Friday, July 26, 2013

Eugenics: it wasn't just Tuskegee

If you read a story about the gov't trying to get docs to talk to their patients about "end of life"  "choices", what they mean is to try to talk patients into not getting treated if they are too old or chronically ill.

And if you read that we need more such "outreach" to minorities, they mean we need to pressure more minorities to sign papers saying let them die.

don't believe me? Try this story about an ethicist who long denied she wanted to kill people, but now the NYTimes comes out with an admiring story on why she wants to do it. Apparently a person with a damaged brain, confused by drugs who pulls his breathing tube out needs their preferences followed?

I don't think so. 

The story is phrased as if he was dying, but the dirty little secret is that the docs did all they could because he had a chance to live. True, he might be left disabled, but that was not and should not have been part of their decisionmaking (if for no other reason that they are doctors, not fortune tellers, and no one can really predict such things).

But of course, a husband who is disabled is a pain in the neck, so of course confronting this made her think about legal killing, or letting him go.

Yes, must "educate" folks.

 The way Julianne Dickelman tells it, people make plans for their lives. They plan for a birth, marriage and retirement. But people aren't so good when it comes to their life's end.

 "We plan for everything in our lives except for this," she says. "We have birth plans, but we don't really have death plans."

 Dickelman is project manager for a new effort in Whatcom County called End-of-Life Choices Advance Care Planning Initiative. Its goal is to help county residents make clear what kind of end-of-life medical care they want, or don't want, via a written plan they make now, in case they can't communicate their wishes later.
notice they never want to educate folks that they might have a chance to live with treatment? Nah. Make them feel guilty that they will be a burden on their families if they live, and of course don't mention the gov't won't have to pay for their care.

At least that article is about a fairly affluent area in Washington state (where I suspect one of the subjects is how to kill  grandmom yourself).

the real problem are those minority patients who just won't stop treatment.

Washington Post article about the problem.
Those folks just won't let us kill them.

After lives in which they often struggle to get medical care, African Americans and other minorities are more likely than whites to want, and get, more aggressive care as death nears and are less likely to use hospice and palliative-care services to ease their suffering, according to a large body of research and leading experts.

 As a result, they are more likely to experience more medicalized deaths, dying more frequently in the hospital, in pain, on ventilators and with feeding tubes -- often after being resuscitated or getting extra rounds of chemotherapy, dialysis or other care, studies show.

 "I think we need to be very attentive to attending to suffering in our patients and do everything we can to help minimize and ameliorate it," said Richard Payne, who runs Duke University's Institute on Care at the End of Life. "African Americans and other minorities are at greater risk of not dying well."
notice it is not about the wishes of the patient, but that of the doctors, who see the treatment as suffering, not as a chance to live. There is a discussion of how people who see life even when suffering as meaningful for them, but then goes on to say ethics committees need to be part of the decision.

In other words, autonomy only means if you want to die, not want to live.

Also note that part about "coma". Too often this has been stretched (like in the case of Nelson Mandella) to "vegetative state" or those confused by delirium or medicines.

a typical example is this one which can be summarized in two words: Die sucker.
 On June 9, 2013, South Africa’s best-selling weekly newspaper, The Sunday Times, reported that Mandela’s long-time friend Andrew Mlangeni publicly stated: “You (Mandela) have been coming to the hospital too many times. Quite clearly you are not well and there is a possibility you might not be well again.”

Mandela’s long-time comrade recognized and verbalized the end-of-life equation whether the rest of the world wants to hear it or not. I applaud him.

The dirty little secret is that some of these folks go home and live longer, but never mind.

as this article admits: If you come home but continue to need care and/or are confused, you are a burden to others, so better you kill yourself.

Again, the "fortune telling" error of logic is here: because no one can tell if a person will live or not, if they will be disabled or not. But the real danger is assuming even if they live, they won't be productive citizens.

the phrase "useless eaters" comes to mind, but never mind.
 Nelson Mandella's recent illness is a good example. Guess what: he is still alive and recovering.

But this article  starts with the usual suspects, affluent white people who are activists in the "right to kill die movement": I had to help my mother to die. Not really. Your other choice was to give her food, but never mind. By cooperating with a depressed person who says they want to die, what you are doing is telling them their life is useless, so if they love you they should die.  Don't say: But mom we love you and you are not a burden. And never mind about alternatives, like decent pain control and hospice care.

as for Mandella: the article admits that Doctors said he was in permenant vegetative state, but he wasn't.

Go figure. Of course he wasn't: He was sedated, and you can't diagnose PVS for three months (I should add: 3 months without sedatives) and even then 40 percent are misdiagnosed.

so into the memory hole with all those who were cheerleading him to die:
From the UKGuardian 18 July:
Whereas the announcement in June that Mandela was in a critical condition brought sombre crowds to the Mediclinic heart hospital for what resembled a wake, on Thursday the mood was closer to a street party with bursts of song and jubilation. Members of the statesman's family visited him there and, according to his daughter Zindzi, gave him a collage of family photos as a present. "Tata (our father) is making this remarkable progress and we look forward to having him back home soon," she said....
 Bill Clinton, the former US president, told the meeting: "Although he is old and frail and fighting for his life and, as Hillary and Chelsea and I have seen in visiting Qunu over the last couple of years, he doesn't hear so well and he walks with the benefit of an elevated walker, what is in his heart still glows in his smile and lights up the room through his eyes." 
So what brought me to write all this?

Well Mrs Gay Caswell, a metis in Canada, remembers the time when her people were denied syphilis treatment in the name of experimentation, and other atrocities against her people by good socialists.

which is why such people end up suspicious of vaccines etc.

I should add that the Hepatitis A vaccine was experimentally given on one of the Sioux reservations in South Dakota, to see if it would work on children. Never mind that hepatitis A wasn't a big problem: we rarely saw any cases in children or adults, most of the liver problems being from alcohol.

and then there was the Red Lake streptococcus experiment: the first epidemic was wiped out by surveying the population and treating every case of impetigo, because there was a strain of strep that caused kidney failure. (Indians develop severe ecsema from sun allergy, which easily gets it is not purely a hygiene lack problem, which is what a lot of folks imply).

But when it returned, the docs decided only to treat those who came to the hospital. So six folks developed kidney disease (two of them on dialysis when I worked there were from this experiment). and that was by the University of Minnesota.

a lot of Americans see death as preferable to not being productive and independent, or preferable to suffering. So some are eager to give out death, especially to others, and are morally blind that this translates to killing the most vulnerable in society, instead of trying to help them.

But in poor areas, where suffering, disability, and other woes are common, it is a part of life, to be borne with stoicism. My Indian patients saw it as a road given to them by the Creator that they had to travel.

When we had a lady with frontal lobe syndrome and inability to swallow, we asked a neurologist the best medicine to control her overemotional reactions, and he spent the entire visit telling the family that they should stop feeding her. The family, being Indian, meaning they are polite and don't open up to strangers, kept quiet, but at the end of the meeting, one cousin turned to him and told him off: that's the difference between we Indians and you white folks. We take care of our elders, not kill them.

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