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The Point Blog – April 2013

April 11, 2013

By Jeffrey Newswanger, Susan Giles, MD, W. David Hager, MD

Article #1

Excerpted from “Connecticut sets aside bill on assisted suicide, for now,” Associated Press, by Stephen Kalin. April 5, 2013 -- A high-profile bill to allow physicians to help dying patients end their own lives was set aside Friday to preserve other proposals that lawmakers considered too vital to risk. Legislators also had concerns about whether the bill, which will be reintroduced during the 2014 session, had enough safeguards to ensure patients’ end-of-life decisions would not be made imprudently. Sen. Jason Welch, R-Bristol, said he supported changes that would have required multiple medical opinions and several waiting periods. But he ultimately opposed the bill, he said, out of concern that protections for the chronically ill were too few and too weak.

The bill would have made Connecticut the fourth state in the country, after Oregon, Washington and Montana, to allow assisted suicide. ‘‘I do think it’s a discussion absolutely worth having,’’ said Rep. Elizabeth Ritter, D-Waterford, one of the bill’s proponents. The Rev. Douglas Peary, president of the Unitarian Universalist Society in Meriden, said at a hearing that his wife begged him to bring her home from the hospital at the end of her life. His father and sister also died after long battles with cancer, he said. ‘‘We are here for the dying,’’ he said. ‘‘We’re not trying to kill people. We want people just to have the choice to stop their pain when they’re dying.’’ Peary said the key to winning support was more education, and compared the issue to the civil rights and gay rights movements.

Welsh also objected, he said, because ‘‘it’s bad public policy’’ for the state to sanction suicide under any circumstances. He suggested it would lead to higher suicide rates in general.


Commentary #1

CMDA Member Susan Giles, MD: "'Do your best to present yourself to God as one approved, a workman who does not need to be ashamed and who correctly handles the word of truth' (2 Timothy 2:15 NIV 1984). These words came alive to me with my recent experience in testifying against a proposed physician-assisted suicide (PAS) bill (euphemistically known as 'compassionate aid to the dying') before Connecticut’s Public Health Committee. To date, I had not been politically active, but upon hearing of the bill’s stealth presentation in my own state, my conscience called me to action just days before the public hearing took place. I hope that my story will convince those of you who have never done so that you too can advocate for what is right in the public arena. After a crash course in civics and familiarizing myself with the helpful ethical resources on CMDA’s website, I wrote my testimony. The nearly 13 hours of public hearing prior to my speaking gave me perspective that the opposition has a very earnest, poignant and human face, yet their arguments are fear-driven and based on the quest for unmitigated self-determination. I was one of only a handful of physicians to testify that long day, and in retrospect, I have a deeper understanding for the credibility our profession carries; our words have clout. Thankfully, the PAS bill in Connecticut has been set side for the moment, but I am certain it will reappear in a modified version, in your state if not in mine.

"More physicians willing to speak against PAS are clearly needed. Educate yourself now on the arguments for and against such practices before a bill is quietly introduced in your state. Familiarize yourself with the data and unintended consequences from the states and countries where PAS is legal. Grapple with the admittedly difficult subset of ALS patients who fear being locked-in and burdening others more than their own pain. Improve your own practices and support others in thoughtful end-of-life decisions, advanced directives and excellent palliative care, thereby reducing the perceived need for PAS. Together we can make a difference to eradicate the notion that PAS is compassionate and dignified, and instead give hope to our terminally ill patients that we will act with integrity and be present with them in both their living and their dying.”


Article #2

Excerpted from “Federal judge rules morning-after pill must be available for women of all ages,” Fox News, April 5, 2013 -- A federal judge ruled Friday that the morning-after pill known as Plan B must be made available over the counter for women of all ages. The decision Friday by U.S. District Judge Edward Korman ordered the FDA to make the pill, commonly referred to as the abortion pill, available for all ages. The decision means that unless the FDA appeals and is granted a stay, by this time next month a teenager 16 or under could walk into a local pharmacy and buy the pill off the shelf.

"This ruling places the health of young girls at risk," said Anna Higgins of the Family Research Council. "There is a real danger that Plan B may be given to young girls, under coercion or without their consent. The involvement of parents and medical professionals act as a safeguard for these young girls. However, today's ruling removes these commonsense protections."

The Center for Reproductive Rights, which filed suit against the age restriction, and other groups have argued that contraceptives are being held to a different and non-scientific standard than other drugs and that politics has played a role in decision-making. "I think this is a landmark decision in terms of providing women and girls in the United States access to a safe and effective form of birth control," said attorney Andrea Costello with the Partnership for Civil Justice Fund. Full story can be found here.


Commentary #2

Former Member of FDA Advisory Committee for Reproductive Health Drugs and CMDA Member W. David Hager, MD: “Plan B (levonorgestrel) has been available as an over-the-counter, 'emergency contraceptive pill' since 2003. This drug may inhibit ovulation if taken just before the time of ovulation, or, as stated in the package literature, it may inhibit implantation of a fertilized ovum. In the 27-4 vote by the Advisory Committee on Reproductive Health Drugs for Women to approve OTC availability for women 17 years of age and older, our opposition to its approval was based on: lack of data on repetitive use; lack of data on safety and efficacy among younger adolescents; and concern that this pill would be used in place of daily contraceptives by sexually-active women. The drug was not immediately made available as an OTC product.

"In 2011, Secretary of Health and Human Services Kathleen Sebelius overruled the FDA decision to make Plan B available to all females regardless of age without a prescription. She based her decision on the same concerns that we had in 2003. Concern had also been raised by data from a study by Glasieriwhich showed no effect on abortion rates with advanced provision of emergency contraceptives; and from a study by Raineii which revealed no significant reduction in pregnancy rates with pharmacy access and advanced provision. Other studies have reported that subjects frequently do not take Plan B as prescribed in the package insert.

"Those of us who believe the science that supports life beginning at fertilization would be opposed to a medication that would inhibit implantation. Even if you did not believe such, however, a federal judge has now ordered that children may purchase Plan B without parental or healthcare professional knowledge. Since no prescription is required, these girls will not receive counseling to make them aware of the risks of sexually transmitted infections, pregnancy and the emotional consequences of non-marital sexual activity. They will be exposed knowingly or unknowingly to a drug that may act as an abortifacient.

"This is just another step in the calculated effort to minimize parental authority under the guise of 'decreasing unplanned pregnancies,' when the data does not support the contention that the medication decreases pregnancy or abortion rates. We have an even greater responsibility to encourage parents to inform their children of the risks that non-marital sexual activity incurs."

iGlasier A, Fairhurst K, Wyke S, et.al. Advanced provision of emergency contraception does not reduce abortion rates. Contraception 2004; 69:361-366.
iiRaine TH, Harper CC, Rocca CH, et.al. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs. JAMA 2005; 293:54-62.


Article #3

Excerpted from “North Dakota passes first state personhood amendment in US history,” Heraldonline.com, March 23, 2013 -- North Dakota House of Representatives has passed the first personhood amendment in the United States, 57-35. SCR 4009 states, "the inalienable right to life of every human being at any stage of development must be recognized and protected." Every major prolife organization in North Dakota has joined forces to defend and endorse SCR 4009, including North Dakota Family Alliance, North Dakota Right to Life, Concerned Women for America North Dakota, North Dakota Life League, North Dakota Catholic Conference, and Personhood North Dakota.

For the first time in United States history, a legislative body has approved a personhood amendment in both the House and the Senate. Now the amendment will be referred to the people of North Dakota for a vote. SCR 4009 was written as to ensure that mother and baby are both treated as medical patients, that medical care is not inhibited, and that fertility treatments are not banned.

Keith Mason, President of Personhood USA said "This amendment strikes the balance of accomplishing more for the unborn than any other amendment the nation has ever seen, while protecting pregnant women and their right to true medical care. We applaud the North Dakota House and Senate for their willingness to protect all of the people in their state." Gualberto Garcia Jones, J.D., legal analyst for Personhood USA, continued: "The North Dakota personhood amendment takes the pro-life plank of the GOP platform and it into practice. Furthermore, it allows the legislature the needed flexibility to implement the specific protections of the right to life through future legislation."


Commentary #3

Chief of Medicine and CMDA Member Jeffrey Newswanger, DO: "North Dakota lawmakers are leading the way in a campaign to make their state the first in the Union to constitutionally guarantee 'the inalienable right to life of every human being at any stage of development.' Obviously this is a contentious issue, even in conservative North Dakota. By using the politically charged phrase 'right to life,' they may well have touched a nerve among some liberals, heating the debate even further. By necessity, the amendment leaves many questions unaddressed, most notably the definition of when human life begins.

"However, the drafters of the bill have done one thing very well. Although characterized by some as a 'personhood law,' the amendment skirts the entire personhood argument by simply focusing on protecting that which is human. Too much time and energy has been wasted arguing over what constitutes a 'person.' The argument is complicated by the fact that the term 'personhood' is used to mean wholly different things by lawyers, philosophers and the laity. The concept of personhood begs a definition based on function and abilities. Personhood arguments, therefore, open the door to admit non-humans while at the same time cutting off some humans from full participation in their birth-right as a member of the species. As Christians, we do not value human life because of what it can do, but because of the One whose image it bears. All human life, no matter how damaged, bears some remnant of its Maker's artistry. Therefore, we need to avoid surrogate arguments such as personhood and focus on preserving in our culture a sense of honor for that which is human."

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