companies from the victims of medical malpractice, just last week pushed a budget resolution through the House that would cut funding for Medicaid by between $15 - $20 billion, and passed the bankruptcy bill authored by the credit card industry.

In the Republican version of a culture of life, the next Terri Schiavo would not have her malpractice award, leaving her more dependent on Medicaid for her care (at least what's left of Medicaid). If this future Terri Schiavo lived in Texas, the hospital will be legally permitted to withhold life-sustaining care over the family's objections thanks to a bill signed by Gov. Bush. Oh yeah, her family will also have a more difficult time getting back on their feet financially thanks to the bankruptcy bill.

That's a culture of life?

Narnia on Tour

Narnia on Tour sounds like a great way to get ready for movie version of The Lion, The Witch, and The Wardrobe, which is now scheduled to open Dec. 9. Here is a blurb from the site:

Welcome to Narnia on Tour. It is a tour that combines the literary prowess of artists and authors with the engaging insights of audiences around the world...

The primary goal of the tour is to foster informed conversation about Lewis, his faith, imagination, and writing.

As this site builds within the next months, it will become a resource not only in terms of the tour dates for next fall, but by offering new articles about Lewis, who was influenced by Lewis, and authors who write in a similar vein as he wrote.

The dates of the tour are between September 30 and November 19. I was excited to see this:

Portland, OR
Reason, Imagination, and Holiness: C.S. Lewis's Creative Vision of Faith
TERRY GLASPEY
Author of The Spiritual Legacy of C.S. Lewis

Looks like I'm going to be able to catch this! Look and see if there is an event near you!

Two movie previews

In case you haven't seen it yet, here is the trailer for Star Wars: Revenge of the Sith.

There is also a new video "featurette" called Behind the Magic of Narnia Chapter II: The Director.

Legal Affairs Debate Club - The Doctor's Court?

Legal Affairs bills itself as "The Magazine At The Intersection of Law And Life." Their website has a weekly debate on legal issues, giving two individuals the chance to make one comment a day on the topic. The topic this past week?

George W. Bush is pushing an aggressive agenda for reforming medical malpractice law, with a focus on capping the amount of damages patients can be awarded if their doctors harm them. But some advocates suggest a completely different reform: "health courts." These jury-less courts would deal only with medical claims and be administered by trained healthcare professionals. This, supporters argue, might improve healthcare by providing quicker resolution to malpractice suits and limiting frivolous claims.

Are health courts a good idea?

I think that they have the potential to be a good idea, and that it would be wonderful to try out some pilot projects. A good friend of mine, who is a Phd/MD and one of the smartest people I know, had this to say about the problems our current system faces.

Patients (and juries) cannot distinguish between a "bad outcome" which can occur even when everyone does everything right, an accidental mistake (which anyone can make), and willful disregard of the standard of care (malpractice). Furthermore, many mistakes which occur are a result of both a flawed systemic process and an individual mistake.
Most catastrophic events are rarely the result of a single flaw or mistake, but rather the chance multiplicity of several smaller mistakes, themselves non-fatal, which together cause a disaster.

Stephanie Mencimer, who writes for The Washington Monthly and argues against the health court, would say that it is elitist to claim that non-medical juries are incapable of making distinctions between bad outcomes, accidental mistakes, and malpractice. Even if it is elitist, it very likely is true. I think that I am a pretty smart guy, but I'm sure that there are many cases in which I would not have the ability to make those distinctions. Besides, in a health court, the defenant would actually be tried by a jury of his or her peers, unlike in our current system. She makes a few other ridiculous claims, like suspecting that defensive medicine is a myth and that unnecessary tests are usually ordered to make doctors lots of money. Many health care providers that I have talked to make decisions every day on the basis of lawsuit avoidance.

Mencimer does bring up a few valid concerns relating to tort reform, however none of them are reasons to oppose the creation of a health court. She says that lawsuits "are a symptom of secrecy" and "distrust within the health care system." I think she is wrong about the reasons for that secrecy (she says the"direct financial incentive to keep their errors under wraps...far exceeds the penalties they might suffer through lawsuits"), but agree that secrecy is a problem.

I have heard "experts" say that most lawsuits are filed in order to get good information about their outcome. (I don't know if there is any empirical evidence for this, but it makes intuitive sense and there is plenty of anecdotal evidence) If there is a bad outcome, "risk management" encourages doctors to tell their patients nothing because anything they say can come back to haunt them in a lawsuit. Then patients, who do not know if the bad outcome is a result of malpractice or not, feels forced to file a lawsuit in order to get that information. A health court might reduce some of the fears on the part of doctors and hospitals that giving information to patients could harm them in a lawsuit, encouraging them to be more transparent in the event of a bad outcome, and reducing the number of lawsuits filed.

The other valid point she makes is critiquing the inclusion of plans to cap attorney's fees and cap non-economic damages. If health courts do a good job of discriminating between bad outcomes, accidental mistakes, and malpractice, then there is no need for these proposals. As Mencimer argues, capping fees, "rather than sav[ing] clients money, ...prevent[s] people from getting representation at all." Since taking on a malpractice suit involves the attorney spending their own cash to prepare the case, capping their contingency fees would increase the risk that the attorney would lose money on the case. And in an effective health court, a cap on non-economic damages would only protect doctors (and their insurance companies) who commit malpractice.

On balance, I believe that the argument for trying out a health court out is a good one.

In a future post I will talk about my perspective that this debate over tort reform, as it is played out in the media, is as much about doctors' distrust for lawyers (and lawyers' distrust for doctors) as anything else. It is interesting that the two professions have so much in common, both when they are at their best and when they are at the worst.

Bitter Pill Awards

I just finished reading "The Truth About the Drug Companies: How They Deceive Us and What to Do About It," by Marcia Angell, former editor of the New England Journal of Medicine. It is an interesting look at one of the most profitable industries in the world, an industry that profits not by excelling in the free market, but rather by manipulating the government's involvement in the market.

On Wednesday, the pharmaceutical "Direct to Consumer Advertising" industry hosted its annual awards dinner honoring drug companies for clever advertising campaigns of prescription drugs on TV, in print and online. Community Catalyst, a national nonprofit advocacy organization focused on ensuring quality, affordable health care for all, gave out its own drug marketing awards.

The categories are:

* Performance Anxiety Award: For Exploitation of Male Fears of Inadequacy
* Speak No Evil Award: For Concealing Drug Risks and Exaggerating Benefits in the Name of Profits
* Least Extreme Makeover Award: For Dressing Up an Old Drug with a New Name and a New Price Tag
* Smells like Teen Exploitation Award: For Shameless Marketing of Prescription Drugs to Kids
* Cure for the Human Condition Award: For Hawking Pills to Treat the Trials of Everyday Life
* Asleep at the Wheel Award: For Failure to Police Drug Advertising
* Real Deal Award: For Providing Unbiased and Independent Information about Prescription Drugs

Jeffrey Overstreet

The Seattle Times has a profile of my favorite movie reviewer, Jeffrey Overstreet.