The ethics of eight (babies that is)

All over the blogosphere people are discussing the California woman who gave birth to 8 babies.  The media was quick to call it a miracle, but it seems it only took a few hours before bloggers, journalists, and doctors began to seriously question the mother’s intentions.  It seems crazy enough to want 8 kids at once, but now rumor has it that the mom is single, living with her parents in a 2 bedroom house, and already has six kids (all under the age of 7 nonetheless).

If you want to be entertained (or appalled), I recommend reading the comments section on articles discussing this woman.  You’ll see a variety of viewpoints expressed, from those who think we should just leave this woman alone, to those who think the government should mandate how many kids a person can have and restrict who can receive fertility treatments.

I guess I fall somewhere in the middle.  Read the rest of this entry »

Prelude to Poetic Justice

By now, we’ve all read the NYT article describing the seemingly inappropriate relationship between John McCain and a female lobbyist. However, the bigger story in my opinion is the one appearing on the Washington Post’s website this morning: FEC Warns McCain on Campaing Spending. McCain is a belligerent statist who openly denigrates the first amendment. It would only be appropriate if he were to be hoisted by his own petard, so to speak, and had his campaign for the presidency significantly damaged by his own ill-conceived legislation.

For those that don’t wish to read the entire article, the gist of the situation is this, when McCain was struggling to raise cash a few months back he attempted to take out a loan using as collateral his ability to draw on public matching funds. The idea was that if he secured the loan, won a few primaries, and gained additional support, he could pay back the principle and interest without tapping public money and so avoiding the spending restrictions that entails. If he failed to win the primaries and couldn’t raise any more money he would have to use the public money and abide by the restrictions, but it wouldn’t matter because his campaign would have been hopeless by that point anyway. It was a clever but disingenuous strategy, spend now, decide on the rules later, especially coming from someone who claims to be opposing big money interests in Washington. Regardless of how this turns out, keep it in mind when you hear someone talking about John McCain the “maverick.” He is as much establishment as Hillary, and if he is unpredictable, it is only because he is hypocritical, not because he is an independent thinker.

~Fox

Obese? Sorry, we can’t serve you (Daily dose of crazy – Southern edition)

No, it’s not April 1…and yes, the title of this post spells out what will be the case for Mississippi restaurant-goers if a house bill (no. 282) introduced by state Representatives W. T. Mayhall, Jr. (R), John Read (R), and Bobby Shows (D) passes. According to the first page of the bill:

“Any food establishment to which this section applies shall not be allowed to serve food to any person who is obese, based on criteria prescribed by the State Department of Health after consultation with the Mississippi Council on Prevention and Management…”

This applies to any state-licensed food establishment, which is probably nearly every restaurant in the state. And since Mississippi has an obesity rate of around 30%, that means that about a third of the population would not be able to dine out. A restaurant that fails to comply may have it’s permit revoked.

Nanny state, anyone? Who has the right to tell you what you can or cannot eat? The government apparently thinks it has that responsibility…at least in Mississippi. I really hope this bill doesn’t pass, and I doubt it will because it’s such an outrageous affront to the rights of people in that state. But it does serve as a reminder of the responsibilities the government will assume if we let them into our lives. For instance, if we put the government in charge of health care, such as through a single-payer system, then perhaps it would be up to our legislators to keep us in line by punishing or prohibiting unhealthy behavior. Consider the UK, where about 1 in 10 people are denied surgeries because they smoke or are obese. I don’t want to pay for someone else’s poor choices, but I also don’t want the government punishing me for mine. To me, this is what insurance is for – protecting yourself against future risks, not (contrary to what many people seem to think) subsidizing someone else’s risks. Greater risks equal greater premiums, pure and simple.

To me, the obesity thing is discrimination…but in a state-run society such discrimination might be ethically justified if it kept costs down and allows more people access to services. Is this really the path we want for our country? First we go against the obese, but who would be next? We’ve already attacked smokers, maybe we should go after people who drink too much, or who aren’t necessarily obese but still live incredibly sedentary lives. If you don’t eat 3-6 servings of fruits and veggies a day then you’ll be denied health care. I know these seem like extreme examples, but are they really that far-fetched? According to the UK article I linked above, physicians across the pond think lifestyle should play a greater role in determining who receives health services. If they continue down that path, they’ll end up with either a country of boring clones who conform to their ideals, or a country where only a minority of it’s citizens have full access to the services their tax-dollars support.

Fortunately I don’t condone discrimination, so I don’t condone a society run entirely by government bureaucrats.

~Lily

Source – The Smoking Gun

Who gets to make end of life decisions?

This is currently being debated by our neighbors to the north, where a situation is unfolding involving the family of an 84 year old man on a ventilator and the hospital/medical staff currently treating him.

Background:

Samuel Golubchuk is an 84 year old Orthodox Jew who suffered brain injury and multi-organ failure, and was at some point admitted to the hospital and hooked up to a ventilator. Many times when we imagine a brain-injured person hooked up to such a machine, we (as a lay person) assume that they can’t breathe on their own – note that this is certainly not always the case, and that mechanical ventilation is often provided to people who are merely having difficulty breathing and need some assistance until they get better. Sometimes people can be removed from ventilators, and sometimes they are so sick that it is one of the only things keeping them alive. Before the advent of mechanical ventilators, death was usually based upon the heart – when your heart stopped beating, you were dead. But now we have so many ways of keeping the body alive, that death (from a medical point of view) is based upon brain function – you are dead when you no longer have meaningful brain activity. It all gets confusing when you add the various terminology including vegetative state, persistent vegetative state, etc where a person’s body appears alive, but clinically/medically they are defined as “dead.” For simplification, it is enough to know that Mr. Golubchuk is not (based on what I’ve read) clinically brain dead – he is merely very sick, and at the age of 84 this is never a good sign. He may not die immediately, but certainly the odds are not in favor of his living for much longer.

Now, enter into this picture the Canadian health system, and the doctors it employs. The hospital treating Mr. Golubchuk, having decided the prognosis is not favorable, wants to remove his ventilator and “hasten his death.” Though not stated directly, we must look at this as a case of resource rationing – the system only has so many ventilators available, and it would be a more efficient use of resources to give the ventilator to someone who has better odds of surviving (e.g. a younger patient).

Enter Mr. Golubchuk’s family – they argue that his condition has been improving, and that he has even regained consciousness. As Orthodox Jews, it is against their religious beliefs to remove the ventilator – plus the patient had signed an advance directive specifically saying that he wants to be kept alive. Says Prof. Shimon Glick, a leading Israeli medical ethics expert:

“From a halachic point of view, removing a feeding tube from a patient who has any brain function is active euthanasia, equivalent to murder… But here, in addition, unless the patient has specifically indicated by advance directive that such is his desire, one has a violation of the patient’s autonomy, as well.”

Alright, so enough background – what do you think should be done in this situation? If you were paying taxes to support such a system, is it fair for your money to be spent on someone who has a small chance of recovery at the expense of other people who might benefit more? If you were in that situation, would it be fair to have your beliefs and specific wishes (as indicated on a legal document) trumped by a physician who has decided the plug should be pulled?

There is no easy answer in this case, given the public funding of the health care system. Many people (in the US at least) seem to think that a national health care system would solve all of our problems, but it really should be seen as a trade-off. Some people gain access into a system that was previously unaffordable, but in the process you lose a (significant) degree of liberty. For me, a libertarian, this is unacceptable. I do not want a doctor, hospital, or government official dictating my health care choices. I don’t want to be “rationed” according to someone else’s belief system. In fact, this quote from Dr. Jeff Blackmer (executive director, office of ethics, for the Canadian Medical Association) scares the bejeezus out of me:

“Our viewpoint is that we want to make sure that clinical decisions are left to physicians and not judges…These decisions are not made lightly and they’re not made in haste, and they’re not made with anything except the best interest of that individual patient at heart.”

The only person who has the patient’s best interests at heart is the patient! And if the patient is incapacitated, as in the case of Mr. Golubchuk, it should defer to his legal wishes or immediate family.  From the standpoint of an American hospital, this situation is baffling. Certainly we have end-of-life issues as well, but rarely of this sort. From the perspective of the Canadian health system, however, the case may be rare but is unlikely to be unique (particularly when you consider our rapidly aging population). How many times each day must difficult decisions be made within such a system as to who gets what test/procedure/equipment, and who doesn’t? I’m not saying the US system is perfect (far from it!), but our way of”rationing” is very different. Americans who favor a single-payer national health system need to think carefully about situations such as these. How much of your individual decision-making abilities are you willing to hand over to a stranger? It will be interesting to see what the Canadian judge decides in this case (I believe it is scheduled for sometime this week).

~Lily

Sources:

Insure Blog – “A troubling conundrum

Jewish Post (1/7/07) – “Canadian judge to rule on Jew facing euthanasia

Retuers (UK – 12/14/07) – “Canadian life-support case pits religion vs. science