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The Point Blog – January 2013

January 10, 2013

By Al Weir, MD, John Whiffen, Susan Rutherford, MD

Article #1

Excerpted from "Study finds spiritual care still rare at end of life," Chicago Tribune, by Kathleen Raven. December 26, 2012--Physicians and nurses at four Boston medical centers cited a lack of training to explain why they rarely provide spiritual care for terminally ill cancer patients - although most considered it an important part of treatment at the end of life. "I was quite surprised that it was really just lack of training that dominated the reasons why," senior author Dr. Tracy Balboni, a radiation oncologist at the Dana-Farber Cancer Institute in Boston, told Reuters Health. Current U.S. palliative care guidelines encourage medical practitioners to pay close attention to religious and spiritual needs that may arise during a patient's end-of-life care. However, the 204 physicians who participated in the study reported providing spiritual care to just 24 percent of their patients. Among 118 nurses, the figure was 31 percent. The 69 patients with advanced cancers who took the survey reported even lower rates, saying 14 percent of nurses and six percent of physicians had provided them some sort of spiritual care.

Past research has shown that spiritual care for seriously ill patients improves their quality of life, increases their overall satisfaction with hospital care and decreases aggressive medical treatment, which may in turn result in lower overall health spending. "I think we are realizing we can no longer ignore this aspect of care," said Ferrell, a professor of nursing who was not involved in the new study. Yet the reasons why spiritual care is rarely incorporated into patient treatment and dialogue have been poorly understood. To gain more insight, Balboni and her colleagues designed a survey - the first of its kind, to their knowledge - to compare attitudes toward spiritual care across randomly chosen patients, nurses and doctors in oncology departments at four hospitals. The questions were geared toward identifying barriers preventing healthcare professionals from delivering spiritual care, beginning with whether anyone felt it was inappropriate for them to be doing so.


Commentary #1

Director of Hematology/Oncology Fellowship and Past President of CMDA Al Weir, MD: “I have followed Dr. Balboni and Dr. Puchalski for a number of years and am grateful for their scientific effort.

"What have they taught us? It is clear from their work and the work of others that:

  1. Religious practices such as regular prayer and church attendance are associated with improvement in many health outcomes.
  2. The majority of patients in the United Sates would like for their doctors to address their spiritual needs.
  3. A small minority of doctors actually does so.
  4. The first step in addressing spiritual needs is to take a patient’s spiritual history.
  5. Those who have been trained to address the spiritual needs of their patients are far more likely to do so.

"This information is well established and provides a rational motivation for addressing the spiritual needs of our patients.

"As Christian doctors, we also have a revelational motivation to bear witness for Christ with our patients. God has revealed to us through Scripture that we shall be His witnesses. So, whether we choose science or Scripture, we need to get about doing the work we have been assigned.

"A lack of training may be your concern, as in this study. If so, I’ve got good news for you. This year, Christian Medical & Dental Associations is introducing a new evangelism curriculum titled Grace Prescriptions. It is a major update on the popular Saline Solution curriculum introduced more than 10 years ago. For more information, call 888-230-2637."


Article #2

Excerpted from "Expanding euthanasia," One News Now, by Charlie Butts. December 28, 2012--Belgium is on the brink of expanding its euthanasia program with a new proposal that will allow minors to commit suicide with medical assistance. Socialist party leaders are also hoping to permit people with Alzheimer's and dementia to do the same. Alex Schadenberg of the Euthanasia Prevention Coalition says the situation in Belgium is indeed deteriorating.

"Recent studies have shown that 32 percent of the euthanasia deaths are done without requests, that only 52 percent of the euthanasia deaths are actually reported, [and] they found that nurses are doing euthanasia, even though the law specifically prohibits it," he reports. Furthermore, couples are permitted to kill themselves when one has a terminal illness and the mate wants to die with him or her. But Schadenberg is especially disturbed by the reasoning behind allowing children to gain medical assistance to die. "It's basically because some children who are born with disabilities … they would say that these children are better off dead. So, what we'll do is since some cases are probably already doing this already anyway … we might as well just legalize this or allow that within the law officially," the pro-lifer relays. "In the case of dementia and Alzheimer's -- well, the fact of it is these people are expensive, and it's much cheaper just to kill them."

While he recognizes that may seem crass, Schadenberg laments it is reality in Belgium. Meanwhile, not one physician has been prosecuted, "although authorities know the law is being violated."


Commentary #2

CMDA Lifetime Member and State Representative Susan Rutherford, MD: “As an obstetrician without end-of-life care expertise or ethics training, I began learning in 2008 about the dangers of euthanasia and suicide when Washington state legalized physician-assisted suicide.

"The 'option' morphs into an obligation, a recipe for elder abuse. Our law, like Oregon’s, hides actual practice, but in Europe where laws permit euthanasia, extralegal non-voluntary euthanasia is well documented. There is also constant pressure to expand the laws, justified by 'it is done anyway.' That gave the Netherlands the pediatric euthanasia Groningen Protocol for 'severely ill newborns.'

"News of a proposal in Belgium to institute a legal process for euthanizing certain children and people with dementia and to force nonparticipating doctors to find and refer to prescribers of death is another stanza in the constant advocacy clamor for death on demand and death for the 'non-productive.' Note that lip service to 'children who want this' quickly changes to 'or the parents.'

"Considering the global context of sin, the Bible clearly describes the truth that people whose behavior is depraved want company in their practices and affirmation of such choices (Romans 1:28-32). In a more narrow application to medicine, induced death runs contrary to the currents of patient safety and quality care of the whole person. Cutting corners (justified by expense and manpower demands) results in the normalization of deviance.

"As Christian physicians, let us be faithful to our patients and their families and put forth the effort to truly care for them. Let us work to protect each fragile and vulnerable person from coercion unto death and thus glorify God, who created every one of us in His image."


Article #3

Excerpted from "Condoms for free at 22 city schools," Philly.com, by Kristen A. Graham. December 24, 2012--Over the holiday break a third of Philadelphia high schools installed clear plastic dispensers chock-full of free condoms. The dispensers were placed in the 22 high schools whose students had the highest rates of sexually transmitted diseases, and condoms will be available to any student - so long as their parents did not sign a form opting them out of the program.

It's a pilot designed to address "an epidemic of sexually transmitted disease in adolescents in Philadelphia," said Donald F. Schwarz, the deputy mayor for health and opportunity. Since April 2011, the city has given away about four million condoms, and now, STD rates are falling. Some city high schools - the dozen that have "health resource centers" - already dispense free condoms. And the Health Department also provides them at city high schools when they go in to test teens for STDs, as they do every year voluntarily with a parent's consent.

"I support the policy strongly," said Mayor Nutter. "This is a serious public health matter." In an email to nurses, Philadelphia School District officials said that the dispensers would be installed "just inside the doorway near the entrance to your office" and that nurses were not to be charged with managing access. "Opt-out letters are to be maintained by the school office," Assistant Superintendent Dennis W. Creedon wrote. "Students are to honor the wishes of their parents. If a student disrespects their guardian's directive then that is an issue of the home." Still, Peg Devine, school nurse at Lincoln High - which is not a participant in the pilot program said, "I just can't imagine the parents of a 14-year-old being happy with this."


Commentary #3

CMDA Lifetime Member and Medical Director at National Physicians Center John Whiffen, MD: “Sadly, the public school system in Philadelphia has decided to place clear plastic dispensers full of condoms in 22 high schools where the rates of sexually transmitted diseases are highest. While this effort is, no doubt, well intentioned, it is unlikely to have the desired effect.

"Throughout the last 40 years, we have seen a rapid rise in the number of sexually transmitted diseases while simultaneously promoting 'safe sex' as a way to combat it. When I was in medical school in the 1960s, there were only three common STDs, all of which were treatable. Now we have more than 40 diseases, many of which have no effective medical treatment because they are viral.

The predictable outcomes of this new effort to provide condoms to teenagers are as follows:

  1. The students will feel that sexual activity is okay according to the adults in their schools.
  2. Socially immature students will have a harder time refusing sexual advances since they will be unable to use their fear of STDs as a reason to avoid sex.
  3. Sexually active students will have more sexual encounters since the barrier has been lowered.
  4. The increased number of sexual encounters will increase the number of STDs. Many STDs are not prevented, or only partially reduced, by the use of condoms.

"These well meaning adults will then be confounded by the failure of their program to help the students in their charge. A realistic discussion of the physical, emotional and moral risks of premarital sexual activity would be far more helpful and appropriate."

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