As mentioned here yesterday, Idaho will sue to stop Obamacare’s mandatory purchase provision.  Virginia’s bill, soon to become law, in effect, opts its citizens out of the mandatory purchase requirement altogether.  From the story:

The Virginia General Assembly [official website] on Wednesday passed a bill [text, PDF] that will ban any federal mandate for individuals to have health insurance. The bill, called the Virginia Health Care Freedom Act, is the first of its kind [WP report] passed by any state, and says that no individual shall be held liable if they refuse to sign up for health care. Governor Robert McDonnell [official website] has said that he will sign [WTVR report] the bill into law. About 30 other states are working on a similar measure to negate [ALEC report] the widely expected federal mandate for health insurance.

Adding to Obamacare’s woes, the VA Attorney General is also threatening to sue if the “Slaughter Rule” is used to pass the bill without actually voting on it.  From the AG’s letter:

Dear Speaker Pelosi: I am writing to urge you not to proceed with the Senate Patient Protection and Affordable Care Act under a so-called “deem and pass” rule because such a course of action would raise grave constitutional questions. Based upon media interviews and statements which I have seen, you are considering this approach because it might somehow shield members of Congress from taking a recorded vote on an overwhelmingly unpopular Senate bill. This is an improper purpose under the bicameralism requirements of Article I, Section 7 of the U.S. Constitution, one of the purposes of which is to make our representatives fully accountable for their votes. Furthermore, to be validly enacted, the Senate bill would have to be accepted by the House in a form that is word-for-word identical (Clinton v. City of New York, 524 U.S. 417 (1998)). Should you employ the deem and pass tactic, you expose any act which may pass to yet another constitutional challenge. A bill of this magnitude should not be passed using this maneuver. As the President noted last week, the American people are entitled to an up or down vote.

President Obama and his team badly lost the political debate over Obamacare, but are hell bent to pass their bill anyway–regardless of the political cost to the Democratic Party and the even greater harm it will cause to the country’s social fabric.  They are recklessly sowing discord, division, and dissension, which will yield years of political and legal strife.

Obamacare would require each and every one of us buy private health insurance unless we are covered by our employers. That sure seems unconstitutional to me.  While the Feds certainly have the power to regulate commerce among the states, I don’t think they have the power to require it.

Laws with suspect provisions generally result in litigation.  (We lawyers always win.)  Such a legal challenge is now certain if Obamacare passes.  Idaho just enacted a law requiring its attorney general to sue to invalidate the must-purchase provision.  If that happens, Obamacare collapses of its own weight.  From the story:

Idaho took the lead in a growing, nationwide fight against health care overhaul Wednesday when its governor became the first to sign a measure requiring the state attorney general to sue the federal government if residents are forced to buy health insurance. Similar legislation is pending in 37 other states.

Constitutional law experts say the movement is mostly symbolic because federal laws supersede those of the states. But the state measures reflect a growing frustration with President President Barack Obama’s health care overhaul…Democratic leaders hope to vote on it this weekend. With Washington closing in on a deal in the months-long battle over health care overhaul, Republican state lawmakers opposed to the measure are stepping up opposition. Otter, a Republican, said he believes any future lawsuit from Idaho has a legitimate shot of winning, despite what the naysayers say. “The ivory tower folks will tell you, ‘No, they’re not going anywhere,’ ” he told reporters. “But I’ll tell you what, you get 36 states, that’s a critical mass. That’s a constitutional mass.”

Sometimes federal law supersedes state law, but not if it is unconstitutional.  And Gov. Otter is right: If most of the states sue to kill this bill–and the Virginia Legislature has passed a similar measure already–I believe it will ultimately kill the bill even if it is enacted.

What a debacle.  If the bill passes, the public fury will grow more intense, not go away as Pelosi/Obama/Reid hope.  Sometimes discretion is the better part of valor.  All of us would be better off if they put Obamacare aside and tried a more balanced approach to needed health care reform.

I have long thought that bioethics is something of a pseudo field. Not that the matters with which it grapples are not important.  They are crucial.  And not that its thinkers are not morally serious–they are. But it has always seemed to me that bioethics lacks focus, e.g., that there is no bottom line goal or purpose that bioethics seeks to attain.

For example, the guideposts for bioethical analyses were established early, e.g., autonomy, beneficence, distributive justice, and non maleficence. But without a fundamental destination toward which these principles are to be applied, they became mere outcome justifiers. In other words, rather than derive the opinion by applying the principles to best attain the desired end, the opinion often comes first and then the best principle that justifies the predetermined conclusion is harnessed to defend it.

Now, an article written by University of Minnesota bioethicist Leigh Turner in the Journal of Medical Bioethics asks the pithy question, “Does Bioethics Exist?” and reaches a similar conclusion to my own.  From her column (no link, here’s the Abstract):

What is clear, though rarely “acknowledged, is that as bioethics has acquired academic standing, institutional authority and public visibility, just what constitutes “bioethics” is becoming increasingly murky. In a sense, bioethics–if by bioethics is meant a shared mode of normative analysis, a common way of thinking an averarching framework for moral deliberation, a recognised set of tools with which to reason and debate or a widely accepted ethics decision-making–does not exist.

This leads to intellectual chaos (if you will) in the field:

Although an increasing number of individuals make their living as bioethicists, there is no recognizable, widely shared, common moral philosophy that bioethicists draw upon to resolve moral disputes. There is no common creed, widely accepted method of moral reasoning or normative theory, or practical body of wisdom that binds together bioethicists. Within the halls of academe, it is just as possible to establish a successful career as a utilitarian or libertarian as it is publishing and teaching as a neo-Kantian, Rawlsian, virtue theorist, casuist or proponent of natural law. We are well past the time when the “principles of biomedical ethics” [the title of the premier bioethics textbook] provided a common reference point for addressing ethical concerns.

I don’t think it did then, but Turner’s point is right. And she asks:

…does bioethics exist as something other than a loosely connected assemblage of conflicts over norms, principles, practices and policies?…If bioethicists cannot provide thoughtful, persuasive responses to such questions, they might find the expansionist phase of bioethics is replaced by an era of retrenchment and decline.

That is to be urgently wished.  Because while I agree with Turner that bioethics has become more heterodox in the last decade, and hence more chaotic, I disagree with her that there isn’t an over arching belief among its most influential members–and that is opposition to human exceptionalism.  As a consequence, their “expert” opinions–rendered in courts, on government panels, while giving testimony in front of legislative bodies, in teaching the doctors, nurses, and societal leaders of the future in our most prestigious universities, etc.–often push society toward policies that promote the actual or potential exploitation and/or oppression of the most weak and vulnerable among us.

This is why I advocate laws that would set the goal of bioehtical analyses as protecting and promoting intrinsic human dignity–the point of my speech to the United Nations International School.  That would anchor bioethics, give it a beneficial direction, and promote universal human rights. Do that, and the bioethics movement would be rendered less capable of promoting harmful policies that threaten those who are most in need of society’s and medicine’s protection than it is today.

Animal rights activists would never stop screaming if the actions they take were directed against them.  They demand the right to free speech–which some activists expand beyond recognition to include threats, intimidation, and even bombings–but have little problem with denying it to those with whom they disagree.  Thus PETA refuses to condemn ALF, even when it plants pipe bombs under animal researchers’ cars–equating the terrorists with the Underground Railroad and the French Resistance on its Web site. This is particularly true of the “direct action” types, the ALFs, SHACs, who are closely allied with anarchists.  I call this the “tear down” arm of the animal rights movement, because it certainly is not interested in building up.

A good illustration of the double standard happened here in San Francisco when an ex vegan was pied at an anarchist book store reading of her book.  From the story:

An ex-vegan who was hit with chili pepper-laced pies at an anarchist event in San Francisco said Tuesday that her assailants were cowards who should direct their herbivorous rage at the powerful – not at a fellow radical for writing a book denouncing animal-free diets. Lierre Keith, a 45-year-old Arcata resident, was attacked at 2:15 p.m. Saturday at the 15th annual Bay Area Anarchist Book Fair while discussing her 2009 book, “The Vegetarian Myth.” A 20-year vegan, Keith now argues that the diet is unhealthy and that agriculture is destroying the world. As Keith stood at a lectern at the Hall of Flowers in Golden Gate Park, three people in masks and black hooded sweatshirts ran from backstage, shouted, “Go vegan!” and threw pies in her face. While they fled, some in the audience cheered or handed out leaflets.

That was an assault and battery.  Alas, being victimized did not teach Keith that it is wrong to engage in lawlessness against people with whom one disagrees:

Keith said her values are similar in most ways to those of her attackers. She believes in militant action, even property destruction, if it can lead to change. In her book, she said, she railed against factory farming and promoted the restoration of prairies and forests. “It’s insane. My entire book is about how the world is being destroyed,” Keith said. She said the first pie hit her just after she uttered the sentence, “You should not eat factory-farmed meat.” Among those rejoicing in the pie attack was the North American Animal Liberation Press Office, which often prints communiques from activists taking credit for attacks on animal researchers. The group said Keith was wrong about veganism, referred to her as an “animal holocaust denier,” and scolded her for calling the “agents of state oppression” – the police.

This is as much the face of animal rights as pretty models posing nude to protest fur.  Rather than being distinct, I am convinced that the movement is one organism, like an octopus, with PETA’s edginess one arm, ALF’s violence another arm, and HSUS’s lawsuits and legitimate political advocacy, a third arm, etc.. That point aside, Keith’s nihilism is so thick that even after becoming a victim, she doesn’t have it in her to condemn lawless tactics against people based on differences of opinion.  She just wants these tactics directed at someone else.  Typical.

The warning sirens are blaring, but will we listen?  Centralized health care planning doesn’t work.  In the UK, the NHS hospitals have an abysmal record on something as basic as hygiene. From the story:

A quarter of health trusts failed to meet standards over hospital infections while five were warned over blood-spattered walls and mouldy instruments under a toughened regulatory regime, the Guardian has learned. Of particular concern was the state of ambulances, which were inspected for the first time. Investigators found dirty forceps stored in some vehicles as well as bloodstains…

The reasons for failure were worrying: 36 trusts were not providing areas to decontaminate instruments; in three trusts there was a failure to regularly flush unused water outlets – crucial for the control of legionella infections; and 13 trusts were criticised for not keeping clinical areas clean. Nigel Ellis, the CQC’s head of national inspection, said: “Good infection control takes constant vigilance – and meeting that every day, for every patient, is an ongoing challenge for the NHS. “We have found evidence of a direct risk to patients and have intervened using our new enforcement powers to ensure swift improvements were made.”

I am tempted to profanity. I am a writer–and a lawyer–word usually do not fail me. But I am at a loss…

In the USA, we have the Joint Committee–a private accrediting organizations the inspections of which are stringent and thorough.  We have federal oversight, state departments of health, and lawyers ready to sue at the drop of a hat, etc.,, all of which work together to keep our hospitals generally on the up and up.  But you accept centralized planning–which is where Obamacare is intended to take us eventually–and you get the NHS.

This is very alarming.  A survey–published in the New England Journal of Medicine!, not a conservative blog site–found that huge numbers of doctors worry they will be forced–or will want–to leave medicine if Obamacare passes.  From the story:

Health Reform and Primary Care Physicians
• 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

That’s a frightening number. If only 20%-25% of primary care physicians actually leave medicine–half the number projected in the survey–we are in bigger trouble than we can begin to imagine. This survey, if nothing else, should stop the bill in its track.

The study also shows how badly Obamacare supporters have lost the debate among physicians (closely tracking the popular numbers):

Physician Support of Health Reform in General
• 62.7% of physicians feel that health reform is needed but should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in legislation.
• 28.7% of physicians are in favor of a public option.
• 3.6% of physicians prefer the “status quo” and feel that the U.S. health care system is best “as is.

It’s not too late to turn back. If this debacle passes–particularly if the House tries to pass the Senate Bill without voting on it–it will tear this country into jagged pieces.  But there is still time for sanity to prevail by moderating course and searching for more targeted and broadly supported reforms.

President Obama, Speaker Pelosi, and Leader Reid have driven this country to the brink of crisis in their obsession to give the government substantial control over American health care.  The continuing comity of our civil society–and perhaps our ability to find a doctor–may literally be at stake in what happens in the next week.

Regular readers of SHS will recall that I was honored to be asked by the United Nations International School to lecture at a two day bioethics conference it held for about 700 students from all around the world.  My theme was the importance of intrinsic human dignity in bioethics.

Part of the speech is now being streamed at the UNIS site.  It begins about half way through my presentation.  The part that is missing concerned the stakes of the debate in bioethics over human intrinsic dignity, as set forth quite candidly in a paper published in Bioethics arguing for an “undignified” bioethics, a paper that I discussed here.

The first question, by the way, was an adult adviser who sat in the front row.  She was later told to let the students ask questions. In that regard, the students were very impressive and asked excellent questions.  Hope!

In any event, if you want to see me tub thump for human exceptionalism in bioethics, here’s the link.

Good grief what next?  I posted previously that two courts found no connection between autism and childhood vaccines. But integrity requires that I now post  about the latest twist in that ongoing controversy: One of the premier scientists involved in finding no link is now immersed in a serious financial scandal. From the story:

A Danish scientist involved in two major studies that debunked any linkage of vaccines to autism is suspected of misappropriating $2 million in U.S. grants at his university in Denmark. Poul Thorsen, a medical doctor and Ph.D., was an adjunct professor at the Drexel University School of Public Health for several months before resigning Tuesday. On Jan. 22, Aarhus University said that it had uncovered a “considerable shortfall” in grant money from the U.S. Centers for Disease Control and Prevention for a research program that Thorsen had directed. The university referred the matter to police, who are conducting an investigation.

Those who believe that vaccines can cause autism believe this undermines the science:

Anti-vaccine groups have seized on the allegations to contend that scientific studies disproving the vaccine link to autism are wrong. Those groups have long argued that thimerosal, a preservative in some vaccines, can cause autism, as can the MMR vaccine for measles, mumps, and rubella. “I think it is quite significant,” said Dan Olmsted of the Age of Autism. “I think someone allegedly capable of ripping off his own university by forging documents from the CDC is capable of pulling off anything.”

The CDC says the science isn’t in dispute:

The CDC and coauthors of the two studies published in major U.S. medical journals maintain the studies remain valid. “CDC is aware of the allegations by Aarhus University against Poul Thorsen,” agency spokesman Tom Skinner said in a statement. Federal authorities are investigating. Skinner noted that Thorsen was one of many coauthors on peer-reviewed studies looking at autism, cerebral palsy, Down syndrome, and alcohol use in pregnancy. “We have no reason to suspect that there are any issues related to the integrity of the science,” Skinner said.

If these charges are true, it is calamitous, because it becomes impossible to put the issue to bed, even if the science is iron clad.

It is important for children to be protected against serious childhood diseases.  Parents need to know that vaccines are safe. Corruption and venality in science is particularly harmful because it undermines the sector’s overall credibility–with the potential of causing very real human harm.  More when I know more.

For years, we heard that if only the Bush funding restrictions were removed, ESCR would quickly demonstrate its promise of curing the multitudes.  Well, it’s been a year since the Bush executive order was revoked.  But are “the scientists” happy?  Not on a bet. From the story:

One year after President Obama announced he was lifting his predecessor’s controversial restrictions on federal funding for human embryonic stem cell research, some scientists are complaining that so far the new policy is — ironically — more of a burden than a boon to their work. “The situation at the moment is worse than it was under the Bush administration,” said Charles Murry, a professor of pathology and bioengineering at the University of Washington in Seattle. “Because of this, we are going to waste a lot of time.”

What!? And the problem is?

So far, the NIH has approved 43 lines. But that includes only one of the original 21 “Bush” lines. An additional 115 lines are awaiting review. But that includes only two more of the original lines. “We’re losing access to those lines in this approval process for some period of time — maybe indefinitely,” Kamp said. “They are the main workhorses for many of our projects.”

But we were told for years that those lines were not really very useful.  Now, they were the “workhorses.”

ESCR researchers had more than $2 billion to work with in private and public resources during the Bush years, with very few ethical constraints.  They complained anyway.  President Obama gave them almost everything they wanted, and they are still not happy.  I suspect that unless and until they receive a complete blank check–both financial and ethical (and not just in the biotech field)–we will hear nothing but moaning–perhaps even then.  Cry me a river…

The Washington Posthas a story about a pilot program to identify donatable organs from the cadvers of people who die in emergency rooms. From the story:

Using a $321,000 grant from the Department of Health and Human Services, the emergency departments at the University of Pittsburgh Medical Center-Presbyterian Hospital and Allegheny General Hospitalin Pittsburgh have started rapidly identifying donors among patients whom doctors are unable to save and taking steps to preserve their organs so a transplant team can rush to try to retrieve them. Obtaining organs from emergency room patients has long been considered off-limits in the United States because of ethical and logistical concerns. This pilot project aims to investigate whether it is feasible and, if so, to encourage other hospitals nationwide to follow. So far, neither hospital has yet gotten any usable organs. “This is about helping people who have declared themselves to be donors, but die in a place where donation is currently not possible,” said Clifton W. Callaway, an associate professor of emergency medicine at the University of Pittsburgh who is leading the project. “It’s also about helping the large number of people awaiting transplants who could die waiting because of the shortage of organs.”

The organ shortage is real and we should do what we can–within proper ethical parameters–to shorten waiting times. But, as the old saying goes, the devil is in the details.  The questions about this approach are real and substantive:

One concern is that under the program, doctors will take organs from people who have agreed to become donors by checking off a box on their driver’s license or by signing up on a state registry, and will not seek a family member’s consent if one is not present. “The problem is there’s no real informed consent in driver’s license designations,” said David Crippen, an associate professor of critical-care medicine at the University of Pittsburgh. “The computer asks, ‘Would you like to be a donor — yes or no.’ . . . Many people may be consenting to something that they really don’t understand.”

Some experts worry that the practice could send subtle signals to doctors and nurses that could influence how hard they work to save patients. “When you do this stuff in such close proximity to treating the patient, the people in the emergency room will quickly start to think, ‘This is a potential organ donor,’ even when they are treating the patient,” said Michael A. Grodin, a medical ethicist at Boston University. “People are going to wonder, if they are being treated in the ER, ‘Are the transplant people going to swoop down to get my organs?’ “

Imagine the paranoid questions that could arise in the minds of grieving loved ones in such circumstances–particularly if “presumed consent” ever became law, that is, we would all be donors unless we explicitly opted out. On the other hand, the plans proponents assure us that such concerns would be prevented:

The project’s organizers have taken several steps to address the concerns, Callaway said. No one will check whether a patient is an organ donor until after the patient has been declared dead, he said. The medical personnel involved in trying to save patients will be completely separate from those involved in obtaining their organs. “If I were simultaneously given the task for being part of the transplant team, and that was in the back of my head, I might have some conflicting priority that your death may benefit someone else,” Callaway said.

But many questions remain:

Some critics question whether patients pronounced dead in the emergency room meet the official criteria for organ donation, or whether there are enough safeguards in place in case someone pronounced dead unexpectedly revives — which can happen, though very rarely…”There’s no consensus regarding how long CPR must be performed before death is determined as irreversible. In other words, when in the resuscitation process does the patient transition from being treated as a patient to a donor?” Whetstine asked. “Are such patients really dead after resuscitation efforts end and after a time interval of two minutes of cessation of circulation elapses?”

But Callaway dismissed any suggestion that the patients technically may not be dead. Only patients for whom everything has been done, and who it is clear cannot be revived, will be considered, he said. “This is donation after cardiac death. No heartbeat. No breathing. Dead. Clinically dead. There is an unambiguous death,” he said.

That’s the key. I don’t know enough about this pilot program to express an opinion.  If it could be done ethically–people who clearly had consented to donation, who were medically treated properly, and only had organs procured when there was no question of death–it might work.

 But these are trecherous waters. The trust of the public in organ donation is very much at stake in this pilot program. I hope its overseers tread very carefully and conservatively.