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To: NYer; Ohioan from Florida; Goodgirlinred; Miss Behave; cyn; AlwaysFree; amdgmary; angelwings49; ...
Some in Hollywood are beginning to understand.

Thread by NYer.

Chosen Child

My mother did not, to my knowledge, abort any of her children. I do, however, distinctly recall a miscarriage she suffered when I was twelve years old, which caused her great emotional and physical pain. I understood, from my adolescent perspective, that what was lost was somehow precious to her. As another of her children, I felt deeply valued by her grief: Loss of an unborn child, I observed, was a sad and mournful event imbued with a full and unconditioned love.
 
Not so today, we must realize. As I prayed with 40 Days for Life in front of a San Francisco abortion clinic, a young woman positioned herself aggressively in front of me and said, "Don't you want to talk to me?" I looked up from my rosary, met her belligerent gaze, and said, "Frankly, no. I don't."
 
But she refused to leave, and I was trapped listening to a monologue about her mother: her mother's abortion, and her mother's opinions about abortion, and her mother's right to choose whether to birth or abort any pregnancy. Her angry, righteous defense of her mother's behavior and opinion was true torture for me; mercy and compassion were not quick to come in the absence of reason and dialogue. But I did learn something I had little appreciated: I learned that loss of an unborn child is no longer communicated as a sad or mournful event, and that the chosen children -- those that a mother chooses to bear -- struggle to reconcile their existence with the elimination of unwanted siblings.
 
A choice to abort a child is never the quick-fix, isolated, personal decision radical feminists and the lucrative abortion industry assert. It affects the pregnant woman, the father, and often the parents of the pregnant woman. It kills the nascent life. But a decision to abort an unwanted child drops the proverbial pebble into a still pond that ripples with effect to the shores of death. One brief, allegedly personal decision by a mother to unburden herself by killing an inconvenient child in utero will resonate throughout life. (We Catholics, of course, believe it resonates beyond just mortal life, a subject for another day.) Sadly, prevailing manners of political correctness stifle discussion and meaningful assessment of this perfectly predictable consequence of violence in the womb.
 
The regret many women suffer for the rest of their lives after an abortion has become so commonplace that it's nothing short of delusion that allows radical feminists to continue denying the phenomenon. That defenders of abortion attribute what regret exists to the induction of guilt by religious opposition is a purposefully unfounded, manipulative refusal to respect experiences that challenge the abortion mythology.
 
Consider the curious case of Ellen Burstyn -- neither a religious woman nor a pro-life advocate. The well-known 77-year-old actress (The Last Picture Show, The Exorcist, Alice Doesn't Live Here Anymore) shocked the secular world when she labeled her 18-year-old decision to abort "wrong, young, and dumb." That choice, she said, was "the lowest moment in her life." Understandably curious how a decision made more than 55 years ago could still deeply trouble Burstyn, an antsy male interviewer then asked, "Do you ever get over that?"
 
"No," Burstyn flatly replied, elegantly explaining that the choice to abort has "ramifications for the rest of our lives": It becomes a "dark thread" in our tapestry.  Burstyn's clear, precise statement is the sort of breach of PC etiquette that renews pro-abortion feminists' commitment to radical denial of reality.
 
 
The "choice" rhetoric so effectively manipulated by the abortion industry has created a hauntingly painful breach between mothers and children, hinted at by my agitated sidewalk companion and similarly ignored by abortion advocates. Another example gives voice to the fear that surely squeezed the heart of that young woman on the sidewalk.
 
I went with a friend to what should have been a lovely lunch out to "catch up." Partway through our meal, after much talk about our female friends working professional jobs, my companion blurted out, "If I had only aborted my eldest, I could have stayed in school and had a profession, too."
 
Shocked into sudden silence, I finally managed, "Do you really think that? Do you regret not having an abortion?"
 
My question provoked a lengthy, emotional rationale for why her life would have been better had she only had the presence of mind to abort her eldest -- a son, now happily married and father to my friend's dear little grandchildren. I listened in grotesque wonder, imagining how her son -- the only of her five children she apparently regretted -- absorbed her remorse for not having aborted him. More, I wondered: How does this young man deal with his mother's characterization of his life as an excuse and disappointment in place of the accomplishments she'd rather have attained?
 
Reasonably, this grown child might fear that his own shortcomings, needs, and development provoked, at least in some measure, my friend's regret. Voicing regret for not having aborted, is, after all, simply an expression of having made the wrong choice, as assessed with the benefit of subsequent consequences. For the mother who regrets a choice for life, those subsequent consequences are none other than the child himself.
 
In this way, being a "chosen child" has taken on a new meaning in the post-Roe v. Wade paradigm, a cultural construct based on the delusion that intentional termination of an unborn child is a private, personal matter and fueled by a commercial industry anxious to cash in on a wide range of abortion services and products. "Chosen" -- a term once richly imbued by Judeo-Christian history as that brand of unconditional love by God for each of His children (1 Jn 4:7, 16) -- has flattened and darkened to signify those children a mother opts to bear rather than abort.
 
Gone is the notion of a child being loved just because he or she has been conceived, without expectation or condition. In its stead, the "chosen" child lives aware of his own mother's reasons for having him, aware that only the mother's sentiments differentiate the living child from the terminated child, aware that his own being might cause such burden or disappointment that his mother -- like my friend -- regrets his very existence.
 
The impact of this redefinition of "chosen" -- from a deeply religious term that conveyed unconditioned love to one replete with expectations, demands, and potential regret -- must concern New Feminists. The realities lived by my angry sidewalk interlocutor, the mother who regrets not aborting one of her grown children, and the children haunted by terminated unborn siblings they will never know will be denied, ridiculed, shamed, and lied about by the pro-abortion interests. The pro-choice interests have deeply invested in a delusion that abortion has, at worst, temporal, limited consequences -- and they will undoubtedly refuse to consider even sound science that could challenge that investment.
 
The work of understanding and publicizing the impact of abortion belongs uniquely to New Feminists, because it is precisely this sort of insipid, ignored cultural shift that has led and will continue leading to "a gradual loss of sensitivity for man, that is, for what is essentially human," as Pope John Paul II so clearly foresaw (Mulieris Dignitatem, 30). As even many non-religious women have recognized, women must "refuse to choose" (Feminists for Life), not only in deference to their own feminine design, but, as importantly, in concern for the whole of humanity to "ensure sensitivity for human beings in every circumstance: because they are human! -- and because 'the greatest of these is love' [cf. 1 Cor 13:13]." Women must not be robbed of their authentic femininity -- which, after all, concerns even the chosen children.

156 posted on 07/05/2010 9:48:07 AM PDT by wagglebee ("A political party cannot be all things to all people." -- Ronald Reagan, 3/1/75)
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To: Ohioan from Florida; Goodgirlinred; Miss Behave; cyn; AlwaysFree; amdgmary; angelwings49; ...
People like Terri are murdered every day purely for greed.

Thread by me.

Withholding Care from Vegetative Patients: Financial Savings and Social Costs

In a recent column in the Huffington Post, Jacob M. Appel argues for “rational rationing” of health care resources by withholding and withdrawing life-sustaining medical treatment from patients in a permanent vegetative state. He considers the case of Ruben Betancourt, which will soon be decided by the New Jersey Superior Court in Betancourt v. Trinitas Regional Medical Hospital.

Mr. Betancourt was a patient at Trinitas Regional Medical Hospital in Elizabeth, N.J., where he had successful surgery for a malignant thymoma in January 2008. But Mr. Betancourt suffered oxygen deprivation, resulting in severe brain damage, after accidental extubation of his breathing tube following the surgery. He lapsed into unconsciousness and was subsequently moved to various health care facilities, including a nursing home, where he was sustained on a feeding tube and dialysis.

When Mr. Betancourt was readmitted to Trinitas in July 2008 with renal failure, doctors balked at providing dialysis, artificial nutrition and hydration, and artificial ventilation, claiming that the patient was in an irreversible vegetative state, was actively dying, and that further treatment was medically and ethically inappropriate and inhumane. The hospital sought to remove him from life support. Mr. Betancourt’s daughter objected, saying that she thought her father was aware and reacted to his family, and that he was responding to treatment. Although he left no advance directive, his family believed that he would have wanted treatment continued. A legal battle ensued between the family and the hospital.

Mr. Betancourt died in May 2009, but his legal case remains on appeal. The court’s decision could have important implications for legal debates about medical futility, patient autonomy, and questions about when and under what circumstances doctors and hospitals can refuse to provide life-sustaining care to patients.

Appel argues that physicians and hospitals should withhold or withdraw care from permanently vegetative patients, because such care is costly and diverts money and medical resources from more worthwhile patients and endeavors:

Money spent on vegetative patients is money not spent on preventive care, such as flu shots and mammograms. Each night in an ICU bed for such patients is a night that another patient with a genuine prognosis for recovery is denied such high-end care. Every dollar exhausted on patients who will never wake up again is a dollar not devoted to finding a cure for cancer. While the visible victims may draw the headlines and attract indignant protests from so-called "pro-life" organizations, the invisible victims are people like you and me who will suffer from diseases that are never cured because funds are being poured down a healthcare sieve in order to maintain permanently-unconscious bodies on complex and costly forms of life support.

Appel does not mince words: “Let us make no mistake about what this would mean: It would mean declaring that the lives of PVS patients are worth less than those of others.”

Put in such terms, Appel’s case sounds simple. If we would just stop spending precious medical and financial resources prolonging the lives of permanently vegetative patients, we could use those resources where they can do more good, like for finding a cure for cancer. If only it were that simple.

Mr. Betancourt’s condition was indeed very grave, and his chances of recovering were slim. He suffered from chronic infections, sepsis, and hospital-acquired bedsores, in addition to his other maladies. Nonetheless, he lived for several months after doctors at Trinitas declared that he was “actively dying.” To generalize from one patient’s extremely poor prognosis to the condition of other vegetative patients, however, is unsupportable for several reasons.

First, and most importantly, there is a widely acknowledged problem of misdiagnosis in disorders of consciousness, which include the vegetative state. It is estimated that more than 40 percent of patients currently diagnosed in a permanent vegetative state are instead in a minimally conscious state – that is, they may be conscious, albeit to a limited degree. Clinicians and researchers are working to improve diagnosis, but at present it remains extraordinarily difficult, even for experienced neurologists, to distinguish between the vegetative and minimally conscious states.

Given the uncertainty, we should not be so quick to jump to conclusions about the irreversibility of a vegetative state. How quick would we be to terminate life support for patients with other conditions if there was a four in ten chance that they had been misdiagnosed? Regardless of the decision of the Betancourt court, any legal guidelines on withholding and withdrawing treatment from permanently vegetative patients will be meaningless – and potentially unjust – absent the ability to accurately and with medical and legal confidence diagnose patients.

Secondly, we do not know very much about the subjective lives of patients with disorders of consciousness. Vegetative and minimally conscious patients cannot, by definition, communicate meaningfully,and, therefore, effective measures of their quality of life are at present lacking.

 There is evidence from neuroimaging studies that minimally conscious patients can experience pain, that their brains respond emotionally to the voices of loved ones, and that they may be capable of cognition at a level that is not evident from their behavior. The evidence is not dispositive, but it nonetheless provides reason for concern about the quality of life experienced by these patients. Their lives may be worth living, or these persons may be even worse off than vegetative patients. We need to know much more, however, before we can draw any conclusions about what their lives are worth to them, or to their families.

Many patients with disorders of consciousness suffered traumatic brain injuries as a result of accidents, and many of them were quite young at the time of their injuries. They did not have advance directives, and, as with Mr. Betancourt, it was left to their families to make life-or-death decisions for them. We should respect the expressed wishes of patients when they are applicable, but when patients can no longer decide for themselves, or when they have not left instructions for their future care, the best way to protect their interests is to allow those who know them best to make decisions for them. Such decisions cannot come from a court in a one-size-fits-all statement about the value of a class of patients.

Finally, Appel’s argument implies a straightforward financial benefit to taking resources away from vegetative patients, as if solving the problem of runaway health care costs is as simple as shifting money from column A to column B on some national medical spreadsheet. That’s an extremely simplistic view of the economics of health care, but even if it were credible, the picture Appel paints of vegetative patients taking resources from more worthwhile patients is not accurate.

It is unknown how many patients there are with chronic disorders of consciousness, in part because most of them are not in acute care facilities like Trinitas, but rather in long-term custodial care facilities. Many of these patients get very little care beyond artificial nutrition and hydration, although they can live for decades. Indeed, one of the tragedies for these patients is that they are neglected both clinically and socially.

Clinical neglect is one of the factors responsible for the misdiagnosis of these patients – once institutionalized, they do not receive follow-up diagnostic tests that might detect a change in their neurological status. Neither do they receive rehabilitative care that might enhance recovery. A diagnosis of permanent vegetative state requires being vegetative for 12 months in the case of patients who suffer traumatic brain injuries, and six months for patients who suffer anoxic/hypoxic brain insults, such as Mr. Betancourt. During that time, very few of these patients would be taking up intensive care beds or resources. Mr. Betancourt himself was in a nursing facility for several months before his readmission to Trinitas.

The bottom line – and we are talking about the bottom line here – is that patients with chronic disorders of consciousness do not typically receive the kind of expensive technological interventions and intensive care that Mr. Betancourt received in his last days of life. These patients are not taking intensive care beds away from other acutely ill patients.

While there may be some savings to be reaped from terminating the lives of patients with chronic disorders of consciousness, it will not be the substantial windfall that Appel imagines. Neither can it be assumed that “every dollar” will be diverted, as Appel suggests, to preventive care, or finding a cure for cancer. Public money saved could well be redirected to priorities outside health care.

There are substantial social costs to declaring an entire class of patients “worthless.” Allowing health care providers, including institutions like acute care hospitals, to unilaterally decide, against the wishes of patients or their legal guardians, to withhold life-sustaining medical treatment invites abuse and diminishes transparency and due process.

In a society that values patient autonomy and decisional authority, taking decisional power away from vulnerable patients or their surrogates would amount to abandoning them and leaving their fates to others who may or may not be motivated by patient welfare. It would change the culture of medicine – at least for these patients, if not for others – from one that is patient-centered to one that is beholden to the bottom line. In weighing the possible financial savings against the social costs of declaring these patients “worthless,” it is not at all obvious that ending treatment for all permanently vegetative patients will result in a net benefit.

"We will not be silent.
We are your bad conscience.
The White Rose will give you no rest."

157 posted on 07/05/2010 9:51:37 AM PDT by wagglebee ("A political party cannot be all things to all people." -- Ronald Reagan, 3/1/75)
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