Obamacare rollout highlights views of government

Excerpted from "An opening for the right," The Washington Post, commentary by Jennifer Rubin, October 27 - The Obamacare debacle challenges a number of liberal mantras that undergird a whole set of policies and campaign appeals. Here are the top 10 liberal tenets threatened by Obamacare:

1. If there is a problem, the federal government should attack it.
2. Government can compel people to act against economic self-interest by passing laws.
3. There is no downside to big government.
4. The welfare state is the best mechanism to help the poor.
5. Those opposed to big government hate the poor.
6. Government is capable of running highly complex systems effectively.
7. When addressing big problems it is best to centralize and standardize.
8. Unintended consequences of government programs are a small price to pay.
9. People will trust the government with private decisions and personal information.
10. Spending more and taxing more are evidence of concern for the poor.

All of these precepts have been challenged by conservatives, but there is nothing like a real example and personal experience to drive home a message. We don’t have just a few “glitches” or even a time crunch for putting up the exchanges, we have in Obamacare a fundamental misunderstanding of the limits of the government and citizens’ aversion to big, complicated entities. The effort to construct one big system with a highly regulated product (Obamacare-standard insurance) may in fact be the entire effort’s undoing.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics):
“Our healthcare system is broken and badly in need of a fix. The root problem is that healthcare costs too much, so individuals and businesses can’t afford insurance. The Affordable Care Act, unfortunately, is built on the premise that most people’s health insurance programs are not adequate and all perceived inequities must be solved. So the law says preventative services and contraceptives must be free. It doesn’t allow surcharges for age or preexisting conditions. Children can stay on their parents’ plans until age 26. There are no lifetime cost ceilings. Plans must contain psychiatric, eye and other coverages that most insurance plans have not provided.

“I like all those things, just like I like all the bells and whistles on a Mercedes Benz 500 with its great ride and exquisite comfort. But I’ve never owned a Mercedes because I can’t afford one, just like most people in our country. I drive a Honda Civic and, you know what, it gets me there. We can’t afford the Affordable Care Act either. It will add a whopping $2.8 trillion to our healthcare costs over the next 10 years. Already, self-insured individuals are experiencing the reality of that sticker shock but they are no longer in a market-driven healthcare economy. They can’t buy a well-used insurance vehicle at an economical price. Only a Mercedes is adequate.

“We very well may be headed for a debacle. The ‘cure’ may be worse than the disease. If so, everyone may be so traumatized that they refuse to even give a hearing to a real solution.”

Should Christians engage in public policy?

Excerpted from "Should we pull back from politics?" blog posting by Russell Moore, President, Southern Baptist Convention's Ethics and Religious Liberty Commission - A recent profile in the Wall Street Journal highlighted a generational change in terms of the way evangelicals approach cultural and political engagement: toward a gospel-centered approach that doesn’t back down on issues of importance, but sees our ultimate mission as one that applies the blood of Christ to the questions of the day. The headline, as is often the case with headlines, is awfully misleading.

I don’t think we need a pullback from politics. I think we need a reenergizing of politics. Millennial and post-Millennial Christians are walking away from the political process, and this is what alarms and motivates me. They are disenchanted with movements that seem more content to vaporize opponents with talk-radio sound-bytes rather than to engage in a long-term strategy of providing a theology of gospel-focused action in the public square.

Those who wish to retreat are wrong. Ignoring so-called “political issues” doesn’t lead to a less politicized church but to a more political church. One cannot preach the gospel in 19th century America without addressing slavery without abandoning the gospel. One cannot preach the gospel in 21st century America apart from addressing the sexual revolution without abandoning the gospel.

A church that loses the gospel is a losing church, no matter how many political victories it wins. A church that is right on public convictions but wrong on the gospel is a powerless church, no matter how powerful it seems.

That means modeling a Christian political engagement that doesn’t start or end with politics alone. It starts and ends with the gospel and the kingdom of God. Those who oppose our convictions will hate us. Those who want to use our church voting lists as their political organizing tools won’t understand us. So be it. Kingdom first.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: (excerpted from "MLK and Wilberforce show why Christians should engage more--not less--in public policy," Freedom2Care blog, October 23, 2013) Imagine a world bereft of the political engagement of Christian religious leaders like Dr. Martin Luther King, abolitionist William Wilberforce and myriad lesser-known leaders like Jonathan Mayhew, whose sermons and writings helped undergird the American Revolution. Christian political engagement has helped secure racial justice, free slaves and throw off tyranny.

We demonstrate our faith in God by defending the defenseless, advocating for the poor, righting injustice. The political process offers one arena for such ministries. Public policy engagement for Christian believers means encouraging our countrymen to take faith steps toward God and His principles. To choose life, to defend the defenseless, to advocate for the poor and downtrodden.

With this perspective, we must not disdain but instead honor the ministry of working in the political realm as an evangelistic ministry. Rather than stepping back from politics, more believers need to engage in public policy, proactively advancing policies promoting the welfare of their countrymen and defensively advancing religious freedom for people of faith.

We can't desert the battlefield just because a few soldiers may have misfired. If some believers have fought political battles in an antagonistic way, let us show how to engage in a winsome way. If others have let bigotry and hubris mar their testimony, let us demonstrate Christ's love with grace and humility. If others have proven emissaries of ill will, let us serve as ambassadors of good will.

"Therefore, we are ambassadors for Christ, as though God were making an appeal through us; we beg you on behalf of Christ, be reconciled to God" (2 Corinthians 5:20).

Read full blog article by Jonathan Imbody

"Roe" abortion decision lacked medical evidence

Excerpted from a book review by Michael J. New in The Washington Times, October 13, 2013 - a review of Abuse of Discretion: The Inside Story of Roe v. Wade by Clarke Forsythe - Clarke Forsythe persuasively makes the case that even under liberal standards, Roe v. Wade is still deeply flawed. That is partly because the public health data and the historical information that Justice Blackmun relied on in his majority opinion were often incorrect, incomplete or misleading.

For instance, public health research that purportedly showed that abortion was safer than childbirth played a prominent role in Blackmun’s opinion. However, of the seven studies that Blackmun cited, none was peer reviewed and none even considered long-term health risks involved with legal abortion.

The concept of viability was never once even mentioned during the oral arguments. Mr. Forsythe presents correspondence between Justices Blackmun, Thurgood Marshall and Lewis Powell showing that their decision to expand the abortion right to viability was not based on any legal argument, but instead because it would mean more access to abortion.

This expanded access to abortion has had a profoundly negative impact on public health. Mr. Forsythe details the numerous abortion clinic scandals that have come to light since 1973. He also ably summarizes academic research that shows that abortion is linked to an increased risk of breast cancer and a higher incidence of various psychological problems. There is no evidence that Roe v. Wade significantly reduced maternal mortality, child abuse, spousal abuse, poverty or the out-of-wedlock birthrate.

Abuse of Discretion should engage readers outside the pro-life movement by making a compelling argument that even under liberal standards of jurisprudence, Roe v. Wade is a deeply flawed decision.

Commentary

Author Clarke Forsythe, Senior Counsel, Americans United for Life:“Abuse of Discretion details and documents the erroneous medical assumptions adopted by the Justices in Roe v. Wade and Doe v. Bolton. The principal medical assumption was that “abortion was safer than childbirth.” That drove the outcome and the shape of the Court’s opinions in Roe and Doe, though there was no evidence or reliable data to support that assumption. Abuse of Discretion thoroughly disputes the accuracy of that assumption in 1972 and today.

“Chapter 8, entitled “Detrimental Reliance,” summarizes the contemporary international medical studies finding increased risks of, for example, pre-term birth after abortion.

“The Supreme Court has three abortion cases before it this fall, though the Justices have not yet decided to hear the merits of any of the cases. However, the medical data will be critical in these cases and in all future abortion cases in the courts.”

Proposed treatment to fix genetic diseases raises ethical issues

Excerpted from “Proposed treatment to fix genetic diseases raises ethical issues,” Shots: Health News from NPR. August 14, 2013 -- The federal government is considering whether to allow scientists to take a controversial step: make changes in some of the genetic material in a woman's egg that would be passed down through generations. Mark Sauer of the Columbia University Medical Center, a member of one of two teams of U.S. scientists pursuing the research, calls the effort to prevent infants from getting devastating genetic diseases "noble." Sauer says the groups are hoping "to cure disease and to help women deliver healthy, normal children."

But the research raises a variety of concerns, including worries it could open the door to creating "designer babies." Specifically, the research would create an egg with healthy mitochondrial DNA (mtDNA). Unlike the DNA that most people are familiar with—the 23 pairs of human chromosomes that program most of our body processes—mtDNA is the bit of genetic material inside mitochondria, living structures inside a cell that provide its energy.

Scientists estimate that 1 in every 200 women carries defects in her mtDNA. Between 1 in 2,000 and 1 in 4,000 babies may be born each year with syndromes caused by these genetic glitches; the syndromes range from mild to severe. In many cases, there is no treatment, and the affected child dies early in life. "We have developed a technique that would allow a woman to have a child that is not affected by this disease, and yet the child would be related to her genetically," says Dieter Egli of the New York Stem Cell Foundation.

But this is all still very controversial. First of all, the baby would be born with genes from three different people: from the father, from the woman trying to have a healthy baby, and from the woman who donated the healthy egg. There are even bigger concerns, which start with whether the technique is safe for the resulting infant, and whether by trying to fix one problem, scientists may inadvertently introduce mistakes into the human genetic code. That's why this sort of thing has always been off-limits — even banned in many countries, according to Marcy Darnovsky of the Center for Genetics and Society.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “Germline genetic engineering, where a portion of the egg or sperm’s genome replaced, changed or supplemented, is unethical, unnecessary and unsafe. It crosses a bright line in the bioethical sand labeled, ‘That shalt not!’


“It is unethical because it permanently changes the child’s genes and any unforeseen consequences that occur are passed on to every generation that follows. Thus, it violates the ethical principle of autonomy. How does the doctor get informed consent from their grandchild yet to be conceived? Some of the techniques proposed involve destroying human embryos, not just manipulating women’s eggs. For example, some propose discarding female embryos created and only implanting male embryos to avoid the risk of passing on an inheritable defect.

“It is unnecessary. Women who have an identified high risk with a high mutation load, (under 18 percent mutations of mtDNA, there is 95 percent certainty of no risk) already have the option of not having children, adopting, utilizing a donated egg, preimplantation genetic diagnosis and prenatal diagnosis with abortion. Some of these options are unethical because they destroy life, but they are legal. Scientists are trying to justify germline manipulation so that women with this genetic liability might have the option of having a child with their genes. While this ambition is understandable, because there are alternatives, and because there are significant risks to generations of offspring, we should prohibit this option.

“It is unsafe. This type of genetic manipulation is not human cloning but uses similar techniques that have been associated with serious problems when used in animals—large organ syndrome, malformations and miscarriages.

“The ‘hard cases’ have been historically used to justify crossing the ‘bright lines’ in bioethics. We saw this in abortion, but once society agreed that abortion was justified because the mother didn’t want a child because of rape, incest or a genetic defect, it soon became justified for a woman not wanting a child for any reason. In other countries, physician-assisted suicide was justified for patients who had lives ‘not worthy to be lived’ because they were terminally ill and suffering. Now it is allowed for any reason the patient conceives that their life is unworthy to live. It is not unreasonable to predict if society says germ line manipulation is okay to avoid having a child with an imperfect genome that society will soon open the door for germline genetic engineering in the quest for perfect children.”

Resources
Novel techniques for the prevention of mitochondrial DNA disorders
Position Paper on Human Germline Manipulation
CMDA Resources on Reproductive Technology and Health

Autistic boy “debarked” to prevent screaming

Excerpted from “Autistic boy ‘debarked’ to prevent screaming,” BioEdge. October 5, 2013 -- Controversy has arisen around a procedure performed on an American autistic boy to stop him from screaming. At the request of his parents, Kade Hanegraaf had his vocal cords separated so as to greatly reduce his ability to scream.

The family chose the operation after three years of enduring the boy's uncontrollable screaming—a high pitched cry louder than a lawn mower that he would make more than 1,000 times a day. According to the boy's mother, Vicki Hanegraaf, the behavioral problem was destroying the family. They were unable to take the boy anywhere, and his brother, also autistic, was highly sensitive to the loud cries.

According to a case report in the Journal of Voice, the boy can now only produce a scream half as loud, and his “episodes” have been reduced by 90 percent. The operation, called a thyroplasty, is said to be reversible. The boy's family is happy with the outcome, but others in the autistic community have criticized their decision. Some have described it as torture and compared it to debarking a dog.

Bioethicist Arthur Caplan defended the decision: "21st century medicine gave Kade and his family a solution that has already allowed the boy to live a richer life -- and the solution can be reversed at any time. That seems to me to be cause for celebration, not condemnation."

However, an autism rights activist told Salon that the operation was profoundly unethical. “There is a long history of family members and providers viewing these behaviors as strictly a medical phenomenon and not recognizing they’re important for communication. To violate a person’s bodily autonomy and damage their ability to communicate to serve the convenience of the caregiver is nothing short of horrific.”

Commentary

CMDA Member and former member and chair of the CMDA Ethics Committee Nick Yates, MD, MA (Bioethics): “Parents should be and are allowed to make healthcare decisions for their minor children (and those who cannot be granted decision-making authority) under a best interests model. Traditional and more commonplace care is easier to accept, but sometimes not only is the treatment a bit unusual and unconventional, but the best interests extend from the individual to the family. Patient autonomy and decision-making capacity are extremely important considerations, and thoughtful communication is how these notions are expressed and preserved. However, if one can only communicate in deafening screams and exhibits little social grace, how is autonomy and decision-making imputed in a meaningful manner? These are extremely difficult decisions where pundits—nearly all of whom have not and will never experience the extreme medical situation—love to wage commentary.

“The family followed traditional care recommendations—behavioral and medical management—for nine years with no persistent improvement. Following surgery, vocalization frequency and intensity dropped significantly, socialization improved, he began to speak better and his appetite improved.

“Children do indeed need protection, and social services are appropriate, but children also must have an advocate, and so rights activists and external guardians may be necessary. In this case, neither is necessary as the family's choice is ethically permissible (and medically reversible), and should not be condemned.

Resources
CMDA Ethics Statement on Parental Limits
Autism’s Hidden Blessings by Kelly Langston
Complete Guide to Baby & Child Care

Physicians prepare to deal with increased demand, strain on practices under ObamaCare

Excerpted from “Physicians prepare to deal with increased demand, strain on practices under ObamaCare,” Fox News. October 1, 2013 -- As enrollment in ObamaCare begins, physicians throughout the country are preparing to deal with an influx of newly insured patients – as well as the increased financial demands this will place on their practices. While it will take a few years for doctors to fully determine how they will be affected by ObamaCare, some physicians are already anticipating the need to make major changes to the way they run their practices.

One of the most immediate changes that physicians in these areas expect to see is an increase in patients seeking preventive health care – something many avoided when uninsured. However, scheduling more routine check-ups and screenings may place a strain on already short-staffed practices in rural areas. As a result, some doctors are considering handing over some basic aspects of patient care and education to nurses, nurse practitioners, or physicians assistants in order to treat patients more efficiently. Dr. Jason Marker, of Wyatt, Indiana, is already looking to hire additional staff members in order to meet the increased needs in his community.

Rural areas throughout the country already face a shortage of primary care physicians and doctors like Marker fear that this problem might become exacerbated in coming years, as more patients have the means to seek regular care.

“We know definitively that health insurance coverage and access to a physician are what improve health care outcomes.” Marker said. “We’re about to get changes in coverage, but we don’t have a ready way to say, ‘Here’s another million family doctors.’ So there’s a pipeline problem where it will be another five to 10 years where we are able to get the volume of doctors to take all these patients.”

Marker said Congress will need to step up in order to help fix this problem. “The big weak link is whether or not Congress is willing to put additional dollars into family medicine residential training,” Marker said. “That’s the current bottleneck in the training pipeline, is having residency slots. It doesn’t do good to have residents interested if there aren’t slots to do training.”

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): -- “When we went as missionaries to Africa, Jody knew we would be far from the grocery store yet entertaining many guests, so she bought a cookbook called More With Less. That phrase succinctly describes the focus that every healthcare professional will need as we move forward. There are going to be more patients to see than ever before but not enough physicians to see them. Though more medical schools are opening, including two Christian ones, there are not enough residencies being funded. Physician assistant and nurse practitioner schools are expanding to help fill in the gap, but the problem is bigger than that.

According to leading economic John Maudlin, reimbursement rates are going to plunge by 25 percent in the next five years. (I encourage you to read the eye-opening article.) The Cleveland Clinic now collects $6 billion a year and expends $5.5 billion. They are projecting their income to plunge to $4.4 billion by 2018, despite a significant increase in their patient load, as commercial insurance companies on average go from paying $.38 on the dollar billed to $.26. (Medicare now pays $.23 and Medicaid $.18.) Since 60 to 80 percent of their cost is for personnel, that is where cost savings will have to be realized. That is why you are already hearing of hospitals and practice groups laying off staff and if those staff are rehired elsewhere, they probably will be paid less.

CMDA’s Executive Vice President Gene Rudd, MD, told those attending the CMDA Midwest Regional Conference a few weeks ago that they would all need to become missionary doctors…but not necessarily by going overseas. They will have to have a missionary's mentality of working very hard and not getting paid as much, but doing it because God has called them to minister through medicine.

Though we will all being doing "more with less" I believe that the opportunities to minister through healthcare are going to be greater than ever! God does His best work in the midst of crisis and change if we simply rest and trust in Him!

Resources
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Why HR 3200 is No Healthcare “Reform” by Gene Rudd, MD
Affordable Care Act Impact on Doctors and Patients

Doctors Look For A Way Off The Medical Hamster Wheel

Excerpted from “Doctors Look For A Way Off The Medical Hamster Wheel,” Shots: Health News from NPR. August 14, 2013 -- Doctors are on a hamster wheel these days. We're compelled to run faster just to stay in place. It's about to get worse. Obamacare means millions more people will want our services, with not enough primary care doctors to meet demand. Government incentives that are pushing us toward computer-based records mean that doctors now spend as much time documenting our visits with patients as we do examining them.

As the hassles have gotten worse, I've seen many colleagues jump ship. But there might be another way. Dr. Christine Sinsky, an internist in Dubuque, Iowa, has made it her mission to find ways to mitigate the drudgery of modern doctoring. With funding from the American Board of Internal Medicine Foundation, she and four colleagues traveled the U.S. in search of practices that provide top-notch, effective primary care, while making the work satisfying for the doctors and other health professionals. Sinsky and her team found 23 examples of innovative practices from coast to coast, and reported on them in both an academic journal and an in-depth white paper.

Dr. Ben Crocker was so burned out in in 2007 that he lamented, "Working at Starbucks would be better." Now, his practice at Massachusetts General Hospital employs health coaches to work with patients on making the lifestyle changes that doctors recommend but can't adequately teach or monitor. Virtual visits have replaced some in-person visits. Perhaps most incredibly, the practice offers staff downtime each week to come up with innovations.

Sinsky offers examples of tedious tasks that take doctors away from providing undivided attention. No. 1 among them is data entry. "Inbox management" — all the phone calls, emails, forms to sign and prescription refills — can take up to two-thirds of a physician's day. "All of this inbox work can and should be handled by nonphysician personnel, freeing us up," she says. "So many mandatory tasks are crowding out the work of real doctoring.”

Commentary

CMDA Member Julie Griffin, MD: -- “Demanding schedules, flawless precision and an enduring calm in calamity—these are expectations of physicians. We have often placed these ultimatums on ourselves with our detailed, driven personalities pushing us to unattainable perfection. Nevertheless, the culture increasingly demands a new maximum.

Hardly imaginable is Hippocrates rushing around the office, then being paged across town for a delivery. Medicine’s revered father never had to defend his decisions to a third-party payer. We prefer the tableau of a wise, forbearing professional to grateful patients and an engaging professor to eager students. In truth, we were in this picture ourselves as we entered medical school.

Have our dreams run amuck? Perhaps, if we lose the focus of our callings in light of career demands. Yet, if we are confident of our callings and moved with the same compassion which moved Jesus (Matthew 9:36), we will not be distracted from our opportunities to serve.

To be sure, we must employ new methods, including delegation of duties. Medicine is moving to team-based care. This change is neither revolutionary nor futuristic. It is an overdue move toward our biblical heritage. Jesus readily embraced teamwork in ministry, and we as physicians should do likewise.

We must remember our calling and the true Strength by which we fulfill it—paperwork, phone calls and all. We cannot be chased out of our ministries for there is no joy or peace in life apart from our appointments as God’s coworkers in the gospel of Christ (1 Thessalonians 3:2-3).

Resources
In Search of Balance by Richard Swenson, MD
Practical Practice Issues in Today’s Christian Doctor

Obamacare May Trigger Exodus of Christian Doctors

Excerpted from “Obamacare May Trigger Exodus of Christian Doctors,” CBN News. October 1, 2013 -- Thousands of Christian doctors across the nation are considering quitting medicine or working overseas because of concerns over the new healthcare law.

Dr. Gene Rudd, senior vice president of the Christian Medical Association, says they're worried they could be forced to facilitate abortions or prescribe drugs that violate their convictions.

Rudd says many of them have avoided hiring and taking on new patients due to uncertainty over Obamacare.

Thousands of the doctors provide care for the poorest areas of the United States and feel called by God to help the sick, but say they need to be able to do so with a clear conscience.

Commentary

CMDA Senior Vice President Gene Rudd, MD: “I rarely view or read media reports after I have been interviewed. (In part, this is because someone else at CMDA does that.) But being asked to comment on this article that was based on what I said to a reporter reminded me of how the media uses their perspectives and agendas to create the news. Too frequently I find a failure to report ‘the truth, the whole truth and nothing but the truth.’

“Timed to coincide with the beginning of the enrollment for Obamacare, my interview with this AP reporter covered many perspectives on healthcare reform, perspectives I classified as ‘the good, the bad and the ugly.’ My limited comments about Christian doctors were almost an afterthought. But only those comments made the news.

“Among the many perspectives I cited, one ‘good’ aspect of reform is that some of our neighbors who previously couldn't obtain health insurance coverage would now have some basic level of protection. A ‘bad’ aspect is that now healthy individuals and families who did not have coverage and had little healthcare costs will now have to pay either a penalty for failure to participate or pay premiums. Even with subsidies, one estimate placed the average family premium at more than $5,000. That will be a substantial burden to most family budgets.

“One of the ‘ugly’ aspects of the current reform bill is the permission assumed by the Administration to usurp individual rights and undermine the First Amendment. Already we have seen HHS interpret and implement legislation in a way that attempts to force employers to provide coverage that includes provisions they find morally objectionable. And under the guise of providing required services, we will be required to fund abortions. Only with the use of smoke and mirrors do they attempt to claim otherwise.

“Will reporters continue to filter the news to suit their agendas? Of course. But we will continue to speak the truth in love. Will Obamacare survive? I don’t know. But we will continue to contest provisions that are morally unacceptable and dangerous to our foundation of freedom."

Resources
Voice of Christian Doctors Media Training
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Nationalized Healthcare – Prescription or Problem?

New Poll Results on Physician-Assisted Suicide

Excerpted from “Should Physician-Assisted Suicide Be Legal? Poll Shows Divide Among Experts,” Huffington Post. September 12, 2013 -- Medical experts in the U.S. remain divided in their opinion of whether physician-assisted suicide (PAS) should be legal, a new poll suggests, indicating that the way in which patients die and the role of palliative care will remain issues of much debate. In the poll conducted by the New England Journal of Medicine (NEJM), about 65 percent of votes were against the idea of permitting PAS. The rate among U.S. voters was similar, with about 67 percent voting against PAS. In PAS, doctors provide terminally ill patients with the means to end their own life - for example, giving them a prescription for a lethal dose of medicine, which the patient can later decide whether to take.


Proponents of PAS say that people, in face of an inevitable death, deserve the right to end their lives on their own terms, without pain and suffering. Opponents say that a physician taking a role in a patient's suicide violates a fundamental tenet of medicine by contradicting the doctor's role as a healer. Oregon was the first state to legalize PAS, with the passing of the Death with Dignity Act in 1997. Two other states, Washington and Vermont, followed suit. In 18 U.S. states, a majority of votes supported PAS. Interestingly, the researchers said, Oregon and Washington were not in that group.

More than 200 comments were posted, in which readers made arguments to support their beliefs. Many commentators on both sides of the divide agreed that palliative care, including hospice, are important for helping terminally ill patients manage their pain and suffering, both physical and psychological.

Commentary

Family physician, ethics consultant and CMDA Board of Trustees Member Robert E. Orr, MD, CM : “The New England Journal of Medicine recently reported that in its international poll, two out of three physicians oppose the legalization of PAS. They also reported several years ago on a survey of U.S. physicians that gave similar results.¹ The good news: (a) most physicians think PAS is a bad idea; (b) the NEJM is willing to report this in spite of their own editorial support of PAS. However, there is also bad news about such polls.


First, it is well documented that the way polling questions are worded can have a significant effect on the results obtained.² Equally important, poll results may (or may not) reveal what people think about an issue, but they cannot tell us whether the issue in question is right or wrong.

It is possible to effectively speak against PAS using arguments based on principle, virtue or consequences.³ For the believer, there is a strong additional reason to oppose PAS: each person bears the image of God and we must not intentionally end a human life.

Another piece of good news from the poll results is that most people, whether for or against PAS, agree that excellent hospice/palliative care is the preferred response to end of life suffering.⁴

Bibliography
¹Meier DE, et al. A national survey of physician-assisted and euthanasia in the United States. N Eng J Med 1998;338(17):1193-1201
²Hagelin J, et al. Surveys on attitudes towards legalisation of euthanasia: importance of question phrasing. J Med Ethics 2004;30:521-523
³Orr RD. What are the arguments against legalization of physician-assisted suicide and euthanasia? Today’s Christian Doctor 2011;42(2):30-2
⁴Orr RD. Pain management rather than assisted suicide. Pain Medicine 2001;2(2):131-137

Resources
CMDA Ethics Statement on Physician-Assisted Suicide
Resources on Physician-Assisted Suicide
What are the arguments against legalization of physician-assisted suicide and euthanasia? by Robert D. Orr, MD, CM