Thursday, December 17, 2015

Secularizing Maryland Health Care

Many health care facilities in the United States are owned or operated by religious institutions.  About twenty percent of all hospital beds in the United States are owned or controlled by the Catholic church.  Religious health care facilities sometimes opt to give their religious authorities the final say over the provision of health care services.  Religious restrictions on the provision of health care are enforced not only on hospitals, but also on HMOs, universities, and social services agencies, which provides a significant amount of care to poor and lower income communities.  

Enforcing equal standards of care has been further hindered by an increase in the number of states with health provider conscience laws.  Maryland is one of the states with a health provider conscience law. Both individual and institutional health care providers in Maryland can refuse to provide their customers with "artificial insemination, sterilization, or termination of pregnancy" [MD. CODE ANN., HEALTH-GEN. § 20-214].  

The role of religious institutions in trying to restrict citizen access to health care options does not stop with conscience clauses.  Some religious institutions object to allowing doctors to prescribe a fatal dose of barbiturates for the purpose of hastening the voluntary death of terminally ill people.  For some people, their religious beliefs only make sense to them if length of life always takes priority over the quality of life.  Other people think surviving as long as possible will sometimes be a misplaced goal for terminally ill people.  The strength of the religious lobby in the U.S. ensures that the only way most states can pass and enforce a law to accommodate the latter people is by including a conscience clause to accommodate the former group of people who also work in health care.

An "End of Life Options Act" bill that would legalize physician assisted dying is expected to be introduced in the 2016 Maryland General Assembly session.  Maryland patients and their families should be allowed to make their own health care decisions and need to be informed which health organizations and providers will refuse to honor their decisions.  Concerns like this make statewide action on health care laws a priority.

Oregon has been collecting data on physician assisted dying for 21 years.  Under Oregon’s law, every step of the process is in the hands of the patient, and those who interfere with or coerce the patient can face criminal prosecution.  About 0.3% of deaths in Oregon are physician assisted.  About one third of terminally ill patients who receive the barbiturates do not consume them.  People with Lou Gehrig's disease (ALS) are the most likely to deliberately hasten their death with prescribed drugs.  Loss of dignity, inability to enjoy life, and lack of autonomy, are the leading motives.  Similar laws were enacted in Washington in 2008, Vermont in 2013, and California in 2015.  The Montana Supreme Court legalized physician aid in dying there in 2009.

The provisions of the Maryland End of Life Options Act bill are expected to be similar to those in the other states.  To qualify the patient must be diagnosed with a terminal illness with a prognosis of death within six months, be mentally competent, and be able to self-administer the drugs.  The qualifying patient makes two oral requests to the prescribing physician separated by at least 15 days.  A written request to the prescribing physician must be signed in the presence of two eyewitness, at least one of whom is not a relative.  A prescribing and consulting physician must agree on diagnosis, prognosis, patient capability,  and the patient lacking any psychiatric or psychological disorder that would impair judgement.  Either doctor can refer the patient for psychological examination.  The patient must be informed of alternatives by the prescribing physician (comfort care, hospice care, and pain control).  The prescribing physician must talk privately with the patient to verify that the patient is freely opting to hastening their own death.  

The current draft of the End of Life Options Act specifies that the death certificate identify cause of death as pharmacological accelerated imminent death.  Some states allow death certificates to be issued without cause of death.  Maryland lawmakers may want to consider enacting a law to publish death certificates without cause of death and to restrict access to the full death certificates containing cause of death.  An option to omit cause of death helps to allay privacy concerns that may otherwise dissuade people from seeking physician aid in dying.  The Department of Health and Mental Hygiene should be directed to publish a booklet that explains end of life options in Maryland.

To better protect the ability of patients to obtain appropriate health care there is also a need to enact a state law protecting patients’ right to know when a health care provider does not provide certain care based on religious or philosophical beliefs.  Such a law could require any health care provider who refuses to follow standard medical guidelines and practices, thereby resulting in any health care options being omitted, to inform patients in writing of health care services that are not available to the patients through this particular provider.  Patients could be required to provide signed consent acknowledging they have received this information. Additionally, this law could require health care providers to inform health insurance companies of the specific health care options that are not provided.  Health insurance companies will share that information with their enrollees and insured participants.

Maryland's health provider conscience law should be amended to clarify that the clauses granting institutions a conscience right to refusal apply only when the institution is privately controlled.   Also, health provider institutions should be allowed to mandate that their employees agree in their employment contracts to provide the medical procedures that the conscience laws otherwise render optional.  Freedom of conscience is not a one way street that applies selectively only to the people who adopt one side of the two opposing sides.  Whenever institutions objecting to some medical procedures can mandate refusal to provide them on freedom of conscience grounds it necessarily follows that institutions that support those same medical procedures have the corresponding right of conscience to mandate agreement to provide them.

Monday, December 07, 2015

Can leftism be saved from Jeff Sparrow?

The Guardian newspaper has been on the attack against New Atheism for some time, and the latest salvo from Jeff Sparrow, titled "We Can Save Atheism From the New Atheists" begins with the question "Why are the New Atheists such jerks?". The provided explanation for the New Atheist's "dickishness" is "anti-Muslim bigotry" and "paranoid, racist shit".

To prove his characterization he cites Dawkins' comments regarding the 14-year-old who was "humiliated in school" and "falsely accused of terrorism on the basis of his religion".  The boy was arrested for carrying a briefcase with wires containing a clock that resembled a briefcase bomb.  There are school employees who feel that they have some responsibility for the safety of the staff, teachers, and students at the school.  It is easy for someone sitting and typing in London to declare this was a racist incident, but if the same thing happened in a London school there is a high likelihood that the reaction would have been similar.  

If the boy was not Muslim then my guess is that the likelihood of arrest would decrease, but still be substantial.  This has not happened often so anyone's guess is as good as anyone else's.  Does the possibility that people in both the US and Britain may be more wary of, and suspicious of, Muslims, demonstrate racist, anti-Muslim bigotry?  In the unreal world of leftism maybe it does.  In the real world such greater suspicion of Muslims reflects the fact that on social media, and in some publications, and in some mosques, etc. there is an ongoing, organized, effort by groups of people to incite violence against the citizens of Britain, the US, and other countries for the stated purpose of promoting Islam.  This is a highly relevant fact, but we will rarely, if ever, hear the left acknowledge this fact, let alone properly incorporate this fact into their analysis of current events.

I think President Obama made a mistake when he invited Ahmad to the White House.  Nevertheless, I think I can understand why he did that. The right wing in the US is somewhat crazy, they over generalize, they fear monger, and much of what they do is unfortunately counter-productive.  So maybe the president wants to communicate we welcome people of all religions. But then the left should not therefore be excused for reacting by going crazy in the opposite direction.  Ahmad provoked his arrest by his actions and his being Muslim maybe made his arrest even more likely.  Maybe he was treated unfairly by government employees after his arrest, the details of what happened may be in dispute.  We may never know if he was an innocent boy or a provocateur.  People who argue either way on this question are not therefore on the left or the right.  Not unless we define "left" and "right" narrowly and intolerantly.

It is crazy to equate Dawkins' questioning the integrity of Ahmad's claim that he assembled the clock with "a 9/11 truther obsessing about jet fuel".   There is good evidence that the clock in the briefcase was purchased already assembled and then relocated to the briefcase.  This discrepancy between what the boy and his family claimed the boy did and what the boy probably actually did has some relevance here as it raises a question about their honesty.  This is another example of a fact that some on the left do not deal with sensibly because it does not comport with their desired story line.  The effort to point out that there is substantial evidence that the science project may be fraudulent is thusly rejected by Jeff Sparrow as an "effort to discredit".  No, it is an effort to spread information that is relevant, an activity people on the left like Jeff Sparrow routinely also do.   Apparently, for some on the left, evidence does not matter, or it only matters when it is evidence that favors their preferred conclusion.  When evidence favors a conclusion contrary to theirs the same activity of publicizing that evidence is declared by some people on the left to be motivated by ill-will.

Then the attack against New Atheism proceeds to Sam Harris.  Sam Harris is critical of some on the left for not taking the threat from people claiming to be fighting for Islam as seriously as he thinks it should be taken.  He bemoans that the people who take this threat seriously are crazy right wingers who spout a lot of nonsense.  Some on the left then strike back by saying Sam Harris is a paranoid racist.  President Obama, who is not a right wing nut, recently paired fighters for Islam together with global warming as two major problems that the international community needs to confront.  We can disagree about how big a threat the fighters for Islam are, but such blatantly false ad hominem attacks against Sam Harris are uncivil and beyond the pale.  This is not the way to carry on a discussion. It is not reasonable, it is not responsible. It is pure, unadulterated, bile and slander of the sort that has no resemblance to anything liberal or humanistic.  This kind of nasty name calling by Jeff Sparrow reveals that his brand of leftism is infected with anti-intellectualism and intolerance.

He then goes on to criticize the New Atheists as "privileged know-it-alls telling the poor that they’re idiots".  This is a cheap, below the belt, accusation.  In the U.S. religious believers spend more money, by far, on political lobbying and political candidates than do atheists.  Some of the wealthiest American billionaires are religious.  The same is probably true in the Muslim world. Adults who are poor are not therefore mentally deficient, or child like, or somehow entitled to live in special safe zones unexposed to debate.  All argument involves one person claiming that his arguments are superior to someone else's contrary arguments.  A similar accusation of "superiority" can thus be leveled against anyone in any context of disagreement.  Does Jeff Sparrow make this universally applicable accusation against everyone who argues over anything or only against the New Atheists?  He then argues that all such debate should be focused on acceptance of all religious beliefs.  No sir, beliefs are to be discussed and debated, and Jeff Sparrow's insistence that there is a special exemption for religious beliefs is without merit and is illiberal.

Then he goes on to falsely claim that "the privileged know-it-alls are usually white and those they lampoon the most are invariably Muslim".  This is crazy false.  We do not have to do a study to recognize that most New Atheists are very likely spending more time speaking to, and about, other people who share their language and live in their own countries. The result is we who live in the U.S. and Britain most often argue with Christians, and lampooning is infrequent.  Given all of the nasty personal attacks thrown around by the dozens like pennies by Jeff Sparrow in his article, his criticism that New Atheists are lampooning is hypocritical.  New Atheists have many different occupations, many different levels of education, from all different races and religious backgrounds.  And if we are mostly white then therefore what?  Therefore we are tainted?  Therefore we are wrong?

Finally, towards the end of his article, Jeff Sparrow almost deals with a question of substance.  He points out that Hitchens and Harris think that problems in the Middle East stemmed from Islam, and they thus both parted company with Chomsky who argued it stemmed from imperial meddling.  Then Jeff Sparrow immediately goes into closed minded ideological mode again, accusing Hitchens of aligning himself with the right.  Maybe Hitchens was aligning himself with what he genuinely was convinced was the truth?  No, no, no, Jeff Sparrow must impute nefarious motives to such traitors.  Jeff Sparrow says Hitchens argues "All religions are bad but some religions – especially those in the Middle East, by sheer coincidence! – are worse than others."  So does this criticism of Hitchens imply that the left insists that all religions must be equally bad and anyone who dares to suggest otherwise is automatically wrong?  Is this a rationally tenable position?  Or is it a shallow presumption?

If Hitchens and Harris are guilty of arguing some religions are worse than others then maybe they are guilty of rational, evidenced based reasoning of the sort we need more of?  And ditto for the debate over the role of imperial meddling versus Islam as causes of problems in the Middle East.  Reading Jeff Sparrow it is difficult to avoid the impression that he considers merely asking whether Islam has a role in problems occurring in the Middle East to not even be a legitimate question open to debate.  For him, it appears that leftism is synonymous with declaring the cause of problems in the Middle East to be entirely the result of imperial meddling and therefore anyone who claims otherwise must be a crazy right winger, or in league with crazy right wingers.  Jeff Sparrow does not seem to be aware that there is evidence otherwise.  It is as if he never read Hitchens or Harris who have repeatedly cited evidence favoring their conclusions that Islam is itself contributing to Middle Eastern problems.  Or maybe the problem is deeper than this, maybe Jeff Sparrow and his cherished brand of leftism does not care if the evidence favors the conclusion that Islam has a primary role in problems in the Middle East.  In his article Jeff Sparrow never justified his insistence that Hitchens and Harris are wrong beyond citing Chomsky and making lots of false ad hominem and straw man attacks. For the anti-intellectual, ideological left, this is not about the evidence.  It is about closed, circular, fixed, leftist ideology and attacking anyone who challenges that ideology.  If this the best they can do then they have lost this argument by default.

Jeff Sparrow falsely equates criticizing bad beliefs in Islam with "old-fashioned imperialism: the people we just happen to be bombing are simple-minded savages, impervious to reason and civilisation."  People who seek to open a debate about bad beliefs in Islam, and about the veracity of religion more generally, are seeking dialogue and are treating all people, including Muslims, like adults who can reason.  It is some people on the left who desperately want to shut down this discussion, and we all know why although many will not admit it.  It is on the left where the bigots really reside.  It is this left that conceives of religionists as incompetent children and that employs one standard for Christians and a different standard for Muslims.  This brand of leftism then falsely accuses the New Atheists of what they are themselves guilty of.  This left fears Muslims, more than they fear Christians, and they seek to shut down public conversations advocating for atheism out of cowardice.  Jeff Sparrow cites something Marx said dismissing religion as easily refutable, but the truth is that refuting religion takes effort and advocacy.  If we shut down this conversation then what?  Then we still have bullets and bombs?  Maybe for some on the left we should not care who wins or who gets hurt along the way because all religions are equally bad anyway.  This leftism is not liberalism, it is not humanism, it is not factual.  It is ill-tempered, bilious, slanderous, censorious, and anti-intellectual.  What we really need is to save liberalism from bigoted regressive leftist dickish know-it-all jerks like Jeff Sparrow.  And it is a shame that the Guardian publishes such crappy commentary.