Should we starve Alzheimer's patients to death?

Alex Schadenberg - Tue, 2017-08-22 21:43
This article was published by Wesley Smith on his website on August 20.

BWesley Smithy Wesley Smith

The idea of starving a helpless elderly person to death used to be thought of as the most egregious crime. An abhorrence.

Now, for some, it is merely another form of “death with dignity.”

The assisted suicide advocacy organization Compassion and Choices–formerly the more honestly named Hemlock Society–teaches people (with a prime focus on the elderly) how to starve themselves to death, a form of suicide they call “voluntary stop eating and drinking” (VSED). 

But many in bioethics wish to take that avenue to dying further, requiring nursing homes to starve dementia patients to death if they so stated in an advance directive.Now, as these things are wont to do, the idea has gone from the professional literature into the popular media. USA Today has a story about a man trying to force his wife to be starved because she has Alzheimer’s–this even though she willingly eats snacks and her meals. From the story: Across the U.S., the more than 5 million people living with dementia are typically encouraged to put their end-of-life wishes into writing early and to pick a trusted person to carry them out, said Beth Kallmyer, vice president of constituent services for the Alzheimer’s Association. That’s no guarantee, however, that those requests can — or will — be honored. In Nora Harris’ court case, her advance directive and testimony from her husband, her daughter and two close friends all indicated that she wouldn’t want anything to prolong her life. “That court decision basically condemned Nora to the full extent of the Alzheimer’s disease,” Bill Harris said. “They gave her no exit out of this situation.” The “exit” is to refuse medical treatment, such as antibiotics or a feeding tube when it becomes needed–which under the law, is deemed a medical treatment.

Feeding is care. not treatment.But spoon feeding and handing out snacks, willingly eaten, is not medical treatment. It is humane care, the kind owed to every human being.

Advance directives govern medical treatments desired or to be refused when the signatory becomes unable to make her own decisions. It does not require caregivers to violate the fundamental rules of humanity.

Think of it this way: If a dementia patient had requested to be left in bed in front of an open window without a blanket on a winter’s night in order to die by hypothermia, should the nursing facility be forced to do that? Of course not! They owe the patient a duty to be kept warm. 

Ditto if a patient asked not to be turned to avoid bed sores. Or directed that their linens never be changed.

The same must go to spoon feeding and offering liquids, or we are no longer a moral country. That isn’t to say forced feeding, but if a patient willingly takes nourishment, that must control. 

The article goes on to describe VSED and says it can be a peaceful death without suffering. No–unless a doctor participates in the suicide with heavy palliative interventions. But even then, VSED committers can always change their minds.

That would not be true of a nursing home patient from whom food and water was withheld. Of course I understand that no one wants to go through Alzheimer’s. Of course I understand the grief families feel and the many sleepless nights caused by having a beloved stricken with this dread affliction.

But life is what it is. We should mitigate suffering as much as we can, but there are just certain lines that must not be crossed, both because others could be victimized–ever hear of elder abuse?–and because some acts and omissions are inherently wrong. 

On a more practical level: How many nursing homes would close their doors if the operators–many of which are religiously focused–knew they would be forced to starve some of their patients to death? 

How many loving and caring people would opt out of dedicating their lives to the people who live and are cared for in such facilities rather than risk killing their patients by a means that would now be branded criminal neglect, at best?

And no more of people saying that I don’t know what it is like to have people I love suffer. My mother died of Alzheimer’s in my home last year. My uncle died of it several years ago. Believe me, I know what Alzheimer’s is like, up close and personal!
Categories: Discussion

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Marie Stopes International: carrying out unsafe abortions in the UK and across the globe, using taxpayer millions

Christian Medical Fellowship - Fri, 2017-08-18 11:33

For the past five years, the charity Marie Stopes International (MSI) has been given £163 million in UK taxpayer money to spend on abortions in developing countries. This money also went on helping to liberalise laws on abortion. No other country gives as much money to MSI than our own Department for International Development (DFID).

MSI is one of the main providers of abortion in England, but most of their business is to provide contraceptives and abortions in developing countries in order, they claim, to reduce the number of ‘unsafe abortions’ in developing countries and to reduce maternal mortality rates.  In 2016, they said they have ‘averted 7.6 million unintended pregnancies’. (ie carried out 7.6 million abortions).

Not only is this flawed reasoning for increased abortion provision, we have to ask if MSI can be trusted to carry out ‘safe abortions’ across the globe.

MSI abortions in the UK

It is hard to find out facts and figures. Data collection is very poor on abortion follow up in the UK. Even the RCOG acknowledges that there is ‘a lack of standardisation in reporting which hampers collection of accurate data.’ Private abortion providers do not record NHS numbers so health events cannot be linked to a prior abortion. In other words, many complications are missed off records and not collected by Government stats so we have no accurate figure of how many complications post abortion there are nationally.

Bearing that in mind, unannounced inspections of MSI clinics give us an indication of some of the outcomes of abortion. A highly critical Care Quality Commission (CQC) inspection report published in December 2016 found major safety flaws at MSI clinics, with more than 2,600 serious incidents reported in 2015. Now MSI has again hit the headlines here (and here) with news that they carried out nearly 400 botched abortions in just one month, earlier this year.

The latest report found:

  • 373 abortion failures in one month
  • 12 emergency transfers from MSI clinics to NHS hospitals in a two month period
  • One recorded case where consent was given after the abortion had taken place
  • Employment of an unregistered nurse
  • Significant concerns with staff training, procedures, oversight of care, leadership and evaluation of equipment quality

One can only guess at what is happening in clinics where there have been no unannounced inspections.

This is happening in UK clinics, under relatively strict health and safety rules and regulations. Yet the irony of claiming to reduce unsafe abortions in developing countries while carrying out hundreds of unsafe abortions in the UK is probably lost on the provider of a significant proportion of MSI’s income, DfID.

DfID funding for 6 million abortions a year abroad

 In a Parliamentary answer Alistair Burt MP, Minister of State for International Development says: ‘By helping the world’s poorest women access modern contraception, we will prevent an estimated 6 million unintended pregnancies and 3 million abortions on average each year.’

 But even that is not enough.

Priti Patel, the Secretary of State for International Development, recently pledged an extra £225 million a year for family planning ‘aid’ for the next five years, including on ‘safe abortions’, up to a total of £1.1 billion. Much of this money goes directly to MSI.  How is it spent?

MSI abortions globally

Between 2011-2106 DfID gave nearly £100 million to one specific project called Prevention of Maternal Death from Unwanted Pregnancy (PMDUP), run by MSI and close partners. This money went to 14 counties across African and Asia with three of the four targets being to:

  • Train over 12,000 health care workers in comprehensive abortion care
  • Provide nearly 5,500 more service delivery sites
  • Support locally led changes to the regulatory and/ or policy environments for abortion services at national level and across the Africa region
  • A review of the project outcomes in 2015 reported that they had prevented 1.9 million ‘unintended pregnancies’ (read abortions) while in 2014 they prevented 1.4 million in these 14 countries.

Not only that, they also targeted and measured the number of ‘disability life years saved (their words, their metrics).  In 2015 this was 1.5 million and 2014 it was 1.2 million in 14 countries.

I find all these shocking statistics.

We talking about millions of lives lost and mothers harmed, using our money. I also find the language of ‘disability life years saved’ (a term I have not seen used elsewhere) incredibly offensive and the numbers very sad.

Then there are the MSI targets to liberalise abortion laws in Africa and Asia, again, funded by us. MSI ‘encourages’ countries to make policy changes (which of course gives them more ‘business’ and helps achieve higher target numbers of abortions).  As a consequence of this campaigning, eleven countries reduced restrictions on access to abortion or increased their own funding for abortions, and five regional declarations ‘adopted progressive language’ across the African region.

Here are a few quotes from one annual PMDUP report illustrating how UK taxpayer money is used to push deliberately for legal changes on abortion in Africa and Asia:

  • MSI is ‘…proactive in all countries seeking Government money for reproductive health services.’
  • Advocacy for legal reform continued in Malawi…’
  • ‘It is appropriate that PMDUP are proactive in all countries seeking options for government financing of reproductive health services.’
  • MSI report success in ‘…directly influencing decisions by policy makers to allow expansion of services.’

Will this reduce illegal abortions and maternal mortality?

Again, facts and figures are hard to ascertain. Illegal abortions undoubtedly take place in developing countries but I suspect that the actual numbers are significantly below WHO estimates. A useful catalogue of known abortion statistics on line is that of William Johnston who challenges official figures here because of incomplete reporting.

As for maternal mortality, I explored this here in more detail. Research in Mexico where abortion legislation varies from State to State (and thus provides a unique scenario to test its effects) found that:

  • Permissive state abortion laws do not reduce maternal mortality and morbidity
  • States with restrictive abortion laws have lower maternal mortality and morbidity rates

While the research showed a clear correlation between restrictive laws and lower maternal mortality the authors did not claim this was necessarily a cause. Instead they said lower maternal mortality was best explained by literacy, maternal health care, obstetric care, sanitation and clean water.

However we cannot ignore the effect of abortion legislation, as the example of Chile shows. Strikingly, after abortion became illegal in 1989 in Chile, deaths related to abortion continued to decrease. A tighter law reduced deaths.

 The best way to transition towards low maternal mortality rates in developing countries is to address other factors – maternal healthcare, trained birth attendants, water, sanitation and women’s literacy etc. As Nigerian Obianuju Ekeocha says: ‘My lifeline out of poverty was education.

It is not through a lucrative, unsafe, abortion trade, whose leading beneficiaries are paid more than government ministers from a shrinking health budget, operating under the protection of a bestowed charitable status, funded by us.



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