Uechi-Ryu.com

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Life begins & ends cold, naked & covered in crap.

I think that genital mutilation is monstrous and was figuring the AAP supported a little nick as an alternative when the parents wanted to go for something horrid and drastic.

When I searched the AAP site I found this:

"The American Academy of Pediatrics:

Opposes all forms of FGC that pose risks of physical or psychological harm.

Encourages its members to become informed about FGC and its complications and to be able to recognize physical signs of FGC.

Recommends that its members actively seek to dissuade families from carrying out harmful forms of FGC.

Recommends that its members provide patients and their parents with compassionate education about the physical harms and psychological risks of FGC while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters."

http://aappolicy.aappublications.org/cg ... 125/5/1088

or

http://pediatrics.aappublications.org/c ... 010-0187v1

This policy was reaffirmed in July and appears to represent all of their policy. The offending statements can be found in the section "education of patients and families" and note that all FGC is illegal in the USA and note the pluses and minuses of benign FGC (little nicks) as an alternative to severe FGC. If you read the source it's clear they're doing adequate research and trying to protect girl's health and safety as best they can.

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--Ian

Yeah, next time I'll actually look at something like that before I post here. So WTH are these activists going on about?

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Life begins & ends cold, naked & covered in crap.

http://www.businessweek.com/lifestyle/content/healthday/642525.html

Ian, how do you think your religious/philosophical beliefs impact your decisions in this area?

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Life begins & ends cold, naked & covered in crap.

I think the activists are upset that they're permitting ANY genital nicking because it's the unjustified harming of a child and because it accepts and perpetuates the practice. I do sympathize. I don't think I could ever cut someone without their consent unless in self defense (and parental consent doesn't do it). I imagine many of these activists eagerly lop off the foreskins of their male kids, so, whatever, activists. Your cut-culture is better than theirs? Pshaw.

How do my beliefs affect end of life care? Well, I've always found this confusing to me. Recently JAMA published evidence that the religious seek more aggressive / futilre care when dying.

http://jama.ama-assn.org/cgi/content/ab ... 01/11/1140

But I don't get it; if you believe you're destined for a soft landing on a heavenly pillow, and God has made you gravely ill, then why not let go? Atheists ought to be more scared. Is it all out of a sense of obligation and the impossibility of refusing a gift God gave, a gift that's not a choice, so you have to extend your life if you can?

My approach is that torturing people (no bias, right?) with ineffective therapies at the end of life is a bad idea because 1) it's an inappropriate use of resources 2) it's dishonest not to be 100% level with the patient about their future / odds 3) I feel the issue is at some point out of our hands; if someone with survival potential codes, I'll work tirelessly, but we used to make paramedics resuscitate anyone they found until a doctor pronounced them, even if most of the head was missing. Whom does that help? and 4) it prevents people from making realistic plans, feeling their best, and dying the way they'd like.

I *will* help people of any belief system and do my best for them and understand their views differ; in some settings, doctors whose patients won't accept every single possible intervention sign off and abandon them because their fundamentalist views tell them to. Nice!

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--Ian

It's also been shown that people get more religious when they're reminded about the inevitibility of death.

My opinion is that fear of death is (one of ) the cause of religion, not so much the other way around. So it's not surprising that the religious people are more likely to take more drastic measures, given that those are also the people who are more fearful.

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- Justin Powell

So atheists are less fearful of death than, say, Muslims or Buddhists?

I think that's quite a leap of faith you've got going there.

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Life begins & ends cold, naked & covered in crap.

I believe it was the sage Kenny Chesney who said

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Glenn

I think both are fearful concerning death, but they have different fears.


Maybe the religious are more likely to try to delay death because they are inwardly fearful of what the verdict will be at their judgment

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Glenn

That comment was both funny as hell and spot on.

Maybe none of the above, Ian.

Read that very, very carefully.

First...

It has been shown that "Positive religious coping" extends life. The experts in this are at Duke University.

Religion can be a funny thing here. On the one hand... If you believe that God is loving and benevolent, then religiosity can extend your life. On the other hand if you believe God to be vengeful and you are sick because you were naughty on earth, well THAT kind of religiosity is associated with a more negative medical outcome. And when you think about it, it makes perfect sense.

Along those lines...

It stands to reason that if you are praying for a good outcome and getting all your friends to do the same, well then maybe you WANT to live. And it is the prerogative of the patient to WANT to live.

Furthermore if you have the means, well... a person then doesn't just have the right to WANT to be alive longer. They DESERVE to get evidence-based, life-extending treatment because they've paid for it via Medicare payroll taxes and quite possibly some Medicare supplemental policy.

Just thought I'd share that perspective, Ian. Sometimes one's own "religion" can distort one's perceptions.

It's worth noting that many who have paid a lifetime into the Medicare system aren't going to get their money's worth out of it because:

1) Medicare is a true Ponzi scheme. You pay now for the old (via a lifetime of payroll taxes), and hope to hell that there will be enough taxpaying citizens to pay for you when your time comes. But with the boomers, that ain't gonna happen. And...

2) Obamacare just pulled off a major Medicare cut (20 some-odd percent) to medical providers - because they could. And so now many MDs and hospitals are refusing to see Medicare patients. Isn't that lovely?

No wonder JAMA and The AMA are fretting over why people want to live longer.

But I digress.

- Bill

I worry about getting into this because I think you have objectivity issues with the subject. Of course, you think I have objectivity issues with the subject. In brief: the fact that people with positive religious coping do better than average tells us nothing about whether it is actually beneficial to adopt a religious worldview when ill, or whether that's even possible. COPING is probably a wise thing to suggest, and since most people have a fairly religious worldview in this country, even the ones that don't practice, things tend to get interpreted that way, especially under the stress of serious illness.

Another topic, then:

"Furthermore if you have the means, well... a person then doesn't just have the right to WANT to be alive longer. They DESERVE to get evidence-based, life-extending treatment because they've paid for it via Medicare payroll taxes and quite possibly some Medicare supplemental policy."

Lots and lots of things to unpack there. What do you mean by evidence based, for one? But the larger issues there is that people deserve to get any life extending treatment? Because they've paid insurance fees? There are limits to insurance. Let's say I drive my car into a newborn convention and kill 300 infants and maim 500. Will I get all liability coverage needed because I "paid for it"? No. To extend the question: what would happen if an insurance company didn't have any limits, but rather, allowed their benefits to be paid out by highly individual, mostly educated professionals with a long track record of inefficient services and causing further injury (eg, doctors), without any caps or guidance or eye toward sustainability? And if you add anyone who develops a need for car insurance by virtue of preexisting crashes, whether or not they paid, or can pay, again, with unlimited benefits, and pay for their needs out of the funds of the paying group?

Basically, first rates rise far faster than inflation then the whole thing goes bankrupt then everyone is hosed. Is that the practical thing to do? Thoughtless endless charity until failure ensues? Is it even the ethical thing to do?

I'll give you a very specific case: the progression free time extending drug vigorously endorsed by the WSJ editorialists the FDA wants to squash. Would you provide that? What if the drug extended survival (in pain with metastatic cancer) by 6 weeks, not a reach at all. Would you endorse that? How few extra days, or how much additional money, would something have to provide or cost, for you to lose interest? Or is it ANYTHING, ANY COST, if evidence based? I'm curious to know. If the stats don't sound interesting, how about another real, individual?

Mrs. Mary Anderson is 63, and has a widely metastatic cancer, which has failed first, second and third line treatment. Tumors grew through it all, and she got progressively weaker and more bed bound (too bed bound for chemo--makes things worse at a point), rapidly losing weight, scans show liver almost completely replaced by cancer with many other metastases. She comes in seriously ill, low blood pressure, with possible infection and kidney failure and is admitted to the ICU (probably inappropriate at all, per me, but difficult to stave of without prior planning). There, broad antibiotics and pressor support reverse the decline briefly, and she comes out to my service. Off pressors, she promptly begins to decline again. No specific source of infection, just appears to be dying of metastatic cancer. Confusion increases. Kidney failure is the most measurable failing organ; it becomes severe in days and unsurvivable for more than a few more. The large, loving, and involved family wants to donate their kidneys to the dying person. Or they want dialysis. They want to return to the ICU. They even want chemo. What do you do?

A) ICU, kidney transplant, chemo, the works
B) ICU, dialysis
C) offer ICU, but no dialysis
D) offer dialysis, but no ICU
E) offer maximal conservative care on the floor
F) offer antibiotics and fluids, insist on ensuring comfort, and explain that dying is unavoidable
G) explain that dying is unavoidable and transition to comfort care

This is how it really goes down. If people (or politicians) want to weigh in on costs and deaths in the USA, they should have to at least say what they would do to real individuals like Mary (not her real name). I for one am willing to make the decisions AND spend any time or effort I can to explain them and make them work in the patient's room--which is, of course, my duty. What says everyone?

*It's worth noting that the boomers, the people who are our current crop of about to be highly expensive medical patients, didn't really pay their way. They paid for the benefits and care of a smaller retiring nation, as a population bulge. Debt grew anyway. Now, a smaller group of workers needs to pay their way and deal with the debt.

reasonable starting article for dialysis:
http://www.usatoday.com/news/health/200 ... ysis_N.htm

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--Ian