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Stealth Euthanasia:
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By Ron Panzer
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Dedication
This book is dedicated to the vulnerable who have been targeted for stealth euthanasia.
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IntroductionThere are numerous books about the history of euthanasia and eugenics proposals in our society. This book is not one of those. It offers a rare glimpse from my experience within the end-of-life industry, my work as a patient advocate, and includes the revelations of hundreds and hundreds of people as they have recounted it to me. This book explains how we got where we are today and provides statements by many of our nation's leaders in health care, government and patient advocacy, that taken altogether form the pieces of the puzzle that reveal what has been hidden from the American public for decades: stealth euthanasia is being practiced throughout the United States and elsewhere. I have many friends within the hospice industry who confirm what I recount here in this book, so I urge you to read through to the very end, as you have never heard all that I am about to share with you. Some of it may surprise and shock you. Some of it will trouble you, but all of it will affect what happens to you, your family and our society in the days to come. This is the story of the intentionally "below-the-radar" changes that have been aggressively pursued in our society for decades. Because these changes are not covered by the major media in any coherent, connected way, or at all, the public has difficulty "putting a finger" on what is happening and why. They see changes here and there as situations arise in their lives, especially in health care. They hear stories about what is happening and mistakenly assume they are isolated incidents. Sometimes, they just can't believe the changes that have already been made. They seem so "foreign" to what American society is all about, and the reason they seem "foreign" is they do not arise from American Constitutional values. Some people are frightened by these changes, changes that seem to be imposed upon society without the approval of the majority of citizens. They question the wisdom of abandoning the traditional values that formed the foundation for American life. They question the declining percentages of Americans who support the traditional value of a family (husband, wife and children), marriage (husband and wife), sanctity of life, faith in God, the value of work and the opportunity to get ahead in a free society. They wonder how we have strayed so far. They question whether we are still truly free to express our religious faith in a public setting, or even whether the dedication to "do no harm" within health care is the prevailing mindset. Shockingly, often it is not. If you want to know what all that "death panel" talk is really all about, this is the book that explains exactly what is going on and will be going on. There are no formal "death panels," but there are bureaucrats in government, HMOs, and private health insurance companies whose decisions knowingly result in denied tests, denied treatments and certain death in many cases. This has been well-documented. However, when the federal government becomes the big HMO itself, test and treatment denials will be the equivalent of death sentences for some, even many. The new health care reform law creates several methods that are likely to result in rationed care. For example, the "Independent Payment Advisory Board" ("IPAB") is supposedly not allowed to make recommendations that directly result in rationing care, but it can exert overwhelming pressure on providers by reducing how much they get paid to provide a service. Politicians say, “we are not going to ration care.” But they will set in motion many processes that reduce reimbursement under the guise of “limiting expenditures,” or “keeping costs down,” and these processes will result in rationing care. Ultimately, many services will simply not be provided, because physicians, hospitals, and others cannot afford to provide them at the steadily decreasing reimbursement levels determined by the bureaucrats who run Medicare, Medicaid and other government-controlled health services. Those on Medicare and Medicaid are already on a government-run plan and are experiencing the effects of decisions made by unelected bureaucrats in Washington, DC. We need to remember that Medicare passed into law in 1965 and is nominally a "voluntary" program. However, to assure participation by all seniors, then President Lyndon Johnson pressured all private health insurers to cancel all policies available to seniors. If seniors want to completely opt-out of Medicare, they have to give up their Social Security benefits and then pay privately for all services they receive. Only the very wealthy can do that. Since there is no private health insurance available for seniors in the United States, we cannot say that participation in Medicare is truly voluntary. Seniors must accept whatever those running Medicare decide regarding their treatment options. Certainly, there are many who would have no health coverage without Medicare, and millions have benefited from the program. Many seniors are comfortable with Medicare the way it has been up to the present time. What needs to be recognized is that changes are coming no matter what political party or agenda controls those changes, with or without the new health care reform law. One political party will accuse the other of threatening the well-being of senior citizens and vice-versa. But both will silently promote the stealth euthanasia already begun in this nation. The generous benefits of Medicare over the past are going to be phased out selectively to streamline the program and make it more "efficient." The idea that the future Medicare will be like what we've had till now is quite mistaken and those that trust in the promises being made by either party need to wake up to the realities.
Former Federal Reserve Chairman Alan Greenspan has said, "telling America's aging population that its entitlement programs such as Social Security and Medicare will survive without significant changes is dishonest." The debate about the health care reform law or other proposals are important, but like some demonstrations of illusion and "magic," you never see what's really happening. Misdirection and skill fool all except those trained in the art. While we focus on the public debate, drastic changes are being made quietly without fanfare. "The Obama administration has released a report saying that health reform will save $575 billion in the Medicare program over 10 years." All while the number of Medicare patients will grow exponentially. Isn't it obvious what is happening? The health care reform law (H.R.3590) has already modified how Medicare will be run. Under Section 3021, "Establishment of Center for Medicare and Medicaid Innovation," the Secretary of HHS "shall adjust the payments made to an eligible safety net hospital system or network from a fee-for-service payment structure to a global capitated payment model." [H.R.3590 p.205] Going from a Medicare and Medicaid reimbursement system that pays fees for each service provided to a system that has a cap on payments made for all services provided to a patient is one of the most significant changes to Medicare ever made and will certainly result in drastic changes. Just think about how hospitals will change what tests, surgeries and treatments they provide if they know the amount they will be paid is capped for each patient they serve! And if the patient has already used up the cap amount, do you think the hospital will continue to provide services for free? In addition, once the government takes over management of our nation's entire health care system under H.R. 3590, as it already has in the Medicare and Medicaid programs, it acquires control over how care is delivered, what care is available, and who receives that care or not. It controls how much the providers are paid, and by deciding to pay providers less than service costs and capping total costs paid out, it is driving some physicians to leave the field and will discourage the young from entering the field. Some hospitals will close their doors, reducing the total number of hospital beds available to those in the community. On average, physicians train until they're close to 30 years old, graduate with $150,000 to $250,000 in debt for their education, and are subject to being sued on any given day. When the nation's supply of physicians lags behind the growing elderly population and hospitals have to serve that increasing number of patients, health care services will certainly be limited. According to the Association of American Medical Colleges. "America will face a shortage of more than 90,000 doctors in 10 years." There is no question that, in order to keep health care costs down, patients will see more physician-assistants and nurse practitioners providing primary care. Actually getting to see the physician will become increasingly difficult over time. For example, "employment of physician assistants is expected to grow by 39 percent from 2008 to 2018." To cut costs even more, if a patient is chronically ill, with more than one diagnosis, or very elderly, and enters the hospital more than once, that patient will likely be referred for hospice or palliative care services to prevent more costly acute care hospital admissions. You may not realize this, but leaders in government of both political parties are promoting palliative and hospice care as the destination, your destination ... the end of the road in a patient's health care journey. There is no need for something to be called a "death panel." Rationed care will result in destabilization and consequent death for many of the chronically ill, elderly and disabled. Interventions and treatment options, as well as denials, can be manipulated so that death is made to happen. There is no one place to point the finger and say, "he" alone is responsible, or "that group" or "that government department" alone is responsible. It is much more sophisticated and complicated than that. There are webs and webs of interconnected efforts that have resulted in a massive wave sweeping over our land, something that has not happened overnight, though it may seem so. It's been coming for over seventy years. Americans have been quietly "asleep" while those who have made war on American values achieved success after success. We don't want to think about "death and dying" even if some have been shouting the "death and dying" talk from the rooftops. There have been thousands of news articles and speakers all across the country promoting the wonders of end-of-life care, and there is much good that can be done when dedicated professionals make their best effort to relieve suffering at the end-of-life. However, there are some who have dedicated their lives to move American society away from its traditional values, and they have not been asleep. They've been very busy for over seventy years working in the background, training others and teaching in the universities, arranging to have their ideas inserted into public school curricula. They've written sections of textbook after textbook or controlled the slant of content used to train physicians, nurses, other health care professionals, attorneys, and therefore some of the justices who eventually serve on the courts, until they have succeeded in changing how the powerful-to-be think and act ... how they view the world from deep within. And now the indoctrinated are the powerful. They've even gotten rid of the Hippocratic Oath for graduating physicians in most medical schools (contrary to what we Americans assume). They are accomplishing the last acts of their grand project: changing completely how Americans die and how Americans view death and dying. When physicians, attorneys and judges as well as other leaders of our society no longer affirm the sanctity of life, and when leaders within health care no longer pledge to "do no harm," there is no obstacle to the devaluation of selected lives and the discarding of those lives. Before the advent of widely available hospice services in the 1980s, most Americans died in acute care hospitals in a "medicalized" environment where death, just like birth, was reserved for doctors and nurses. It was hidden from view, something that otherwise has been quite unusual over the course of human history. The modern hospice movement with its openness to caring for the dying with family present, with its recognition of the opportunity for healing in family relationships at the end-of-life, and its focus on working to do a better job at pain and symptom management has been a wonderful thing. It incorporated the very best of the latest medical advances in symptom management with a more natural atmosphere for those facing death. But this positive step has been negated in many segments of the industry due to financial or utilitarian concerns. Although many of us would like to think otherwise, there has always been a side of American society that has had a utilitarian streak. We will explore how this has affected health care and especially end-of-life care as well as what it means for you. There has been a very slick, sophisticated and well-financed campaign to completely twist the positive contributions of hospice into something the public would never openly accept. Because most people in our modern society do not have the background or experience within the health-care industry, they don't have the information to understand what is really planned for us when it comes to health care reform or entitlement reform. And many of those who work within health care still do not know about many of the changes that have been put in place within the end-of-life care industry. Even among those who work in hospice or palliative care, most do not know the history of the industry and who is directing its continuing development. This book contains the essentials needed to truly understand the monumental changes being planned for our society and how it is being accomplished in our time. The issues discussed in this book will affect American society whether the health care reform law is upheld, declared unconstitutional on appeal, repealed or not, or nullified through various efforts by some of the states. How health care is provided to the elderly and disabled is being modified, significantly. Efforts to make Medicare and Medicaid services more efficient and less costly will affect many, and the changes made are not being made solely to make them more efficient. There is something else going on. Many worry that a government-run health care system will do away with the freedom to choose one's own physician, treatment center or treatment. Others have noted that some physicians are "opting out" of Medicare and Medicaid protesting that the reimbursement is often lower than the costs of providing services. "By 2013, less than one-third of U.S. physicians are expected to remain in private practice and patients may increasingly find that being treated by physicians in private, small practice settings may be a thing of the past." Many wonder if patients will be able to find the care they need or if they will have to wait months to get to see the doctor or have a needed surgery. With the budgetary pressures on our nation, many worry how this will impact end-of-life care for the vulnerable. Through the years, many people have called the Hospice Patients Alliance (and many other patient advocacy organizations), pleading for help, reporting problems they have encountered, like the failure of the hospice agency to provide services as needed, reporting that the staff prevented them from giving food or liquids to their loved one when he or she could still take them in and benefit. They sometimes report that their loved one was literally killed in a health care setting. I've listened and carefully thought about the depth of the problems. Through the years, the accounts given by these family members are eerily similar. When family members recount what hospice staff said to them, the language and phrases used sometimes are exactly the same, the actions taken exactly the same, the outcome exactly the same. The reason? The staff at different agencies across the country are being trained in the same way, and the actions taken were quite contrary to what the patient and family expected. The services and treatment provided are not what the American people have come to expect from hospice. Those who report to us are not uneducated in the ways of medicine and health care. Many of those who call in are themselves physicians, nurses, social workers, ministers and lawyers. Yet, even with their training, some are unable to resolve problems encountered or to even prevent the hastened death of their own family member. Those who are quite familiar with the standards of care in health care are often surprised at the wanton disregard for adherence to the standards by some hospice agencies and staff. They often cannot believe that the violation of the standards could ever be so knowingly and willingly done. This is not to say that all hospice and palliative care units violate standards. Certainly not! But, there are too many that do, and there is a reason for it. There is a reason why government regulators surprisingly do nothing about it as well. Hospice Patients Alliance's outreach to the public was designed to bypass the media censorship and that's how we have continued to work, to get information out to the people directly and to work individually with them as problems arise. Our website has had millions of visitors through the years. Those who need information are getting it because of what we provide. It is strange that of the thousands of websites maintained by all the hospice agencies, ours is the only one that has all the standards of care and laws set out for the public to access easily, along with easily understood explanations of what should be expected. Yet, it simply confirms what I noticed back in 1998: there was no place for the public to get complete information about what is going on in hospice and palliative care, what the standards of care are, what to do when problems arise, and what others are experiencing in this largely unregulated niche of health care. Except for our organization, there still is no place for the public to get complete access to the standards of care with easily understood explanations, honest information about what problems do exist, and what can be done about them. Why should the realities be hidden from the patients and families that end up using these services? With about 40% of all American deaths now occurring in hospice, the public certainly has a right to know! Why do the media's editors censor the truth so people are repeatedly blind-sided and taken by surprise when their loved one is medically killed in a hospice, hospital or nursing home? I know that if you've had a positive experience with hospice and palliative care, you may be shocked and upset to read this, but just because you had a positive experience does not mean that all others will as well. You might conclude that I am against hospice and palliative care, but that would be completely untrue. I care very much about the field of end-of-life care and have the greatest respect for those who work in this field and dedicate themselves to relieve suffering while allowing a death in its own natural timing. We've worked hard to encourage the highest standards in end-of-life care and have worked with many in the field through the years. Yet, we believe that it's important for the public to know the hidden truth about end-of-life care as well, because each of us will be confronted with these issues sooner or later. Whether you are a person of faith, an agnostic or atheist, this book provides a rare glimpse of the realities of health care in America that you will find nowhere else. There is much material here that you do need to know so you can see exactly what is happening, how it is happening, when it started and why. There is a lot of material covered, but bear with me and read on, because this book explains why you have not been informed about the hidden realities in the industry, why the major media is censoring one of the most important stories of our time, and why the realities of end-of-life care are not what the media portrays them to be. This book is our way of reaching out to the public directly, bypassing the big media censorship, the government's silent complicity, and the industry's own deception. Our nation was founded upon principles that many of us still hold dear. It is true that some ridicule these principles ... such as a right to life, free speech (which is not limited to "politically correct" speech) and freedom from an overbearing and oppressive government. Some are rejoicing that a socialized health care system may be implemented, while others are absolutely horrified. While there are court challenges to the health reform law, changes are being implemented anyway. No law is required for government administrators to modify some of Medicare and Medicaid's internal administrative rules. The Centers for Medicare Services already has authority to change many things. With the threat of drastic changes in private health insurance, some private insurance companies may go out of business. Other insurers are making changes that drastically affect how they do business, and as the trend continues, many changes will be irreversible. By the time some of you read this, the high court may have already ruled, however, businesses around the country have been scrambling to try to comply with the regulations of a law that will comprise thousands of pages with all the administrative regulations included. Small businesses don't know what to do and must consult attorneys, tax accountants, and other experts to plan what to do, further bogging down productivity and economic recovery. Same thing for large corporations. The uncertainty of "what the federal government will do" is like a cloud over every business in America. The certainty of changes already made is depressing business as well. With economic pressures mounting, deficit spending completely out-of-control in a manner never before witnessed in America, and international leaders urging that the world abandon the U.S. dollar as the world's global reserve currency, citizens worry that our nation is spiraling out of control and that our basic way of life is seriously threatened. It clearly is! We live in especially "historic times," I tell my son. And, "there has never been anything similar in American history." We pray that our beautiful and inspiring American experiment in representative democracy will find its way back to the values that allowed it to create and maintain a stable and free society. When what our elected leaders have done through the years to endanger our nation's economic security is fully known, Bernie Madoff (the convicted Ponzi scheme investment leader) will seem like a saint. Our national trade, tax and regulatory policies have decimated the manufacturing base in this country, sent jobs and corporations overseas, and made us debtors to the world. A once proud nation is imperiled, teetering on the edge of bankruptcy, and the health and economic well-being of its citizens is imperiled with it. Nations are discussing returning to a worldwide gold standard, rather than the American dollar being the global reserve currency. Even if the gold standard is not adopted, simply downgrading the U.S. dollar and "removing America's 'AAA' status would make it more expensive for the world's largest economy [the U.S.] to borrow money on the international money markets. On Aug 5, 2011 Standard & Poor downgraded the U.S. dollar to AA+. This may eventually trigger austerity measures in the U.S. far more drastic than its current deficit reduction plans ...." And yes, that means cuts in health care spending of all sorts. Threats of terrorist attacks on our people are taken very seriously, but nobody really knows what to do to stop them. We must trust the government to protect us; that is what the government is supposed to do. But when the government itself makes changes that are inconsistent with our values and Constitutional freedoms, the people become alarmed, awakened and move to block those changes and re-assert the foundational freedoms of our nation. That is the beauty of our nation's regularly and freely held elections When it comes to health care, there are numerous arguments about what solution can be found for the problems of rapidly rising costs, people who can't access care, and how best to distribute tax dollars for health care. Those of us who are focused on health care hear about "evidenced-based medicine," but in the major media there is little or no discussion of the potential misuse of evidence-based medicine. We hear about "comparative effectiveness research," but in the major media there is little or no discussion of the potential misuse of "comparative effectiveness research." We hear about the "complete lives system" of leading national health care advisors, as well as the rationing of health care, but the major media reports downplay any concerns being raised. Why have we not had an open dialog about the benefits of, or problems with, the ideas that are changing the way health care will be delivered? Why do most people have no idea what these three concepts involve and how they will dramatically affect their lives and those they love? Evidence-Based medicine is: "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." Probably most physicians today want their decisions to reflect the latest medical science and the evidence. It makes sense. But anyone who knows anything about medical studies knows that different studies result in different outcomes and conclusions. The design of the studies, the number of subjects, the controls used, and so many other factors effect what conclusions are reached. Sometimes, if you want a certain result, you can be sure to get it if you design the study just so. In fact, there are well-respected physicians debating the whole idea of "evidence-based medicine. A November 2008 seminar was entitled, "The Evidence Never Lies? Critical Debates in Evidence-Based Medicine" with leading physicians, bioethicists and professors of philosophy debating the pros and cons of this whole field of endeavor. Topics included: "What's right and what's wrong with evidence-based medicine?" "What is the role of clinical research evidence in medical practice?" and "What is the patient's role in medical decision-making?" If evidence-based medicine is used to ration care and decide what treatments are offered citizens under Medicare, Medicaid or a possible national health system, who decides what evidence and what studies are used? Who decides what the conclusions should be? Will the physician and patient decide or will a bureaucrat somewhere in the government, a PPO, HMO or other managed care company decide? When it comes to the care of the elderly, disabled and chronically ill, many questions remain. Even among those who respect and value life, there is a lack of information about what is going on in the end-of-life care arena, what the hospice leadership is doing, what the successor organizations of the Euthanasia Society Of America are doing, who the major players are and how they operate. I'm sorry to say that many leaders of the culture of life, pro-lifers, have no idea what is going on, really, even if many of them think they do. They have been misinformed or intentionally kept in the dark completely. I realize that may offend some, but our role is to serve and inform and provide complete information so that citizens can influence the course of our nation knowing all that is at stake. Many supporters of the sanctity of life simply do not know how deep this all goes and how successful the heirs of the original Euthanasia Society of America have been in our nation. They do not know how the Euthanasia Society is connected with the largest segment of the hospice industry in America, and when some have finally understood it, they have been shocked. Most of those who affirm the sanctity of life view hospice as the rightful alternative to euthanasia and assisted suicide; they would be correct in some cases, but wrong in many others! Those who affirm the value of each life have been outmaneuvered by those who hold a utilitarian worldview, and when some of them encounter a hospice that does not respect the sanctity of life and hurries death along, they realize bitterly that they have been betrayed. Did you know that the largest hospice organization in our nation is the successor organization to the Euthanasia Society of America? Did you know that according to the most prominent hospice leaders in the world, many hospices in the United States today have no reservations about hastening death through a method called "terminal sedation," (also "palliative sedation" or "total sedation")? Did you know that the federal regulations governing hospice are far fewer in number than those protecting patients in nursing homes or hospitals, or that state agencies inspect hospices less frequently than nursing homes or hospitals? Did you know some hospices may go years without being inspected at all? Did you know that because of the HIPAA privacy regulations, nobody interested in researching what is actually going on in hospice can get access to the data, so hospices that have an agenda can act without any outside interference or supervision? This is how Robin Love's father who was not terminal was hauled off to hospice, deprived of food and water and was given large doses of morphine and sedatives. He died shortly thereafter. Wendy Ludwig, RN reports that a Catholic priest she knew was hastened to his death as well. Some hospices have gone eight years without ever being inspected, except for the initial inspection when they opened their doors! What the public thinks about hospice is a carefully constructed image. In some cases, that image is fulfilled in practice, but sad to say, in many cases, it is not. We have reports of young infants being hastened to their death in peri-natal hospice because they didn't die "soon enough!" You could say that our society has been manipulated, maneuvered, even "conditioned" to think in ways that are completely contrary to the way Americans thought for the past two centuries. And millions and millions of dollars have been spent to achieve this. The proverbial example of the frog in the pot of water applies here. Although there is debate about what really happens, if you put the frog in lukewarm water, he won't jump out. If you put him in hot water (not boiling), he will jump out, and will definitely notice that he's in "hot water." Our society is like that. Slowly, but surely, the "temperature" has been "turned up" toward "culture of death" thinking and we don't even notice how "hot" it is anymore. You may be surprised but today, many people have adopted the "quality of life" ethic where it's "ok" to end someone's life because they are "seriously disabled," "very elderly," have dementia or any number of other reasons. In a very real sense, many of us have become numb to the killings so that we accept an increasingly larger category of lives that may be ended in a medical setting. And many times, we don't call them "killings." We say, "We let him go." "It was time." And to "let go" is certainly appropriate when someone is truly at the end-of-life, but when someone is not imminently dying and they end up dead, it really is a "medical killing." If there were no medical murders, books like Caring To Death: A Discursive Analysis of Nurses who Murder Patients (by John Field, PhD; where over 50 cases of nurse killers from around the world are discussed) would not be written. That book is about the sensational cases that leaked out into the media and the killer nurses were apprehended and convicted. Articles like, "Angels of mercy: The dark side" would not exist. Stealth Euthanasia: Health Care Tyranny in America is about the policies and actions that result in imposed death and are not leaked out into the media and are given the government's complete stamp of approval: death on demand, or "stealth euthanasia." In stealth euthanasia, policymakers, nurses, doctors and others, whose actions or decisions cause death, are not apprehended and they certainly are not prosecuted. Not so very long ago when sanctity of life was the mainstream ethic for our society, we recognized that we are here to care for each other, not to kill each other. Now magazine articles promote hospice as the "other way" to make someone die on demand. Bobby Schindler, Jr., Terri Schiavo's brother, reminds us all when he says, "Terri and others like her should be a constant reminder to all of us that caring for the disabled is never a burden, but is instead an act of God's unconditional love." We've been conditioned to think otherwise. We've been conditioned to think that caring for the disabled is an exercise in foolishness, that the disabled and very elderly are "better off dead." Over and over, we hear stories about the suffering of the disabled who are dependent on others, but rarely do we hear about the loving interaction between the disabled and those around them who care for them. We hear less and less about the blessings that come to those who serve and care for the severely disabled and dependent, the changes brought about in those who serve, or the blessings to those who are served. Whether openly conveyed or subliminally imprinted upon us, the message for decades has increasingly been, "let them die," they are "better off dead," "let go," "kill them." The message may not be conveyed openly in those words, but that's the message, ... from health care facility staff, newspaper articles, TV shows or wildly successful movies like "Million Dollar Baby" (about the woman boxer who becomes a quadriplegic and wants to be killed) or the highly successful television series, "House." The show's main character Dr. House is portrayed as an obnoxious, arrogant, but strangely likable genius who serves as a platform for promoting the quintessential secular bioethical view; he is a skeptic and a utilitarian who ridicules people of faith, denies God and casually approves abortion and euthanasia. He exalts in his own intelligence without giving credit to anyone else for his abilities. The secular devaluation of life pervades our society and its messengers are getting shriller and less tolerant of other views each day. The major media outlets do promote hastened death in many ways. Our society is almost "schizophrenic" when it comes to how it approaches these issues. On the one hand, almost everybody openly praises the Special Olympics, and applauded how actor Christopher Reeve fought to regain function through rehabilitation therapy after he became a quadriplegic due to a horseback riding accident. Yet, there are many who would say that Reeve should have committed assisted-suicide or that those competing in the Special Olympics should never have been born! Killing a congenitally disabled baby before birth is applauded as the "right decision" by leaders and especially many doctors in our society. While under existing law, killing a baby a few days after birth is technically still a homicide, many in our society view the killing of a severely disabled baby or child, or a very elderly disabled person, as a "mercy killing." We have organizations like Final Exit Network with its euthanasia proponents selling "helium hoods" and other devices for people to kill themselves, and promoting the "right-to-die." In 2011 they started putting up billboards all over the country with the message, "My Life. My Death. My Choice." Many praise those who care for the disabled but hide their wish that many of the disabled not be alive at all. Health care reform, whether implemented through the new law or through changes to Medicare and Medicaid, will bring rationing of treatment in that spirit. It will have life-changing and life-ending effects, and we will see exactly how. Many disability advocates favor government-provided health care, universal health care, but like pro-lifers looking to hospice for an alternative to euthanasia, they will be disappointed when the government uses a heavy hand to limit expenditures for the disabled, elderly and chronically-ill. We can get a taste of what is coming by looking at the United Kingdom's socialized National Health Service where the disability rights group, "Scope, found that 70 percent are 'concerned about pressure being placed on other disabled people to end their lives prematurely'" if assisted-suicide is legalized there. Anyone who has read the book, To Kill A Mockingbird, by Harper Lee, knows it is a modern classic dealing with race relations. It portrays the struggle of attorney Atticus Finch who heroically defends a falsely-accused black man in a racist society. Yet, there is a parallel theme considering the societal attitudes toward the mentally-ill or disabled. The mentally-ill but good-hearted character, Boo Radley, shuns any public interaction, but manages to watch over and save Atticus' children from harm. Author Harper Lee says that Atticus is a model for Christian honor and conduct who treats the town recluse Boo Radley with kindness and gentleness. Her message is that we all do the same. People like Atticus Finch still exist, however there are some today who are less tolerant of the mentally-ill. Some view the mentally-ill as less than fully human and less worthy to even be here. Members of our society are quite divided in how they regard the disabled, the mentally-impaired or ill, and about how they should be treated. Not all would look upon Boo Radley with the same loving-kindness of an Atticus Finch. The vulnerable are among us, but are often not so visible. I have written this to help us remember what it means to be a humane society, to save the vulnerable and re-establish a just society, to make a difference in your life and the lives of your friends and family. If it is not shared widely with others, then it will not have satisfied my goal to alert people throughout our nation. We are distributing this book online for free so that all can benefit from the information being shared, and our hope is that the book or links to it will be re-distributed virally by email throughout your own circle, posted on your own websites, social-networking sites, blogs, or printed out and shared with those who do not have access to the internet. Some tell me that people won't appreciate this book if we give it away. Some tell me that I should not mention much about abortion ("it's too controversial") or have too many religious quotes in here ("people will get turned off"), and I've thought, "well, they're right, some people won't appreciate this because it's free. And some people won't read this because I have faith and share it a little here and there. And some say I should leave the controversial abortion topic till later in the text. But I've thought about it and the material is presented in the context of how changes arose in the United States historically which makes the most sense if you truly wish to understand how we got to where we are today and where we really are today. I can't promise to please all the people, and I know if it's the truth, it will really offend some. Some people oppose euthanasia and assisted suicide yet approve of abortion. It seems that I can't help offending some. I have to "call it the way I see it." Take what you can from it, and leave the rest, as they say. I do promise to give you the truth, and give it freely as the dear Lord has given so much to me. I never set out to be where I am today, sharing this information which is so troubling to me and so many others. I just couldn't turn away and say "no" to those who were and are now suffering. I knew that I had to do something, and this book is part of that effort. There is no question about the direction our nation's health care is being taken. Ezekiel Emanuel, MD, who our President appointed Health Advisor, promotes the "Complete Lives System" that is being implemented to ration care. Donald Berwick, who our President appointed administrator of the Centers for Medicare and Medicaid Services, is a strong proponent of Comparative Effectiveness Research which will also be used to ration care. Under the new law, "Accountable Care Organizations" are set up which will force very aggressive rationing practices by medical groups. Cass Sunstein, who our President appointed "Regulatory Czar," states that unless you specifically record your wish not to donate organs, doctors should be able to harvest your organs (should you be declared "brain dead") for donation on the basis of "presumed consent," even if you never actually give consent. He also has stated that an economic crisis can be "used to usher socialism into the United States." Susan Rice, who our President appointed Ambassador to the United Nations states that we must increase the role of the United Nations in world affairs. Regarding end-of-life care within the health care system, as we shall see, the nation's most prominent hospice physicians (such as Joanne Lynn, MD and Ira Byock, MD) are proponents of terminal sedation to hasten death. Willard Gaylin, MD, co-founder of the Hastings Center is a proponent of euthanasia who applauds the efforts to expand the definition of "death" in order to overcome obstacles to legally performing euthanasia. Gaylin is widely accepted in the mainstream media and policymaking circles, and the Hastings Center is one of the organizations that has most influenced the modern American hospice industry to betray its original mission to care, not kill. To top it off, our President appointed John Holdren "Science Czar." Holdren is the co-author of the 1977 book, Ecoscience that promotes ideas like forced sterilizations and abortions to limit population growth, compelling single mothers to give up their children to others, putting chemicals in water supplies to prevent births, and a planetary world government that would implement these ideas for the good of the world. Although Holdren is a man-made global warming alarmist in the present (necessitating dramatically increased government-imposed regulations), in the late 1970s he was warning about disastrous global cooling (necessitating dramatically increased government-imposed regulations). It is not a mistake that these specific leaders were chosen to shape our society and our nation's policies. Each of them has at one time or another stated that he is not what the record shows him to be: an advocate of a much bigger government role in our lives. Their public reassurances and denials of the obvious are not credible. Taken all together, it is certain that increased government-control of our lives and health care based upon a utilitarian philosophy is being promoted. America will certainly be changed by their collective efforts. The new health care reform law has created agencies such as the Independent Payment Advisory Board (IPAB) and the Patient-Centered Outcomes Research institute (PCORI), whose main activities will result in rationed care. The role of secular culture-of-death hospice and palliative care within the health system will be expanded dramatically. So, it is right to be wary about the changes being proposed: we are swiftly moving toward a utilitarian-controlled and callous society that will victimize many. It is already happening to many at the end-of-life. This book will explain exactly what is happening, how it's being accomplished, who is responsible, and why it is being done. The book will also explain what must be done to truly reform the health care industry, our government and how to restore the American respect for life. We cannot rely on the government to respect the sanctity of life at any stage of life, even though respect for an individual life is central to traditional American values and our Constitutional system. Respect for life is central to preventing harm to patients, patients who could be your loved ones. Health care professionals who have a reverence for life view their work as a mission and an opportunity to express their love for each patient. Those with faith, view their work as an opportunity to glorify the Giver of life through service to those who are most vulnerable. However, federal law and Congressional budgetary expenditures approved by the Presidents (current and past) encourage abortion, eugenics and stealth euthanasia. You will understand exactly how after reading this book. The simple truth is that we are entering an extremely dangerous period in American history ... dangerous for those who are the most vulnerable of all and dangerous for our society as a whole. If people contemplate and really see the sanctity of life, their quality of life arguments fall away and they will understand that we are here to care for each other, not to kill each other. Caring, and not convenience, is the sign of a civilized and just society!
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I - Trends in American SocietyAlthough the health care reform law was opposed by many who value our freedoms, utilitarians know that their decades-long activities shaped the thinking of our leaders and made it possible. The "Patient Protection and Affordable Care Act's" enactment represents a coup by elites who believe they know better than most Americans what is best for Americans. Sold to many in America as a way to bring coverage to those who had none, it represents the assumption by government of 1/6 of the American economy and therefore, a huge increase in the size of government and its role in every American's life. It may be hard to believe, because nobody has been speaking about it, but it represents a "fait accompli" for the Euthanasia Society of America's descendants in this generation. You may find such a statement completely shocking, especially if you think that government is the answer to most of our society's problems. And you will reject the statement if you believe some of the language in the law without reading all of the law. We have to remember that it is the people who implement the technical details and interpretation of the law that will have the greatest impact on what really happens. Many segments of the law have vague language such as, "the Secretary ("Secretary of Health and Human Services") shall establish ...." "The Secretary shall promulgate regulations ...." "The Secretary shall develop standards ...." What is clear is that many of the details are going to be filled in with "administrative rules," ... regulations that are just as much "the law of the land," but which are created not by our Congressmen, but by bureaucrats in the federal government. For example, if you read the following segment of the law, and take it literally, you may come to believe that a utopian health care heaven has suddenly emerged and taken shape in America:
Ah, the devil's in the details. What exactly are "essential" health benefits? And who will receive them? The language is made to sound as if everyone is going to get the essential services that would reasonably be expected to be provided. Yet, the man our President appointed Health Advisor, Ezekiel Emanuel, MD, has stated, This is not surprising since Dr. Emanuel is a fellow at the Hastings Center ... the same Hastings Center co-founded by the euthanasia proponent, Willard Gaylin, MD ... the same Hastings Center whose other co-founder, Daniel Callahan, explained in 1983 that taking all food and fluid away from vulnerable patients was probably the only way to make sure certain patients actually die (without legalization of euthanasia in America). This is the same Hastings Center that has worked side-by-side with hospice industry leaders to transform hospice and palliative care into the practical laboratory where its utilitarian, pro-euthanasia ideas are implemented, practices we now know as stealth euthanasia and direct euthanasia. Utilitarians, like Dr. Emanuel, refer to individuals who are not working, not producing goods or not providing services for society, as non-participating citizens. These are the dependent individuals who society normally cares for or assists with the activities of daily living. It is very clear that those who are brain-injured, cognitively-impaired, developmentally-disabled or very elderly fall into the category Dr. Emanuel is referring to. If there is to be no "discrimination" resulting in "denials of care based on their age," or "disability" why would Dr. Emanuel categorically state that the disabled or very elderly (those who are "irreversibly prevented from being or becoming participating citizens") should not be guaranteed services? Why would the government set up the mechanisms for rationing care known as the "Patient-Centered Outcomes Research Institute (PCORI) where "comparative effectiveness research" will be done and committees will decide what treatments are appropriate or effective for different populations of patients? Shouldn't such decisions be made by a physician and the patient? Not according to the new health care reform law. Not according to those who will run the government-run health system. Shining a light on how services can be denied, "Dr. Richard Della Penna, M.D., a former Kaiser physician and one of America's leading medical experts in Elder Care and the treatment of Special Needs Patients (SNP'S) has filed suit against Kaiser Permanente, [et. al.], ... as a result of Kaiser's calculated plan to deny legally mandated proper treatment to approximately 57,000 seriously disabled and chronically ill patients in California, Colorado and Georgia because it just didn't want to spend the money." An example of such denied treatment? Laura Shumaker, the mother of an autistic child, writes that in 2009, she "received [her] first set of denials associated with basic treatment for my son's disorder. They denied Applied Behavior Analysis (ABA), Speech therapy, and Occupational therapy. To deny these treatments to children with autism is the equivalent of denying insulin to a diabetic or chemotherapy to a cancer patient." These are examples of the callous hand of rationing for profit in real life. When it's your loved one being impacted, you understand how evil it can get. CEOs of these corporations make millions of dollars per year, but basic treatment for many of the disabled and chronically ill is denied! All in the name of rationing or having "effective" practices. There is a difference between making health care more efficient while making a profit and unethical exploitation. What is Comparative Effectiveness Research? With the U.S. Patient-Centered Outcomes Research Institute, a non-elected committee will be making recommendations that will likely be accepted by the Centers for Medicare and Medicaid Services in deciding what treatments it will or won't cover. If treatments are not covered, they won't be available to anyone, or they won't be available to "selected" groups within the American population! Those promoting "controlled death," "death with dignity," or outright "euthanasia," know what it all means, what the implications are for changes to come in the future, even if those on the side of life still don't fully "get it." The bottles of champagne have been uncorked by those favoring eugenics, euthanasia, assisted-suicide and utilitarian government. And while the major media produces programs and prints articles that ridicule those who criticize the law as "right wing nuts," the aggressive rationing of health care it involves will eventually, directly and negatively impact the lives of you and your family. The "Patient Protection and Affordable Care Act" enshrines into law a system diametrically opposed to what most Americans believe. It creates a system where government bureaucrats (not the public) determine whether care is provided or not. Its mandate that all Americans buy into the government-approved system negates the basic freedom that Americans have always had to choose whether to buy something or not. "Pro-choice" does not apply here. "No choice" is the new policy. While promising to extend health care coverage to all, they intend to limit care that is provided to the elderly, disabled and chronically ill. How do we know this is their intent? The leaders the administration has put in place to design and administer the program have told us what they think, what their goals are and how they will implement them. It is clear they will achieve some of their goals by limiting reimbursements to those who provide medical services. We know that rationing is on its way when we see that reimbursement to medical providers will be limited severely. The American Medical Group Association, whose members provide care for "roughly 1 in 3 Americans" has analyzed the regulations regarding accountable care organizations ("ACOs") created under the new health care reform law. The AMGA's member medical groups include the Mayo Clinic, Cleveland Clinic and many other well-known leading hospital and medical group practices. The AMGA regards the regulations as, "overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve." They fear that complying with the regulations will cause significant financial loss for the hospitals and medical groups. And we know that when reimbursements are limited, the medical groups will take steps to limit services and treatments to minimize their losses, i.e., health care rationing. The AMGA also warns that, " if ACOs are not successful," they are "concerned that the only alternative to future delivery system "reform" will be draconian cuts across the provider spectrum." [Emphasis added] Government officials and bureaucrats may not target you or your loved ones individually, but they definitely will target government's reimbursements to providers for specific groups of individuals, and then, medical providers will allow or deny access to treatment based on government-designated reimbursements for these categories of the population. There is no need for the so-called "death panels" for lives to be shortened. Bureaucratic "decision trees" will guide paper-pushers (either in private medical groups or a future government-run program) who issue determinations about whether diagnostic tests, treatment, surgeries and so on will be provided, or not. Needed treatment when denied equals shortened lives. If it is government-run, health care will replicate the "cost-efficiency" practices of private health insurers, with outright treatment denials impacting the lives of those most vulnerable. And if it is privately-run, insurers will follow managed care models of care (as they already do) and continue to evolve along these lines promoting profit beyond what can reasonably be accomplished if the members of the health plans are to be given the health care they need and pay for. When it comes to "patient protection," protecting citizens from treatment denials, the health care reform law fails completely. The law may only make health care "affordable" for the government through aggressive rationing of care provided. It will not make it "affordable" for many. There is no protection for the patient's right to choose a private health insurance plan over the long run. In fact, over time, private health insurance as we have known it will completely end. More private insurance companies will ration care aggressively or may go out of business as time moves forward. Health insurance plans in America are already being forced to change in ways that have caused an increase in insurance premiums. In the long run, those health insurance companies that survive will be either government-run or government-controlled. In America, we have mainly had a privately-delivered health care system along with safety nets provided for those who could not purchase health care on their own. The safety net in years past could simply have been free clinics, free services at hospital emergency rooms for those without insurance, charitable giving from the neighbors in the community, a doctor who would treat someone for free if they were unable to pay, or an extended family that stood ready to provide bedside care as needed. Today, Medicare and Medicaid represent the biggest government-run safety net, yet the character of the services to be provided will be drastically changed. For those who are not on Medicare or Medicaid, with implementation of the health care reform law, we will see "a dramatic decline in employer-provided health insurance -- with as many as 78 million Americans forced to find other sources of coverage." Where will these employees find coverage? Clearly, the main, or only, provider will be a government-run or government-controlled program. There certainly are problems with our current system, and there is no question it should and can be improved. Under any system there will probably always be some who "fall through the cracks." Yet, our health care system is internationally known to offer the highest quality health care in the world. People come from all over the world to get care here under the private health care system we have had. Private charities and government programs have helped many who are in need. The state Medicaid programs provide access to health care for millions. Numerous charities provide services to the poor, hungry, and ailing. In an effort to help some (the purported aim of the health care "reform"), the ability of many to access care is likely to be destroyed, especially when it comes to the elderly and the disabled. Sure, if their illness is easily treated, they'll get care just as they always did, but when seriously ill, treatment will be hard to obtain. As we begin to wonder if the freedoms which make up the American way of life will disappear right before our eyes, we also wonder what are the government and media not telling us about the realities of "health care reform?" Why was a bill that provided for the government seizing control of 1/6 of our economy not read before the Congress voted on it? Why wasn't there extensive open debate about the pros and cons of such reform if the best interests of America were to be determined? Why wasn't input from all sides of society on this extremely important issue reflected in the law? How has our society seemingly been split down the middle? When it comes to our own private lives, our own health, people have good reason to ask questions about what will happen under a government-run health care system. We don't know what will result from having a government-run or privately-run health care system that is heavily-influenced to do certain things, provide certain treatments or not, and what the government's influence will have on our lives. But we can already see the direction those pushing "health care reform" are taking us. We must understand who is running the show and how they think. Today, "quality of life" has been substituted for "sanctity of life." The short section of the law quoted above even mentioned the phrase, quality of life, not sanctity of life. When you disregard sanctity of life and focus on quality of life exclusively, in the language of the Nazis, those "unworthy of life" with a poor quality of life are, in the name of mercy, going to be hastened to an early death. In fact, the Nazis used the phrase, "giving a merciful death." You may say, "Oh, that's going too far!" But all we have to do is look at the case of Terri Schiavo to understand that in some cases, yes, a living, human being can be made to die in a hospice by court order, with the approval of the federal, state and local government as well as the police in that area. I can hear some say, "oh, here we go again." "I've heard enough about that case and don't want to hear anymore." "I already know what happened." In most cases, you didn't hear the complete truth and you don't know what happened. Some things were never published anywhere. Of course, many said she was "brain dead," "already dead," "better off dead" and the like. And it is clear that almost everyone has a very, very strong opinion about the case and believes they know a lot about it. They may have even read dozens of articles about it and discussed it at length. I have spoken directly with Terri's parents and family, nurses who cared for her and others who saw her themselves. And, after reading numerous letters to the editor, online posts, hearing all sorts of discussions about the case, and reading hundreds of articles, it is clear to me that most of the people in this country have no idea what her real condition was, what really happened with her so-called "collapse," what was involved in her death, who was behind it and what the agenda was. Almost no people really think about her admission to hospice as being central to what really occurred there! Almost nobody thinks about the euthanasia movement in this country and what that has to do with her court-ordered death. But the euthanasia movement working within the hospice industry was the force that manipulated her into hospice for the purpose of imposing death upon her. The major media stories about the case provided absolutely false information about her. By the end of this book, you will know how and why they lied. This is easily proved for anyone who takes the time to truly research the case, read the actual court and medical records as well as speak directly with some of the nurses who cared for her, doctors who examined her, and with the family as I have. Sometimes, there is a financial motive to deny treatment to an individual. People say, "life support is too expensive." In Terri's case, like many others who today are hastened to their death, she was not on any "life support" at all but was merely getting food and water through a tube. On the other hand, there are some very expensive medical procedures, surgeries and/or medications that do cause people to think, "We need to determine who best should receive this." Decisions are made every day about who gets an organ transplant, and that is a form of "rationing." It's something that is necessary, and because the lives of patients can depend upon it, health care decision-making needs to be done fairly, ethically, and humanely. We can all agree on that. But then the question arises, "what determines if an action is "fair?" How do we know if the decision is "ethical" or "right?" What does it mean to be "humane?" These questions are answered in different ways by those who hold different worldviews and values. Some who have religious faith would decide one way. Many who are agnostic or atheistic would decide another way. How do we determine what is ethical and right? If society discards the Judeo-Christian values which are the acknowledged foundations for much of America's laws as well as the Constitution, what will be substituted for them? Anyone who's been around for more than a few decades knows that one day the experts tell us it's "bad to eat this or that." A few years later, they tell us there's new research and what they told so authoritatively before no longer applies. People just don't know what to think. In business, especially health care, every ten years it seems there's a new "system" of management being implemented in the hospitals (those who work in them know what I'm talking about), ... a new "modern," "progressive" way of doing things. The same type of regular change holds true in terms of what the latest thinking about societal issues is. With no societal "anchor" to keep us stable, we would be going through chaotic change every decade. Just think about what happened in 1960s Communist China with the Cultural Revolutions there. One moment the Red Guard was killing "counter-revolutionaries," and a few years later, another group was killing the "old" Red Guard (calling them "counter-revolutionary," and on and on it went with millions dying in the chaos. If we don't have a stable societal "anchor" in our values, then one "crackpot" philosopher, bioethicist or politician will come along and later, another will come and change it all over again. A stable nation cannot exist without a stable system of values and traditional beliefs. Our traditional American values are founded in the Judeo-Christian traditions which have given rise to our many freedoms: freedom of religion, freedom of expression, freedom of assembly, freedom of the press and so many others that have made our nation a model for the world. So, we need a stable set of values that help to preserve the freedoms that are part of what America is all about. When it comes to these freedoms, freedom from discrimination is a passionately-defended right, a Constitutionally-guaranteed right. Those of us who are of different ethnic groups want to be free to live our lives without being subjected to unfair discrimination. Those of us who are ill and need an organ transplant or medical procedure, also do not want to be subject to unfair discrimination. Today, transplants may be distributed to those who are waiting on the list and those who have waited longest, who are first on the list, get the organ. It seems fair and can make sense, but sometimes, decisions are made that negatively impact a patient because people believe they are less worthy of living at all. Some people suffer much due to illness or disability, but that does not mean they are less worthy of life itself or that they want to be killed. Utilitarians do not agree; they believe some of us are expendable, better off dead, and if not dead, then relegated to the deplorable conditions found in many nursing facilities and left there to die. In hospitals, the elderly may be treated very differently than a middle-aged or young adult. Families have told me so many times of the difficulties they have getting physicians in the hospital to treat their loved one with simple medical care that meets the standards of care. For example, a 90 year-old who has some stable but chronic condition may be under or over treated for a condition, with the intent of causing death. Sometimes, powerful antibiotics or other medicaitons are given when they are not needed at the same time the patient is not taking in fluids, in order to damage the kidneys and cause death. Sometimes, an anti-coagulant such as Coumadin is given in a large dose while lab tests to see if the blood levels are within the acceptable range are intentionally put off for weeks, with the intent that the patient have a stroke due to bleeding and die. Sometimes the patient is kept on an I.V. solution of saline water at a very low rate with no nutrients for days on end, with the intent that the patient destabilize and eventually die. Sometimes, blood glucose levels are not maintained in the normal range in a diabetic patient, so that the patient dies. Sometimes, something as simple as leaving the blankets off a patient overnight is done so that the patient goes into hypothermia and dies. I've heard from families where three or four of these methods have been used to make their elderly parent die. Don't believe it? Believe it! Just as " in some instances, medical personnel in hospital emergency rooms and physicians' offices have reported parents to state child social services agencies for child medical neglect for refusing to vaccinate their children," hospital staff may threaten the family member (who has the power-of-attorney) with a complaint against them with adult protective services if the POA doesn't go along with whatever the hospital is doing, just to intimidate them and shut them up. And we have reports that when families refuse to go along, hospital staff do use the social service agencies to get their way and remove the caring family members from the picture (even the member with the POA). Hospital staff may intimidate family members into signing a Do-Not-Resuscitate order and then put their loved one into hospice. It happens every day, because some doctor in the hospital decided "it's time" for that patient to die. In nursing homes, neglect and abuse can cause death as well. There have been Congressional hearings on abuse, neglect and severe harm to residents of many nursing homes for decades, yet nothing of significance is ever done to improve the conditions in these facilities. And while some facilities do a good job, too many maintain horrendous conditions. In August 2009, Congress's "investigational arm," the General Accounting Office reported that, "the Most Poorly Performing Homes, ... tend to Be Chain Affiliated and For-Profit." [GAO-09-689] Just think what happens to the patients there when they are enrolled in hospice at these for-profit nursing homes! There have been extended, decades-long campaigns by millions of people to achieve the civil rights blacks enjoy today. There have been decades-long campaigns by millions to achieve equal rights for women. There have been decades-long efforts to stop the killings of babies in the womb and yes, decades-long efforts to continue that practice. There have been many efforts made for years to achieve rights for immigrants, illegal immigrants, gays, migrant workers and others. There have been all sorts of marches and political efforts and protests throughout our history. Where are the millions, or even thousands, speaking out for the rights of the disabled, the very elderly, even those deemed "terminally ill?" Many do not really know how terrible the conditions are for some of the very disabled, elderly and those who are terminally ill. Many not only do not march for the rights of the disabled, elderly and terminally ill, many think they don't really have a problem. They like to believe that they are well-cared for if they think of them at all. Others, who have seen patients suffer under the conditions at some facilities, simply block out the thought of their existence and their problems. These are society's forgotten, the voiceless. There are reams of documents detailing the abuse, neglect and harm being done to these very elderly and the disabled, but no marches. Yet, the numbers of elderly and disabled individuals victimized is in the tens of millions through the years. No action. No marches. No civil rights movement. No justice. "Civil rights" are not restricted to the struggle of any one group of people! We all have civil rights. The trend is to "write off" this group and give them a one-way ticket out of here. It is the greatest civil rights struggle in America, yet the voices of the vulnerable are censored. If their voices reach out somehow, they are quickly silenced and ignored. It as if our society is "lynching the elderly and disabled" and nobody comes to rescue them. If a movie were made about this civil rights struggle, it might be entitled, "What if there were a civil rights struggle, and nobody came?" It could show a blank screen with intermittent flashes of some patient advocates or organizations who've dedicated their lives to speaking out on behalf of the voiceless. But very little response from the public. No "movement" to rescue the voiceless. While there is life, we must care for and respect it! We must do more. Every day, courts, guardians, people with a health care "power of attorney," doctors, nurses, agencies and others, make decisions that may result in the harm or death of some patients. Sometimes, the decisions are made in accordance with the patient's actual well thought-out wishes. Sometimes, they are not. There are many articles about such cases, some of them actually called "mercy killings." People are beginning to see the trends. What is being planned today is unlike anything that has ever been done in America before, and we will see that the foundation for today's "reform" has quietly been built over decades while Americans simply looked the other way. We didn't pay attention when a change here and a change there occurred. A change in the law here, a court ruling there, and after a while, the changes add up. We now have a completely different approach among health care professionals and the courts. What is planned for our society is obvious to those who understand the history of the culture of death and the "flavor" of hospice and palliative care promoted by the culture of death. Most people don't realize there even is a different type of hospice and palliative care. Talk of managing scarce health care resources must be balanced with the Constitutional rights and basic human rights of citizens living within a just and civilized society, and the vulnerable are still citizens of our nation! Their struggle is in numbers the greatest civil rights struggle in our history. Yet, if health care rationing is carried out on a utilitarian basis, it can become the preferred "tool" for a tyrannical exercise of power, actually eliminating many individuals and threatening the basic fabric of our society. The Fourteenth Amendment to the Constitution of the United States:
Of course, the original context when that was written had to do with punishment for crimes against society. But the idea of not executing someone, not ending their life without "due process" under the law has been an obstacle that the Euthanasia Society of America had to overcome. Over the course of seventy years, the Euthanasia Society (and its successor organizations) has made war on this central Constitutional right to life expressly stated in the 14th Amendment. They have made war on the American way of life. Through like-minded legislators along with justices of the Supreme Courts of the states and of the United States, they have succeeded. It is now possible to deprive a person of life without due process in the United States! You will see how here. The successors of the Euthanasia Society of America are now proceeding with their plan to implement stealth euthanasia for citizens whose "quality of life" is deemed "unworthy of life." These are the last acts of this lethal society. And who will be their target? The elderly and severely disabled. In every state and county. Affecting your family and you. And they don't have to be the "very" elderly or "very" disabled. I've heard of the "not-so-elderly" (even 60 years old) or disabled being placed in hospice and dying shortly thereafter, even though they had no terminal illness at all. Others have warned about these developments: "In an era of cost control and managed care, patients with lingering illnesses may be branded an economic liability, and decisions to encourage death can be driven by cost. As Acting U.S. Solicitor General Walter Dellinger warned in urging the Supreme Court to uphold laws against assisted suicide: "The least costly treatment for any illness is lethal medication." In addition to what I share with you directly from my own experience and knowledge gathered from people all around the country and around the world, I've chosen to include extensive quotes from experts in relevant fields so you are presented with a collage of ideas and information, reference sources that allow you to see how the American respect for life has been devalued over seventy years. This book is presented less as a "literary work" and more as a practical tool you can use to understand completely where we are at today when it comes to stealth euthanasia, medical killings "under the radar" that are becoming increasingly common. You will understand the real significance of the changes in health care being implemented today and what needs to be done to protect those you care about. Because some people become extremely offended that anyone would dare to write something critical of "those wonderful hospice people," let me respond before people get worked up. I have worked in hospice and know many wonderful professionals working in the field. Through the years, some people regularly write in and suggest that we post many positive stories about hospice. There are literally thousands of websites promoting the good that is done, some of it true. And at a hospice that is run by those who adhere to the mission, there are many benefits to the patients and their families. Yes, there are extremely dedicated professionals working in the field. And, we have hundreds of pages of information on the Hospice Patients Alliance website detailing all the helpful services that hospice and palliative care units should be providing, how good end-of-life care is provided and the regulations governing hospice agencies. We certainly know the difference that good end-of-life care can make. For over a decade I've said that: serving hospice patients and their families is one of the greatest privileges and trusts a health care professional could ever be granted. Only those staff with great love, sensitivity, and compassion understand the real mission of hospice. Really, it is a calling. Health care professionals are taught to be detached and not get too involved. But those of us who view our work as a spiritual calling believe in simply loving them unconditionally, being with them, treating them as we would be want to be treated. Unfortunately, there is another side to the story that must be presented! This book is an urgent wake-up call to Americans and people around the world, because what is happening in the United States is also happening in other nations as well. Worldwide influences are impacting what happens here in our country and around the globe. No nation is untouched by what happens in the other parts of the world. With the internet and so many forms of communication, with the ease of traveling around the world, groups from one nation can network with those on the other side of the globe. The European Institute of Bioethics has been warning about these developments for many years. This book is not written for any one particular group of Americans, or any one particular religious group. We are all people, and people everywhere want the same things: the ability to provide for their families, and to live a fulfilling life. All people want the lives of their loved ones to be respected and normally do not want their lives ended in an untimely and involuntary manner. Yet, global influences and exchange can be a blessing or a curse. The World Federation of Right-to-Die Societies, for example, has had much influence on what is happening here in the United States (such as in Oregon, Washington, and other states where efforts are being made to legalize assisted-suicide). It also promotes legalization of medical killing in other nations. When it comes to hospice and end-of-life care, hospice and palliative care leaders from around the world network through the International Association for Hospice & Palliative Care Organization. Information about improvements in end-of-life care can rapidly be shared and implemented. And then, America's hospice trade group, the National Hospice & Palliative Care Organization helps to shape how many hospice agencies deliver care in the United States. It is the nation's main end-of-life care industry lobbying group. That would all be fine if the National Hospice & Palliative Care Organization was not the final successor organization to the Euthanasia Society of America. Unfortunately, it is! Whether we consider end-of-life care or health care in general, how care is delivered can be shaped by worldviews that may not be in harmony with our U.S. Constitutional values. Health care reform efforts being made today in our country are very much influenced by models of health care in place (and trends) in the United Kingdom, Canada, France and other nations. And with that influence comes much talk about health care rationing, legalization of euthanasia and assisted-suicide and other problems. Health care rationing is directly linked with the end-of-life care industry, yet this connection has not been appropriately explored. Perhaps it is because those who cannot access care, who may be denied treatment, will be placed in end-of-life care clinical settings or at home, even if they are not "terminal" in the sense we have come to understand. In the United Kingdom, Dr Howard Martin stated on February 11, 2011 that, "giving morphine to terminally-ill patients in hospital to end their lives was a regular occurrence." At the highest levels of policy-making in government and the corporate world, stakeholders shut out those who respect the "right to life, liberty and the pursuit of happiness" for all citizens at any stage of life. How do we respond to this? Do we really want politicians, bureaucrats and ideologues making decisions that impact our lives and our loved ones' lives? As most Americans have little trust for what politicians say, in general, why would we ever want them to have such an intrusive impact on the most personal decisions of our families' lives? ... on our health care? For those who must enroll in Medicare, there is no choice but to have politicians, bureaucrats and ideologues making decisions that impact their lives. On the other hand, some with private insurance may have nameless claims adjusters who seem to whimsically deny treatment in the name of "managed care," something HMOs have specialized in. Whether you call it a "treatment denial" or "rationing," it still has the same effect, and after you look at the patterns, you know that it mostly has to do with money, but sometimes there's something else going on. Only those who are more concerned with quality of life than sanctity of life are taken seriously at the government decision-making "table." And however many committees arrive at consensus, policies that arise out of a quality of life mindset will always end up victimizing the vulnerable, often causing shortened lives. However, we must remind ourselves what the medical missionary, humanitarian and 1952 Nobel Peace Prize recipient Albert Schweitzer's life was all about: reverence for life! He said: "Reverence for Life is a philosophy that says that the only thing we're really sure of is that we live, and want to go on living. And this is something that we share with everything else that lives - from elephants to blades of grass. So we are brothers and sisters to all living things, and nothing else, neither race nor colour nor religion nor sex, should be more important than this one deepest, most extraordinary thing connecting us. We have forgotten so much. Reverence for life is the remedy we need to heal our nation's descent into the abyss of imposed death and stealth euthanasia. Reverence for life brings sanity back into the discussion of these issues. When we have reverence for life, the question of imposing death does not arise. We simply love and care, allowing for a natural death when it truly approaches on its own. We can honor life, loving all the way from life to death. |
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This Thing Called HospiceHospice is about caring for those approaching death, whether they are young or old. People say they would like to live "forever," but when illness, old age or major disability hit, the majority begin to let go of their attachments here and think about what, if anything, comes next. They go through a process of leaving behind everything they love and finishing whatever they have left to do, and then they must let go altogether. Hospice professionals help them with these transitions, the most important they will ever go through. Hospice is a hybrid of medical, spiritual and emotional caregiving for the terminally ill and his or her loved ones. Hospice and palliative care (symptom management) services are provided when curative treatments are no longer effective, when the patient's death is foreseeable. Under the traditional Medicare hospice benefit, patients are enrolled in the hospice benefit when the physician certifies that death is likely to occur within six months or less. Often, the physician-ordered diagnostic tests reveal cancer, heart disease or other illnesses have progressed to what is called the "end-stage" and medical treatment can no longer prevent further deterioration of the patient's health. Large percentages of those admitted to hospice care are in the winter of their lives and also experience what many elderly face: isolation, loneliness and depression. Even for those terminally ill who are younger, visitors may be infrequent if they come at all. People don't know how to act around the dying, and tend to stay away even if they wish to visit. Elderly patients may already be "shut-in" in their homes, living off of their retirement funds (if they have any) and Social Security. They may not be well enough to travel out to the stores to shop and depend upon other family members, neighbors and programs that serve shut-ins to help them. With failing eyesight, decreased coordination, flagging energy levels and forgetfulness on the rise, seniors struggle to do the ordinary tasks of life, the "activities of daily living" such as bathing, dressing, cooking and cleaning. Their spouse or other family members may also be frail and are often unable to help them adequately. Being terminally ill, all of these tasks become even more difficult. In the early stages, programs like "Meals on Wheels" can continue to help the elderly enjoy a cooked meal from time to time. There are also many forms of assistance available through home health agencies. Hospice agencies offer many of these same services. As disease progresses, there is a recognition that the patient will be able to do less and less. Home care aides may help with bathing and dressing when they are available. Nurses visit to make sure patients take their medications for the week and to check on the senior's health status. Social workers inspect the overall environment, helping to make sure the senior citizen is accessing all the support networks available to make the living arrangements work. They also offer counseling to help resolve problems the senior may be experiencing and to cope with the challenge of facing approaching death. If the patient's medical condition has interfered with their abilities to carry out the activities of daily living, physical therapists are also available to help with movement and strength conditioning, occupational therapists can help with detailed tasks involved in daily life, speech-language therapists assess and offer help with swallowing and speech problems. Sometimes, elders may not be able to safely function on their own and need placement in a facility where more supportive services are provided. Whether elders are living in a facility or not, they may not know others around them and may experience a feeling of complete isolation. They may feel out of place, out of touch, forgotten and alone. The young staff seem like little children, even though they may be twenty to forty (or more) years old! Some elders adjust well as they age and are able to make new friends, learn new things and participate actively in the world. Others simply can't. And as they age into the very elderly category, memory problems may increasingly interfere with their lives. Having worked with the elderly, the disabled and the dying for many years, I've seen first-hand how difficult it can be for these individuals. The smallest tasks may have become extremely difficult, and emotionally, they face the grief of losing everything, not only their possessions, friends and family, but their very lives as death approaches. The supportive care that a good hospice provides can make a big difference to those approaching death. Knowing that you will be cared for when everything seems to be closing in and having your family with you are what most of the dying want most. They want to be able to say things that were left unsaid, to share the love they have in their hearts, to patch up problems that may have arisen over the years and to say goodbye this last time. And while curative measures are no longer effective, there is much that good end-of-life care can do to help the patient live more fully and comfortably till the end comes. This is what has made the idea of hospice and palliative care so appealing to many. As the days pass, the patients and families may become very attached to the hospice professionals who spend time with them. There are many opportunities for staff and patients or families to speak, share stories and get to know each other. All present share a very intense, intimate and special period in their lives. Patients and family alike often have their "guard down" and speak openly about all sorts of things that normally, they'd never share with anyone. It is a time like no other, and people know that. In many societies, there is the idea of "keeping vigil" with the dying, being there for him or her, supporting them as they make the transition from this life to the next. This is the story of hospice, palliative care, and health care reform. It is also my story, and whether you know it or not, it is your story too, because every family in our nation will be touched in one way or another by hospice, palliative care, or the reforms being implemented. The government plans on having each of us die within hospice (or palliative care) eventually. That means you and your family members. This concerns you! Most of the public thinks there is one "thing" called hospice all over the country. Mostly, they really don't think about it, and don't know how it's set up or how it works. The hospice industry has carefully promoted this false image of the hospice industry and carefully avoided portraying themselves as separate individual business entities, i.e., "corporations," providing services. "Hospice is a philosophy!" exclaim some websites (run by hospice business entities). "Hospice is the place" for compassionate care, exclaim many others (business entities). Is it a philosophy? Is it a place? I can tell you that for about thirty years it's been a business! It's corporate! And it's big, getting bigger every year! Most of the public does not know that "hospice" is not that big, warm, fuzzy thing they imagine when they think of hospice. It's not what they've been led to believe. Hospice has always been a business aside from the purely volunteer hospices that dominated the field completely in the 1970s. There are still a couple of hundred volunteer hospices in the country, but they are not what we're discussing here. The volunteer hospices in the country do much good, and do not pose the threat that some big hospice corporations do. In 1983, the federal government implemented the Medicare hospice benefit and that's when all the non-profit (and a very few for-profit) hospice corporations started being created around the country. Some volunteer hospice organizations simply re-formed, incorporated under their state's nonprofit regulations and started providing services while billing to Medicare for reimbursement. For-profit hospice agencies really weren't much of a factor back then. Yet, even non-profit hospice agencies (business entities) take in revenue and pay their staff and administrators salaries. You would get the impression that there were no problems in hospice as an industry if you considered most of the articles written over the years. There are literally thousands of articles touting the wonders of hospice, the good they do, and how families and patients are so well-served. If you read any paper in the country, you must have seen some of these "feel-good" stories, promoting hospice services. The only problem is that picture is completely unbalanced. Because the major media's editors have chosen to censor the other side of the story for decades, we have chosen to provide the information the public needs. I remember six years ago when the hospice was dehydrating Terri Schiavo to death. ABC Worldwide radio had contacted me to come on the air and be interviewed about the case. I brought my son along to the WOOD AM Radio station high up in the Monroe Center office building in downtown Grand Rapids, Michigan. It was exciting and upsetting at the same time. The radio technicians told us where to sit and counted down as we "went live" and I was on the air answering a question posed. As soon as the words were out of my mouth, they had Michael Schiavo and George Felos, his attorney, on to counter what I said, though they were not telling the truth, and there was no opportunity given for me to respond and explain that there was abundant proof to confirm what I had said. They didn't want to hear about it. They were just interested in a sound bite, not the truth. It's similar to the ongoing cover-up in the 1995 bombing of the Murrah Federal Building in Oklahoma City. Everyone who paid attention to the news at the time knows they were looking for "John Doe #2." And then suddenly, they weren't looking for "John Doe #2." People forget, but the truth is that the investigative reporter, Jayna Davis, found him fairly quickly, even though the FBI and federal government painted the story that Tim McVeigh and Terry Nichols acted alone. They weren't interested in finding him. In her book, The Third Terrorist: The Middle East Connection to the Oklahoma City Bombing, Jayna Davis shares conclusive proof showing that Saddam Hussein's Republican Guard was behind it. It is clear that sometimes what is presented as "reality" by the government and the media is absolutely not. The realities of hospice are just as "covered-up." Have you read any major newspaper exposé about hospice recently? I'm sure you haven't. Not every agency or facility provides that supportive care the public has been led to believe hospice is about. Not all hospices are managed with an eye on assuring the very highest standards of care for their patients. Some are run as competitive, money-making machines. Some have committed health care fraud. Some do not honor the sanctity of life. These are why I call them "rogue hospices." Rogue hospices are much more common than people think. Most people don't even know they exist. The shocking and unfortunate truth is they do, and we shall see what they have been doing in America and how that affects all of us. Over the years, I've been interviewed by USA Today, CNN, the Washington Post, Washington Times, Chicago Tribune and many others. Yet in almost all cases, the reporters use me to educate them about hospice and end-of-life care. They question me for hours by phone and email. Then when the article comes out, they quote one sentence from me, leaving out the major thrust of what I was emphasizing. That's the reality of "news" coverage in many cases. They have editors and an angle on a story they want to print. So, they gather material and then shape it to appear how they want it to appear, not how the reality is. While there are some wonderful hospices, rogue hospices are something else. Like all other industries, hospice has problems of some sort. Because the mission of hospice is unique and because these patients are among the most vulnerable of all, I believe that the public needs to be informed and to know how to deal with and correct those problems. I do not want another family to go through tragedies that others endured during the most emotionally-charged time of their lives. After witnessing serious violations of the standards of care at the Hospice of Michigan where I worked, I formed the Hospice Patients Alliance in 1998. We are a nonprofit, all-volunteer, patient advocacy organization, providing the most complete information about hospice and the standards of care on the internet, what services are to be provided, how to get the best care and how to resolve problems when they do occur. Hospice Patients Alliance promotes the type of hospice and palliative care that respects the life of those served, providing the best in professional end-of-life care till a natural death occurs in its own timing. People often have no idea how to get help when they have real problems with a rogue hospice agency. When problems do arise, hospice administrators and staff have become expert at giving patients and families the supreme "runaround" with evasive answers, stalling techniques and even intimidation techniques to shut them up. Eventually, families search for an organization that can help them and they find us. We give them the answers they need to get the best care for their loved ones. In my own hospice work, I have been confronted with situations at work where I had to ask myself: What do you do when you've been shaken to your core by what you've seen, something so profoundly antithetical to everything you believe in? I saw administrators and other staff lie to the patients and families, exploit them for gain and deprive them of needed services. I had to consider, "what will happen if I do not get involved?" I asked myself, "What will happen if I do not run to the rescue of those who are utterly defenseless?" And if I did run to their rescue, "what price will I pay?" I did act and intervene, and I have paid the price. There are many whistleblowers and patient advocates in the country like me who have paid a steep price for remaining loyal to the duty we owe to our patients. Doors close, career paths change, finances take a hit. Plans are changed. In 1997, there was the case of Jose Alvarez who had a terminal illness. The only thing Jose wanted was to be able to die at home, and the hospice in Michigan, seeking to gain financially, prevented Jose from staying at home or going home once they manipulated him into their facility to charge extra room and board fees. Jose's family came to all the staff for help. I helped them and they shared their concerns with the public and filed a complaint with the State of Michigan. Their complaint was corroborated by evidence that the Hospice of Michigan had violated the standards by not providing the care needed. Since then I've received hundreds of calls about all sorts of problems in hospices around the country. Grieving families call and report that hospice staff and physicians actually yelled at them! In many cases, family members have even been banned from being at their own mother's or father's side (or other family members' side), simply because they objected to the patient receiving an overdose of morphine or other un-needed medications. I remember being called by a man who told me that he was the terminal hospice patient and was afraid they were going to kill him. He had end-stage heart failure, though he was in his late 40s. We talked quite a while a few times, and then I heard nothing more from him. He had told me they were taking away his regular heart medications, thereby making his condition worse. He didn't want to be in hospice. He just wanted to be cared for and allowed to die a natural death when it came, not when they decided he should die. In many cases, the Adult Protective Service system is even used to intimidate those who truly care about the patient and object to clinically unnecessary or harmful interventions. These can be as common as giving morphine when there is no pain, sedating a patient who is not agitated, depriving the patient of needed medications when they are still benefiting from them or not providing food and fluids as needed when they patient is still benefiting from them. We have received many calls from families who tell us the hospice falsely accused them of being a threat to their own loved one and called APS when they voiced their objections to the death-protocols being implemented at the hospice. So we have those who truly care about the patient being accused of being a threat, and those who hasten death in charge of the agency entrusted to care for the patient! Back in 2001, Pam Yates called about her son Sean Reynolds who had died in hospice care. Due to a medication error, he ended up having terrible seizures when a needed medication was not given as ordered. Bob Davis of USA Today covered this story he titled "Family sues hospice over son's suffering." The problems in hospice can be from a myriad of causes, too little intervention or medication, too much intervention or medication, inappropriate interventions or medications and so on. Pam, like any mother, suffered terribly as her son came closer to death and then passed away. She wrote about a spiritual transformation that she underwent in her book, The Gift of More: Lessons of Faith and Love from a Life Cut Short, which tells the story in her own words. For those who doubt that miracles can still happen, read Pam Yates' book. In other cases, staff members have berated family members who request that a patient who is not imminently dying be given food and water, or treatment for a urinary tract infection. Hospice professionals have derided family members for not believing that their loved one had "terminal cancer," because the referring physician said the patient had "terminal cancer," even though there were no lab results, biopsies or testing of any sort to confirm it, and upon autopsy no cancer at all was found. They yell at family members when they object to strong doses of morphine or sedatives being given when the patient has no uncontrolled pain or agitation. Most families who experience the callousness, unresponsiveness and sometimes outright cruelty of some hospice administrators and staff are completely shocked. They never expected it and could never have imagined it happening to anyone, let alone to their loved one and their family. Others do not believe hospice staff could ever act this way. Many wonderful nurses and doctors, as well as others, who work with those at the end-of-life are not aware of the havoc and harm being caused by some others in the industry. They cannot imagine anyone doing what they themselves would not do, and they get very upset reading about these realities of the rogue hospices. Anyone who has seen their own family member die knows how traumatic and upsetting it can be. With good end-of-life care it doesn't have to be that way, but sometimes it is. It is intense, and each family member has to come to grips with their own mortality, the loss of their loved one and the pain experienced when watching someone you love decline in health and die. The last thing they need is to have a palliative care or hospice professional act rudely or worse to them. Adjusting well to the dying and death of a loved one is so important to the mission of end-of-life care services, yet families whose loved one has been hastened to death against their will cannot grieve properly. They are wounded by the victimization of their loved one and suffer endlessly. Having spoken with hospice staff, administrators, physicians, therapists, patients and families from all over the country for years, I've gained insight into what is really happening in this industry. While there are other leaders in the hospice industry who know what is truly occurring, they are not sharing that information with the public. They know very well how they are turning this industry upside down while maintaining the appearance that nothing has changed except that they are "better and improving every day." They withhold the truth from the public they serve. They won't reveal how the hospice mission has been twisted intentionally into something it was never meant to be. They especially don't share the truth with those hospice leaders and staff who are pro-life. They don't want them to know that they are infiltrating the industry. If you read the language used by some of the hospice leaders or listen to them speak, you will quickly realize they sound almost exactly like the hospice leaders who remain committed to providing the very best end-of-life care. Probably you'll think they're the "real thing." They're slick and very convincing. Their websites sound like they promote the very best in end-of-life care. If you've ever met a really good con-man, you'll understand what I'm talking about. But these hospice leaders do not go out of their way to condemn the hastened death of the elderly or seriously disabled. They do not commit themselves to promoting the sanctity of life. Their salaries are obscene, beyond what anyone with a conscience could accept knowing that some patients are not getting the care they need so that salary can be paid out. While the leaders of what I call "rogue" hospices withhold the truth from the public, we do reveal what is going on: the good and the bad. We think it is necessary to reveal the truth. If people are given the necessary information, they are empowered to make the best decisions for themselves and their loved ones. They are also empowered to understand what is really going on with health care reform, end-of-life care and what their own family will face soon if our nation remains on this course. Of course, we've been attacked by those who wish to hide the changes seeping into end-of-life care. We've also been attacked by pro-life hospice leaders and staff who adhere to the original mission we also support. They don't want to admit that any problems exist in the industry or that it has been heavily infiltrated by culture of death professionals with an agenda contrary to the mission they support. These professionals feel threatened by the truth and find ways of explaining away the repeated accounts of wrongdoing at the end-of-life. Just as our society is experiencing clashes between those with different values and worldviews, the world of hospice is experiencing internal struggles that are completely unknown to the general public. There are actually two diametrically opposing visions of what hospice (and health care in general) should be and what type of services should be provided. Even though there are religious differences, traditional Judeo-Christian, Muslim, Hindu, or Buddhist individuals respect the life of the individual. They expect hospice to allow a natural death in its own timing, and when that is not done, they realize their values are being disregarded (no matter how much "talk" there is in hospice circles about respecting everyone's religious values). I've received calls from people of several different religions who are horrified by what they've witnessed happen to their own family members. They only too late realize that respect for the sanctity of their loved one's life has been replaced with a secular utilitarian view, often mixed with an eye toward increased revenue, resulting in a hastened death. For those who think this is an issue only for Christians or Jewish people, the Koran states, for example, "....take not life which Allah has made sacred" (Chapter 6, verse 151)." American physician Mahjabeen Islam, MD states, "there is no confusion about playing God for the Qur'an states clearly that it is God alone that decides the moment and the mode of death." Whatever the religious faith of the patient, when they first receive word from the physician that they have been diagnosed with a terminal illness, they don't suddenly decide that they want someone to kill them. They are thinking about living, and about the end of living. They're thinking about what death will steal from them, the lost opportunities to be with loved ones, to accomplish goals, to live. If they have faith, they will be thinking a lot about what comes next. For most people, they are thinking about how they might live longer, how to improve their chances, what they can do in the time they have left. The ailing need people around them who support their beliefs and affirm the value of their life. We need to understand that when decisions about our loved ones' care and future are concerned, those coming from different worldviews and values may arrive at completely different conclusions. Sometimes, the worldview may be a secular, utilitarian one, and that is one of the main problems in how health care is delivered (or not delivered) today. A physician, nurse or even a health insurance company (and its claims adjusters) who respects and values the lives of those being served will provide or allow for better care than those physicians, nurses or health insurance company (and its claims adjusters) who look upon the patient as a number and not a person, as an excuse to bill for services, an opportunity to profit, or even an unwanted cost. Removing the spiritual element from health care is a dangerous step that has introduced all sorts of problems into the industry. The mission to serve is truly a spiritual mission, and those who are called to serve, serve according to the gifts given to them. When I went to Raleigh, NC to speak at the 2010 Annual Life Conference, I was asked whether hospice and palliative care is pro-life or culture of death. The short answer is that it can be both, depending upon the hospice agency or palliative care unit and staff providing care. However, the culture of death "flavor" of end-of-life care is becoming much more dominant, and we will see why. Although a hospice agency, as a business, must assure revenue in order to provide services, when a health care agency such as a hospice views the patient as an opportunity to profit or solely to bring in revenue, it has strayed far from the original mission that was so widely well-received in this country. When the hospice agency is run by a corporation rather than an individual person, it can become unaccountable to the patients it serves. To understand what is happening today in hospice, we need to understand how the hospice movement got started and what has happened to businesses in general.
Three Hospice "Giants"There are three individuals who have had the greatest impact on end-of-life care in America: Physician Dame Cicely Saunders, Dean of Nursing (at Yale) Florence Wald, RN, MN and Elizabeth Kubler-Ross, MD:
Dame Cicely Saunders is the visionary pioneer who founded the first modern hospice in 1967 in London, England: St. Christopher's Hospice, named after the saint who, legend has it, helped carry travelers to the other side of a dangerous river. |
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Saunders was dedicated to improving care for the dying and their families. She recognized the value in a person's life up till the very end, and her vision of end-of-life care is what was so inspiring to many Americans who came to embrace the new way of caring for the dying. And so, Americans have enthusiastically accepted hospice as it was envisioned by and practiced by Dame Cicely Saunders: a service that relieves suffering at the end-of-life but does not hasten death in any manner.
Elizabeth Kubler-Ross & Stages of Grieving No discussion of end-of-life care and hospice would be even marginally complete without mentioning Elizabeth Kubler-Ross's contribution to society's popular understanding of the grieving process. While working at Billings Hospital in Chicago, The Swiss psychiatrist wrote her classic book, On Death and Dying, which describes five stages of grieving at the end-of-life: denial, anger, bargaining, depression, and acceptance. Grief is something that must be confronted and processed by the patient, the family and friends. Understanding the sometimes intense emotions being experienced and the stages some patients go through may be helpful for all those working with the dying and their families.
Kubler-Ross's work helped professionals be much more sensitive to the range of emotions patients may go through as they near death. Her work helped our society think more about the quality of life of the patient going through the dying process. Although she observed "stages" terminally ill patients experienced, these stages were later applied to families grieving the loss of their loved one. Although her work was widely accepted, recent studies show that not all families go through her now-classic "five stages" of grieving. A 2007 Journal of the American Medical Association article, "An Empirical Examination of the Stage Theory of Grief" reported that Yale researchers found that most bereaved individuals actually accept the death of their loved one from the beginning and did not necessarily go through "anger or depression," two of Kubler-Ross's stages. See Time Magazine, January 24, 2011. It may be that the widely accepted application of Kubler-Ross's stages of grief (that some patients undergo), to the grief of the bereaved, rather than just for the patient himself, is a mistaken approach not borne out by current research. In any case, hospices and palliative care units often provide bereavement counseling services, as do funeral homes and grief counseling centers that have sprung up. Bereavement counseling has been required by government regulations in all licensed hospices for decades, yet its provision may be most needed by the 15% or so who experience "prolonged grief disorder." Based on some of the latest research, most adjust quite well over time. A 2002 study published in Journal of Personality and Social Psychology indicated that for most of us, the worst symptoms associated with grieving diminish within six months. ["Good News About Grief," Time Magazine, January 24, 2011]
Florence Wald, RN, MN The third "giant" influence on hospice in America is certainly not "third" in her impact. In 1974, Florence Wald, RN, MN stepped down as Dean of Yale University School of Nursing to create the Connecticut Hospice, the first American hospice. From that time, Wald devoted her life to hospice in America. Though she wasn't the only worker in the field, she is the most famous leader of the modern American hospice movement. As productive and influential as she was, she sharply disagreed with Saunders' life-affirming approach to end-of-life care and said:
Think about that for a minute! What does it mean that assisted-suicide should be available to patients for economic reasons? Whose economics? Surely not the patient's. So, is assisted-suicide supposed to be made available for society's economic needs? Or the family's (who stand to inherit the estate) economic needs? We need to let that sink in and really understand the significance of her revealing statement. The American people have had no idea that the most prominent leader of hospice in America, Florence Wald, was pro-euthanasia and pro-assisted suicide. Wald's pro-euthanasia flavor of hospice is what is being delivered in many parts of this country, though many hospice professionals will strongly deny that. Those who do remain faithful to Saunders life-affirming vision, who relieve the suffering of the dying until a natural death occurs in its own timing, will say they do not hasten death. Those who do hasten death will say the same. The public often has no way of knowing which type of hospice their loved one will experience. So, here you have two leaders at opposite ends of the spectrum regarding "assisting suicide" or "imposing death," etc. Saunders and Wald may have agreed on the rest of what hospice should do, but adding in a "service" to hasten death is antithetical to everything Saunders cared about and is antithetical to the very mission of hospice. If you accept the idea of hastening death, imposing death at the end-of-life, you will not make providing good services the top priority, and if you do provide services, who decides when "time is up," and services end, and assisted suicide begins? Many hospice leaders have spoken out and voiced their opposition to assisted-suicide or euthanasia, because if you kill the patient, you clearly can't care for them in hospice while allowing a natural death in its own timing. Hospices for decades would loudly proclaim that they never hasten death. The facts today tell a different story, as we shall see. There is one practice that is sweeping through hospices and being very widely used: terminal or palliative sedation. This involves permanently sedating the patient, allowing the patient to dehydrate and die. It looks outwardly peaceful as the patient is made to sleep in a medically-induced coma, but the patient's death is the result. Terminally-sedating the patient is something that can be done in hospice that doesn't outwardly appear like euthanasia where a lethal agent is given. It also doesn't outwardly appear like assisted suicide where a patient takes a lethal medication prescribed by a physician. Terminal sedation is more subtle and deceptive. It allows the hospice to keep a patient for a week or two and bill for services rendered until death occurs. With the baby-boomer generation entering the target zone (suitable for hospice), there is always another patient waiting in the wings to be served. Surprising to many, terminal, palliative or "total" sedation is so commonly used today to hasten death (a method of stealth euthanasia) that it is defined by the pro-euthanasia Compassion and Choices's "Good to Go Resource Guide" glossary. They define it as: "the continuous administration of medication to relieve severe, intractable symptoms that cannot be controlled while keeping the patient conscious. This treatment renders the patient unconscious and relieves suffering by inducing an artificial coma. The unconscious state is maintained until death occurs." Saunders' caring, life-affirming view is the "flavor" of hospice marketed to the public by all hospices. It's the public image of hospice and palliative care. However, there are hospices that impose death through terminal sedation or other means, like wolves in sheep's clothing; these hospices are dangerous, even lethal to approach. Once admitted to these hospices, it can be almost impossible to get a patient out. They pose as caring hospice but provide treatment with an agenda that blindsides the patient and family and results in an untimely death, to the ever-lasting regret of those family members that cared. Hospices that remain true to the life-affirming mission will not hesitate to proclaim the sanctity of life while they intervene to relieve suffering at the end-of-life. Hospices that are willing to hasten death normally do not speak about the sanctity of life and they do not teach their staff to never impose death, in fact, their training results in quite the opposite. Hospice as the industry has marketed itself as a vague, compassionate "thing" that exists all over the country, filled with angelic hospice staff that care and work the kind of wonders that Cicely Saunders encouraged. And the staff at many hospices do care. There are thousands of articles and hundreds of books about the good work these staff do. Many patients and families have benefited from them. They have Cicely Saunders to thank for that. I, and others who work with the dying and their families, we understand that to work in this field is a privilege and a sacred trust. This is the mission so many of us care about: relieving the many forms of suffering that occur at the end-of-life, supporting the patient and family on many levels, supporting the family even after death occurs, and especially, affirming the sanctity of that life all the way till the very end when death occurs naturally in its own timing. And those who have experienced this type of hospice are deeply grateful. However, what will happen with health care reform? Economic pressures push government officials to try to reduce health-care spending through rationing. Rationing care on a utilitarian basis means denial of certain types of care which will precipitate a medical crisis for many, especially the elderly. Where will these elderly end up? Hospice and palliative care units. Hospice corporations already in existence are gearing up for increased revenue as additional formerly chronically-ill, non-terminal patients are sent their way. Each year, new hospices are springing up all over the country to enroll them.
The Hospice Interdisciplinary Team Approach to End-of-Life CareHospice care has pioneered the use of an interdisciplinary approach to providing health care. Accessing the expertise of a team of professionals, the patient's needs are discussed from a multi-disciplinary perspective and a plan of care is created and updated on a weekly basis. The interdisciplinary team (the "IDT") is composed of nurses (both registered nurses and licensed practical nurses), home health aides, home service aides, medical social workers, chaplains, counselors, dietitians, therapists, volunteers, hospice medical director (supervision of your medical care), and the pharmacist (if the hospice has its own pharmacy and pharmacist). Any member of the hospice IDT can bring up concerns at the weekly IDT meetings and members of the team can brainstorm to find solutions to the problems that are confronting the patient and their family. While the patient's own attending physician in the community gives the orders for medications and treatments, the hospice medical director reviews these orders and can consult with the attending physician to make sure that the patient's needs are met, sometimes educating the local physician on better ways of relieving pain or other extreme symptoms that arise at the end-of-life period. Not all physicians have experience in treating extreme end-of-life symptoms, even though most think that they can handle it. It sometimes causes terrible problems for the patients when a physician without adequate training in pain management attempts to find the right dosage for the patient and does not know the standard protocols for titrating (adjusting) these opioid medications. Nurses are often extremely frustrated if a physician refuses to order adequate pain medication. While the team approach has its advantages, it also has some disadvantages. In a rogue hospice where corners are cut, services are not always provided and revenue is often the first priority, the team meeting can be an opportunity to intimidate or indoctrinate staff into "how things are done" at that hospice. Some members may be afraid to speak up after experiencing disapproval from the team. Prolife nurses who object to a patient getting unnecessary medications have found themselves the target of retaliation, harassment, even false accusations or outright termination. There is a wide variation in how receptive management and other team members may be to objections about the way care is being provided in the end-of-life care setting. If the hospice management, the interdisciplinary team and especially the medical director do not respect the sanctity of life, they may prevent treatment that will help the patient live while initiating a variety of treatment decisions that will tend to hasten death. Some interdisciplinary team meetings are merely a formality to rubber-stamp whatever the director decides. For example, commonly prescribed medications that stabilize the patient are commonly removed prematurely even though the patient is still deriving benefit from them. This is all part of "manipulating death" that shortens the lives of patients.
Volunteer, Nonprofit and For-profit Hospice CorporationsHospice began as a completely volunteer effort in America. The first volunteer hospices were staffed by doctors, nurses, social workers and lay people who simply wished to provide care for the dying that was focused in a wholistic way to relieve the suffering at the end-of-life. They were inspired by the work of Dame Cicely Saunders and recognized that the traditional health care system was simply not responsive to the needs of the patients. They saw that it often failed to provide good pain relief, and sometimes used the patient to prove what medicine could do in an alienating acute care hospital setting, rather than focusing on respecting the patient's own wishes. They tried to bring about an awakened insight into the needs of the dying, and over time, their efforts succeeded. Currently, the volunteer hospices belong to the Volunteer Hospice Network, which:
Over time, volunteer hospice leaders and some of the first hospice corporations in America realized that to be able to serve a larger segment of the community, and to offer all that modern medical science can offer, they would need to operate with reliable funding sources (rather than operating on a donation-only basis as volunteer hospices do). Several hospices and their leaders worked with the government to convince them to fund end-of-life services through hospice agencies. One such hospice,
With the implementation of the Medicare Hospice Benefit in 1983, federal funding for hospice services to the dying was assured. Studies on the financial benefits of using hospice services were completed, demonstrating that overall, hospice services result in significant reductions in expenditures by the federal government. Some volunteer hospices incorporated as nonprofit hospice agencies under their state nonprofit laws while other volunteer hospices continued to serve on a purely volunteer basis. Nonprofit hospice corporations began to spread all over the country. Over time, some for-profit hospice corporations also were formed. While the legal structure is different for the nonprofit and the for-profit agencies, the mission remains the same and the federal standards of care are the same.
"Palliative Care" and Its Approach to End-of-Life CareWell, not only are the people confused about what hospice is, they are even more confused about what palliative care is. I've heard from people who say hospice is the greatest thing for the dying, while others say that hospice is evil and killed their loved one. Same thing for palliative care. Hospice is not the same as palliative care, but they are very closely associated. Really, hospice is the place (whether in a home or facility) where a certain approach to caring for the dying is provided. That approach involves the total philosophical mission presented by Dame Cicely Saunders. It is an approach that affirms the life of the patient, though they are in the end-stages of a terminal illness, and it promotes the relief of distressing symptoms throughout, until a death occurs in its own natural timing. Saunders' basic message can be summed up:
This is the type of care that encourages, cares for and supports those nearing death, and warms the hearts of those who think about how to care for the dying. However, palliative care is not exclusively practiced in a hospice. It's not a place or a philosophy. It is a niche within the field of medicine that specializes in the relief of distressing symptoms of any serious illness at any stage of life, whether of the terminally ill or not. The World Health Organization states that:
Palliative medicine is the field of medicine that most effectively empowers hospice professionals to be able to relieve the suffering of the dying. Palliative medicine guides the administration of medications that can relieve pain, swelling, inflammation, seizures, spasms, fever, intestinal difficulties, respiratory afflictions and many other problems encountered at the end-of-life. It is clinically precise and is administered uniquely for each and every patient that is served. That being said, there is something else masquerading as palliative care just as there is something else masquerading as hospice care in this country. When every patient in a facility is "sedated, because all patients who come there are agitated" (as I've heard more than once from staff around the country), that is not palliative care or the clinically-precise application of palliative medicine. It is a perversion of hospice as well as palliative care. It is a deliberate railroading of patients to an imposed death, a hastened death through what is called "palliative" or "terminal" sedation. Many of the state organizations of hospices in the United States changed their names to "Name of State -- state-hospice and palliative care organization." This move reflects the reality that not all end-of-life care is provided in an actual hospice agency. Sometimes, care is provided in specially designated palliative care areas of a hospital or nursing home. There has been a lengthy effort to transform and twist the way death is perceived by the public and how Americans die. The patient, loving, reverent approach that Dame Cicely Saunders practiced and gave to the world was too religious and too "pro-life" for the leaders of the industry in this country, because they did not and do not adhere to Judeo-Christian values, traditional American values, and are not pro-life in any sense. Many leaders at the top of the American hospice industry are not like Dame Cicely Saunders, though they pretend to be. They are utilitarians mostly concerned with expanding the industry's influence and making profit in the end-of-life care arena. The leaders at the top of the National Hospice & Palliative Care Organization ("NHPCO") are the Euthanasia Society of America's heirs and benefactors philosophically. The NHPCO is legally and corporately the final successor organization of the Euthanasia Society in the very strictest sense of the terms. |
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Anyone who doubts that the Living Will which is urged upon all Americans comes from the Euthanasia Society can read the main article proposing its adoption written by attorney, Luis Kutner in 1969 entitled, "Due Process of Euthanasia: The Living Will, A Proposal," [Indiana Law Journal v. 44, 1969, p. 549] There you have it! The Living Will was written to create a due process of euthanasia. In addition, in 1970, the Euthanasia Society of America distributed 60,000 living wills. They knew where they were leading American society, even if Americans did not! What is a patient's "due process of euthanasia" but having the government create a patient right under the law to be medically-killed. In other words, Kutner's intention in creating the Living Will was to provide a way that governmental authorities could allow a form of euthanasia. The living wills were "sold" to the public as patients determining what type of care they would or would not want, but their main effect is to limit care that might allow them to live longer, an incremental step toward open euthanasia. Even though the public today never thinks they are agreeing to "euthanasia" when they make out a Living Will, the effect of filling one out can interfere with getting treatment if you change your mind and want care. For example, some physicians will "write off" patients who have a Do Not Resuscitate order or a Living Will and simply provide "comfort care" while refusing to treat easily-treated infections. Not treating such infections results in an early death. While "palliative care" in its purest form is made possible by advances in medical science and practice and is applied to relieve suffering at any stage of life, there are palliative care leaders who seek to use this newer specialty within medical practice to further an agenda that takes our society further away from affirming the value of human life and "doing no harm." Ione Whitlock of The LifeTree Organization tells us that:
Transitions in BusinessUnderstanding what is happening in hospice and end-of-life care today can only be fully understood by considering how businesses have evolved over time. Today's hospice agencies are corporate business entities, whether for-profit or nonprofit. The change from personally-owned businesses to corporately-run businesses does affect how end-of-life care is provided. We all know that through the years people bought from local farmers, local markets, and local shops. With industrialization came the ability to produce more goods, sometimes better goods, and cheaper goods. Buyers flocked to buy the cheaper goods. However, as a result, many small shopkeepers and makers of goods went out of business. "Progress." They had to adapt to survive. Things changed. Over time local farmers, markets, craftsmen and shops became bigger local shops, bigger groups of craftsmen, bigger farms, but they were still local. If a craftsman made shoddy goods, you could always go down the street to the other craftsmen for quality work. Good quality work was (and still is in many cases) rewarded by people buying those goods, foods, and services. Competition among different providers of goods and services resulted in efforts to maintain high standards. Providers with good values and integrity keep to those standards while still trying to find ways to make things, grow food, serve at a lower price. Why not? Lower prices bring more buyers, and eventually more profit if it is done right. Nothing wrong with that -- everyone's happy. When everyone's generally following moral, ethical guidelines, it works well. Those who violate the laws and standards eventually get caught, exposed, and punished. It's a self-correcting system. Small or big, the providers of good services or products are rewarded and the providers of lower quality are not. We've all heard this before. But what's this got to do with you? Or me? Or hospice? Plenty. What happens if the society and providers of goods and services no longer care about the quality of what they provide, or even about dealing honestly? What if all they care about is profit? If they are a monopoly, the only source of what they have to sell, they can raise their prices, lower their quality and people will have to buy what they can get from them. They will suffer exploitation without remedy, at least for a while. And we all know that has happened at times, for ages. What if there's no monopoly, but many or most of the providers no longer care about top quality goods? The quality available goes down. People won't be able to buy the highest quality goods or services anymore except ordering it at a high price perhaps from afar, if what they want is still available somewhere. When a business, farm or shop is run and owned by an individual person or small group of persons, they are more directly interested in what the customer wants. They are more likely to be sensitive to complaints and want to create satisfied customers with every business transaction. However, when the businesses are no longer controlled by individual persons, but are run by a board of directors and the business is no longer the responsibility of one man or woman (or a small group of individuals) decisions may be made for different reasons. If the businesses become legal entities with a life of their own, corporations that get funding from investors who buy stock in the corporation, the corporation's administrators no longer answer directly to the customers. The administrators answer to the stockholders, even though they will say, "the customer always comes first." The corporation is loyal to and controlled by what the investors, or usually the most powerful investors, want. The investors' goal is a return on their investment. How much do they want and how soon do they want it? Do they want long-term growth or short-term growth? If they want short-term growth, do they care so much about it that they are willing to let the corporation's agents provide fewer services or goods, lower quality services or goods, even cheat, steal, commit fraud or worse? If you've gotten this far, you may still be wondering what this has to do with end-of-life care, hospice or the dying. Good question! When the hospice corporation is for-profit, clearly the investors' eye on profit controls many decisions. This leads to cost-cutting, denial of services to patients and many problems in the end-of-life care setting, and more hospices are now run by for-profit corporations than nonprofit! When the hospice corporation is nonprofit, many problems can still arise. The hospice corporation's administrators may be there for reasons other than serving the dying, as we shall see. In areas that have a state-limited number of hospice providers for any one geographical region, the hospice corporation has a virtual monopoly. For example, in states like Florida, there is a "certificate of need" system where the state determines how many hospices may operate in one area. Often, only one hospice is "certified" to conduct business in an area. That state-determined monopoly status allows the hospice to do things it would not do if it had competition. On the other hand, in states where there is no "certificate of need" system, the state allows as many hospices in as wish to operate, sometimes as many as 60 hospices in a metropolitan area. Competition for patients is fierce, something the public never sees. That competition for business dollars has many consequences, often damaging to small hospices with greater dedication to the mission of hospice as envisioned by Dame Cicely Saunders, the mission people expect to be reflected in the services provided to their loved one.
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II - Hospice Today
The Business of HospiceThe largest and incredibly profitable hospice corporations don't provide hospice services the same way as those who run hospices with a real dedication to the mission. Many of the CEOs of very large hospice corporations have expanded their size by using cut-throat tactics that shut out smaller hospices, sometimes stealing patients from them, sometimes putting them out of business. Some are being destroyed by shutting them out of hospice referrals or being bought up by the larger hospice corporations. One way of "cornering" the market in an area is to find a way to get more referrals or to "grab" patients before other hospice agencies have a chance to enroll them. I've repeatedly been told about some of these big hospices placing hospice admission nurses right in the halls of acute care hospitals, literally "trolling" for terminally ill patients to enroll. You might think that the HIPAA Privacy Rule would prevent a hospice nurse from accessing information that her hospice is not involved in and that she does not have a direct professional relationship with; you would be wrong. There are hospitals allowing hospice nurses to access records and know who is likely to be discharged to a hospice, and these trolling hospice admission nurses scoop them up for the big hospice they serve, even though the patient has the right to choose their own hospice. Physicians may refer their hospitalized patient to a particular hospice because it provides really good end-of-life care, and what happens? The family that has been told a hospice representative will show up at the hospital mistakenly thinks that there is only one "thing" called "hospice." When the big-hospice agency nurse arrives, the family thinks she is from the hospice the physician wanted them to go to and signs their loved one up with the wrong hospice. This happens a lot, and many hospice administrators know about this scam. Competition can really be fierce for hospice patients. That's what Hospice of the Sunrise Shore's CEO, Gerry Habermehl told me back in 1998. I put Chuck Babcock, investigative reporter for the Washington Post in touch with Gerry and this is what he wrote back in 1998:
Babcock also wrote about Vitas' marketing efforts: "Each patient also means money for ... nearly 100 Vitas agents earning commissions by recruiting the doomed."
Vitas said that they had discontinued the practice of paying agents finder's fees for bringing in new dying patients. ["Hospices Big Business, Thanks to Medicare" "Exploitation of Some Patients is Alleged" June 14, 1998] The 1998 Washington Post article continues:
That was then in 1998. In fiscal year 2009 the hospice reimbursements were:
For good reason: the continuous care in the home requires that an R.N. or L.P.N. provide care for the patient one-half of the hours the continuous care team is in the home, anywhere from 8 to 24 hours a day. Patients who are placed in the higher levels of care demand much more services, because they have extreme symptoms which are uncontrolled. The greater intensity of care helps get those symptoms back under control and costs a lot more to provide. However, some hospices have refused to provide the required continuous care level of care even though they had all the staff to provide that care. After the Alvarez family filed a public complaint to express their concerns and later expressed their desire to speak with reporters, I put Babcock in touch with Jose Alvarez' family. The family's goal in going public was to prevent such problems from happening to other families in the future. Babcock interviewed Jose's family and wrote:
"Erred?" The hospice in Michigan purposely refused to provide care in the home in order to bolster their financial status. Jose Alvarez's family wanted the public to know what happened to them and wrote:
The hospice not only ignored the family and Jose, they ignored me even after I directly confronted them and questioned their illegal policy. I simply asked them to follow the standards of care within hospice that allow the patient to choose for himself. Dying at home is very important to many patients. Carole Alvarez was devastated and told the Washington Post:
In Jose's case, the hospice in Michigan was making sure to keep all their beds filled at their two free-standing facilities so they could charge for room and board there. In addition, they could bill at the higher rates for patients with uncontrolled severe symptoms (either "continuous care" or "general inpatient" level of care). The hospice was attempting to acquire funds they had been ordered to repay Medicare due to past "inappropriate billing" (fraud) they had committed. When they told Jose Alvarez and his family "there are no nurses" available for continuous care at home, they lied. I was on the continuous care team and we all knew we were available to provide care in the patient's home. It really bothered me that the hospice in Michigan cared nothing for the standards of care or the patients. Well, money is what allows a hospice to provide services. Problems arise when money becomes the first priority and service comes second. Aside from billing for services rendered, hospices often use fundraising campaigns to bolster their revenue. Nonprofit and for-profit hospices accept donations and bequests from the public. "Donate to hospice." "Support hospice." "Hospice: compassionate care."... That's what the public hears. They don't hear "Donate to this business "Hospice of the so-and-so Region." The public doesn't know where all the money goes or how it is used! Of course, those hospices that do provide the full range of required and needed services absolutely need those donations to help provide the best care. Many charitable nonprofit hospices also take in patients who do not have health insurance and cannot pay for the services. Donating to these charitable hospices helps them provide care for the most needy. But hospice administrators who are in it for the money don't advertise that the public's donations, "go to support the administrators of this business, 'Hospice of the so-and so Region." Top administrators can use contributions to help themselves to $200,000 or $300,000 or more as their annual salary, plus benefits and other perks. I know of administrators that not only get the big bucks, they get all the health insurance, retirement benefits, fancy cars and much more, and these are CEOs of "non"-profit hospice agencies! For example, Hospice of the Florida Suncoast, Inc. ("Suncoast Hospice"), the largest nonprofit hospice in the U.S., reports it paid $320,347 in 2009 to its CEO, Mary Labyak. The Hospice of Michigan, Inc., the second largest nonprofit hospice in the U.S., reports it paid $447,008 in 2009 to its CEO, Dorothy Deremo. Hospice of the Western Reserve, Inc., the third largest nonprofit hospice in the U.S., reports it paid $323,740 in 2008 to its CEO, David Simpson. Clearly, hospice is big business. We still hear about hospices that provide doctors with incentives of various sorts to refer patients to that hospice exclusively, just like pharmaceutical companies "wine and dine" physicians or give them all sorts of gifts, paid seminars and trips in efforts to get them to prescribe certain medications. These are forms of kickbacks and in many cases are not acceptable incentives and are not legal. Would you want your loved one to be referred to a particular hospice just because the hospice was paying your physician to do so? |
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You get the idea. Never in a thousand years would these hospices want the public to know about these obscene salaries. At $25 per donation each, it might take about 10,000 - 17,000 people to donate enough just to pay one of these CEO's salary! Just think about that when you think of donating to these hospices! Or willing your estate to them. Where is your money really going to? Well, now we know. Let's get a reality check here: whether for-profit or nonprofit, the top administrators at many big hospice businesses are paid hundreds of thousands of dollars each year. But the public doesn't have a clue. The hospice agencies that really need the donations most are the nonprofit hospices that affirm the sanctity of life, abide by the standards of care and provide all the services the patients really need. There are some smaller for-profit hospices that work hard to provide good care, but not all hospices do that. Several of the really large for-profit and nonprofit hospice corporations have been found to be committing Medicare fraud by the Justice Department. Even though hospice corporations take in donations, they are funded mostly by the federal government's Medicare and state Medicaid programs, with much less coming from private health insurance. Why would the federal government do that? Because "hospice" saves big bucks over acute hospital care. This has been proved many, many times, study after study. Hospice lobbyists brag about that to the feds so they can keep the funding flowing in: The biggest hospice industry lobbying group is the National Hospice & Palliative Care Organization. They write:
But when hospice reaches their corporate hands to the public, they don't brag about the money they save the government's Medicare and Medicaid programs. They only talk about "compassionate care for the dying." They don't mention the obscene salaries the CEOs, VPs, and others are getting at these larger hospice businesses. Some administrators of the "Hospice of the so-and-so Region" are more concerned about the money, i.e., "please insert your retirement accounts here and make sure to leave your estate and life-insurance payout at the door when you enter. We'd really appreciate it." And here they get real specific: "Please make your checks out to Hospice of the So-and-So," not "hospice" all over the country. Every couple of years I get a call from someone around the country asking how to donate to "hospice," because "hospice" gave such great to care to Aunt Arlene, and they want to make sure it gets to the right people. But, they don't know who the "right people" are, and I have to explain to them that it was a unique, specific "hospice" business that provided care and they have to donate to "that" hospice. I end up looking up the information and letting them know what the hospice's address is so they can mail the check. People are just very confused, and it's been planned to be that way as part of a long-term "feel-good about this thing called hospice" strategy of the hospice industry. Top administrators at these large hospices are usually more interested in their own annual salary increase than an individual patient's needs. I've heard about hospices denying something as simple as a certain type of over-the-counter medication to a patient whose family had paid many thousands of dollars for room and board over a long time, all to save on the cost of medications ... while at the same time, the CEO was earning over $200,000. There's the "mission of hospice," and there's the "business of hospice." Many staff really care about the mission. The administrators of the huge hospices? Safe to say they care more about the business of hospice: revenue, profit and what they can bring home for themselves. In the 1980s, there were a few hundred nonprofit hospices and the number of for-profit hospices was almost nonexistent. In 1992, there were about 1,000 nonprofit and a couple hundred for-profit hospices. In 2009, about 1,400 of the hospices were nonprofit and more were for-profit, about 1,800, some of these with several branches in a region. The ratio of nonprofits to for-profits has completely switched with growth in for-profit hospices leaping far ahead. This is a clear sign that from the business perspective, hospice is looked upon as an opportunity to make money, and I know that when hospice corporations are making a lot of money, there is major fraud involved. And for-profit hospices still receive donations. Where does the money go?
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artwork by Vickie Travis, design by Ron Panzer and Vickie Travis |
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Medscape Today reports that "Patients Receive Fewer Services From for-Profit Hospice Providers" than from nonprofit hospice providers. This is not encouraging news for those facing enrollment in a hospice which is more and more likely to be a for-profit hospice. Now don't get me wrong. There are some really good hospices (hospice entities) that put their patients first and provide a full range of services to the terminally ill. I worked with some really great hospice professionals. I trained with Mary C., RN who had been a cardiac care specialist at a major big-city hospital medical system. She demonstrated the highest level standard of care for hospice nursing. And there are other wonderful nurses and doctors serving in this field. But let's get back to the business of "hospice." "Hospice" is like an investors' dream (if we're talking for-profit hospice). And even a large non-profit can rake in the dough for the chosen few at the top. A recent article focuses on the business angle where for-profits scoop up the less demanding patients and let the smaller nonprofits deal with the more difficult cases, so the for-profits make even more profit. "Without changes to the current reimbursement structure, coupled with measures to ensure greater accountability in the use of these benefits, we are concerned about the potential for a more dominant hospice provider to serve selectively a higher percentage of patients with a non-cancer diagnosis. The patient population at such a hospice could thereby average significantly longer and more lucrative periods of time during which the provider would realize a great return on the Medicare per diem payments for those patients, while potentially shifting a disproportionate share of the more costly short-term patients to hospice providers with a broader commitment to a community beyond those with an ownership interest. If you look at the "business" outlook for the United States economy or world economy, it's pretty glum right now. But if you look at the business outlook for "hospice," (i.e., "Hospice of the so-and-so Region" all across the country) it's better than finding oil on "Uncle Jed Clampett's" Tennessee swamp (think "Beverly Hillbillies"). It's a lot better than the meteoric rise of and future forecast for gold prices. No wonder that 8 out of the 9 largest hospice corporations in America are for-profit. |
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Gold prices through the years look like this: 
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The number of hospice patients being served through the years looks like this: from www.medscape.com/viewarticle/549702_2 |
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Other sources differ on the exact numbers, but the trend is there. The expansion of hospice as an industry looked at by the number of patients served, number of agencies serving patients is much more impressive from an investors' perspective than the rise in gold prices over the past few decades! From the government perspective: Well, if you know any other industry where the funding is increasing by $1 billion each year, let me know. The federal government obviously has big plans for hospice and its future role in the American health care system and in your life and your family's lives. Think health care reform! "There were more than twice as many Medicare hospice patients in 2008 than in 1998." -- Hospice Data 1998-2008 - Centers for Medicare Services With the number of patients, i.e., "customers," increasing by 10% every year, without fail, I project the likely trend for the industry could be something like this: |
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In 2009, only about 40% of hospice patients were cancer patients. However, in the 1980s, almost all of them were! Think about it. Why the change? In 2009, 13% were in hospice simply because they were weak ("debility"), 11% were in hospice because they had "dementia" of some sort (and that can be a true dementia or simply mild forgetfulness). When patients enter hospice simply because they are elderly, weak or forgetful, it is a red flag that something definitely is not right. Just because someone is elderly, weak or has dementia does not mean they are imminently dying at all, or that they are going to die naturally even within the year or a few years. Many elderly individuals are weak and have dementia to some degree. Does that mean we should kill them? Some clearly believe the answer to that is "yes." Sometimes, the elderly are neglected intentionally and not given the close attention they require. And their health declines because of that neglect. This type of neglect can occur in the patient's own home or in a nursing home. How would you feel if it was your grandmother or grandfather, or mother or father, who was targeted in this way? Or your children's grandmother or grandfather? They still have their dreams of seeing your children grow up or even seeing them at all. Just because they're elderly doesn't mean they don't have any dreams of their own, that they don't want to live. Who decides that this doctor or administrator has the right, the moral authority to end someone's life? ... to cancel your dreams for that life? ... to cancel his or her dreams? Why do "they" get to play God and decide? |
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| Artwork by Graffiti artist Banksy |
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My own mother-in-law was neglected and malnourished, even emaciated. My wife and I took her into our home when she was visiting and cared for her, made sure she ate and bathed and got all her medications. She had not been getting her B-12 injections for pernicious anemia nor had she gotten her medications for high blood pressure where she had been living. It was a miracle she was still alive. But once we had her here, she gained about 30 pounds and was at her optimum weight and health, even though the family had told us she had "failure to thrive" and "could not gain" weight. All she needed was decent food, common medications and loving care. If she had remained where she was, she would very likely have been sent to hospice, continued to be deprived of the simple blood pressure medications she needed and her B-12 injections, and died at least three years earlier. She lived another few years with us till she died a natural death. And yes, a good hospice was involved, then, at the end. What is happening with the change in the type of diseases that "get someone admitted into hospice" in America? It's a complete transformation of what normally happens at the end-of-life. In the past, most patients had incurable cancer as an admitting diagnosis and entered hospice. Now, dementia, the simply elderly or "weak" patients make up a large percentage, and they die sooner rather than later ... by design, and it's been in the works for a long time. The plan is for close to 100% of Americans to die in hospice rather than an acute care hospital. Some private insurers are creating "Advanced Illness" programs where patients are admitted for care by a hospice agency even though they are not expected to die within six months. This appears to be a move to save money by having patients die sooner with fewer or no hospitalizations, thereby saving the private insurance company (and the government) significant expenditures and increasing profit (helping to reduce the budget deficit). They may not achieve total utilization for hospice or palliative care, but they will increasingly narrow the gap toward their goal. Hospice and palliative care will figure in almost every American's life at the end, and certainly, it will handle one or more members of every American family, your family. If you were a betting man, you couldn't find a better bet than hospice and palliative care. As sure as anything, we know the federal government has, is, and will promote "hospice" and "palliative care." They're increasing Medicare funding for hospice alone by $1 billion each year! We know the media editors will promote "hospice." Literally thousands of heart-warming stories about hospice have been written. We know that the economic pressures of the times will force greater utilization of hospice. What form that hospice will take is being shaped by those who don't care about you and me. When you understand who has been shaping end-of-life care for their own agenda, you may be very concerned about health care reforms coming to your neighborhood. You should be. There are disturbing trends that are washing over the industry. The largest nonprofit hospice in the country, Hospice of the Florida Suncoast immediately comes to mind. That hospice's CEO, Mary Labyak, has told her staff, "We've got to corner the market." What kind of statement is that when hospice is supposed to be a caring place where the focus is on serving patients at the end-of-life? How does that statement jive with the idea that hospice is a philosophy of caring well for the dying as well as for their families? And Labyak? She's regularly been placed on the board of directors of the nation's largest hospice lobbying group, the National Hospice & Palliative Care Organization. She's the one with a salary of $320,347 in 2009 at her nonprofit Hospice of the Florida Suncoast.
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Why Hospice Is a "Protected" IndustryWell, it's pretty clear that hospice is being promoted at every level of government and by every major player in society, including the major media, big business, hospitals, nursing homes, policymakers, budget analysts and others. We've seen that hospice has been proved to save money over acute hospital care. The savings amount to billions of dollars. "In 2009, an estimated 1.56 million patients received services from hospice." "Researchers at Duke University found that hospice reduced Medicare costs by an average of $2,309 per hospice patient."
1,560,000 hospice patients per year |
"Hospitals across the United States now have Palliative Care Units, where physicians and staff specialize in the care of the seriously ill. The choice to have these units has nothing altruistic about it; it is driven by the bottom line. Studies have shown that the cost incurred on a patient in the last few days of hospitalization when they are in the Palliative Care Unit is one quarter of what it is when they are in a non-Palliative Care Unit." The top level policymakers have decided that people will die in hospice or palliative care units, and that they will be pushed into hospice through a wide variety of means. $3.6 billion saved in one year. Think that motivates the government? That's nothing compared to the savings when the people placed into hospice doubles in the years to come. That's the plan. If patients are hurried along toward death, the savings skyrocket! We may not wish to think about it, but the U.S. Department of Public Health has long looked at the American population as a "herd," in other words, as a total group to be managed. They do not think of what is best for a particular person or even thousands of people. They do what they decide is best for the whole population. For example, when the U.S. Dept. of Public Health wanted to protect the "herd" of American people from polio, they used oral polio vaccine that had been weakened, but still contained live virus. A health department physician I contacted told me the idea was to promote "herd" immunity by exposing not only those who were vaccinated to the attenuated virus in the vaccine, but also those who refused to take the vaccine to the live virus floating around in the community due to many having been vaccinated. The rate of polio cases declined dramatically shortly after the polio vaccine was introduced in the 1950s. That some people could develop actual full-blown polio did not stop them from using the live virus vaccine. That some people had chosen not to be exposed to the live virus did not stop them from exposing them to the live virus involuntarily (through contact with others who had been vaccinated). Predictably, some people did become quadriplegics due to having been exposed to the vaccine, either directly through vaccination or otherwise. In the case of Griffin v. United States, we see that in 1963, Mrs. Griffin was vaccinated and she became a permanent quadriplegic. "Dominick Tenuto was stricken with polio in 1979 after coming into contact with his daughter's stool while changing the diaper. The infant had been given the ... vaccine, ... which contained a live virus." Thirty years after Mrs. Griffin got polio back in 1963, they were still using live virus in the oral polio vaccine. In 1993, I had to fight the local county health department to have my own son get the inactivated, "dead" polio vaccine safely used in Europe for over a decade. I didn't want him to unnecessarily risk contracting polio. After several refusals by the health department, I stood my ground against very strong efforts to intimidate me into using the live oral vaccine. Finally, the physician "magically" produced the version of the vaccine that we wanted, that was safer individually for him, and administered it to my son. They had it all along, but only wanted to use the live oral polio vaccine as it promoted herd immunity. We can understand the thinking behind the government's program. They wanted to expose the non-vaccinated to the live virus to help immunize the entire U.S. population. The Centers for Disease Control states: "Polio was one of the most dreaded childhood diseases of the 20th Century in the United States. There were usually about 13,000 to 20,000 cases of paralytic polio reported each year in the US before the introduction of Salk inactivated polio vaccine (IPV) in 1955. Polio peaked in 1952 when there were more than 21,000 reported cases." [and] "The last cases of naturally occurring paralytic polio in the United States were in 1979, when an outbreak occurred among the Amish in several Midwestern states. From 1980 through 1999, there were 152 confirmed cases of paralytic polio cases reported. Of the 152 cases, eight cases were acquired outside the United States and imported. The last imported case caused by wild poliovirus into the United States was reported in 1993. The remaining 144 cases were vaccine-associated paralytic polio (VAPP) caused by live oral polio vaccine." 144 people contracted polio from the live polio vaccine from 1980 to 1999. So, to prevent 13,000 to 20,000 cases, they risk 144 acquiring the disease. Seems logical, but could they do better? The 144 would not have gotten polio if they had gotten the inactivated polio vaccine, but they were given the live version due to Public Health Department policy. So, who should decide? The government or you? When it's your child, should you decide or the government? The government's leaders decided they will decide for you. The policymakers at the U.S. Public Health Department recognize that some individuals will either die or have severe reactions to vaccines that they mandate be administered to the general population. Children are mandated to have many vaccinations to prevent the spread of disease and only those given a waiver can be excused from receiving the vaccine and still attend school. There is even a table of vaccinations and likely serious consequences some individuals may suffer. The Code of Federal Regulations's "Vaccine Injury Table" lists the time periods within which someone receiving a vaccine has to manifest symptoms in order to be compensated for their death, injury, disability or condition. If you don't manifest "death, injury, disability or some other condition" soon enough according to the table, then you're not likely to get compensation.
While most people may not suffer much or at all from a vaccination, in rare cases some do suffer severe, immediate, life-changing consequences, chronic illness, disability or death. I've met people who were perfectly normal at birth, received a vaccination, and then within days had severe neurological damage and became permanently developmentally-disabled (mentally retarded). The "one-out-of-a-million" chance; it happens to someone, somewhere. Another example of how government leaders think and the consequences of government-promoted vaccinations? "The HPV vaccine Gardasil, which is being vigorously pushed on unsuspecting young girls and women to theoretically guard against cervical cancer still has never been proven to actually prevent cancer. On the contrary, evidence suggests that under certain circumstances the vaccine increases your risk of precancerous lesions by nearly 45 percent, and an ever increasing number of girls are being seriously injured by this unnecessary vaccine. But can you sue and win in court? Not really. In order to encourage manufacturers to continue to make vaccines, Congress enacted: the National Childhood Vaccine Injury Act of 1986 [that] created a so-called "vaccine court" to address safety claims in an attempt to ease the threat of lawsuits in state courts against pharmaceutical companies and insure against them pulling out of what they claim is an unprofitable vaccine marketplace completely. The intent here is not to scare anyone, though we do need to carefully think about what we do medically. The intent is to show how government policy-makers think and how policy is implemented. They are willing to sacrifice some who are healthy in order to carry out the vaccination programs. If they can prevent the spread of terrible diseases, they would argue it's worth it. They take chances with our lives and are willing to experiment upon us with what they mandate we take. There may be safer ways to do the work. And even though vaccine manufacturers take credit for the reductions in deaths from certain communicable diseases, others say that vaccination is not really the only explanation. Improved nutrition and water quality, sanitation and sewer services as well as improvements in medical care are also important contributing factors. On February 22, 2011, the Supreme Court ruled in Bruesewitz v. Wyeth that "the NationalChildhood Vaccine Injury Act preempts all design-defect claims against vaccine manufacturers brought by plaintiffs who seek compensation for injury or death caused by vaccine side effects." Now, "increasingly, pediatricians are refusing to treat children who are not fully vaccinated. We need to understand that this same type of thinking flourishes among the policymakers at the top levels of government. When they wish to, they use government authority to mandate the results they seek. Aside from vaccination, government can use other methods to prevent the spread of infectious diseases. The government has "emergency powers" that set aside and void normal Constitutional procedures. When a serious epidemic threatens to spread to larger areas of the population, the U.S. Health Department, the President and the Governors in each state are involved. Decisions they make are based upon what they deem best to prevent that spread. However, it may include the imposition of martial law in specific areas. It all sounds fine theoretically until it affects you and your family. In between the rule of law and completely implemented martial law there are steps that have been taken that increase the power of the government at the expense of individual rights. Quarantine policy is based on these same principles: what is best for the "herd" or total population. The government will sacrifice many if it saves a larger percentage of the total population. Entire cities can be quarantined, with the military surrounding the city limits to enforce the quarantine zone with threat of lethal force if necessary. While some may think these things only happen in movies, it is realistic to consider these scenarios might happen at some time in the future. Why do I raise these issues? It's to get a rare glimpse into how the stakeholders create policy at the very highest levels of government today. How they think. It's the same type of thinking with current health care reform, reform that's already begun for Medicare and Medicaid, utilitarian rationing of health care (which already happens in managed care organizations all over the country), and the push to have patients enter hospice or palliative care units earlier. There is nothing wrong with making health care systems more efficient and doing away with truly ineffective treatments, but utilitarian rationing (which is what we're talking about in this book) has an agenda behind the decision-making. The government and its agents and providers of care will do whatever the elite policymakers deem "best" for the entire country (not what is best necessarily for you and your family). All the state and local county health departments will follow suit. In addition, all licensed physicians (or any health care professionals) who wish to retain their license, will toe the line should a federal policy tell them they have to do this or that, or not do this or that. Physicians will be directed to order a patient into hospice under certain circumstances. Or, treatment pathways that are open now will be closed, so hospice or palliative care becomes the only available "treatment!" The patient's right to choose will be extremely limited.
Good and Bad HospicesOne of the more common questions that we've heard through the years is, "how can I find a good hospice?" "How do I know which hospice will provide the care my loved one needs?" There really is no one certain answer to these questions. Often, the recent experience of someone in the same town or city who has used a particular hospice is very revealing, but someone else's "wonderful" experience with a hospice is no guarantee that the next person will have the same level of care. Recommendations from health care professionals who are in your family or from those you trust can be very valuable, but again, they are no guarantee. Do these health care professionals share your values about how care should be provided? Do they value the sanctity of life or do they think it is "ok" to end life (one way or another) to relieve suffering? Do they believe in quality of life as the main determinant of whether a life has value? Someone who thinks quality of life is the main factor to consider may rate a hospice very highly even though they hastened a patient to an early death. If you get a recommendation from someone who recognizes the sanctity of life, that would be a good sign. Sometimes, the patient and family simply have to call different hospices and get a feel for how the hospices present themselves, how committed they are to the mission of service to the dying and then, take a shot and try one. If things go well, good. If not, the patient and family need to listen to their instincts about what is happening. When medications are given that are not clinically indicated, when services that should be provided are not being provided, when it's hard to get in touch with staff that can help, then we need to see these as "red flags" and have another agency manage a transfer to their care, or get care in a home health care setting. Sometimes, that is the only option if there are few or no other hospice agencies in the area. Some hospice leaders are just now forming a new Hospice Life Association of America, which will help form more pro-life hospices, where all the hospice agency members affirm the sanctity of life and share the Hospice Life Pledge with their employees. Member agencies are committed to the pro-life mission and will never hasten or impose death unnaturally. If you know that a hospice agency actively promotes a pro-life message, that it honors the sanctity of life and will not impose death, but allows for a natural death in its own timing, then that is probably the best choice for those who wish to protect their loved one from exploitation, inadequate service or staffing, or outright hastened death.
Hospice Reimbursement: Is it a Problem?The Medicare hospice benefit, instituted in 1983, was a boon to the expansion of hospice in America. It provides for a per-diem payment for every day the patient is enrolled in the hospice agency. Hospice administrators have told me over the years that the reimbursement is frugal, but that with good business practices a hospice agency can break even and make enough to pay for all services required to be provided under the federal and state standards of care. The nonprofit agencies often receive donations from the public to help them provide services, but it's not always easy! The cap on reimbursement, is it a problem? Most people have no idea there even is a "cap" or limit on how much the hospice corporations get per patient each year. Well, over 500 hospice agencies have joined together to fight the government's hospice cap formula. They call themselves the National Alliance for Hospice Access. They think reimbursement is a huge problem. They have a lot of data showing that the cap does not pay for all the services required and are working hard to either change the formula or do away with the cap as it exists now completely. There is a lot of merit to the claims that the reimbursement system leaves much to be desired and should be updated to assure hospices have the funds to provide the very best care. All hospice corporations would welcome increased reimbursement per patient each year. However, the per-patient reimbursement is not likely to be increased much (or at all) if the economic strains on our economy continue. Although we may wish that funding should be provided adequately for each patient's end-of-life care, other health care agencies, hospitals and corporations are going to be fighting for every federal dollar they can get. This does not mean that overall spending on hospice as an industry will not grow; it will ... due to the increase in the number of hospices and total patients served. To admit a patient into hospice, a physician must certify a patient as "terminally ill" indicating the patient is likely to die within six months. But, physicians cannot always accurately predict how long a patient is going to live, and patients often do live beyond six months. What is the result of having a patient live longer or require services beyond what the reimbursement cap will pay? When the patient lives beyond a certain time period, the patient's cost of services becomes a "net-negative" to the corporation. Although hospices with integrity balance out the revenue from some patients to help pay for services to others, problems arise when top administrators wish to use the hospice as a vehicle to pad their own income. They twist the hospice into a "rogue" hospice. CEOs of hospice agencies can manipulate boards of directors to raise their salaries into the hundreds of thousands of dollars, while staff struggle with increased case loads and patients suffer from fewer visits, fewer services being provided and a failure to meet their very urgent needs at the end-of-life. This is a problem common to all health care agencies, whether hospitals, nursing homes, assisted-living centers or hospice agencies. However, hospice's reimbursement is quite unique. There are four levels of care: the routine home care level, the respite level, the general inpatient care level and the continuous care level of care, all with different reimbursement payments. As we have seen, from October 2010 through the next year, the routine Home Care level is reimbursed at $146.82 per day; Continuous Home Care is reimbursed at $856.12 per day or $35.67 per hour; Inpatient Respite Care is reimbursed at $159.65 per day; General Inpatient Care is reimbursed at $652.27 per day. What does this mean? It means that at the lower level of service, routine home care, hospice agencies provide routine nursing visits 1-3 times per week, aide visits 1-5 times per week, and a social worker visit occasionally as needed, and so on. If the caregiver is exhausted from caring for the patient, the hospice can take the patient into a hospice facility and provide respite care for about five days. If the patient develops extreme symptoms out-of-control, then the hospice can provide more intensive services. If these more intensive services are provided in the home, it's called "continuous care." If these services are provided in a facility, it's called "general inpatient care." All of this can work very well if the hospice agency is dedicated to the mission. When that happens, hospice services can be a real blessing to the patient and family. The hospice makes adjustments to the plan of care as the patient's needs change and provides those services. Good clinical intervention which is tailored to the unique needs of the patient and their very specific clinical condition can make a huge difference in the lives of the patient and his or her family. However, a rogue hospice looks at the hospice reimbursement arrangement completely differently. They don't think, "Mission first" and "how are we going to provide all the services needed?" Rogue hospice administrators think about "cornering the market," driving other hospices out of business or reducing the other agency's slice of the local business. Rogue administrators think of how much they can earn personally if they cut this or that service. They think about how they can build a hospice "empire" and not about reasonably restricting their own pay to meet the needs of the patients. Administrators who have created a rogue hospice agency view hospice as an opportunity to exploit Medicare, Medicaid, private insurance and families as well. They plunder these resources for all the money they can seize, even committing fraud or other criminal activities. Administrators of rogue agencies will arrange kickback arrangements with nursing homes, physicians and hospital administrators in their area. They will use their political connections to "grease the wheels" moving their agency to the top of the list in their area while working to actually harm and diminish the role of other hospices in their area. I've heard from several hospice administrators through the years who have related the dirty tactics that these rogue hospice administrators use to further their selfish ends. Administrators of the rogue hospice agencies are basically dishonest, yet they are often hailed as very successful business leaders! The ones I've met have an incredible ability to lie to your face with a smile. They have no conscience, or appear not to have one, and they think nothing of the harm their actions cause the patients, families and the staff. The ones I've met care nothing about the standards of care, morality, or the law. They use the hospice reimbursement levels to increase the revenue to their hospice and themselves while decreasing services to the patients. Over the years, I have heard from hospice staff around the country about "inner-circle parties" at some big hospices with the abuse of drugs, alcohol and casual sexual relations of all types among these rogue hospice administrators and some of their "inner circle" staff. They just do not respect traditional morality at all. The administrators of rogue hospices proudly dress very professionally and outwardly appear to the public to be the very picture of dedicated public servants. We need only look at their individual salaries and actions to see the hypocrisy. When they make sure that some innocent patients will be medically killed (by using staff training to misinform them about the effects of medications), encouraging the casual administration of morphine to COPD patients, not allowing oxygen for patients who need it, encouraging staff to remove needed medications from the patients they admit or to terminally sedate the patients, or actually sending "closers" to end their lives, they never let the public know what really is going on. In these cases, they always lie and pretend to honor the caring, supportive hospice services the public has come to respect.
Hospice and Health Care Industry FraudMary Labyak's Hospice of the Florida Suncoast was cited in 1996 for overbilling $14.8 million from Medicare. The administrators: selfless servants? Hardly. The staff? Many have been dedicated nurses, many of whom leave once they see the cut-throat nature of pro-euthanasia Labyak's approach to the business of hospice. And what kind of actions does this hospice take to create its success in Florida? I've written dozens of articles over the years about this hospice, but basically, most of what they do is hidden from the public. You have to do some digging to learn about the strange choices they make and you immediately understand who they are and what kind of people they are. Hospice of the Florida Suncoast hired Susan Wynn, a convicted felon who embezzled $370,000 and was found guilty of over 100 counts of money laundering. Not only did they hire her, they hired her first thing, the moment she was released from jail. The St. Petersburg Times reported that:
Astounding! But true. They did hire her into the finance department! And:
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That's not all. In June 2003, The St. Petersburg Times reported that the hospice hired yet another felon into its finance department. The paper announced, "2nd felon gets 2nd chance at hospice."
Knowing that they hired these two felons directly into the Finance Department, Wynn (the embezzler) to assist the head of Finance, and Eckerd (the thief) in payroll, it's perfectly clear, without any exaggeration, they value felons' expertise and wanted that expertise for their own. If it were fiction it might make for an interesting story, but it is tragically true. This is how the largest nonprofit in our nation is run, and it is very revealing indeed about what kind of people run it. This hospice is very big and powerful in Pinellas County, Florida. Founded in 1977, it's among the earlier hospices in the country. And like many hospices, its board members consist of some of the most prominent leaders in town, the executives of some local businesses, a few county commissioners and other wealthy citizens. The hospice brings in huge amounts of money from donations in addition to the government's reimbursements. While the hospice itself is nonprofit, it has a for-profit subsidiary, Suncoast Solutions that produces hospice management software. Some of the board members of the nonprofit hospice have also served on the board of the hospice foundation as well as the for-profit subsidiary. A class action lawsuit was filed in February of 2003 against the Hospice of the Florida Suncoast. The lawsuit was brought against the hospice for disclosing private information about patients including their names, addresses, diagnoses and telephone numbers. I personally went online and saw the Suncoast Solutions "ftp" website where the data was publicly accessible (1, 2, 3) and verified that personal information was being released on the ftp site as well as within software help screens, contrary to patient privacy protections. The "publicly accessible ftp" site was not password-protected and contained files that could be downloaded that contained the information. The lawsuit also was brought alleging that the hospice (run by CEO, Mary Labyak) diverted funds (that had been donated to the nonprofit) to the for-profit subsidiary: "the nonprofit loaned $1.9-million in donated money to its for-profit software company in 2001, calling it an investment in hospice's financial future. Documents and interviews show the money was used to buy out a Louisiana corporation that worked with hospice to develop software. The company is headed by the son of Labyak's friend Jo-Ann Mueller." |
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My friend, Christina Brundage, RN, a very experienced and dedicated nurse has told me and others about some of her experiences working at that Hospice of the Florida Suncoast:
These initiatives were done under the leadership of hospice CEO, Mary Labyak, who received "the Healthcare Architect Award from the National Hospice Foundation" in 2011. What kind of health care is she designing when she approves of euthanasia and terminal sedation? And why would the National Hospice Federation let her chair their board of trustees and honor her in this way? Is this the type of leadership our nation's hospices need to protect the vulnerable? What Christina Brundage, RN witnessed shows how Labyak has twisted the hospice mission and demonstrates what Labyak and others are doing all around the nation. I met Christina Brundage, RN in the years when so many of us were working to try to save Terri Schiavo. Christina exemplifies the dedicated hospice professional who is horrified by the changes in the industry, just as I am. She left the Hospice of the Florida Suncoast before Terri Schiavo was enrolled there, because of what she saw, how the primary focus on caring was lost. She stepped up to become a tireless volunteer for the Schindlers, the Terri Schindler Schiavo Foundation, Hospice Patients Alliance and the pro-life movement in general. Some time after she left the hospice, she was visiting a friend in a hospice facility and saw for herself how a patient could be hastened to his death. American hospice as an industry, led by cut-throat corporations like the Hospice of the Florida Suncoast (that want to "corner the market"), is not the pure "thing" that they market themselves to be. We've got really huge for-profit corporations like Vitas, Odyssey, Gentiva, Vistacare, and "Golden Living" that acquired the infamous mega-corporation Beverly Enterprises in 2006. How big are these for-profit mega-hospices like Vitas? The Vitas website tells us:
1983: ... the year Vitas and others convinced the federal government to create the Medicare hospice benefit. Vitas saw the government's Medicare reimbursement as a profit-making opportunity, just as Washington Post reporter Chuck Babcock wrote in 1998:
That "72%" figure is from 1998. And the amounts needed to start up a single hospice facility are much higher now. The current stats show there are more for-profit corporations running hospices than nonprofit corporations!
Vitas Hospice was acquired by Chemed, the corporation that also owns Roto-Rooter plumbing services! Notice that this thing called hospice is discussed as a "market" and that competition among hospice agency providers for patients is very intense. For-profit hospice is an investment opportunity that is not being ignored by those who know anything about health care or making money in the stock market. For example, Beverly Enterprises, now Golden Living, owned many, many hospices and nursing facilities around the country. Odyssey Health Care owned many hospices and has now been acquired by Gentiva Health Services, another for-profit corporation:
$1 billion was paid to purchase Odyssey health care. $1 billion! If you think hospice is all about compassionate care for the dying, you are very mistaken. It's big business! And if you think I'm kidding when I talk about "profit" in the health care industry, take a look at Gentiva:
Gentiva: $1.42 to $1.45 billion in net revenue! What about Beverly? Before being acquired by Golden Living, Beverly ran many hospices and nursing homes as well. Now "Golden Living" does the job. "Golden Living" sounds so wonderful. At least that's what they want us to think. There are other huge hospice corporations out there, too. Let's discuss Beverly because they were the poster boy for what's wrong with health care in America today. Beverly, for those who know, ran one of the nation's largest chains of nursing homes around the country, and you know how "great" the care is at many nursing homes. Beverly had 82,000 employees with sales of $2.98 billion in 1994. Beverly had some problems with the federal government, big problems. The U.S. Justice Department investigation found that Beverly had defrauded the U.S. Government to the tune of $460 million! How? By billing for services not rendered, asking to be paid for work not done. A good scam if you ask me, one that many other health care corporations are doing as well, so don't think Beverly is the only one. When I spoke with the U.S. attorneys' office, they told me they had thousands of health care fraud cases pending that they couldn't even get to. Sometimes it takes three years to process one of these fraud cases. It's easier to rob the federal government through Medicare than to commit what we've come to think of as the "real" crimes, like bank robbing. Why risk your life when white-collar crime pays so well, and you can be assured that the federal government will reward you for the effort? Reward you? Let me explain. The feds found Beverly had fraudulently billed:
In other words, Beverly requested reimbursement for services they didn't provide and got paid for six years without being caught. The U.S. Justice Department and Beverly did come to a settlement. "Beverly Enterprises agree[d] to pay to the United States One Hundred Seventy Million Dollars ($170,000,000)." I think even "little Johnny" can come to the blackboard and do the arithmetic. Department of Justice arithmetic is very simple: |
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Beverly steals $ 460 million |
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Does that make sense to you? It doesn't make sense to me. When someone robs the corner store for $500 and gets sent to jail for fifteen years, you know that felon is going to be out-of-work for at least fifteen years. And bank robbers often are ordered to make restitution, paying back what they stole. A health care corporation robs close to $500 million and nobody goes to jail, plus they get to keep $290 million? You know they're going to just keep on doing it. You couldn't design a more ineffective policy at the Justice Department than what they do. It encourages the opposite of what they say they are doing: "curbing health care fraud." What could be more rewarding than raking in all that money for free and not suffering any significant consequences? It's the same kind of thing you see with environmental protection enforcement. Say some corporation really pollutes somewhere and they get caught as well as convicted of violating the law. The law says the E.P.A. can slap them with up to a million dollar fine or something like that. The company that brings in billions every year looks at that fine as just a "cost of doing business" and pays the fine without even blinking. There's no deterrence in these fines to such huge corporations, and there's no deterrence to fraud in how the U.S. Justice Department deals with health care fraud. In fact, let me tell you about the U.S. Justice Department. They often just don't make the health care corporations that steal from the government (our tax dollars) pay everything back. Do you wonder why? Back in 1997 when I worked at the Hospice of Michigan, the hospice had defrauded Medicare. A year earlier, they had been ordered by the federal government to repay more than a million dollars "wrongly billed." They thought they'd get away with it of course. It was in all the Michigan newspapers at the time. I remember speaking with Raja Mishra, Detroit Free Press reporter who later wrote in his article, "A Business of Death and Dollars," November 7, 1997:
That's obviously a huge sum of money. So what brilliant strategy did the hospice in Michigan figure out to do in order to "correct" their "wrong" billing of $1.5 million? They fired 80 employees, cut costs and decided to commit other violations to get the money to pay the feds back. This involved depriving patients of required services while making sure all the beds in their two hospice facilities were filled, (this is why Jose Alvarez didn't get to die at home as he wished) thereby collecting more room and board. The hospice administrators also ordered the nurses (me included) to record continuous care (a higher level of care) as being provided, even though there was no extra nursing staff on hand. When I saw this, I realized that they could receive millions of dollars more each year for services not provided if they billed at the higher rate of reimbursement. I guess they were not good at "learning" the lessons the feds wanted to teach them. The top administrators of the large Hospice of Michigan knew they were violating the standards for hospice and so did the Vice-President of the corporation. When I confronted management first in a detailed confidential letter and later in person about the needs of the patients not being met, about the exploitation of patients and the violations of the standards, the Vice-President walked me into an office, closed the door securely and just laughed in my face and told me, "Ron, you're absolutely right! This is a violation of the standards of care, but we're not going to stop." "We will get cited, sure." "We'll get a "deficiency. But, they won't shut us down." And that's exactly what happened. When I spoke to the U.S. attorney managing the case against the Hospice of Michigan, I asked him, "Why don't you have them pay back all the money?" I also wondered why they didn't prosecute the administrators. His answer? "Well, if we did that, the business would be shut down and we can't do that." If the people of this country, the taxpaying people of this country, had to come up with a policy for those who commit fraud, they wouldn't say, "we can't do that." They'd shut them down if they were repeat white-collar criminals, throw the administrators who designed the fraud into jail and make them pay back 100% of what they stole. I know that the real reason health care fraud is so rampant and out-of-control is this one policy of the U.S. Justice Department. It is extremely rare for any administrator to be prosecuted, let alone serve jail time. The so-called "corporate integrity agreements" the dishonest corporations enter into with the Justice Department only make them "promise to be good," ... show on paper a plan of how they will "prevent" fraud from happening at their business ("hospice" or other agency), and then pay back a portion of what they stole, plus or minus a few million here and there. Doubt it? Head to the Department of Health & Human Services, Office of Inspector General ("OIG") website and read them for yourself: The Office of Inspector General ("OIG") works with the U.S. Justice Department in its investigations and eventually a settlement is often arranged with the offending business ("hospice," "hospital," or other business entity). As we've seen, the hospice industry does commit Medicare fraud, thereby bolstering the revenue they bring in. I remember the director of a state Medicaid Fraud Control Unit that called me almost ten years ago asking questions about hospice. She was just beginning her evaluation of what hospices were doing in her state. In response to her questions, I explained how hospices commit fraud and she was stunned. She didn't believe me at first, but we continued speaking on and off. Several months later, she called me to report her investigations had found widespread fraud in hospice in her state. What about one of the largest for-profit hospice chains in the USA, Odyssey Health Care? They settled with the U.S. Justice Department by paying $13 million. In 2006, they had 82 hospice agencies located in thirty different states! I've been contacted by Odyssey hospice nurses who told me about the fraud being committed there. They felt terrible that the patients were suffering because they were not getting the care they needed. I also got calls from some therapists that had contracted with Odyssey Hospice to provide therapy services and complained that they were just listed as the hospice therapists, but were not allowed to go out and really provide service. So, they told me, when Odyssey billed for full service, they provided less, and therefore, Odyssey made more profit. Just like at some of the other hospices committing fraud.
"Robust" compliance program? They make it sound like the administration never knew about the fraud going on. They make it sound as if the top administrators truly care about running a completely honest operation. Fraud of this magnitude can never occur without the knowledge of top administrators. These corporate integrity agreements allow those who initiated and then carried out the fraud to plan on paper how they will "prevent" future fraud. What would the public think if we had every bank robber write down a plan for how he is not going to rob banks in the future? And then release him from custody with half the money he stole from the bank? How many bank robberies would that stop? We need to understand that intentional fraud committed by the administrators of these hospice corporations is really organized crime, crime intended from the top levels of the corporation with policies set in place that guarantee fraud continues. Even one of these rogue hospices steals many millions of dollars each year. This is white-collar crime on a scale that boggles the mind. I know from my own experience that some of the most well-known leaders in the hospice industry are basically white collar criminals that belong in jail. Yet, they lead the national hospice organizations and are hailed as great business "successes." You think Odyssey and Hospice of the Florida Suncoast are the only ones? Not even close. What about Vitas, the largest hospice provider in the country? Now, Vitas is a special case, a very interesting case. Based in Miami, Florida and founded by Hugh Westbrook, the hospice is, as we've seen, a for-profit hospice chain (now owned by Chemed Corporation), just like Odyssey, VistaCare, Beverly (now "Golden Living") and others. Vitas was under investigation during the Clinton administration for Medicare fraud with $50 million in "disputed federal payments." As we've seen, the reporter who broke the first national story about hospice wrongdoing in the country was Washington Post senior investigative reporter Chuck Babcock. That was the reason he called me. He was working on the story and wanted to get my reaction to the Vitas case and also to research hospice and get more information. His article, "Hospices Big Business, Thanks to Medicare; Exploitation of Some Patients Is Alleged" contains references to problems I told him about at the Hospice of Michigan where I had worked, problems that confirmed that hospice had become a big business, with the potential to create terrible problems for patients. Who was U.S. Attorney General when Vitas was being investigated? Miami resident Janet Reno. This same Janet Reno had been a state attorney for what is now Miami Dade county and certainly knew Hugh Westbrook, CEO of the Vitas Health Care Corporation based on her home turf. Westbrook was and is a huge Democrat supporter, fundraiser and friend of Bill Clinton. And Janet Reno was a huge supporter of Democrat politics. The Justice Department investigation of Vitas Health Care? When I contacted Chuck Babcock a few years later (now at Bloomberg News), he told me that the case was just closed, no explanation. It just mysteriously disappeared under the Janet Reno Justice Department! This is how the system works. Remember that old saying? "It's not what you know ... It's who you know....!" I guess Hugh Westbrook, Bill Clinton and Janet Reno would all agree. This is not "being negative." It just is reality. When I was younger, I never wanted to believe it. The more you see, the more you experience, and it becomes obvious. And the crooks keep stealing when nothing serious is done to stop them. As just one example, "the Texas Attorney General's Office and U.S. Department of Justice are investigating" Vitas again for committing Medicare and Medicaid fraud. Of course, the public doesn't think about Vitas's or Odyssey's fraud when they think about hospice. They don't think of Beverly Enterprises, the Hospice of Michigan or the Hospice of the Florida Suncoast. They just think warm, fuzzy thoughts about comfort care and relieving suffering at the end-of-life. End-of-life service should be what they are thinking, and sometimes it is, but it isn't always that way. It can be a real mess, a mixture of very good care in some cases and very bad care in other cases. The public doesn't know that leaders at such large hospices such as Hospice of the Florida Suncoast, the Hospice of Michigan, Vitas, VistaCare, and Odyssey also serve on the board of the National Hospice & Palliative Care Organization, the largest hospice lobbying and trade organization. But we're getting ahead of ourselves. Back to the Hospice of Michigan where I worked: just like all the big hospice corporations, it has a big law firm on retainer. I'm certain they may have told them about the Justice Department policy, that they didn't require corporations to pay everything back. It's public knowledge this is the U.S. Justice Department policy. So it pays hospices and other health care corporations to commit fraud, and then wait and see what happens. I get some of the industry seminar and leadership conference announcements. One year I had to laugh when I saw a picture and announcement that one of the hospice in Michigan's administrators was going to give a lecture at the big conference on how to prevent fraud in hospice. I imagine that behind the scenes "tricks of the trade" are shared in how to defraud Medicare and Medicaid, but can't be sure. What the public doesn't know! What kind of fraud is the most common in hospice? Usually it's admitting patients who don't require a lot of services, like chronically ill but stable patients with a wide variety of conditions. These are patients that are properly enrolled in home health care agency services with a visiting nurse to keep an eye on their medications and condition. Sometimes dementia patients who are not at the very end-stage of the disease are also admitted. Why admit them? Well, the hospice agency doesn't have to send out lots of staff, but they bill every day for services. Hospice is funded on a per-diem basis. Every day a patient is enrolled is a day they can bill. The less service-intensive patients balance out for the patients who require a lot of intervention and staff. Like we've seen, good hospice administrators I've met through the years tell me that providing all the required services can be done under the reimbursement structure, but it's "tight." Whenever I hear about a hospice corporation making a lot of profit, or paying hundreds of thousands of dollars to its administrators, I know they are committing fraud of one sort or another. As a regular part of their work, the Medicaid and Medicare fiscal intermediaries investigate bills for reimbursement from the hospices, determining if bills should or should not be paid, whether patients qualify for hospice or not. Hospices may or may not be committing fraud when the fiscal intermediaries request further information and are looking more closely at a particular hospice. Several law firms specialize in helping hospices get out of trouble with the fiscal intermediaries or even with the OIG or U.S. Attorneys' offices. How the hospice fraud game is played is simple: they admit non-terminal patients and bill for services for several months or longer. There are other methods as well. Kaiser Permanente's Oregon Unit is just another example of this common method. They paid $1.8 million over "billing flaws" in 2009.
Of course, Kaiser denies any wrongdoing, but the Justice Department investigated for a few years and found false billing had been committed. In the old days, in order to avoid detection, hospices committing fraud would actually discharge the patient from hospice after several months saying the patient was not "declining" or not showing evidence they were coming closer to death (they wouldn't because they weren't "terminal”). Nowadays, it's done differently. They're more willing to be in-your-face pushing imposed deaths upon those patients that are inconvenient to them. A patient who lives too long is a liability, a legal embarrassment. The Medicare fiscal intermediaries look at every case that's billed and if a patient has lived too long, it becomes a "red flag." They look into it, looking for possible fraud. Well, do you think the U.S. Justice Department "solved" the problem and got these hospice businesses to shape up and stop committing criminal fraud? No way! In 2011, Vitas, Vistacare, Gentiva and other for-profit hospices are in the news again, and it just continues, with serious repercussions for patients. Peter Waldman of Bloomberg News writes, "Preparing Americans for Death Lets Hospices Neglect End of Life." Of course, there are patients who truly are terminally ill and happen to live longer, but if the pattern is widespread, it's fraud. Killing off the patient, falsifying the medical record to show the patient died of "natural causes" "proves" on paper that the patient died of his terminal illness and that the hospice was "not" doing fraud (although they were). Simple.
Hospice Kickback ArrangementsThe bigger the hospice, the bigger the pressure is to keep patients coming their way. In March of 1998, the U.S. Office of Inspector General (DHHS) warned a second time about fraud in hospice, but it has also warned about kickback arrangements being used. It has specifically warned about kickbacks occurring between nursing homes and hospices, but illegal kickback arrangements can occur between hospice and other providers as well.
Kickback arrangements can be made between hospices and physicians, hospices and nursing homes, hospices and hospitals, even hospices and funeral homes. Let your imagination run wild and you will be sure to figure out what benefit it would be to a nursing home or a physician to get kickbacks for referring exclusively to one particular hospice. If a particular hospice is getting all the referrals, the other hospices are financially damaged. The bigger hospice just gets bigger and bigger, and more powerful. Word of mouth spreads that this hospice is "the one" to use and it "corners the market." What if a particular funeral home pays kickbacks to one hospice so that the hospice makes sure the dead are sent to that funeral home exclusively? Other funeral homes are shut out, and sometimes destroyed. Some of those who died that had prepaid funeral plans with one funeral home have had their bodies sent to another funeral home favored by the hospice. I've been contacted regularly by funeral home directors who report this scam occurring in their area. The public is unaware of these illegal activities. What does the National Hospice & Palliative Care Organization have to say about this publicly? Nothing. Does the NHPCO take a stand against hospice nurses trolling the halls for patients and stealing them from the smaller hospices? No, they don't even mention it. Do they make a big fuss about kickback arrangements that are occurring? Do they specifically condemn the fraud or violations of standards of care that occurred at the Hospice of the Florida Suncoast, Odyssey Hospice, or the Hospice of Michigan? No. They elect CEOs of those hospices to the NHPCO board of directors. They certainly don't make it a mission to encourage the respect for life in the hospice industry. Other big hospices are also playing the game:
Hospices are increasingly involved with nursing home patients, and some hospices have taken advantage of the opportunities for fraud that exist. Recently, a November 2010 Atlantic Information Services newsletter stated that the:
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The Art of War by Sun Tzu Chapter VI, verse 9 |
III - The Culture of Death: Covert Operations |
Hastening Death at the End-of-LifeThe "culture of death" that promotes imposing death through euthanasia, assisted-suicide or the Third Way in hospice (terminal sedation) views the pro-life movement as "the enemy." In fact, they view traditional American society as "the enemy," something to be manipulated and defeated so that their goals can be achieved. It is clear that traditional American values are pro-life. The Declaration of Independence mentions specifically the right to life!
The founders of our nation recognized, and said that everyone understood that these rights were given to us by God. Charles Galloway shows in his book, Christianity and the American Commonwealth that every original colony in America had founding documents that openly give thanks to God for the blessing of being able to live in freedom here. Had they not been persecuted for their faith when in Europe, most colonists would never have risked everything to come here. The right to live free from coercion, the right to choose how they practiced their faith, and certainly, the right to life itself were sacred to them, not something taken casually at all! Though it is convenient for some to criticize the strict codes of the Puritans and others of that time, they were much more lenient and freedom-loving than any of the societies that they left behind in Europe. We owe much to the original colonists for the freedoms we enjoy today. Because the colonists established societies that treasured the rights of individuals in a free society, the founders of our nation said that the rights were "self-evident" and needed no explanation. Today, however, the culture of death crowd does not agree. The Jack Kevorkians of our world do not believe that society is elevated when people make their best effort to serve each other and honor life throughout life. The Jack Kevorkian style assisted-suicide advocates of our world believe in death-on-demand. They believe suicide shoud not be restricted in any way! They sell their agenda by appealing to the public's concern for the suffering of the terminally-ill. However, contrary to the media's portrayal of Kevorkian, he was a ghoulish and bizarre character. "At least 60 percent of Kevorkian's suicide patients were not terminal. At least 17 could have lived indefinitely and, in 13 cases, the people had no complaints of pain." Though Jack Kevorkian is dead, the harm he and other assisted-suicide proponents have done to traditional American values is only increasing over time. Where assisted-suicide has been legalized such as in Oregon, suicide rates have increased. The inner prohibition against killing oneself is actively being eroded and many in society are just fanning the flames for those troubled souls who need encouragement, counseling and love. The suicide advocates do not respect the right to live for those they deem unworthy of life, or as they suggest, "better off dead." Many of them support the ability to access assisted-suicide for any reason. So, we find patients who are not terminal but are mentally disturbed, perhaps in deep depression, killing themselves in Oregon and elsewhere. We also find Final Exit Network groups around the country encouraging suicide and providing information to people on how to commit suicide. Derek Humphry, founder of the former Hemlock Society and chairman of the Advisory Committee for Final Exit Network says that the reason Oregon was the first to legalize assisted-suicide is that "fewer Oregonians go to church" and more Oregonians are unaffiliated with any religion at all. Reverence for life goes along with faith, while devaluation of life and approval for assisted-suicide goes along with atheism and utilitarianism. The assisted-suicide and euthanasia advocates are, therefore, at war with America's traditional values themselves, at war with you and those you love. Hospice, which has many representatives of both the pro-life and pro-death movements, is truly divided, though the public would never know. Mixing intentional killing with hospice is like throwing gasoline on a fire: it can only cause an explosion, injury and even death to many. Just because hospice deals with those who are dying does not mean health care workers should cause death intentionally! I worked with reporter Susan Brinkmann, Catholic Standard & Times Correspondent who researched the topic and wrote in her March 2005 article, "Managed Death: Hospice's 'Civil War'"
The idea of a "culture of death" contrasts starkly with the affirmation of life and its value by those who adhere to a belief in the sanctity of life. A culture of death encourages the deaths of many, whether unborn, newly born, disabled or ill, orphans, the very poor, the elderly, the otherwise "expendable." Rather than seeing life as arising from the dear Lord, with meaning at all stages of life, adherents of the culture of death view life as an accident of chance, an amalgamation of cells that give rise to "life" without any Creator or ultimate meaning at all. To better understand the "culture of death" at the end-of-life, we need to understand the "culture of death" approach to ending life at the beginning of life. We need to understand how certain lives can be devalued, mistreated, manipulated and harmed by those with an agenda. Those who seek to promote the culture of death trade in deception, sometimes using what may seem as "sensible" language to hide their intent. For example, in the guise of promoting "choice" and a "woman's right to choose," the culture of death has denied the right of the child to choose to live. All living things seek to live. Self-preservation is perhaps the strongest instinct of all. Biological science is filled with examples of self-preservative behaviors by animals of all sorts. Although babies at all stages of their development are dependent completely, they nevertheless show their choice of life in everything they do. Once born, they seek nourishment and warmth. Their cries alert the mother to their needs. This demonstrates the instinctive choice of life by the child throughout the day, throughout their lives. If we must speak only of "women's" right to choose, what about the little women's right to choose life? Abortion is used to end the lives of more girls than boys, so any talk of women's choice is an appalling deception. Even before birth, babies filmed in the womb during an abortion instinctively recoil away from lethal probes used to end their lives. In her new book, unPlanned, Abby Johnson, former director of a Planned Parenthood clinic tells how horrified she was when she watched the ultrasound monitor and saw a baby in the womb frantically move away from an abortionist's tool. She realized that they had lied to her when they told her that babies "feel no pain" during an abortion, or that a "fetus" is not a human being. She realized that when she had counseled others, she had also misled them into ignoring their instinctive knowledge that they were killing a real human baby, their baby. It was the same technology that convinced one of the leading original proponents of legalizing abortion to completely change his position and come to the conclusion that a baby, in utero, was truly a complete human person. Abortionist Bernard Nathanson, MD, "co-founder of the pro-abortion vanguard group NARAL," says,
Nathanson also reveals how years earlier he and others purposefully distorted the facts in order to gain public support for legalization of abortion. In other words, they lied to achieve their goals.
It is important for us to understand that the "big lie" strategy Nathonson mentions is used also by those using end-of-life care to end life prematurely through euthanasia, assisted-suicide and Third Way palliative sedation killing. They tell us that the patient is better off dead, that it's time to "let go," and use many other manipulative and deceptive phrases to get people to go along with their agenda. They mean something other than the "letting go" that should occur when death arrives in its own natural timing. Margaret Sanger, the founder of Planned Parenthood, lied frequently in order to achieve her goals. What were her goals? "Margaret Sanger spoke of sterilizing those she designated as "unfit," a plan she said would be the "salvation of American civilization."
This is the same time that the Euthanasia Society of America was just getting started.
So,Margaret Sanger, the founder of what became Planned Parenthood, was racist, a leading eugenics proponent (having written many articles on the subject) and considered birth control the true method of eliminating those deemed "unfit" or as the Nazis said, "unworthy of life." It was the same thinking in the same time period leading up till Nazi rule in Germany and the second World War. Hitler bragged about being up-to-date on the latest eugenics ideas circulating in America. Sanger was willing to engage in deception to get blacks to accept birth control on a widespread basis. The goal, reduction in the black population. The result? Contrary to Sanger's plans, as birth control was more widely adopted, sexual activity actually increased. With increased sexual activity, there were more births among unmarried nonwhite women:
While Sanger's promotion of birth control among the black population backfired and did not decrease the population, it did create heartache and pain for them and a huge business opportunity for her organization, later called "Planned Parenthood." What is the fruit of Sanger's efforts? Well, one merely has to look at the statistics in any large city (places where a larger percentage of blacks Sanger and Planned Parenthood targeted live). The January 7, 2011 headline from CBS New York screams,
That there were more births, not fewer, was not her goal. In order to achieve her goal, she promoted abortion and specifically focused those efforts on black neighborhoods. So, what do we see today? The largest percentage of Planned Parenthood clinics are in predominantly black neighborhoods. Access to "birth control" obviously doesn't prevent pregnancies in many cases, even though that's what that access is said to do. Access to birth control increases casual sexual relations and therefore, when it eventually fails, it increases the overall pregnancy rates. "Failure rates for most of these methods are higher for teens than adults because teens are more fertile than older couples, and they are less likely to use the methods consistently and correctly." Access to birth control certainly has increased the rate of unmarried women becoming pregnant and then having abortions, or becoming single mothers. Who provides the most abortions today? Planned Parenthood. One of its slogans is that they seek to make abortions rare by providing birth control and counseling. The reality is their efforts increase the rate of abortions, and Abby Johnson reveals that she was pressured to increase the number of abortions performed at her Planned Parenthood clinic. She realized they were a business taking in most of their revenue from abortions, so she quit. "Abortion advocates often promote contraception by claiming that as contraception use increases, the number of "unwanted" pregnancies and therefore abortions will decrease. But a new study out of Spain has found the exact opposite, suggesting that contraception actually increases abortion rates." So, we get more lies from those who promote abortion, contraception as well as euthanasia and Third Way hospice killings. Planned Parenthood likes to claim it provides "many" services for "women's health," yet, "Planned Parenthood is the nation's largest abortion provider and 96% of its services for pregnant women are abortions." Clearly, Planned Parenthood is almost totally about providing abortions! Seeing how Planned Parenthood and other organizations like it work helps us understand the culture of death seeking to end life at any stage of life. What does Dr. Martin Luther King's niece, Alveda King, have to say about Planned Parenthood?
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Today, the widespread killing of African American babies continues: "It has been estimated that since 1973 Black women have had about 16 million abortions. Michael Novak had calculated "Since the number of current living Blacks (in the U.S.) is 36 million, the missing 16 million represents an enormous loss, for without abortion, America's Black community would now number 52 million persons. It would be 36 percent larger than it is. Abortion has swept through the Black community like a scythe, cutting down every fourth member." "A highly significant 1993 Howard University study showed that African American women over age 50 were 4.7 times more likely to get breast cancer if they had had any abortions compared to women who had not had any abortions."
The forced sterilization of the mentally ill and others deemed "unfit" was carried out in Nazi Germany, along the same lines of thinking that Sanger promoted in the United States. Just as Sanger lied to promote birth control mostly among the black population since she wanted to eliminate them, or at least decrease the size of their population, the abortion proponents of the 1960s lied to achieve legalization in New York State in 1969 (before the Supreme Court ruling of Roe v Wade). "In 2009 60 % of the pregnancies of African-American women in New York ended in abortion." Euthanasia and assisted-suicide proponents lie just the same. And there are many who tell people to place their elderly parents in hospice so that "they will get better care," and "access to a wide range of services." Well, that is true in some hospices, but many families who have called me have reported they didn't get better care or a wide range of services. They report that once their loved one was enrolled in hospice, his or her death was hastened even when death was not expected in the near future. Aborting a baby in the womb, medically killing a patient through euthanasia, "assisting" a patient to commit suicide by providing a lethal drug? Medical killing is medical killing, technicalities apart. A human life is just that, something to be respected, nurtured and shared, not killed. Yet, those intent on killing keep on keeping on. They have never stopped pushing their agenda. Philip Nitschke, MD, Australia's "Doctor Death" has said,
[Philip Nitschke, MD, Australia's "Doctor Death" Hastening death at the end-of-life is done in many ways, and deception is often used, just as it is used with the promotion of contraception, abortion, and sterilization. We hear reports of hospices that take away the oxygen given to patients who are chronically ill and dependent upon the oxygen for their well-being. Years ago, and in hospices with integrity today, oxygen is considered a necessary and ordinary treatment to maintain the well-being and comfort of the patient. Take it away, and a stable patient is destabilized, falling into an acute crisis from which they are not allowed to recover. They are often chronic obstructive pulmonary disease ("COPD") patients who are especially sensitive to morphine and other opioids. When they are given these medications, they quickly fall into a medically-induced coma and their breathing is stopped due to their very weak respiratory effort. Yet, hospice staff all across the country tell these patients that "morphine will help your breathing," even though it causes the breathing to stop in these patients! The trusting family members don't understand whether their loved one died of their terminal illness, or if an overdose of an opioid medication caused the death. Other methods of hastening death include giving medications that are not needed. "The FDA has linked off-label prescribing of antipsychotic drugs [like Zyprexa, Abilify, Risperdal, and Seroquel] to an increased risk of death in the elderly." Also, "the use of benzodiazepines [like Ativan] among elderly patients has been associated with intellectual and cognitive impairment." The elderly may never recover from these adverse effects and then be labeled "dementia" patients. "Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, fainting, or coma." And what do we see when patients routinely get unneeded high doses of Ativan in many hospices? They are intentionally placed in a medically-induced coma (terminal sedation) and then die in less than two weeks. Sometimes unneeded laxatives are given to promote uncontrolled diarrhea and contribute to life-threatening dehydration. Removing the medications used to treat chronically-ill patients precipitate an intentional acute crisis from which they are not allowed to recover. Patients with heart or blood pressure conditions no longer are given their medications and they die shortly thereafter. The lie told is that the patient "no longer needs these medications." As usual, the deception is to apply something that may be true at another time, at an inappropriate time. Patients who are already at the very, very end, active phase of dying do not need their regular medications, as these medications can no longer help at that time. The patient's organs and organ systems are already failing. But withholding the patient's regular medications, way before the patient reaches the end, active phase of dying, pushes the patient into a crisis. The patient then appears to be "actively dying" and is then either sedated, given morphine and other opioids, or both, and that un-needed cocktail of medications completely destabilizes the patient, who then dies. The trusting family doesn't know what happened. Manipulation of patients and families occurs by mixing some things that may be true at the wrong timing or with the wrong patient. This intentional manipulation results in hastened deaths, and there are many, many deceptions we have heard about through the years. Only an experienced hospice physician or nurse would be able to know that the professional-sounding advice was not appropriate at that time or for that particular patient. Similar deceptions happen in an acute hospital setting when the patient has been selected for stealth euthanasia. Certain patients are denied treatment, forced to sign a DNR order, and manipulated into hospice; the pattern is becoming more and more common.
When is a Person a "Person?"It is also convenient for proponents of the culture of death to deny that in addition to having a material body and rational mind, humans have a soul. They deny the spiritual purpose of life and all life involves. In addition to denying the "soul," they often ascribe all mental processes and the experiences of life to chemical processes in the brain. In other words, there is no "love," just a chemical process in the brain. There is no "purpose," just a chemical process in the brain. For them, there is no such thing as a "person," separate from what goes on materially in the body of a human being. For them, our experiences, thoughts, feelings and relationships are just a chemical process in the brain and the result of some hormonal influence. Proponents of the culture of death attempt to create false distinctions in a myriad of ways, using a myriad of different phrases, using bogus "science" and distortions to convince the public that imposing death or even performing experiments on innocent human beings is morally acceptable. Yet, they assert that those of faith are "unscientific" when the reality is exactly the opposite. Science confirms what faith reveals. In 1991 Dianne Irving, M.A., Ph.D., wrote in her Georgetown University PhD dissertation, "Philosophical and Scientific Analysis of the Nature of the Early Human Embryo" Linacre Quarterly Feb 1993, 60:1:18-46
Each of us may not have even heard of these "bioethical" distinctions proposed by the culture of death, but enough of them may "ring a bell" to recognize that the value we place in human life has been persistently attacked by those in academia who embrace the culture of death. Dr. Irving tells us in her article, "When do human beings (normally) begin?" "scientific" myths" and scientific facts that:
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Well, the science is not tentative. It is an accomplished, accepted fact without any scientific dispute. And of course, human life can naturally occur during "twinning" (asexually for the 2nd twin) and the zygote again has 46 chromosomes, ... human chromosomes, a human life begun. We must realize that today there are many alternative methods of scientifically manipulating life whether it be "in vitro" fertilization of egg and sperm or very high-tech methods of extracting genetic material and combining it, even cloning techniques, embryonic stem cell research and other methods. Prof. Irving has mentioned some of the following methods: "SCNT, germ line cell nuclear transfer (GLCNT), twinning (blastomere separation, blastocyst splitting, embryo multiplication, pronuclei transfer, mitochondria transfer, and dozens of other genetic engineering techniques." The new life does not have to "wait" until implantation in the uterus to be a unique, human life.
Technology has succeeded in complicating the normal answer about when life begins and how it begins. Technology changed all that:
Dr. Irving has stated: "International agreement and documentation by the experts in human embryology and human molecular genetics make the following perfectly clear. The new single-cell human embryo formed sexually at the beginning of the process of fertilization (when the sperm makes first contact with the oocyte) is a new living human being. The new human embryo formed asexually by various natural or artificial reproductive techniques (such as one of every two identical twins) is a new living human being. They are not 'eggs.' [Emphasis added] |
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Those marketing the lies necessary to accept abortion, contraception, infanticide, or experimentation on innocent human individuals do so for financial gain or because they are "true believers" in the agenda, the culture of death. These industries are huge, representing billions of dollars in revenue each year. The motivating force behind the leaders of the culture of death is not "the good of society" but rather profit outright or death that they demand. They truly hate that some of us are alive and they will lie to achieve their aims. Those lies told by those promoting the culture of death have been accepted by a large portion of our society, so much so, that those who fight for the victims of this "culture of death" are mocked as extremists, even though they are upholding the basic values upon which our nation was founded. Those marketing the lies also attack the people who respect life and accept the scientific facts about human life. They ridicule those who respect the sanctity of life. Sometimes ridicule (or the attack "ad hominem") is the only method they can use successfully, since the facts are on the side of those who respect life and understand that a human life normally begins truly, at the beginning, at the moment the sperm and oocyte merge and a unique human individual is created. Lies are also used to promote devaluation of the lives of the vulnerable. Lies are told in arguments given to promote assisted-suicide, euthanasia and/or terminal sedation of the elderly, chronically-ill, disabled, and/or cognitively impaired. Most of the names of these organizations are based on lies, even the phrase "right-to-die" at the end-of-life is not what it's about. At the beginning of life, "pro-choice" has nothing to do with being concerned about choice in principle; otherwise, those who are "pro-choice" would respect the baby's right to choose to live. Thus, they are more accurately called the "anti-choice to live" movement. If the "anti-choice to live" movement cared about choice, they would not be working to eliminate a health care professional's right to choose not to perform an abortion. If they respected everyone's right to choose, they would also respect the medical students' right to choose not to learn to perform abortions. However, they have regularly been working to make abortion training mandatory in medical schools! For example, the Abortion Rights Coalition in Canada is pressing for "mandatory education in abortion and contraception for all medical students, and mandatory training in abortion techniques for all Ob/Gyn residents." And the "medical students for choice" in the U.S. and elsewhere also is working to make abortion training "a part of standard medical education and residency training." That means that all medical students would be forced to perform abortions and those that are pro-life and refused might be thrown out of medical school. "Right-to-die" proponents tell us that "only" those seeking assisted-suicide and/or euthanasia will be hastened to their death. Research in the Netherlands and Belgium conclusively shows the opposite: patients are involuntarily killed. We will see further on that the more frank statements of the euthanasia proponents in earlier years tell us this is their goal. We know that involuntary medical killing occurs when euthanasia is legalized. The studies in the Netherlands reported, "There were one thousand cases [of euthanasia] without explicit and persistent request in 1990, and nine hundred cases in 1995." And that was 1,000 cases a year in such a tiny country. Just imagine how many medical killings that would equal in the United States if the same rate applied here. I believe that we are experiencing that rate of involuntary medical killings (of many sorts), all hidden behind the HIPAA privacy shield. No one should have the right to make that decision for you. In 2007, Belgium research showed patients have been killed ("euthanized") often without their knowledge or permission. "Researchers found that a fifth of nurses admitted being involved in the assisted suicide of a patient." Of those, one-half admitted that the so-called "assisted suicide" was "without consent." If there is no consent, no permission, no knowledge on the part of the patient, how can you call that "assisted suicide?" It's involuntary medical killing, plain and simple, and 10% of the nurses in Belgium admit to doing it. 10 percent! That's where euthanasia is legal, but has "safeguards" for its strict practice only under professional guidelines. We see how effective those "safeguards" are. "Right-to-die" proponents tell us that the reason they seek legalization of assisted-suicide and euthanasia is to end unbearable pain in the case of terminally ill patients. We know, however, that modern medical science can relieve and reduce all sorts of pain and that pain is absolutely not the reason they seek legalization. So why do they keep lying saying it's all about relief of "pain?" Achieving legalization under this pretense is viewed as a stepping-stone to complete legalization of euthanasia and/or assisted-suicide for a variety of reasons. In fact, some of these groups wish to legalize suicide outright, whether for medical purposes or not. Prof. Peter Singer of Princeton University has made a name for himself arguing that fetuses, embryos, even newborns are not real "persons" until they develop and actually exercise higher reasoning capacity. He even suggests that some higher primates or other animals may be "more" of a person, than a newborn baby, toddler, or fetus. Steven Ertelt wrote in 2006 for Lifenews.com that "Peter Singer Defends His Views on Killing Disabled Babies Via Infanticide" saying:
Singer has admitted that infanticide has always been an aspect of his work, part of what he promotes. So, once a human being is no longer considered a "person," then it is "morally acceptable" (according to culture of death proponents) to experiment on or kill that whatever-it-is (but is not a "person"). What people believe sometimes is determined by ulterior motives. We may wish to relieve our guilt over aborting a baby by telling ourselves it wasn't a "real" baby. It's not a "person." Soldiers in war may do something similar rather than really think about killing people (the "enemy") who is the son or daughter, father or mother with a family. Often, derogatory names are given to the "enemy" that makes killing easier psychologically. When a baby is wanted and valued, the "fetus" is considered anything but a "thing," and there is no doubt it is fully "human," and there is no question about it at all. Everybody knows this! The mental gymnastics that are necessary for people to lie to themselves, even with Supreme Court sanction, are truly monumental. Truth is truth and science shows us what the truth is. A baby, even a human at the zygote stage, is not a tadpole, not a baby dog, cat, horse or cow; it's a human, a unique person. |
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It is sad to say that I have seen cases where adult children stood before their dying parent and argued about who would inherit this or that possession, while the dying parent lay in bed, helplessly watching the uncaring children, unable to say, "I am still here!" Sometimes, the patient may still be able to speak and say those words, but the patient is still ignored. The patient may no longer be considered a "person" because they can't actively reason or speak up for themselves. How cruel! Say we are recovering from surgery and are in a medically-induced coma; we can't speak for ourselves. Does that mean we are not "persons?" What about if we are temporarily brain-injured from a car accident, for example, and cannot say a word? Are we not persons? When we can speak up later after receiving rehabilitative therapy, are we then "persons?" What about babies, two year olds, four year olds? Where does one draw the arbitrary line? How many times is a patient talked about as if he were not even in the room or a useful participant in a discussion? This unfortunately happens often with the dying. We should remember that truly, we are all dying; it's just a question of when each of us will die. And that is something most people avoid thinking about. Even if a person is cognitively impaired, or a child, or imminently dying, they are still completely human and still "a person." Yet, there are those who take it upon themselves to end the lives they are supposed to care for. They believe they "know better" and act on that basis. A February 2011 Canadian Medical Association Journal article states that, "In Quebec last year, 81% of [physician] ... specialists surveyed said they had seen "euthanasia" practised...." And that is in Quebec where euthanasia is illegal. The culture of death's fabrications and propaganda (continually presented to members of our society) have convinced many that certain categories of our population are not "worthy of life" because they are not "real" persons. This is exactly the thinking promoted by the Nazis in Germany during World War II. And the moment one mentions the example of the Nazis, the objection is raised, "how dare you compare us to those evil monsters?" I dare, because what we are doing to the vulnerable is what they did, and that is a fact. We are doing it based upon the same line of reasoning as they used. While human history is filled with a never-ending succession of dictatorial governments, brutality, violence, and genocide, what the Nazis did was unique in recent history. They exalted involuntary experimentation on human subjects as "medical science" and perfected methods of medical killing through a variety of methods. Some of the methods of medical killing perfected by the Nazis are being used today, right here in the United States! Some involuntary medical experimentation is also being done in the United States, even today. The dark worldview that was the basis for all they did has not been extinguished. It lives on and is being implemented today. To understand what is happening today, to the ailing, elderly and disabled, we must review what happened in Nazi Germany and understand how it began and what exactly occurred. In Nazi Germany, the Nazis began to implement their eugenics and extermination program by executing the frail, the mentally ill, the terminally ill and other chronically ill by order of the federal German government: "The campaign to remove unwanted children from the community was not only the result of Nazi racial biology and eugenics, it was part and parcel of the effort to impose control and conformity on the entire German population."
The numbers are astounding. According to Milton Meltzer:
20,000 dead through "starvation and medication" in Nazi Germany! What can terminal sedation misused to impose death be other than the exact same thing? The patient is not given any nutrition. The patient is not given fluids. And the patient is medicated in a variety of ways, often using liquid morphine and a sedative like Ativan (lorazepam). Taking the mentally ill to be executed during the Nazi era is the same thing as taking the dementia patients from wards where care is provided to them and then moving them to hospice for disposal. The language seem too harsh? Please tell me how it is different. Death was certain when Hitler ordered the extermination of the mentally ill, mentally retarded and very ill. Death is certain today for those given unnecessary medications, something as simple as antipsychotic drugs: "The Food and Drug Administration in 2005 mandated that drug makers issue warning labels on atypical antipsychotics, noting that the drugs - which are generally FDA-approved for treating schizophrenia and bipolar disorder - increase the risk of death for elderly patients with dementia. Yet when the government examined 1.4 million Medicare claims from 2007 for atypical antipsychotics for elderly nursing home residents, the government found that 88 percent of the time, the drugs were prescribed to individuals diagnosed with dementia [Emphasis added]. Can it be any clearer? The drugs cause death in dementia patients and they are given to dementia patients ... stealth euthanasia! Death is also certain when patients are placed into hospice and terminally-sedated, as is being done all around the country already. Dying from terminal sedation or an overdose is not "dying a natural death." And "aiding" a completely dependent, cognitively-disabled patient to commit "assisted-suicide" is nothing more than medical killing, cloaked in deceptive language. Cognitively-disabled patients who are mentally-retarded, brain-injured, in a "PVS" or "minimally-conscious" state cannot choose or agree to commit suicide. "Surrogate" decision-makers who choose "assisted-suicide" for the vulnerable are merely "choosing" to "euthanize" the same class of people that Hitler chose to exterminate. Whatever you think about the circumstances of the disabled, those with Down's syndrome or the mentally-ill, they are vulnerable people who need protection and care. Treatment denial for these vulnerable individuals is designed to encourage an early death. A United Kingdom review of the literature tells us that "about 90 percent of pregnant women who are given a Down syndrome diagnosis have chosen to have an abortion." Maura Butler, a mother of a special-needs child, wrote in Lifenews.com, "none of us is perfect; some of us just have more visible crosses than others." "But none of us could ever imagine our life without her, without her smile, her laughter, her hugs and (extra wet) kisses. Our courts have greased the wheels for medical killing of the vulnerable to move forward. This is how it happened: in 1997, the United States Supreme Court in Washington v Glucksberg 521 U.S. 702:
However, here is where they "greased the wheels" for medical killing to move forward. The Supreme Court in the same case (Vacco v Quill): tacitly endorsed terminal sedation as an alternative to physician-assisted suicide, thus intensifying a debate in the legal and medical communities as to the propriety of terminal sedation and setting the stage for a new battleground in the "right to die" controversy. That ruling allowed for the "principle of double-effect" to be used to justify terminally-sedating or giving high doses of pain medications so long as the intent is not to cause death. Well, who's checking? When the patient is terminally-sedated or given high doses of an opioid for valid clinical reasons, then fine. But if the intent is to kill, the treatment is the same but the patient has no need for the medications. What happens? The patient dies. No surprise. The "intent" of the physician or nurse is not going to be checked, so widespread use of high doses of an opioid or terminal sedation is now being practiced in hospice and palliative care units across the country. This is the "Invisible Holocaust" I have been warning about for a decade. "... we must be wary of those who are too willing to end the lives of the elderly and the ill. If we ever decide that a poor quality of life justifies ending that life, we have taken a step down a slippery slope that places all of us in danger. There is a difference between allowing nature to take its course and actively assisting death. The call for euthanasia surfaces in our society periodically, as it is doing now under the guise of "death with dignity" or assisted suicide. Euthanasia is a concept, it seems to me, that is in direct conflict with a religious and ethical tradition in which the human race is presented with "a blessing and a curse, life and death," and we are instructed '...therefore, to choose life." I believe "euthanasia" lies outside the commonly held life-centered values of the West and cannot be allowed without incurring great social and personal tragedy. This is not merely an intellectual conundrum. This issue involves actual human beings at risk..." At the site of the three Auschwitz death camps, a plaque reminds us that over one million people, mostly Jews, were murdered there. Additional millions were murdered throughout Europe and at other camps during the Holocaust (Shoah). As Jews, Gypsies, some homosexuals, political dissidents and the intellectually and physically disabled were selected to be murdered by the Nazis, the elderly, disabled and those deemed "better off dead" are being selected for stealth euthanasia. The Nazis kept detailed records of every individual selected for death at the camps, but we can be sure that today's records of those victimized by stealth euthanasia are always falsified to reflect a natural death. The patient's diagnosed condition (or an improvised diagnosis) is listed as the cause of death. "Stealth euthanasia" is never listed as the cause of death. Morphine overdose or terminal sedation is almost never listed as the cause of death. In today's Invisible Holocaust, stealth euthanasia has and will result in the murders of unknowable numbers of the vulnerable, because they are killed in separate locations, by separate people, and the killings are hidden behind the privacy regulations in place. The staff who perpetrate these crimes falsify the medical records to justify whatever method was used to hasten death. I estimate that easily over 100,000 vulnerable patients may be hastened to their death through a variety of means each year in the United States alone. Just as there have been many "Holocaust deniers" who attempt to deny the reality of Nazi genocide or minimize its impact, there are those who vehemently deny that many (or any) patients are being hastened to their death in America and elsewhere around the globe. Research definitively shows that patients are being involuntarily medically killed in the Netherlands and Belgium. In the United States, we have those who adhere to the standards of care who are deeply offended by the idea that anyone would commit these egregious crimes, and they frantically attack those who expose the realities in the end-of-life care industry, even when they repeatedly hear the same type of stories from separate sources over and over again. And we have others (who are casually implementing the culture of death and hastening death) doing everything possible to hide the truth so that their agenda can continue to be implemented and expanded. We also have many in our society who simply know the truth, that the health care system can be, and is being, "wielded" just like a gun, to medically kill some of the vulnerable. Some of them take advantage of the medications available in hospice and the terminal sedation protocol available in hospice, to impose death, and the hospice staff often go right along with the plan. However, even though many segments of society do not want the truth to come out, as Martin Luther King has said "a time comes when silence is betrayal." The realities of the horrors committed continue to surface, no matter how hard the deniers suppress and censor the truth. Year after year, people call here and to other patient advocacy organizations, seeking recognition of the medical violence that took their loved ones from them. They seek justice and reform. Family members who cry out after a hospice or palliative care staff member imposed death upon their loved one demand justice, but the Halls of Justice have been completely shut off from them, just as it is so often shut off from those who are victimized by racism, ethnic-cleansing, war, murder and genocide. The anguish of the people who are victimized cannot be hidden forever! |
artwork (c) by Vickie Travis, design by Ron Panzer and Vickie Travis |
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Prosecutors refuse to act in these medical killings for another reason: prosecutors know that the federal and state governments save many millions of dollars when people die sooner rather than later. They know that hospice is being promoted by the federal and state governments. They also know that their own political future would be damaged if they went after the local respected physician or hospice and brought negative attention to the protected industry: hospice. Yes, you can prove that the doses of morphine are massive, that the doses of sedatives are massive, and you can have two or more doctors who swear under oath that nobody should require that high a dose. The problem? The hospice agency will hire two or ten physicians who swear just the opposite, so you have a "he said-she said" type scenario where nobody is believed for sure. Families that wish to take the case to court have no access to either the criminal or civil courts when a patient is hastened to their death. And so, stealth euthanasia continues to sweep across our nation and the Invisible Holocaust swallows up more victims. How did this problem arise? You have two completely different worldviews, value systems, caught in a battle right in front of us. The traditional American values respecting life and the utilitarian materialistic view that devalues life. Adherents to either worldview are going to say the exact opposite things about the exact same case! We can say that "Hitler did this" or "the Nazis did that" and people just turn off and say, "that was then," "what they did was unheard of before and will never be heard of again," or, "that's not to be compared with what is going on now." "Hyperbole!" Well, eugenics is eugenics. Euthanasia is euthanasia. They did it then; they're doing it now. Instead of piling bodies up in mountains or mass graves or incinerators, they're separately handled one-by-one, sometimes with color-coordinated decorating at the facilities. So, if medical killing is done one-by-one, in a cheerful and relaxing setting, then it's not the same medical killing? Today, the justification is given that it's all being done for the good of the suffering patient. Guess what? The Nazis did use exactly that language! In the Netherlands, "eugenic" medical killing of babies is practiced under the Groningen Protocol - Euthanasia in Severely Ill Newborns: "life-ending procedures for newborns may be carried out only in rare circumstances and in accordance with very strict criteria: the prognosis and diagnosis must be certain, untreatable disease, severe and unbearable suffering that cannot be alleviated, a second medical opinion, the full consent of both parents." So, doctors and the courts decide who lives and who dies, and when. In the United States, we have peri-natal hospice, so we don't necessarily need the "Groningen Protocol" legalized here, and court can be avoided if the parents accept peri-natal hospice for their ailing newborn. When the newborn is truly dying, making sure the infant is kept comfortable makes sense, but nurses who work in peri-natal hospice have confessed that in some cases, "the baby just didn't die soon enough." (Maybe, the baby would have lived if cared for.) So, the peri-natal staff, "made sure the baby died using morphine." How would anyone know if peri-natal hospice has been misused to hasten death of newborns that fit the criteria used in the Netherlands for infanticide under the Groningen Protocol? Who is checking? Nobody. And the methods used in peri-natal hospice can be the same as used on adults: increasing doses of morphine and other opioids, and sedatives (if necessary), and definitely deprivation of nutrition and fluid (Third Way killing: terminal sedation). Anita Catlin, DNSc, FNP, FAAN one of the "founders" of the peri-natal hospice work has written about "Five Incredible Babies, Five Paradigm Cases That Greatly Influenced Neonatal Ethics What Do Their Parents Say Today?" Barbara Farlow ( a mother of a child whose life was taken in peri-natal hospice) wrote about her experience in an article called "Misgivings." Peri-natal hospice is fast becoming the "2nd net" to "catch" and kill any babies with congenital abnormalities that weren't aborted pre-birth. The use of terminal sedation as the Third Way to medically kill (aside from direct euthanasia or assisted-suicide) began to accelerate in the 1990s and now is at an epidemic level. Of course, there are also outright overdoses administered in hospices which is direct euthanasia, but who's supervising in private settings? Nobody that cares to enforce laws prohibiting euthanasia. Staff who work in a rogue hospice do not think they work in a rogue hospice; they think they're providing very professional care according to the latest, "most progressive" ethics. How do the administrators regard the suffering? They are looked at as pathetic remnants of something that might have been a "person" years ago. They are looked at as a means to bill for services, a "ticket" to continued revenue, and certainly "better off dead." Let's face it, as shocking as it may be to those of you who admire the good work of many in hospice, the hospice industry is being converted, within the rogue hospices around the country, into killing fields! In a hospice that respects the sanctity of life, these things are unheard of. That is why pro-life hospices that do not impose death work hard to educate their staff and make sure the focus is on serving the patients, relieving suffering at the end-of-life and allowing for a natural death in its own timing. However, pro-life hospices are becoming rarer as time moves on, due to competition from rogue agencies that steal patients, use kickbacks and other unethical methods to "corner the market."
Respecting Life vs. Ending Life in HospiceWhile the industry may promise to provide the very best for all patients they serve, something else will be delivered at those hospices that no longer adhere to the original mission of hospice which respected life. Any hospice that is engaging in Medicare or Medicaid fraud is certainly not adhering to the original standards of care. In rogue hospices in America, it's becoming common-place for many, if not all patients, to be sedated unnecessarily. One hospice volunteer with twenty years' experience called me in tears a while back. She had started working at a new hospice home and every patient was sleeping continuously. Being an experienced hospice volunteer, she knew this was quite unusual. Hospice volunteers can do much good for the patients, but not when they are all in a medically-induced coma. In fact, it just doesn't happen at all naturally. She was familiar with good end-of-life care and how important patient and family interactions were at the end-of-life, how much "unfinished business" could be accomplished, and what a blessing good care could be for the patients as well as the families. When she asked the charge nurse why everyone was sleeping, the nurse said, "Everyone who comes here is agitated, so everyone is sedated." And when she said, "sedated," she meant permanently sedated. It was terminal sedation, something that used to be restricted to only those patients who had "terminal agitation" or even "terminal psychosis." These patients are in extreme distress and may also have uncontrolled pain. Sometimes, sedating them can help with control of very extreme pain and agitation. Some are having terrifying hallucinations and are actually violent or may injure themselves. Terminally-sedating a patient who is not agitated and not psychotic is a decision to end that patient's life, because they don't take in fluids or food by mouth: they're asleep. Assisted-suicide and euthanasia are just two main categories of ways to openly and obviously impose death, but the most prevalent form of ending life in America is the Third Way, this misuse of terminal sedation.
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Euthanasia Society: Covert Operations in the Health Care & Hospice Industry |
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But, the Euthanasia Society of America changed names after repeated failures to legalize euthanasia from 1939 through 1975. They became "Society for the Right to Die." The Euthanasia Society proposed killing the unfit to live, those deemed defective. "Society for the Right to Die?" That's a completely different approach. The change of names effectively confused Americans, so the euthanasia society members could operate in stealth mode, to work "under the radar" and subvert the traditional American respect for life. Americans have been strong defenders of the "rights" of citizens. So, the Euthanasia Society/for the Right to Die tapped into this "fight for rights." Ever since then, they've framed the debate in terms of a "right" to end life at the time of one's own choosing: "death on demand." Every name change thereafter has been even more "confusing" to the American public, with a more "compassionate ring" to it: "National Council for Death and Dying" (1991) what does that mean to most Americans? "Choice in Dying?" (1991) Again, what does that mean? What kind of choice? And Americans always want the right to choose! Even better: "Partnership for Caring" (2001). That sounds like we're all working together and caring, nothing about euthanasia in the name. "Last Acts Partnership (2004)?" That's totally unrecognizable as to what it's about. And lastly, the NHPCO's "Caring Connections" (2004). That's as far from "Euthanasia Society of America" as you can get. But the National Hospice and Palliative Care Organization's "Caring Connections" project is the successor of all these organizations! ... the final successor organization to the Euthanasia Society of America. From the very beginning, the euthanasia, eugenics and birth control leaders were of one mind. Medical killing ("euthanasia") would be used to accomplish the eugenics proponents' goals of eliminating unwanted, "defective," "useless" individuals. Who? The elderly, disabled, and seriously ill. With economic pressures rising every day, rationing health care services is certain in a federally-run health care system or in the Medicare and Medicaid systems. Rationing care will become much more aggressive, just as it has been done by HMOs and managed care systems. How will the change in services be presented to the public? "Choice." "The right-to-die." The freedom to decide." In 1962, "theologian Joseph Fletcher ... [became] the chief philosopher of the euthanasia movement ... [who] "fashion[ed] a new rationale for euthanasia based primarily on the notion of patient autonomy." Patient "autonomy." "Patient Self-Determination." Haven't we heard that before? We have. Again, this is the language being used today to justify legalization of assisted-suicide, the "right to die," and has been one of the three principles of the federal ethics set forth by the Congressionally-created Belmont Commission in 1978. Also, in 1962,
"Letting someone die." It's become common to hear that from our own family members. People will die all on their own, naturally. It's inevitable, but what "letting someone die" really means is what the Euthanasia Society of America meant: hastening death one way or another. We heard often from the early 1970s onwards about the "horrors" of 90 year-old patients getting cracked ribs from doctors pounding on their chest doing CPR, or being forced onto terrible machines, being on "life support" that kept them alive against their wishes, being treated by doctors who cared more about themselves and what they could prove than their patients. We heard about physicians who made decisions to treat when patients had refused, when very elderly patients were ready to die, but were not being allowed to die naturally. The newspapers published stories about patients wrongly being kept alive under "horrible" circumstances in the hospitals. Yes, there may have been some cases, even several cases, and there was a need to care for the dying in a much more sensitive way, a way that relieved their suffering, didn't force treatment on those who truly were imminently dying. But much of it was hype. There was an agenda behind it, a method to the messages we were being fed. Nancy Valko, RN tells us in her Women for Faith & Family 2001 article, "Of Living Wills and Butterfly Ballots" that:
The rest is history, our history. The living will which was designed to limit treatments provided was widely accepted. Again, it was "sold" to the public under the guise of "patient autonomy," the patient getting to decide what treatments he or she wants or does not want. However, in the case of a patient who is not able to express their wishes at the time, what is considered "patient autonomy" by a group of secular bioethicists is not the same as what others who have reverence for life would decide. More and more people filled out advanced directives or living wills expressing their wishes. However, all the while, the euthanasia proponents were working to expand their use, knowing that once the public accepted limitations of care at the end-of-life, it would only be a short step to limiting treatment that would end up hastening death, and then directly imposing death. The Do Not Resuscitate ("DNR") forms also became universally accepted over time, and the elderly and disabled are often pressured to sign a DNR form in health care settings. Burke J. Balch, J.D. writes:
The adoption of Living Wills, the DNR forms and most importantly, the reclassification of food and water as "medical treatment" pushed forward the incremental steps towards legalized euthanasia. Rita Marker, PhD and Wesley J. Smith, JD, J.D. of the Patient Rights Council tell us:
And it now is the "nontreatment of choice," implemented in many hospices, hospitals, and nursing homes around the country making "sure" patients who just won't die "soon enough" actually die. To make it seem more humane, sedation is added. Note that Callahan calls the elderly "superannuated" which means "obsolete," "too old for further service," and the implication is that they are ready to be discarded, like some worn out, useless tool ... and that's exactly what he means. As a utilitarian, the old who don't contribute actively providing goods or services are "useless eaters" as we've heard before. Callahan's predicted removal of food and fluids combined with sedation is the "palliative" or "terminal sedation" practiced widely in America today. Euthanasia advocates knew that once food and water were classified as medical treatment, then withholding it would become the easy way to impose death. The public did not truly realize the significance of this change. Those who work with the dying know that there comes a time when death is imminent, in what is called the "active phase of dying," where the patient no longer wants to eat and also cannot eat, where their system is shutting down. They begin to mouth-breathe, their breathing patterns often change, organs and systems shut down, their tongue and mouth dry up. Good end-of-life care seeks to help the dying with the discomfort that can accompany this process, and there are many things that can be done. However, those who wished to further the agenda of legalizing euthanasia realized they could "use" what naturally happens at the end-of-life to their advantage. They realized that because patients naturally stop eating as much, and then stop altogether, they could simply move up the timeline, withholding food and fluids before the patient was actively dying and death would occur from dehydration. Marker and Smith continue:
In the end-of-life care setting, the way that the provision of food and fluids is halted is quite simple: the patient is sedated, then food and fluids cannot be given orally. Misapplying terminal sedation of the patient makes the whole process of withholding food and liquids look "peaceful" to the family at the bedside. They tell the family members that the patient "can't" eat or drink, before the patient really is unable to eat, and so, accomplish the permission to terminally sedate and dehydrate the patient, and then impose death in this way. I've regularly heard from families that say the hospice staff sedated the patient, then gave them food or water when they were lethargic, almost asleep, and when the patient coughed, having trouble swallowing, they say, "he can't take fluids by mouth. He has a swallowing problem." And they make the patient "NPO," which means "nothing by mouth" is to be given. And without fluids, the patient dehydrates. This could be done to anyone, including you or me. It is a prescription for death. And it's deceptive. This is not formal euthanasia or assisted-suicide, but accomplishes death just as effectively. It is the most widely-practiced form of euthanasia in America today, and is allowed by law enforcement, the district attorneys and the courts. They have chosen not to get involved, so the killings continue. A little lie here, a little lie there, and families are fooled. Of course, if a patient has fluid building up in their lungs or extreme swelling throughout their body, giving large amounts of fluid can cause problems. Normally, diuretics are given to relieve fluid in the lungs or body; sometimes a very low dose of morphine is given with a diuretic for end-stage heart failure with pulmonary edema. But that's not the same as giving a large dose of morphine with no diuretic when there is no pain. Giving large doses of morphine with no diuretic when there is no uncontrolled pain, but there is a fluid buildup is a sure sign that death is being hastened. In other words, what can be done appropriately medically, if done at the wrong time, can become a method of imposing death. In health care, every intervention needs to be done in a certain way to be done safely for the patient's welfare. Done in a certain way, when actually needed, interventions relieve suffering and help the patient. Done intentionally in the wrong way, at the wrong time, and the patient dies. Hospice and palliative care staff who work to impose death are expert in manipulating the family through deceptive language and information. They are also expert in manipulating the interventions so that the patient destabilizes and dies. Marker and Smith conclude:
One example of a mind-boggling changed definition is basic food and water. Everyone normally considers this just "ordinary" care. If a baby or a dependent elderly person is hungry, you feed them. You help them drink. Same thing with the disabled. If they needed a feeding tube and wanted to be fed that way, it was provided without question. However, something big happened in Florida in 1999. It has everything to do with the rogue Hospice of the Florida Suncoast. Michael Schiavo sought out the local pro-euthanasia attorney, George Felos, who was chairman of the board of the hospice, seeking to have Terri's life ended. Attorney Felos saw to it that his client's wife, Terri was accepted to the hospice though under the law Terri could not legally have been admitted into the hospice; she didn't have any terminal illness. She was not in a persistent vegetative state. Her own physician testified she had no illness that would cause her to die in the near future. The hospice admitted her anyway, expressly for the purpose of ending her life, and we shall see exactly what was done to make it happen. In April 1999, the state law was changed to allow Terri's life (and those like her) to be ended. Florida Statutes Title XLIV, Chapter 765.101 was changed to reclassify nutrition and fluids provided by tube feedings as a "life-prolonging procedure," not ordinary care.
Also, see: "Anatomy of right-to-die law - Proponents, hospice industry given rare authority to change Florida statute" by Diana Lynne, WorldNetDaily Reporter. This was exactly the change desired by those promoting the euthanasia agenda within hospice and palliative care circles. Remember that back in 1983, Daniel Callahan predicted "...a denial of nutrition, may, in the long run, become the only effective way to make certain that a large number of biologically tenacious patients actually die." And finally, this pro-euthanasia movement which has worked so long to change how Americans die, got the type of law they wanted all along. It is interesting to note that when this specific change was made, the language just "magically" appeared in the proposed bill and not one person or group stood up to say they wrote it, proposed it and were responsible! Staff in state government suggested that "it might have come from hospice," but they wouldn't go on the record about it. In any case, that language was put in, voted on, and passed into law, and Terri was killed by withholding food and water as authorized by the new law that said food and water is not "ordinary" care but "life-prolonging" care. With this type of logic, all of those who are fed through tube feedings, many of them in nursing homes, may be considered to be undergoing "life-prolonging procedures," not "being fed." And "life-prolonging procedures" can be withdrawn according to one's advance directive or the guardian's or surrogate decision maker's wishes. Food and water are no longer food and water if they are given by tube feeding. This change in status was a monumental success for the stealth euthanasia movement in America, what many in the hospice industry wanted, what many in the health care community wanted and what many people wanted ... all of whom no longer believe that food and water should be provided to the disabled, the very elderly, the "unworthy of life."
Robert Woods Johnson Foundation, Last Acts & Last Acts PartnershipThe Robert Woods Johnson Foundation ("RWJF") has been involved in all sorts of end-of-life initiatives, funding projects over many years. They want the public to think that they are solely focused on "improving health care" and being a benefit to the community. But if we look closely at what they are funding and what projects they have thrown their weight behind, we get a different picture. The direction of their contributions is aimed at changing how Americans think about dying and changing how Americans die. That doesn't just mean promoting greater acceptance of hospice and palliative care, as they would like the public to think. It means really changing society from a sanctity of life culture to a quality of life culture. Lifetree's Timeline lists the three pronged strategy used by Last Acts:
Carey Goldberg of the Boston Globe reported in 2003 "After 10 years, $200m effort on dying reaches its own end"
The writer confuses "specialists in end-of-life care" with those who promote hastened death at the end-of-life. Even the founder of the hospice movement, Dame Cicely Saunders, would not be considered a "specialist in end-of-life care" if one has to favor hastening death or imposing death outright. There are professors of palliative medicine who strongly opposed the medical killing of Terri Schiavo. It is revealing that the culture of death specialists view those who sought to protect Terri Schiavo from being medically killed as forces opposed to "progress." Their goal is obvious: imposing death on patients like Terri should be normalized and a regular part of end-of-life care services! They say that keeping the severely disabled alive is to be discouraged. Physician Frank J. Mongillo III, M.D. says that "hospice has 'become abortion for the elderly', and he is only one of many physicians who know this can be the case. Robert Woods Johnson Foundation is still making grants and supporting the work to change how Americans think about dying and how they die. They are funding the National Hospice & Palliative Care Organization's "Caring Connections" program. This is the successor to the Euthanasia Society as we've seen.
Last Acts Rallying Points Regional Centers & What Their Selection Tells UsIt is confusing to the public when hospice industry leaders speak about the good works they are involved in and then hear about euthanasia advocates in the hospice industry. Elizabeth Wickham, PhD of the Lifetree Organization tells us:
It is important to note how the Hastings Center was in the thick of things, releasing the official report on the conference that resulted in concrete plans to change America. Yet, the Hastings Center was founded by Daniel Callahan and Willard Gaylin, MD in 1969. Callahan was a member of the American Eugenics Society. Willard Gaylin, MD was a self-proclaimed communist. For example, Last Acts had a project called Rallying Points" and selected the Hospice of the Florida Suncoast as a regional center representing excellence in end-of-life care. The Last Acts website said, "Rallying Points is a major initiative of the Last Acts campaign to improve care and caring near the end of life. Two of its other Rallying Points Regional Centers were the Life's End Institute in Missoula, Montana and the Midwest Bioethics Center (now the Center for Practical Bioethics) in Kansas City, Missouri. The Center for Practical Bioethics tells us about its mission:
The only problem with all that flowery very nice sounding language is, who is considered a "person" to have "intrinsic worth?" Does "practical" bioethics mean bioethics that allows for imposing or hastening death? ... as if bioethics that respect the sanctity of life are no longer practical? Does "person" include those who are very elderly, disabled, cognitively-impaired or who have Down's syndrome, for example? What is meant by "autonomy?" Does that mean that a baby should have the right to choose life and to not be aborted? And what is "social justice?" Does that include not having your life snuffed out as is happening in the Netherlands and Belgium where "safeguards" written into the euthanasia laws are routinely ignored? Is their idea of "social justice" the same as your idea of "social justice" or not? It's not about the sanctity of life given as a gift from God! The other Rallying Points regional centers were the Hospice of the Florida Suncoast in St. Petersburg, Florida and the National Resource Center on Diversity in Washington, D.C.
In 2003, the Life's End Institute (the work of pro-terminal sedation physician and co-founder of Partnership for Caring, Ira Byock MD) posted an article by Dr. Byock about getting quicker access to one's living wills and advanced directives through the "Choices Bank" that was created. That may sound good. Get the documents when they are needed, but what is not mentioned is what happens if the patient requests that care be provided at the hospital or hospice and the staff members don't agree? The patient's wishes can be overridden. The documents do not protect wishes to receive care; they protect choices to limit care, a one-way street. It all sounds very professional and well-meaning. That's the pattern: use language that many can agree with while slipping in an agenda item. People like the idea of their wishes being honored at the end-of-life and euthanasia advocates have capitalized on that. However, the "honoring of patient wishes" is tainted by efforts to make sure treatment is not provided if the hospital or hospice don't agree. "Ethics committees" can override the patient's wishes. Byock was also co-founder of the successor organization of the Euthanasia Society of America: Partnership for Caring. It's starting to make sense now, isn't it? What does the disability rights organization, Not Dead Yet have to tell us about Last Acts? They write:
So, we've learned something about Last Acts and Last Acts Partnership, but what happened after Last Acts Partnership was absorbed by the National Hospice & Palliative Care Organization in 2004? What was the final really big "last act" of the Rallying Points center, Hospice of the Florida Suncoast? Of course, it was the implementation of their agenda: the ending of a life they deemed "unworthy of life," Terri Schiavo's life, at the hospice in front of the whole world by court order. They didn't "terminally-sedate" Terri; they just stopped giving her food and liquids and had police making sure not one drop of water or an ice chip was given to relieve her thirst. But it was essentially a Third Way killing. It wasn't direct euthanasia with a lethal drug, nor was it "assisted suicide" by providing a lethal drug. It was dehydration and the consequent circulatory collapse, and that's what happened to Terri.
George Soros' Project on Death in AmericaElizabeth Wickham, PhD, Executive Director of Lifetree explains how billionaire George Soros has shaped American culture:
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The Art of War by Sun Tzu Chapter I, verse 19
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End-Run Around Right-to-Life:
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Well, clearly there's been a lot of change since the first hospices started up. You probably didn't expect to see that and don't want to believe the National Hospice & Palliative Care Organization is a "right-to-die" resource, but that is what the World Federation of Right-to-Die Societies says. And, NHPCO is the successor organization of the Euthanasia Society of America, as clear as can be! We must realize that the "universe" of hospices is not solely pro-life like it was with Dame Cicely Saunders' St. Christopher's Hospice. It took me a long time to accept this, because it was contrary to what I had been taught. I also didn't want to believe that the mission has been hijacked by corporations that have taken over, many of them for-profit. And fraud is widespread in rogue hospices. Even worse for the patients, those who are true believers in euthanasia and assisted suicide manage many of these hospices or palliative care units. They run the National Hospice and Palliative Care Organization. They're on the board of directors. They train the staff, perpetuating twisted clinical practice and interpretations of the hospice and palliative care mission. Hospice has become a playground for the right-to-die zealot! Except for those of faith, the sanctity of life is viewed as nothing more than an obscure phrase spouted by "right-wing zealots." Quality of life is almost universally promoted by those in the mainstream media, by most bureaucrats running the government, the schools and universities. If any of them were to start speaking openly about the "sanctity of life," they'd be fired for "violating the separation of church and state," something that is part of communist constitutions (as in the former USSR), or Communist China, but is not part of the U.S. Constitution. We have the First Amendment's prohibition against establishing a government-mandated religion, but we have no prohibition about individuals having a religious faith or expressing their reverence for each life. The Constitution and Declaration of Independence are based upon reverence for individual life. For the modern secular culture, when a person's quality of life is seen to be declining, the value of that life is now also viewed as declining. When it gets bad enough, ending the life of the patient is seen by many as the best way to resolve the problem of suffering. Allowing the person to live and go through the dying process till a natural death occurs is seen as meaningless, cruel and uncompassionate! Though they don't openly say it, killing the patient to end suffering is what is meant by "death with dignity." This is the belief of the Euthanasia Society of America's heirs who are now entrenched within our health care and hospice industry. They are more "mainstream" in health care management and policymaking circles than people of faith who honor and revere life. Pro-life health care professionals "butt heads" with these secular health care bullies every day in the workplace.
The James Bond theme song written by Paul McCartney, "Live and Let Die" expressed the transition very well: "When you were young and your heart was an open book In other words, in earlier times when you were "young and open," you forgave and turned the "other cheek" allowing the offending party to live, but now. after suffering in the world and you became bitter, you should no longer believe in the value of forgiveness. You should say, "live and let die." And in the context of the Bond films, "let die" obviously means "kill." Though the Bond films can be tremendously entertaining, the coarsening of our society is clearly reflected. People of faith do not view the suffering which comes with life as a justification to become bitter, withhold forgiveness or kill, but those who are secular and utilitarian do. They do not respect the biblical moral imperative, "you shall not murder" and think nothing about imposing death upon the vulnerable. For those who revere the life given to each of us, "death with dignity" means respecting the sanctity of each person's life, all through life, caring for those in need lovingly, relieving suffering as best can be done, but allowing death to occur in its own natural timing. With regard to the patient, David Mills writes: "Lying in a hospice bed, in the very last situation he would have chosen for himself, my father taught me that to die with dignity means to accept what God has given you and deal with it till the end. It means to play the hand God has dealt you, no matter how bad a hand it is, without folding. It means actually to live as if the Lord gives, and the Lord takes away, and in either case blessed be the name of the Lord. Many churchgoing people of faith believe, want to believe, that hospice is the alternative to euthanasia. It's the "simple" solution that seemed to answer the need of the times. It was and is too simple. The right-to-kill crowd got to the hospice industry and overpowered the influence of those who remained true to a sanctity of life ethic. They created and duplicated rogue hospices that pretend to be like Dame Cicely Saunders' hospice but are nothing at all like what she demonstrated. They have hijacked the industry and are leading them and our society into disaster. |
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No, many of the hospices today model themselves after Florence Wald, RN, MN's vision where assisted suicide would be available for economic reasons or just about any other reason! The euthanasia proponents, knowing Americans' traditional opposition to medical killing, have pretended to be powerless to do anything. Yes, they have pretended to be far away, as if they weren't even acting here in America, except for the "overt" euthanasia proponents run by what some people would think were "loonies" like Derek Humphry of the Hemlock Society. But, the euthanasia proponents have been very slick, operating behind the scenes in high places, sitting down "at the table" where stakeholders make policy for the nation, sitting down "at the table" when textbooks are written, shaping our children's worldview so that sanctity of life becomes something to be mocked or considered a "throwback" to the "dark ages" when the United States was dominated by Christian "oppressive" values. They also specifically have targeted medical and nursing students for re-education through the rewriting of textbooks. The re-education was not restricted to simply promoting hospice and palliative care as the public expects it to be; it promoted the secular culture-of-death flavor of end-of-life care favored by Florence Wald, RN, Joanne Lynn, MD and Ira Byock, MD. They have never stopped working to make changes in our society and especially hospice, and they refuse to honor the sanctity of life. They have succeeded in perverting the practice of end-of-life care, so it is no longer a "safe" alternative. The public has no way to know who to trust when they enter a hospice or palliative care unit. Only a hospice that affirms the sanctity of life is truly safe for any patient, and how will you know which one is which?
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IV - The Culture of Death: Overt Operations
Euthanasia Society of America (early decades)
With hindsight, we can see that they changed their tactics. Studying their words, speeches, and activities, we see that after defeat after defeat in the late 1930s and thereafter, they decided to move incrementally, getting the public to accept changes in what was expected in health care, all in the name of "patient rights." Their "enemy," the American people's opposition to medical killing, was too strong to overcome. The Euthanasia Society membership was relatively quite small with respect to the entire country, but they had two things on their side: their willingness to persist for decades and their willingness to deceive the American public. They avoided open confrontation with the American public when they saw they could not win. After World War II, many around the world were so appalled by the Nazi atrocities. It is no surprise that in 1950:
So, when the Euthanasia Society of America was formed, about 46 percent of the American public favored legalization. After World War II, support dropped precipitously. For seventy years, they have never stopped. In the 1940s and 1950s, the cultural "tides" were against the Euthanasia Society, but they kept trying to legalize medical killing, something they call "mercy." A Nov 2, 1946 Stars & Stripes newspaper article, "N.Y. Doctors Seek Legal Mercy Killing" tells us they kept trying. That article could have been written in 2011 just the same. The cartoon included with the story demonstrates their idea of mercy. |
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The dear Lord certainly did not mean the same thing when He said,
Sermon on the Mount: Matthew 5:7
The Hemlock Society and Compassion & Choices: Overt Operations in America |
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There have always been two main groups of euthanasia proponents: the covert operators and overt operators. The covert operators are those who used the "walk, don't run" strategy after the failure by the Euthanasia Society of America to openly legalize euthanasia in the 1930s through 1960s. They decided to work incrementally by encouraging the use of living wills and advanced directives, helping more and more people use the "DNR" forms, putting their ideas into the universities that train the doctors, nurses and attorneys that manage the health care setting. The National Hospice and Palliative Care Organization's "Caring Connections" program continues this work. The other camp remained stuck on "kill" and went for open legalization of euthanasia and assisted-suicide in different states. In fact, the idea of "assisted-suicide" is merely an incremental step to legalization of euthanasia. By appealing to those who didn't want to suffer at the end-of-life, they have gained acceptance for the idea of killing oneself at the end-of-life when a patient has a terminal condition. They always promote their idea as the "right-to-die," but everyone dies, so it's not about the "right" to die, it's about the right to determine the timing of one's death (or the timing of the death of someone you have guardianship over as a surrogate decision-maker). Traditionally, the timing of one's death has been recognized as within God's hands, that we have a purpose in life and a time for being brought into this world and time to pass on to the next world. The euthanasia proponents do not look on life in this way. Leaders of this movement are mostly secular, atheist, socialist and utilitarians. For them, life has no meaning other than what can be accomplished or enjoyed in this world. The Hemlock Society is a grim organization that has promoted all sorts of ways of killing oneself. Debi Vinnedge, Executive Director of Children of God for Life, says:
Wesley J. Smith, JD says this about the Hemlock Society:
Smith explains that the success in legalization of assisted-suicide in Oregon has emboldened euthanasia advocates to push for legalization of the "Third Way" of ending life, through terminal sedation of the patient in an end-of-life care setting:
Although the mandatory counseling sessions for Medicare recipients has been inserted into and taken out of the law twice, something along those lines will eventually be implemented; it's in line with the direction the stakeholders are moving, promoting hospice and palliative care, reducing health care expenditures by rationing care, promoting advanced directives, DNRs, and the new P.O.L.S.T. forms. What Wesley J. Smith, JD means by the "Compassion & Choices" organization wanting to become the "Planned Parenthood of assisted suicide" is clear when you consider that Planned Parenthood "took in $2.02 billion from government grants and programs" from 2002 - 2008; Compassion & Choices wants the federal funding and recognition as a "legitimate national player" and the consequent expanded role in our society. Societally, Compassion & Choices, a pro-euthanasia, pro-assisted suicide, pro-Third-Way medical killing organization would never be accepted as a "legitimate" player on the national scene by a large majority of the American people, especially those of faith. Yet, they're just a Congressional decision away from being funded by the federal government! If the Congress chooses to fund Compassion & Choices in the same way as Planned Parenthood, it will show its open bias toward promoting hastened death, just as the federal government has done for Planned Parenthood. Compassion & Choices' name itself involves deception. They promote the choice to medically kill or to medically kill oneself, but allowing suicide or euthanasia is not compassion. "Those who advocate euthanasia do so in the name of compassion. In this they are undoubtedly sincere, but misguided. Compassion is derived from Latin and means to 'suffer with', and in the context of dying persons, it translates as walking the rest of life's journey beside them, seeking their comfort at every stage. To kill them is a form of abandonment, precisely because the journey is too tough on others...." [Emphasis added] Anyone who has worked with the dying knows what is meant by "walking the rest of life's journey beside them, seeking their comfort at every state." This is the work of hospice and palliative care: to be with them, to relieve their suffering as best we can, to encourage them, to sit with them, to love them, to pray with them, to listen and witness ... to keep vigil and honor their life! Compassion & Choices, the new face of the overt camp of euthanasia advocates has its own "business tagline" to push its deceptive campaign. Every page of the website shouts: "Too many suffer needlessly. Too many endure unrelenting pain. Too many turn to violent means. You have choices, and it's your decision." Their tagline really is misleading. Good end-of-life care can relieve almost all suffering and in extreme cases, can make pain bearable. Those who seek assisted-death do not choose that option because of pain. "Edward J. Larson and Darrel W. Amundsen summarise: "As a result of work by Cicely Saunders and other experts in the field of pain management, nearly all terminally ill patients can obtain sufficient relief from their physical pain. That is the purpose of hospice - and it works. Based on her years of experience treating dying patients with proper pain management at her hospice in London, Saunders reports that none of them have asked for physician-assisted suicide or euthanasia." (A Different Death: Euthanasia and the Christian Tradition, 1998, p.188)." No, those who seek assisted-suicide do so because of the fear of being dependent or a burden on others, as well as to choose the timing of their own death (or the death of someone who has been categorized as "not competent" to make their own decisions . Even though the Compassion & Choices organization deceives with its tagline, it (and others) has been very successful in shaping American thought. Our culture has drifted further and further away from traditional American values that affirm the respect for the sanctity of life.
Global Influences
They make it clear that the manner and timing of one's death should be up to the individual, not God, and they cloak this dark agenda in the language of a "human right" to kill oneself or be killed. WFRTDS lists other resources that are working to make it legal for people to kill themselves or to be killed medically. Some of them include the familiar names such as "Final Exit," Oregon's "Death with Dignity" Center, but surprise, surprise, ... listed prominently is the successor organization of the Euthanasia Society of America, not Society for the Right to Die, Choice in Dying, Partnership for Caring or Last Acts Partnership, but the familiar hospice organization, the National Hospice & Palliative Care Organization!! And how do they list the largest hospice industry group in the country? As one of the "Right to Die Sites!" Confirmation! Yes, NHPCO is the friend of the World Federation of Right to Die Societies and is prominently listed as such. The World Federation of Right To Die Societies is behind some of the groups working in this country and all around the world. It is interesting to note that some of its officers are also board members of the U.S.-based pro-euthanasia organization Final Exit Network. Ted Goodwin is a co-founder of Final Exit Network and also President of the World Federation. So, when any one state has an initiative pushed forward by the local right-to-kill group (Compassion & Choices, Final Exit, or some other) they can get money from other state organizations, George-Soros organizations or the World Federation and outspend the people in the state who are pro-life and respect the sanctity of life. That's what happened in Washington where pro-lifers were outspent in the campaign to legalize assisted-suicide (killing) there. What about other global influences? What can be more global or influential than the World Health Organization? There is no doubt that W.H.O. has promoted palliative care, but which type of palliative care is it promoting? Those health care professionals who respect life tell me about all the good expert palliative care can do for patients, however others point out the spread of "palliative sedation" among providers around the world. Which is it? WHO's list of palliative care leadership is revealing. For example, Kathleen M. Foley, MD is the medical director of the International Palliative Care Initiative of the Open Society Foundations Public Health Program, working to advance palliative care globally. This is the George Soros-funded group that together with Robert Woods Johnson Foundation financed much of the extreme changes in end-of-life care through the 1990s and up to the present time. In fact, the booklet, "the solid facts, palliative care" edited by Elizabeth Davies and Irene Higginson, distributed by W.H.O. was supported by the Floriani Foundation with collaboration of, yes, the Soros-funded Open Society Institute! Other members of WHO's palliative care leadership team include, among others, Joanne Lynn, MD. Elizabeth Wickham, PhD encourages us to: "... Look back to a June, 1997 NY Times story to get a better description of what Lynn believes about total sedation and withholding and withdrawing life sustaining treatment. "When a patient is ready to die, I can stop nutrition and hydration, I can stop insulin and ventilation, I can sedate them." When a patient is "ready to die" is not the same as "imminently dying." When a patient is imminently dying, they naturally do not eat or drink. A patient might be "ready to die" months or even years before a natural death occurs. However, under Joanne Lynn's approach, we can terminally (totally) sedate the patient and withhold and withdraw life-sustaining treatment. We've seen this before, but notice she is talking about limiting life-sustaining treatment. And Dr. Lynn represents very mainstream medical thought in the United States today. Her suggestion that life-sustaining treatment is to be limited is exactly what's spreading across the country with the new P.O.L.S.T. forms that are physician orders limiting life-sustaining treatment. Terminal sedation plus P.O.L.S.T. equals a formidable one-two punch working to impose death on the vulnerable, elderly and disabled. This is why pro-euthanasia Compassion & Choices promotes the P.O.L.S.T. forms as part of the incremental steps to hasten death, what they call being "Good to Go." Their Good to Go Resource Guide specifically encourages each of us to have our doctor fill out the P.O.L.S.T. form, while they admit that if the physician does not agree with our views, he may refuse to fill it out for us. In the case that you want to be treated in the hospital, and the physician disagrees, he can refuse to fill out the form designating your wishes. And because they are truly medical orders (not just a patient's statement of his or her wishes), he can write whatever he wishes to, according to his medical opinion. So, two of the global influences that are having the most impact on American end-of-life care are the World Health Organization and World Federation of Right-to-Die Societies. W.H.O. chooses to name Kathleen M. Foley, MD (working for a George Soros organization) and Joanne Lynn, MD (who has been with the Rand Corporation). Not only does Dr. Lynn not condemn Third Way medical killing, she proudly emphasizes that she can hasten death through withdrawal of food and fluids along with implementing total sedation.
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V - The Courts: Removing Barriers to the Culture of Death
While we may agree or disagree with the rulings in the following cases, it is clear that these cases form a legal foundation for changes in how our society deals with decisions that will result in death. Court rulings, changes in standards within the medical community and new laws have completely changed the landscape regarding life, death and imposing death in America. While the court rulings may make "sense" to some, they have paved the way for the widely-practiced Third Way of killing used in hospices today. It's exactly like the "camel's nose in the tent." Once you give in a little way, you lose the entire battle. |
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| Artwork copyright Vickie Travis 2011. Design copyright Vickie Travis and Ron Panzer 2011 |
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These court decisions have chipped away at the legal protections for life itself in America. They have paved the way for the likely eventual legalization of euthanasia in our country, unless a major restoration of American values and faith occurs. Judges who truly are committed to the values enshrined in our Constitution would never have gone down this path. We need to elect Presidents that will appoint judges who respect the Constitution and revere the life the dear Lord gives us. The founders of our nation acknowledged Him. So should we, and so should our leaders. The freedoms we have enjoyed in our nation are based on the respect for all lives, all citizens. Once that respect for life was diminished, the door was opened to health care tyranny in America. The 1965 Griswold v. Connecticut, 381 U.S. 479 Supreme Court ruling established the "right to marital privacy" for use of contraceptives The 1973 Roe v Wade Supreme Court ruling, 410 U.S. 113 expanded the prior Griswald decision to recognize Constitutional "right to privacy," determined that a fetus is not a "person" separate from the mother, therefore killing the fetus is "legal" and completely up to the mother to decide for herself. Most people think of Roe v Wade as being about the "right to privacy" and that is what gave a legal justification for abortion. That is what those promoting the culture of death would like us to believe. No, privacy is not the problem. Although I'm not an attorney or a judge, it seems to me that clearly when the Supreme Court in the Roe decision ruled that a fetus is not a person, not separate as an individual from the mother, that is where the problem was created and set into legal stone. It's absurd for them to have stated that the unique human life, the fetus, is not a person. Yes, the life is within the mother, but just as it's said, "within the mother" indicates that it is other than the mother. And common sense tells us the fetus, the baby, is a new human life. Redefining life is a habitual technique of the culture of death in their quest to be able to kill whatever category of life they wish. They redefine the baby and say it's not a human life, not a unique individual, even though it is; therefore, killing the baby, the fetus or embryo, is not "killing." The same thing happens when they redefine the brain-injured person and say he or she is legally dead ("brain dead") or in a "persistent vegetative state" or the quality of life is so poor that they can be "let go" and they are made dead through a variety of means. The 1976 Quinlan case heard before the New Jersey Supreme Court. While it is true that there are times when patients are subjected to treatments, even surgeries that are unwanted, or put on machines when they don't want them, it is also true that sometimes treatments can be helpful and patients may recover, even after physicians "determine" that the patient is "brain dead." What physicians "know" about the brain and its function (however much we admire what they've learned so far) is limited and sometimes mistaken. In the 1960s, concerns were raised about these unwanted treatments. And it certainly makes sense that patients should not be subjected to unwanted treatments. Elderly dying patients should not be subjected to treatments that have no purpose and are not going to help the patient. Everyone can understand that, but when you take something as simple as that and misuse it to hasten death by not providing helpful treatment, you've changed the entire purpose of the DNR. In one case, you are honoring the patient's wishes. In another, you can manipulate the treatments to hasten and impose death, even involuntarily or without the patient's knowledge completely. Karen Ann Quinlan was one of the patients whose condition was used to push forward the Do Not Resuscitate protocol and patient rights to determine their own course of treatment. In 1975, she had been drinking heavily, took some drugs and her heart and breathing stopped. She was resuscitated, taken to the hospital and placed on a ventilator. When it was clear that Karen was severely brain-injured, but not "brain-dead." Her father wanted the ventilator removed.
Initially, the lower courts denied the father's requests, but in the landmark case heard by the New Jersey Supreme Court, the father's wishes prevailed and the ventilator was removed. However, she continued breathing on her own until she died of an infection in 1985. Before the Quinlan case, such decisions about withdrawing treatment were completely between a patient and the physician.
There were several other cases that moved the "right to die," withdrawal of treatment theme along, especially the Cruzan and Schiavo cases. In the 1990 Cruzan Case, the Supreme Court affirmed that a surrogate decision-maker has authority to exercise a patient's right to refuse lifesaving procedures (for a patient in persistent vegetative state) consequently causing death through withdrawal of treatment. There is no difference between the withdrawal of needed treatments in passive euthanasia and this court-approved "patient refusal" of lifesaving procedures (actually decided by someone else). Death is intended and accomplished just the same. In the 2005 Terri Schindler Schiavo Case: Terri is said to have "collapsed" with brain-injury in 1990. Medical records show that after that night, she had marked injury to her neck and an L-1 injury to her spine, a posterior rib fracture and other injuries not explainable by simply having “collapsed.” . No police attempted-homicide investigation was ever done. Nobody has ever explained why not. She was later examined to be in a "minimally-conscious state by physicians," but pro-euthanasia physician Ronald Cranford, MD conveniently declared Terri was in a persistent vegetative state which suited the agenda. Rehabilitation therapy had been forbidden for many years by order of guardian Michael Schiavo, and she was later admitted to hospice fraudulently since Terri did not meet the criteria for hospice; she was not "terminal." Her own physician testified under oath that she was in good health. Terri was not on any "life support" at all but had tube feedings. Terri was selected by euthanasia advocate Mary Labyak (CEO of the Hospice of the Florida Suncoast) and euthanasia advocate George Felos (Chairman of the Board of the Hospice and Michael Schiavo's attorney) for the express purpose of expanding the legal foundation for medical killing and chose to do that in the hospice setting. Felos had earlier been involved in another precedent-setting case: In Re: Guardianship of Estelle M. Browning. In Terri's case, the local Judge Greer refused to hear much evidence or to have Terri tested properly, although the pretense that everything had been done was carefully orchestrated. After a long court battle, the court ordered that the guardian's wishes were to be acted upon and Terri was deprived of food and fluids. None of the appeals and other courts re-evaluated Judge Greer's findings of fact; they simply reviewed the legal decisions flowing from his findings of fact. Her medical killing gave the public yet another example where the courts ordered the removal of simple tube feedings, forbade any oral nutrition to be given, in order to cause death within a hospice setting.
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VI - Physicians: Redefining Death to Remove Barriers to the Culture of Death |
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From the 1960s onward, physicians have pushed newer and more permissive definitions of "death" for purposes other than scientific truth. On Aug 5, 1968, the "Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death" released their report, "a definition of irreversible coma." [JAMA. 1968 Aug 5;205(6):337-40]
Many people think of the life-saving effects of organ transplantation, and remember the first heart transplant in South Africa (1967) (with another one performed three days later in Brooklyn, NY on a recently born baby). The recipient of a donated heart goes on to live a much fuller life after coming very close to dying. It is a life-changing surgery that brings prolonged life for the recipient. But with the proliferation of organ transplant teams, the prestige and status accorded to hospitals that perform such operations, the big money made for performing such operations, is there anything else going on here aside from a pure, altruistic motive to save the life of the desperate patient who will die without a donor organ? In some cases, there is something else going on. Clearly, physicians didn't want to openly state the obvious, that they kill the patient to get vital organs for transplantation (such as a heart or both lungs). In the same way that babies have been re-labeled "just an embryo" or "fetus," and "not a person," to justify "aborting," killing the baby, a patient who is seen as a prospective donor is re-labeled "brain dead" so it is easier to kill him and take the organs. Of course, many today think that is perfectly fine. They have been taught to believe that the patient is "already dead," or better off "truly dead" and think they are doing that patient a favor while saving the life of the patient who receives the organs. However, some patients would and do recover if given more time. As we've seen above, the definition of "brain death" was set at "irreversible coma." Yet, Professor Paul A. Byrne, MD and Walt F. Weaver, MD explain that "brain death" is not "death." When everybody knew what "death" was before 1968, why talk about "brain death," and later equate "brain death" with "death?" Well, before "brain death" became a criterion for "death," states such as "Kansas defined that a person was dead once all of his or her organs were dead, making some transplants impossible." We know that transplanting organs "saves lives," but what about the person whose organs have been taken? As Paul A. Byrne, MD has explained, a heart donor cannot truly be "dead," because that would mean the heart and all organ systems had stopped functioning, and all tissues and cells had begun already to break down. Such a heart would be unsuitable for transplantation. Obviously, donors are "alive," but considered "not alive" for transplantation purposes. What happens if a patient is determined to be "brain dead" but later recovers? According to what we've been led to believe, that should never happen, but there have been such cases. Physicians do make mistakes, and sometimes even if they haven't made a mistake, patients have still recovered. Sometimes, physicians are not really interested in whether or not the donor patient might recover. A May 13, 2009 article by Verheijde, Rady & McGregor gets right to the point: "Brain death, states of impaired consciousness, and physician-assisted death for end-of-life organ donation and transplantation." [Emphasis added] The title says it all. It points out, without any pretension or deception, that physicians do impose death, i.e., they kill the patient, in order to get the organs used. It's very simple to understand. So, imposing death upon patients to facilitate organ transplantation must be considered one aspect of the euthanasia movement. Whether they are considered "brain dead," in a "persistent vegetative state," organ procurement organizations want those organs. Modern society may scoff at the idea that patients are being killed, but these doctors admit it, right in the title of the article. It's what's been done all along since "brain death" became an alternative definition of actual "death. With regard to those in what has come since 1972 to be termed a "persistent vegetative state," Professor B. Jennett states:
What will happen to patients thought to be in a "persistent vegetative state" as the push to grab organs for donation moves into "high-speed?" It's just a small step from "brain death" being used as a justification to take organs, to using "persistent vegetative state" as a justification. What about mental retardation, Down's syndrome, or other cognitive impairments like dementia? Some physicians already advocate taking organs from the cognitively impaired of all categories. With the Uniform Anatomical Gift Act ("UAGA") Revised in 2006 and 2009, the default rule for patients who are considered "brain dead" is that the patient is presumed to have given consent to prepare his body for donation of his or her organs for transplantation. Preparing the body for transplantation is not a reversible process! Dr. Paul A. Byrne explains in his article: "Do Your Organs Belong to the Government?" that once the patient's organs are deemed suitable for transplantation, and because of the "presumed consent" to prepare for harvesting of the organs, the transplant team is legally allowed to flood the body with fluids which destroys the brain and any chance of recovery, while preserving the vital organs such as the heart, lung, liver, kidneys and so on. While all of this is going on, the organ procurement team "seeks to make contact" with a relative, friend or other "class" of people who can give "consent" for the "deceased" patient to be made really dead by taking his vital organs. What if the doctors are wrong? Are they ever wrong? Chauncey Crandall, MD is the Yale-educated chief of the cardiovasular transplant program at Palm Beach Cardiovascular Clinic, Florida. Dr. Crandall reports that on October 20, 2006 he had pronounced Jeff Markin dead forty minutes earlier and was finishing up paperwork when he felt a call to pray for the patient and try again to get his heart started. He ordered the staff to give one more shock with a defibrillator. Markin is alive today because the doctor listened, prayed and did not give up. Dr. Crandall is the author of Raising the Dead: A Doctor Encounters the Miraculous. Dr. Paul A. Byrne mentioned the case of Zack Dunlap: "Pronounced dead, man takes 'miraculous' turn -- Doctors can't explain why 21-year-old Zack Dunlap recovered from accident." March 24, 2008 and Val Thomas: "Woman Wakes After Heart Stopped, Rigor Mortis Set In" May 23, 2008, both of whom were officially "pronounced" dead ("brain dead") by the doctors and who came back to life from the "dead" to full consciousness and interaction and functioning here in this world. Clearly, the docs are not infallible and may be rushing the whole "brain death" determination in many cases! On May, 2011, the Australian Gloria Cruz was officially pronounced "brain dead" and her case "hopeless." Medical professionals pressured her husband to have the ventilator turned off immediately, but he resisted and delayed the physicians. When the ventilator was eventually turned off a few weeks later, Gloria continued breathing on her own and woke up completely three days later. Doctors were stunned and said, "it's a miracle." Perhaps doctors need some humility in realizing that they still do not understand all that there is to know. For more information, see "Dealing Death -- A Pro-Life Nurse Looks at Dangerous Developments in Organ Procurement" by Deborah Sturm, R.N. Deborah Sturm is a registered nurse and serves as the secretary of the National Association of Pro-Life Nurses. Dr. Byrne has told us about some of his own patients who were considered "brain dead" and went on to live complete and normal lives, functioning in the community, working, and raising children. Makes you think twice about what is going on, doesn't it? It should! In July, 2011, a Quebec woman, Madeleine Gauron, woke up after being declared brain dead, and immediately recognized her family. Texas does not require the patient's own declaration of intent to donate when it comes to non-visceral organs. See: Texas's Health and Safety Code, Title 8, chapter 693. In Texas, "non-visceral" organs refer to something like a cornea that might be removed without consent to donate. This is the desired outcome for the organ procurement industry. Who was appointed to head the President's Office of Information and Regulatory Affairs? Cass Sunstein, "Obama Regulation Czar [who has] Advocated Removing People's Organs Without Explicit Consent."
Well, it can't be plainer where they want to take us! Earl E. Appleby, Jr. director of Citizens United Resisting Euthanasia quotes Hastings Center co-founder Willard Gaylin, MD and writes: "Over the years, physicians have practiced euthanasia," Dr. Willard Gaylin, of the infamous Hastings Center, acknowledges in Harvesting the Dead. "They have withheld antibiotics or other simple treatments when it was felt that a life did not warrant sustaining, or pulled the plug on the respirator when they were convinced that what was being sustained no longer warranted the definition of life." China has taken it a step further. The government there has ruled that the organs of those to be executed do belong to the government, and they harvest the organs at the moment of execution! The March 2009 MailOnline (U.K.) article, "China's hi-tech 'death van' where criminals are executed and then their organs are sold on black market" reveals:
That's less than 3% that are voluntary donations. The rest of China's donated kidneys are harvested involuntarily! Wesley J. Smith, commenting on the latest health care trends, tells us that "once a society decides that some of its members have a life of such low quality that it is acceptable for doctors to kill them, and once these patients - many of whom already feel like burdens - learn that they can save lives by their suicides, the seductive pull of asking for euthanasia/organ harvesting could reach gravitational strength." Couple the financial motivation of physicians and hospitals who do transplants with the disdain many utilitarians hold for those who are disabled, and you have a lethal prescription for the Perfect Storm about to hit American health care settings. The vulnerable are not only suffering; they must now worry that pressure will be brought to have them end their so-called "meaningless" lives and donate their meaningful organs to others who are considered more important than they are. You may think that what happens in China is so irrelevant to what will happen here in America, but you would be mistaken. We live in a very inter-connected world and Chinese influence in the world is only growing along with its booming financial assets which are mostly controlled by the Chinese Communist government. In the early 1970s I was taught about the hypothesized threat from Communist China as its population grew bigger and bigger over time. The reality of China's growing population has only continued, however, back in the 1970s nobody was talking about China as the financial success it has become. And closer to home, a Communist China-controlled corporation plans on buying and then building a 50 square mile property in the United States south of Boise, Idaho. What "... they have decided to do is to buy up pieces of the United States and set up "special economic zones" inside our country from which they can continue to extend their economic domination. .... the 10,000 to 30,000 acre "self-sustaining city" that is being planned would essentially belong to the Chinese government. The planned "self-sustaining city" in Idaho would include manufacturing facilities, warehouses, retail centers and large numbers of homes for Chinese workers. Basically it would be a slice of communist China dropped right into the middle of the United States." Nothing against the Chinese (or any) people, but the Communist Chinese leaders and the form of totalitarian government there do not share our American values, they prohibit the truly free exercise of religion, having imprisoned many for participating in various religions, including Christianity, and they do not have any sense of the reverence for life that is implicit in our nation's Declaration of Independence and our Constitution. "Through a system of "re-education through labour, - the Chinese government detains hundreds of thousands each year in work camps without even a court hearing. There are more Christians in prison in China than any other country in the world." With America's economy in a man-made disastrous condition and China's government in control of vast sums, Chinese corporations acting within the U.S. are positioned to buy up several or even many sites to build Chinese cities within the United States of America. Our Congressmen as well as state leaders are allowing these plans to move forward, though during the Cold War, we would never have thought of allowing the Soviet Union to buy up sections of America. These settlements would house mostly Chinese citizens in the U.S. and can only grow with the families living here over time. While some may doubt that these are realistic threats to American sovereignty, as years pass, the real nature of these developments will become more apparent. How long can our nation survive as a sovereign nation when our leaders betray their duty to protect our nation from all threats to our national security? When the Chinese harvest organs involuntarily from executed prisons, they demonstrate their values. When they take aborted fetuses and use their remains to create medications they demonstrate their values. These are the same utilitarian values they will bring to America when they settle here, not to become Americans and live the American dream, but to create mini-Communist China zones here, something quite the opposite! China is not the only possible threat to the U.S. The re-establishment of something like the Soviet Union is another possible factor and moves to consider European law in our own Supreme Court decisions is a move away from reverence for life and towards utilitarian secularism.
We also have radical terrorists bent on destabilizing the West and especially the United States. It seems that as our nation responds to these threats, the government is assuming a larger and larger role in daily life, threatening the basic Constitutional freedoms it is supposed to protect. If that government is no longer dedicated to the founding principles of a citizen's right to life and liberty, how can vulnerable patients be expected to remain safe? If transplant physicians are desperate to obtain organs for their patients, they will look to euthanasia as a means to organ harvesting.
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"Do Your Organs Belong to the Government?" |
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June 2008
Reprinted with permission of Paul A. Byrne, M.D. [About the writer: Dr. Paul A. Byrne, a Neonatologist, is Director of Neonatology and Director of Pediatrics at St. Charles Mercy Hospital in Oregon, Ohio, is Clinical Professor of Pediatrics University of Toledo College of Medicine, Board Certified in Pediatrics and Neonatal-Perinatal Medicine, Member of Fellowship of Catholic Scholars. Dr. Byrne is past-President of the Catholic Medical Association (USA), formerly Clinical Professor of Pediatrics at Creighton University School of Medicine in Omaha, NE, and at St. Louis University School of Medicine in St. Louis, MO. He is author and producer of the film "Continuum of Life" and author of the books "Life, Life Support and Death," "Beyond Brain Death," and "Brain Death Is Not Death." Dr. Byrne has presented testimony on "life issues" to eight state legislatures beginning in 1967.] |
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[Note: As of February 17, 2011, 44 states have now enacted the Revised UAGA and 2 have bills in process to adopt it. See the "Revised UAGA Enactment Status Map."]
In the quest to grab organs for transplantation, physicians may withhold treatments from treatable patients who could recover. They may mislead family members about their loved one's medical condition in order to get organs for transplantation. We have already seen that some doctors are very eager to pronounce a patient "brain dead" and begin the pre-harvesting protocol, flooding the body with fluids. But new research is confirming that exactly the opposite is required for recovery:
Nancy Valko, RN, President of Missouri Nurses for Life and spokeswoman for the National Association of Prolife Nurses comments: "... one of the biggest differences between medical care today and that of 30 years ago is time. In the "old days", critically ill or injured patients were not rushed into a determination of hopelessness soon after the illness or injury so that life-sustaining treatment could be withdrawn. Because of that gift of time, we were surprised and humbled when many of these "hopeless" patients survived and even recovered. Now, especially with non-heartbeating organ donation, the "right to die" and economics, there is a lot of pressure to determine when to quit on a patient as soon as possible. This article is an important counter to that view." Even harvesting the organs of the injured is not enough for some physicians. They are looking to plunder the organs from disabled people who are euthanized. In Belgium, it's already been done: "A group of Belgian doctors are harvesting "high quality" organs from patients who have been euthanized. ...." |
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Here is a sampling of some of the major steps our society has taken with regard to "brain-death," organ transplantation, the "wall of silence," and devaluation of life, as well as some landmark court rulings. Even though some of these decisions may "make sense" to you, they amount to steps down the slippery slope, and we are now at the bottom of that slope as we shall see.
1965 Griswold v. Connecticut, 381 U.S. 479
1967 (Dec 1) First heart transplant: South Africa (Christiaan Barnard)
Dec 3, 1967, 2nd heart transplant Brooklyn, NY, USA
1968 First "brain death" article, JAMA 1968 Uniform Anatomical Gift Act ("UAGA") Simplified the Process of Organ Donation
1970 First "brain death" law (Kansas) |
