Dan Savage on DOMA

Dan Savage rocked it on Morning Edition today. 

He spoke out against President Obama's decision to support the Defense of Marriage Act (DOMA). Savage said, "President Obama should be very angry with candidate Obama. ... Our expectations have not been met. Who raised our expectations? Candidate Obama." 

Those expectations were that DOMA would be overturned once Obama was elected. Instead, the Justice Department filed a brief earlier this month defending DOMA.  

Why does all this matter? Among other things, marriage rights allow a partner full survivor benefits, the right to decide on issues of care in the hospital, and the simple right to be there at the bedside when their partner is dying. Even power of attorney is often not enough to guarantee visitation or decision-making ability in the hospital for gay and lesbian partners. 

As he usually does, Savage laid it out like it just makes sense, and you'd have to be an idiot not to agree with him. He pulls off that angle like nobody else can. 

The Costs of Healthcare

So, I'm a little late to the party on this one ... but this is a great episode of NPR's On Point featuring the author of the much-talked-about New Yorker article on healthcare, "The Cost Conundrum." 

Atul Gawande has written about the high cost of health care in the border town of McAllen, Texas. And the article is getting attention in circles as influential as the White House. 

McAllen has one of the lowest average household incomes in the nation but also one of the highest average household costs for healthcare. Gawande investigates why and comes up with some pretty ethically shocking conclusions. 

There are some interesting discussions about end-of-life care peppered throughout the show. And it's just a fascinating listen for anyone who follows debates about the future of the medical industry. 

Here's a link to the actual article. Image from The New Yorker.

Parental Decision Making and Faith Healing

While I'm on a bioethics thread ... I've been reading up on this case in Oregon. 

Parents Carl and Raylene Worthington are being charged with manslaughter in the death of their 15-month-old daughter because they refused to seek modern medical treatment and instead opted for faith healing. 

The child had bronchial pneumonia and a blood infection, both of which the Oregon State Medical Examiner's officer have concluded could have been treated with antibiotics.  

I think it's always unfortunate when the state and the medical system have to interfere in the decisions of an individual family, but when the life of a child is at stake, sometimes it has to be done. Because, let's think about this, you don't want to interfere because of, first or all, the family's autonomy. Also because the parents should know the children the best and have their best interests at heart. Parents should be, and usually are, their child's greatest advocates. 

In the rare cases when the parents are making decision that clearly put the child at great risk, I think it's the responsibility of the state and the medical team to step in on behalf of the minor. 

It really doesn't seem fair to subject the child to religious beliefs that risk their life when they're yet too young to decide those issues for themselves. 

The Worthington case is even more complicated because the state isn't merely intervening in care; the parents are being brought up on criminal charges after the child's death. Oregon actually has a law that makes it illegal to rely solely on faith healing when you have a sick child who needs medical help. 

It will be interesting to watch how this unfolds—to see if the parents are convicted, and also to see if the law is amended at all now that it is facing its first real application.

Here's a great link for further reading on the ethics parental decision making in the medical process, if you're interested. 

Doctors and Lethal Injection

From today's Seattle Times, this article lays out a fascinating ethical dilemma. 

It describes the situation faced by Dr. Marc Stern, who formerly headed the medically program for Washington state's prison population. Stern quit his job when directed to oversee an execution. 

Stern felt the execution violated his ethical obligation as a physician to "first do no harm." Also, The American Medical Association, according to the article, disapproves of physician participation in lethal injections. 

Other medical staff with the Department of Corrections continued to work on the execution that Stern found objectionable, despite Stern directing them not to. 

This raises many interesting issues:

Should a medical doctor be involved with an execution?

Should other medical staff be involved with an execution?

Should a doctor work for a prison system if he/she is opposed to execution?

What would a prison system do without medical staff?

How could a lethal injection possibly be administered without some sort of medical supervision?

Was Stern right to try to impose his ethical concerns onto other staff at the DOC? 

Was Stern right to quit over the execution? 

Yet another example of how murky the world of medical ethics can be. 

No dogmas allowed

Sort of corny but pretty sweet, too. A dog chapel in Vermont, made both for dog owners to grieve the loss of their beloved canine friends and for all of us humans to be able to bring our dogs along with us into the chapel. The chapel was actually inspired by the near-death experience of artist Stephen Huneck. 

I love, love, love that visitors can post remembrances of dogs who have passed away on the walls of the chapel. It must be so comforting both to share your memory and read the memories of other dog lovers. 

And how clever is that sign out front? No dogmas allowed :)

What happens to your MySpace when you die?

Seen on the brilliant Fail blog: a questions from Yahoo Answers—very sincerely, I think—asking what happens to your MySpace account when you die. The best answer reads: "It deletes itself. You see when you die a little microchip goes off in your brain and instantly deactivates any accounts you may have. They are inserted a few months after birth, everyone has them." It is indeed a Yahoo Answers Fail. 

Violent Death Onscreen

Christian Sinclair sent me this great article about Mike Doyle, an actor who has died violently on television (or acted out dying violently on television) seven times.

Several things we learn from the article: it's easier to fake die with your eyes open; find a comfortable position to lie in because you might be there for a while; when thinking back on past roles, sometimes it's hard to remember whether you were the murderer or the murdered; and moms don't like this type of work. 

Every time Doyle dies onscreen, his mother phones: “She’ll call me and say, ‘I know it’s not real, but I just want to make sure you’re O.K.,’ ” he said. “Not that many mothers have seen their son die over and over.”

Sweet and surreal at the same time. 

Blog from a Hospice Patient

One of my favorite discoveries from this month's Palliative Care Grand Rounds is this blog: Life as a Hospice Patient. 

It's a near-daily account of one woman's experiences going through hospice care. Her pain. Her treatment. Her embarassments. Her visitors. 

Entries like "Getting harder to breathe," are not for the faint of hear, but it's a great window into the world of hospice, and I think a personal perspective that maybe only blogging could give us. 

PCGR Volume 1, Round 5

This month's Palliative Care Grand Rounds is up at the blog of Angela Morrow.

PCGR is a survey of sorts of what's been happening in the blogosphere regarding death, dying, end-of-life issues, etc. Hopefully, once it's been going on long enough, we'll all start to get the sense that us palliative-care focused bloggers and blog-readers are part of some type of community. In fact, I can see it happening already. 

Check out the entry, and check out Angela's blog. 

Previous entries of PCGR can be found here. And thanks again to Christian Sinclair for initiating the project! 

Departures

Last week, I had the absolute pleasure of watching the film Departures at the Seattle International Film Festival.

Departures won this year's Academy Award for best foreign film. From Japan, the film tells the story of Masahiro, a young cellist with a Tokyo-based orchestra. When the orchestra is dissolved, he reluctantly gives up his dream of being a professional musician and returns to the small town in which he was raised. There, he stumbles into a job ceremonial preparing dead bodies for funerals. Masahiro finds he has a gift for the work and that he takes a comfort in being able to guide people peacefully and properly through their most difficult times. 

The film is at times hysterical, at times gut-wrenching, but it is always full of so much life and love and beauty. The set-up allows for several scenes in which we are given a window into people's lives at their darkest hours. And the director reminds us that some of us handle grief and sorrow by sinking to our lowest behavior, some of us handle it by rising to our best, and a rare special few among us, like Masahiro, are able to take those who are lost and aimless in the midst of grief and bring them back to themselves. 

I can't recommend this film enough. Even though its subject is death, it is as full of life as any film I have seen. It's a prime example of the strange dichotomy that sometimes the greatest beauty lies in the darkest corners of our existence. 

Alas, Poor Jude Law

From the world of theater: 

Jude Law is currently playing Hamlet on the London stage, and he has requested a real human skull as a prop for the scene in which Hamlet addresses Yorick—Hamlet's former jester whose skull he comes across when speaking to a gravedigger. It's one of the most famous moments in the play. And it seems Law wanted a skull that had actually been populated by a soul, a brain, a mind. 

It makes sense to me where his request comes from as an actor. The production company was actually able to track one down through an anatomic-parts supplier in Salt Lake City, Utah. However, due to health codes in London, they will not be able to use the real skull and have to go back to a fake. 

But I think, as the director of this play, as soon as this move made such a media firestorm, you'd almost have to pull back and return to a fake skull anyway. 

Once word gets out that Law is using a real skull on stage, that's all anyone would be looking at during the speech. It would be completely distracting. Already this hoopla is going to pull away from the moment ... but with an actual human skull up there, audience members would be pulling out binoculars and craining their heads to see how real it looks and whether they can tell the difference between it and any old prop. 

And just for your enjoyment and because I'm a huge Shakespeare fan, here's my favorite Hamlet, Laurence Olivier, handling this very scene. 

PBR Coffin

This story was submitted by blog reader Leigh.

Bill Bramanti really loves his Pabst Blue Ribbon ... so much so that he has commissioned a casket that is wrapped with a faux PBR label. 

This is my favorite part: To celebrate his purchase, the 67-year-old filled the coffin with ice and used it as a cooler filled with, PBR, of course, and put on a party for his friends. (You can see this in the second photo.) 

Well, he's definitely got his own aesthetic, but at least Bramanti is planning for his own death, and he doesn't seem to have any fear of the end, serving up cans of beer in his PBR coffin.