Wednesday, December 17, 2008

Woman Found Guilty of Financial Elder Abuse

December 16, 2008. By Heidi Turner

Lakeport, CA: In a move that shows how horrified the public is about financial elder abuse, a jury convicted a woman of one count of felony financial abuse and one count of felony elder abuse and neglect. The victim's story shows how far some people are willing to go to make money off those who cannot care for themselves. The senior was the victim of financial abuse, but was also not given the medical and physical care he required. Thankfully, the courts do not look kindly on people who violate financial elder abuse laws.

The story itself is appalling. A 53-year-old woman, Shauna Michelle Brewster, took advantage of a 75-year-old man for a year-and-a-half, according to the Lake County News. Brewster was named private conservator for the man, Lawrence Russell, in 2003. Russell was completely unable to care for himself physically and financially, and therefore required someone to help take care of him. Unfortunately, the person who came forward to help Russell was really only interested in helping herself.

Brewster helped herself so much that Russell's medical bills and mortgage were not paid, nor were his other bills. In fact, his debt was left for so long that Russell's home went into foreclosure. By that time, of course, there was next to nothing left in Russell's bank account. Brewster's job, as Russell's conservator, was to ensure that his bills were paid and his finances were looked after, but Brewster instead wrote checks from Russell's account to her boyfriend, her manicurist or her grocery story.

How much money was taken? In just 3 months while Russell was at a nursing facility, Brewster received $4,000 in cash back from Russell's account. According to prosecutors, there is no reason to believe that the $4,000 was used to help Russell. Russell wound up in the nursing home because of the serious neglect he was subjected to. It was so bad that Russell's health was endangered, including second and third degree burns on parts of his upper body that were not treated and became infected. Luckily, protective services and concerned neighbors got involved in the situation and Russell received important medical intervention.

Brewster now faces up to 5 years in prison for her actions, but whether or not Russell will get any of his money back remains to be seen.

Unfortunately, there are many people like Brewster out there: people who are more interested in making a quick, illegal buck than in actually helping a senior out. Russell trusted the woman who was named his conservator, but she victimized him and subjected him to serious medical problems.

What sets Russell's case apart from others is that action was taken on his behalf and justice was served. In many cases, the senior does not realize what is happening or is too afraid or ashamed to take any action. All too often, the victimizer gets away with the abuse and the victim is left to pick up the pieces alone, if he or she survives the abuse at all.

Sometimes, the abuse even comes at the hands of a family member or trusted relative. A woman was recently arrested for using her 90-year-old stepfather's money for unauthorized purchases. In all, the woman used almost $5,000, according to the Victorville Daily Press. The woman was arrested after the victim noticed 30 unauthorized transactions on his account. He then called the police, suspecting that his stepdaughter was the guilty party. Evidence, including surveillance footage, allegedly shows that the woman used her stepfather's ATM card illegally. She was arrested for theft by access card and elder abuse.

As awareness about financial elder abuse grows, so will the number of people willing to take action against those who abuse them. There are laws to protect seniors from financial elder abuse and the courts, and the general public, do not look kindly on those who would abuse members of such a vulnerable population.

Financial Elder Abuse Legal Help
If you have suffered losses in this case, please send your complaint to a lawyer who will review your possible [Financial Elder Abuse Lawsuit] at no cost or obligation

Tuesday, December 9, 2008

A Killer Arguement Against Assisted Suicide

Hot News frum Big-Mouth Broad Casting;
Dec. 9, 2008

A killer argument against assisted suicide

In exposing the euthanasia lobby’s disregard for equality before the law, and for free will itself, Neil M Gorsuch has written the most important book yet on the ‘right to die’.
by Kevin Yuill

Given the currency of the issue of assisted suicide, it is surprising how few well-written books arguing against changing the law to allow euthanasia have been published.

There are a few lucid arguments in favour of changing the law. The best texts to appear so far address the issue from a philosophical perspective. The books produced by Margaret Battin, Ronald Dworkin and Peter Singer present direct philosophical arguments in favour of changing the law to allow assisted suicide, though they do not deal with specifics. In Europe, Raymond Tallis, John Harris, John Griffiths and others have argued in favour of legalisation from a medical-legal perspective.

However, there have been far fewer book-length treatises from the ‘against assisted suicide’ camp. Ian Dowbiggin, though opposed to legalisation, has produced the best history of euthanasia and assisted suicide to date, but, as good histories should be, it is objective. Physician Ezekiel Emmanuel has produced several excellent articles containing secular arguments against assisted suicide.

Now, with his book The Future of Assisted Suicide and Euthanasia, Neil M Gorsuch is clearly filling a gap in the debate about assisted suicide.

Gorsuch comes at the question from a legal perspective and is well qualified in legal philosophy. A former clerk to US Supreme Court Justices Byron White and Anthony Kennedy, he was nominated by President George W Bush and confirmed by Congress last year as a federal judge on the United States Court of Appeals for the Tenth Circuit. The remit of this book is, as Gorsuch tells us, ‘to introduce and critically examine the primary legal and ethical arguments deployed by those who favour legalisation, and to set forth an argument for retaining existing law that few have stopped to consider’. Readers (like myself) who might not warm to the task of following the circuitous logic of American law courts would do well to persevere, for Gorsuch lucidly lays out key ethical and philosophical arguments on both sides.

“For Plato, suicide was an ‘unjust judgement of death’ that sprung from ‘a spirit of slothful and abject cowardice’”

Gorsuch begins by showing how the debate remains unfinished within the context of American law. He then provides an excellent chapter on the history of assisted suicide and suicide. Punching holes in the classical pretensions of some advocates, he notes Plato’s condemnation of suicide as akin to a soldier leaving his post. In Laws, Plato condemned suicide on the grounds that it ‘imposes [an] unjust judgment [of death] on [oneself] in a spirit of slothful and abject cowardice’.

An outstanding historical point – again, a useful counterpoint to the claim by supporters of assisted suicide that they are carrying on an Enlightenment tradition – is that the more lenient attitude towards suicide, away from the medieval tradition of burying the suicide at a crossroads with a stake through them, reflected the view that suicides were often the result of madness, rather than malfeasance. As Gorsuch rightly declares, ‘it is a large leap from that merciful fact to the conclusion that suicide had become normalised in law, let alone a matter of legal right’ (2).

Most of the other chapters deal with the ethical and logical problems with arguments in favour of assisted suicide. Gorsuch reconstructs the arguments of advocates before effectively knocking them down. Willing participation of the victim does not render the act harmless or victimless. As Gorsuch shows, repeating arguments by John Stuart Mill, it takes nothing away from our ‘freedom’ to be prevented from duelling, selling one’s organs, or selling oneself into slavery. There are some activities prevented by a liberal or even libertarian society for the good of all. It would be perverse to say that the prevention of any of theses activities – or suicide – destroys the basis to our freedom.

Gorsuch spends altogether too much time on the canard of autonomy. It needs to be said that all are free to commit suicide, a reflection upon the impracticality of making suicide illegal. What is being requested today, however, is the right to kill those we judge (and who agree with our judgement) to be living worthless lives.

As Gorsuch notes, few argue that all must have the right to be killed if they cannot kill themselves. This leads pro-assisted suicide commentators to draw lines between those with terminal illnesses and others. One of Gorsuch’s stronger and more original arguments shows that delineation between the terminally-ill and everyone else (the basis for Oregon’s definition between those who qualify for assisted suicide and those who do not) erodes equality. To be treated as equals before the law can bear no demarcations between subjects; we cannot set down simple criteria for which lives are worth living and which are not. The arbitrariness of a line based on physical health matches the arbitrariness of lines between, say, Jews and Gentiles. How can one judge the worth of an individual’s life in such random and simple terms?

There is, as Gorsuch makes clear in a laugh-out-loud section (how many books on law or, indeed, assisted suicide can boast of this?) on Peter Singer, a real question of what constitutes a ‘person’ or ‘personhood’ running throughout the debate. Gorsuch demonstrates how Singer’s grotesque argument that a newborn infant can be killed because it is not an autonomous, self-aware being ‘is but a modest extension of the argument advanced by Ronald Dworkin or Margaret Battin’ that we should ignore the demented pleas of an Alzheimer’s patient because they had given a prior request to be killed when dementia sets in (please don’t laugh yet!). Using Singer’s somewhat simple-minded thesis based on a being’s autonomic qualities, Gorsuch concludes that a diet of spring lamb rather than mutton, veal rather than steak and poussin rather than chicken would be appropriate. We cannot establish who deserves to live and who does not on the basis of whether they are self-aware.

“Gorsuch’s concept of the inviolability and the inherent value of human life is somewhat mystical”

Yet Gorsuch also stumbles on the question of personhood. His concept of the inviolability and the inherent value of human life as it is now constituted is somewhat mystical. Humanity is defined socially and historically rather than suspended through time and space, like the monolith in 2001: A Space Odyssey. We define humanity through our relations with others and recognise even the profoundly disabled as human, no matter what Peter Singer argues. Gorsuch would doubtlessly agree that if the profoundly and hopelessly disabled were killed, the importance would be the diminished humanity of those who did the act. Though Gorsuch is correct to note the erosion of the concept of human equality, and thus of humanity itself, the idealist hinge to his arguments must be questioned. It is possible to make a secular case against assisted suicide without the shadow of God looming behind.

Apropos of this, abortion is barely mentioned by Gorsuch but is germane, especially because proponents use the association with anti-abortion to gain support amongst liberals. It would be difficult to justify abortion using Gorsuch’s inherent value of human life without justifying why this should exist from birth and not before. However, it is perfectly possible to argue that placing real value on human life as it is lived between us allows us to prioritise the existing humanity of a woman over the potential humanity of a fetus.

Gorsuch might also be open to the criticism that he does not adequately track the changing justifications for and against assisted suicide. In response to the charge that doctors regularly despatch patients by giving them enough morphine both to kill the pain and the patient, assisted-suicide advocates call for the process to be regulated; though the argument will not appeal to libertarians, it may build on common fears and negate the occasionally hysterical ‘slippery slope’ argument. The issue of disabled rights has also been used to justify legalising assisted suicide; if the able-bodied can do it, why shouldn’t disabled people?

Gorsuch’s book has been criticised for being too abstract, for not dealing with practical issues (3). But if anything, it is not abstract enough. The problem exists almost wholly within the minds of those for whom death is still a distant prospect. It is worth remembering that in Oregon less than one per cent of those who qualify for assisted suicide actually take that option. Despite Gorsuch’s somewhat flimsy supply-and-demand argument (legalisation will create a market for assisted suicide), the evidence from Oregon shows there is no real increase in the numbers annually who opt for assisted suicides.

With these qualifications in mind, Gorsuch’s best contribution – one that is profoundly important – is his insistence that intention be the gauge of actions taken regarding assisted suicide. If a patient requests to be withdrawn from life-saving equipment with the intention of destroying herself, the doctor must refuse the request. If the doctor kills a patient with an overdose of morphine but with the intention of relieving pain, the doctor’s action is justified.

The intention argument directs the issue away from the purported needs of the ‘patient’ towards the rightness or wrongness of an action, towards the actor himself. Gorsuch elaborates on Justice Oliver Wendell Holmes’ discussion of intent: ‘[E]ven a dog distinguishes between being stumbled over and being kicked.’ As Gorsuch notes, ‘[t]o kick a dog intentionally – to choose to hurt an animal – says something about the kicker, his or her way of interacting with animals, and, perhaps, it tells us about the kicker’s character and beliefs, about who the kicker is.’(4)

“In Oregon, less than one per cent of those who qualify for assisted suicide actually take that option”

This intent idea is important, for it places actions in relation to assisted suicide back within a moral sphere. The emphasis on intention also militates against the corrosive idea that there is little to delineate between conscious human actions and unconscious human actions, something that those who would condemn ‘climate criminals’ or equate drunk-driving with murder seek to deny. As Gorsuch comments: ‘To disregard whether or not an act is intended would be…in a very real way to disregard the role of the free will in the world – leaving, for example, those who fail to assist charities that feed the hungry open to the same censure and penalties as those who would starve such persons.’ (5) To put it another way, the driver who speeds with reckless disregard for the lives of others but who has no intent to harm the child is different to the depraved killer who deliberately aims for the child.

Gorsuch’s emphasis on doing rather than on being done to, on intent rather than effect, begins to put the argument about assisted suicide back on track. If trust is to be rebuilt between doctor and patient we must believe that doctors really do have our best interests at heart rather than treating them as all potential Mengeles or Shipmans and demanding regulations.

To conclude, Gorsuch’s is the most important book published so far in consideration of ethical and legal issues. As any good book should, it raises as many questions as it provides answers, advancing a continuing dialogue.

Kevin Yuill is lecturer in American studies at the University of Sunderland. He is the author of Richard Nixon and the Rise of Affirmative Action, published by Rowman & Littlefield. Buy this book from Amazon(UK) or Amazon(USA).

The Future of Assisted Suicide and Euthanasia by Neil M Gorsuch is published by Princeton University Press. (Buy this book from Amazon(UK).)

(1) See Physician-Assisted Suicide: Expanding the Debate, Margaret Battin (ed.), 1998; The Least Worst Death: Essays in the Bioethics at the End of Life, Margaret Battin, 1994; Life’s Dominion: An Argument about Abortion and Euthanasia, Ronald Dworkin, 1993; Rethinking Life & Death: The Collapse of Our Traditional Ethics, Peter Singer, 1994; Euthanasia and the Law in the Netherlands, John Griffiths, et al., 1998.

(2) The Future of Assisted Suicide and Euthanasia, Neil M Gorsuch, Princeton University Press, 2006, p31

(3) Legal scholar Stephen Arons complains: ‘But the primary weakness of the book is that its approach, while not insensitive at all, is nonetheless too detached from the realities to which its ideas are meant to apply.’ See Law and Politics Book Review Vol. 17 No. 1 (January, 2007) pp.5-10.

(4) The Future of Assisted Suicide and Euthanasia, Neil M Gorsuch, Princeton University Press, 2006, p55

(5) The Future of Assisted Suicide and Euthanasia, Neil M Gorsuch, Princeton University Press, 2006, p56

Nurse/Mom in UK Mercy-Kills Bedridden Daughter after 16 Years of Caregiving

Hot News frum Big Mouth Broad Casting;
December 9, 2008

Mother arrested as 'yuppie-flu' daughter is found dead after 16 years in bed
By Vanessa Allen, Colin Fernandez and Tamara Cohen

Last updated at 7:25 AM on 09th December 2008

A mother who nursed her daughter for 17 years with the disease ME has been arrested on suspicion of her murder following what is believed to have been a 'mercy killing'.

Police sources revealed that Lynn Gilderdale, 31, died from a massive overdose of morphine after attempting suicide with the same drug at least twice during her battle with the debilitating condition.

Detectives arrested her mother Kay, 54, over suspicions that she helped administer the fatal dose after watching her daughter suffer since she was 14.

Bedridden Victim Lynn Gilderdale, 31, had been confined to her home for 16 years

Mrs Gilderdale, a trained nurse, was the full-time carer for her frail daughter, who had been bedridden for more than 16 years and was taking a cocktail of drugs for her condition.

Police were called to their bungalow in Stonegate, near Heathfield, East Sussex, on Thursday after the alarm was raised by Lynn's father, Mrs Gilderdale's ex-husband Richard, a former police sergeant.

Mrs Gilderdale was arrested on suspicion of murder, interviewed and released on police bail on Friday. The suspected 'mercy killing' will reignite the right-to-die debate over assisted suicide.

Yesterday she and her ex-husband released a statement on behalf of their family.

Pointedly referring to Mrs Gilderdale's 'total dedication' to her daughter, they said: 'Lynn was young, beautiful, loving and caring. At the age of 14 years she was struck down by ME - an illness greatly misunderstood - and as a result, suffered the stigma attached to this dreadful illness.

'She fought long and hard for 17 years with immense bravery, enduring constant pain and sickness.

'Every system of her body was affected. She required 24-hour care that was provided by her totally- dedicated mother, with continuous support from Lynn's father.'

They said Lynn had been active and healthy until she was 14. She had a tuberculosis immunisation in November 1991 and immediately felt unwell.

She was diagnosed with ME in May 1992 and was left bedridden by her severe condition. She had been unable to speak since August that year.

Her family said: 'Prior to her illness, which left her paralysed, unable to speak, eat or drink and until recently, no memory, she was an active healthy teenager full of life's dreams.

'She enjoyed sailing, swimming, cycling and was an accomplished musician. Her family praise and admire Lynn for her courage, which she showed to the end.

'She was a much-loved daughter, sister and granddaughter who despite her illness always gave love and support to others.

GILL SWAIN: I've seen patients paralysed dying Aids victims, starving children... but I've never seen anyone as ill as Lynn

'Lynn's family say her death will leave a massive void in their lives - and the love she gave so unreservedly, will be missed every minute of the day.' Police were called to the £400,000 bungalow at 8.30am on Thursday. Mrs Gilderdale was arrested just after 10am.

A post-mortem examination has been carried out but police refused to reveal the cause of death pending further toxicology tests.

Chief Inspector Heather Keating said: 'This is a very tragic incident. We are not looking for anyone else in connection with it.'

A Sussex police spokesman said Mr Gilderdale, who still works for the force in a civilian role, was not suspected of any involvement in his daughter's death.

He split from his wife in 2002. The couple, who also have a son, Steven, said their divorce had not been caused by their daughter's illness.

Mr Gilderdale still lives nearby and is said to have visited his daughter daily and to have helped with her day-to-day care.

He was with his Irish-born ex-wife at the family home yesterday, where she was being comforted by her sister.

Mrs Gilderdale has been a prominent campaigner over the illness which struck down her daughter.

The family statement added: 'In life, Lynn strove to help the medical profession improve their insight into ME which affects thousands of people, in varying degrees of severity.

'Her dedicated mother, supported by Lynn's family, has pledged to achieve her ultimate goal - for better understanding and recognition of this life-destroying illness.'


ME affects up to 250,000 sufferers in Britain. Although it was first documented in the 1930s, it was not officially recognised by the Government's medical advisers until 2002.

Until then victims of myalgic encephalomyelitis were often dismissed as having 'yuppie flu', as its symptoms were considered particularly common among overworked middle-class professionals.

Common symptoms include severe fatigue, painful muscles and joints, insomnia, gastric disorders and poor memory and concentration. There is currently no test or cure and doctors are able to diagnose it only after ruling out other possible causes, including flu, diabetes and depression.

The condition usually develops during the early twenties to mid-forties although children can also be affected, most probably between the ages of 13 and 15. Women account for up to three-quarters of all cases.

Prior to her illness at the age of 12, Lynn enjoyed a normal childhood before being struck down.

Sufferers include the athlete Dame Kelly Holmes, who was struck down in 2001 but recovered and went on to win double gold at the 2004 Olympics in Athens.

Scientists believe it could be carried in the genes, or be set off by a 'trigger' including bacterial illness, a viral infection such as glandular fever, stress, depression or a reaction to a traumatic event, such as bereavement or redundancy.

Some sufferers recover fully within two years and the majority learn to manage their condition with anti-depressants and painkillers and through avoiding stress, monitoring their energy levels and taking gentle exercise.

But around a quarter go on to develop severe ME lasting for years or even decades, often leaving them completely housebound and totally reliant on carers.

In his 2002 report the Chief Medical Officer, Liam Donaldson, said ME 'should be classified as a chronic condition with long-term effects on health, alongside other illnesses such as multiple sclerosis and motor neurone disease.'

Sunday, November 30, 2008

UK Leads the Way in Fight Against BDE

Tuesday, July 29, 2008
Everything we know or do or have regarding palliative care in the USA, is modeled after UK standards, as is our religion and legal systems; Read about the UKs fight against backdoor euthansia, IF you care to learn;

2 Withold & When Not 2 Withold & How 2 tell the Difference

Tuesday, July 29, 2008
When to Withhold & When NOT 2 Wthhold & How 2 Tell the Difference
Backdoor euthanasia


James Paul, Specialist registrar in palliative medicine
Kilburn, London NW6 7HH

Intravenous and enteral fluids may cause rather than alleviate suffering

Editor—Recent articles in the general1 and medical press2 on “backdoor euthanasia” illustrate the confusion that surrounds the subject. This is especially true for decisions to withdraw or withhold food and fluids from ill patients. Focusing on the issue of the intention behind such actions may help to achieve some clarity.

Current research, although limited, suggests that the desire for food and drink lessens in terminally ill patients and that artificial hydration neither prolongs survival nor alleviates symptoms.3,4 Furthermore, drips and nasogastric feeding tubes can cause unnecessary distress to patients and their relatives. In such cases the withholding of these treatments is entirely appropriate as the intention is to save the patient from a treatment that has no medical benefit.

But what about those who are not in the terminal stages of an illness—for example, heart patients, COPD patients, or those who have had a recent stroke or with acute infection? In most instances death is not imminent. However, not providing food, fluids & proper nutrients would certainly lead to death. In this case the intention behind the omission is to let the patient die. It fulfils the definition of an act of euthanasia and as such is morally unjustifiable.

This leaves one further question: when is a patient's condition terminal? That is, when is a patient at a stage where recovery is highly improbable and provision of artificial nutrition and hydration is of no benefit? This is not always easy to answer. Clinical signs and biochemical tests act as a good indicator, as does experience in dealing with such cases. But when there is doubt, as there often is, it seems common sense to err on the side of caution and provide all reasonable means to aid recovery, including the basic human needs for food, drink and proper nutrition.
" src="" border=0>Intravenous and enteral fluids may cause rather than alleviate suffering
Intravenous and enteral fluids may cause rather than alleviate suffering in the terminally ill in their end days....

Bliss, Mary (Bryning Day Hospital, Homerton Hospital, London E9 6SR).
Editor—I am worried by the recent reporting and police investigation of “euthanasia” deaths due to dehydration.1-1 I was distressed by articles in the Times which seemed to exploit bereaved families who had supported the decline and death of their relatives over many years, by suggesting that they may have suffered unnecessary pain and distress because of poor, or even criminal, mismanagement.1-2

Not all doctors and nurses agree that giving intravenous or enteral fluids to dying patients who can no longer swallow or feel thirst eases suffering. Many experts in palliative care believe the contrary. Zerwekh, a clinical coordinator of the Hospice of Seattle, observed that giving fluids and interfering with the natural course of dehydration can cause acute discomfort to the patient near death and emotional distress to the family.1-3 He commented that if the kidneys have not shut down, the fluids can sharply increase the flow of urine. If patients are extremely weak, have lost bladder control, or are in a coma, this increase may necessitate insertion of a catheter. The fluids also significantly increase gastrointestinal fluids, which is a major problem for patients whose vomiting is difficult to control, especially when there is bowel obstruction requiring a nasogastric tube. Intravenous fluids also tend to increase respiratory secretions, making it more difficult for patients to catch their breath or cough, and suction may be required. Fluids can also cause a flare up of oedema and ascites and expand the oedema layer around tumours, aggravating symptoms, particularly pain.1-3

With increasing reliance on technology rather than nursing and family support for dying patients, we seem to be following North American medicine into the hole that it is currently trying to climb out of. A study of long term patients found that tube feeding did not prevent aspiration pneumonia. The authors concluded “for almost all conscious patients we suggest a dedicated attempt at feeding by hand.”1-4 As the nurses at Kingsway Hospital observed,1-2 over zealous nil by mouth orders can also cause unnecessary dehydration and suffering. We need to remember the real meaning of the word euthanasia—a quiet and easy death. This is what we all want for ourselves and need to strive to achieve for patients by individual assessment of their needs, not by adherence to prescriptive protocols.
Dyer C. Police investigate “euthanasia” deaths. BMJ. 1999;318:143. . (16 January.). [PubMed]
Various articles on euthanasia Times 6 January 1999:1, 2, 9, 17.
Zerwekh JV. The dehydration question. Nursing. 1983;13:47–51.
Finetune TE, Bynum JPW. Use of tube feeding to prevent aspiration pneumonia. Lancet. 1996;348:1421–1424. [PubMed]
Various articles on euthanasia Times 6 January 1999:1, 2, 9, 17.
Dyer C. Police investigate “euthanasia” deaths. BMJ. 1999;318:143. . (16 January.). [PubMed]
Ellershaw JE, Sutcliffe JM, Saunders CM. Dehydration and the dying patient. J Pain Symptom Management. 1995;10:192–197. [PubMed]
Dunlop RJ, Ellershaw JE, Baines MJ, Saunders CM. On withholding nutrition and hydration in the terminally ill: has palliative care gone too far? A reply. J Med Ethics. 1995;21:141–143. [PubMed]
Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group
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A Good Place to Start Your Learning


About Hospice Patients Alliance

The Hospice Patients Alliance was formed in August of 1998 as a nonprofit charitable organization and is a 501(c)(3) corporation serving the general public throughout the United States. We were formed by experienced hospice staff and other health care professionals who saw that hospices were not always complying with the standards of care, and in fact, were in some cases, violating the rights of patients and families and exploiting them for financial gain, or not providing adequate care to control pain or other distressing symptoms during the end of life period.HPA promotes quality hospice services whether a patient is enrolled in a licensed hospice or not, whether residing at home or in a facility. HPA protects the rights of patients, their families and caregivers, the bereaved and staff by providing information about the standards of care governing the health care provided, the services required to be provided by law, standard industry practices and how to obtain the very best hospice care available.

Why Euthansia? In Hospice, Longer Lives Mean $$ Lost

Friday, August 1, 2008
Why Euthansia?

Ozier Muhammad/The New York Times
For Charles Brown Jr., 81, with his wife, Cora, growing old in Wilcox County, Ala., means care from Hometown Hospice. By KEVIN SACK
Published: November 27, 2007

CAMDEN, Ala. — Hundreds of hospice providers across the country are facing the catastrophic financial consequence of what would otherwise seem a positive development: their patients are living longer than expected.

Uncertainty at Hometown Hospice

Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare.

The charges are assessed retrospectively, so in most cases the money has long since been spent on salaries, medicine and supplies. After absorbing huge assessments for several years, often by borrowing at high rates, a number of hospice providers are bracing for a new round that they fear may shut their doors.

One is Hometown Hospice, which has been providing care here since 2003 to some of the most destitute residents of Wilcox County, the poorest place in Alabama.
The locally owned, for-profit agency, which serves about 60 patients, mostly in their homes, had to repay the government $900,000, or 27 percent of its revenues, from its first two years of operation, said Tanya O. Walker-Butts, a co-owner. Its profits were wiped out in the time it took to open the demand letters, Ms. Walker-Butts said.

Hometown paid its first assessment with a bank loan. When the bank declined credit for the second year, the hospice structured a five-year payment plan with the Centers for Medicare and Medicaid Services, the federal agency that administers the program, at 12.5 percent interest.
The next bill is expected any day. If they hit us with a number in the several hundred-thousand range, I just don’t see how we can survive,” said Gaines C. McCorquodale, Hometown’s other owner.

In the early days of the Medicare hospice benefit, which was designed for those with less than six months to live, nearly all patients were cancer victims, who tended to die relatively quickly and predictably once curative efforts were abandoned.
But in the last five years, hospice use has skyrocketed among patients with less predictable trajectories, like those with Alzheimer’s disease and dementia. Those patients now form a majority of hospice consumers, and their average stays are far longer — 86 days for Alzheimer’s patients, for instance, compared with 44 for those with lung cancer, according to the Medicare Payment Advisory Commission.

The commission, which analyzes Medicare issues for Congress, recently projected that 220 hospices — about one of every 13 providers — received 2005 repayment demands totaling $166 million. The National Alliance for Hospice Access, a providers’ group that is lobbying for a three-year moratorium on the collections, places the numbers at 250 hospices and $200 million.
Because fewer than a tenth of all hospice providers have faced repayment, Medicare officials suggest that management might have been an issue. But Lois C. Armstrong, president of the hospice access alliance, said that if the cap on Medicare reimbursements was not lifted, the availability of care would tighten at a time when demand for hospice care was exploding and when new research suggests it saves money for the runaway Medicare program.

Many elderly people here in the remotest reaches of the state’s Black Belt would most likely live out their last days alone if not for Hometown Hospice nurses like Meg Appel Youngblood.
One recent autumn morning, Ms. Youngblood forded the Alabama River by ferry and set off on her rounds of the storied quilting enclave of Gees Bend, looking in on old women who had grown too feeble to quilt or to care for themselves.

Inside a clapboard house, she checked the vital signs of Loretta L. Pettway, a former farmhand whose stitchwork has been celebrated in postage stamps and picture books, and found that her blood pressure was a bit high.

“Miss Loretta, have you had your medicine?” she asked, and Ms. Pettway, 65, weary from chronic heart disease, shook her head no. “I didn’t think so,” Ms. Youngblood said, as she started to inventory the 14 pill bottles Ms. Pettway had stowed in a plastic bag.
Medicare’s coverage of hospice, which began in 1983, has become one of the fastest growing components of the government’s fastest growing entitlement. Spending nearly tripled from 2000 to 2005, to $8.2 billion, and nearly 40 percent of Medicare recipients now use the service.

To be eligible, patients must be certified by two doctors as having six months or less to live, assuming their illness runs a normal course. They must agree not to bill Medicare for curative procedures related to their diagnosis.

Medicare, which pays the vast majority of hospice bills, reimburses providers $135 a day for a patient’s routine home care. The hospice is then responsible for providing nurses, social workers, chaplains, doctors, drugs, supplies and equipment, as well as bereavement support to the family.

Studies have reached various conclusions about whether hospice care actually saves money, especially for long-term patients. But a new study by Duke University researchers concluded that it saved Medicare an average of $2,300 per beneficiary, calling hospice “a rare situation whereby something that improves quality of life also appears to reduce costs.”
In 1998, Congress removed limits on the number of days that an individual could receive Medicare hospice coverage, a move that encouraged physicians to refer terminal patients.
But lawmakers did not remove a cap on the aggregate amount that hospice providers could be reimbursed each year, a measure designed to contain the program’s cost. A hospice’s total annual reimbursement cannot exceed the product of the number of patients it serves and a per-patient allowance set by the government each year ($21,410 in 2007).

For reasons that are not fully understood, problems with the cap have been most prevalent at small, for-profit hospices in Southern and Western states like Mississippi, Alabama and Oklahoma.

Those programs typically have had higher proportions of noncancer patients and, thus, longer lengths of stay. But the Medicare advisory commission’s analysis also determined that the average length of stay in the cap-busting programs was significantly higher for all types of patients, including those with cancer.

Herb B. Kuhn, the deputy director of the Center for Medicare and Medicaid Services, said that finding was attracting attention at the center, which is eager to keep the hospice care benefit from morphing into a long-term care entitlement. “Well over nine out of 10 hospices seem to be managing well, including the ones in higher-wage areas, so it does raise an issue of management,”

Mr. Kuhn said. Mr. Kuhn said it remained a question whether hospice care saved money, but called it “a wonderful benefit” that “probably needs refinement” after nearly 25 years.
Among the matters meriting review, he said, is whether doctors have been premature in certifying patients as terminal. Medicare has issued disease-specific guidelines for the certifications, which must be made by both a personal physician and the hospice medical director.

The medical director at Hometown Hospice, Dr. Sumpter D. Blackmon, said he relied heavily on the judgment of the hospice’s nurses to determine whether prospective patients were rather likely to live longer than six months. But of the 56 patients on the books on Oct. 31, 17 had been there for at least that period, including two for more than 500 days.
“Doing this for 40-something years,” said Dr. Blackmon, a longtime physician here, “every time I think somebody is going to die tomorrow, damned if they don’t live for a year and a half.”

A number of hospice providers said ethical and legal constraints would prevent them from discharging patients who outlived their profit potential. But some said they sometimes delayed admission for those patients with illnesses that might result in longer stays.
Like other providers, Richard R. Slager, the chairman and chief executive of VistaCare, which is based in Arizona and has programs in 14 states, said his company now aimed its marketing at cancer patients.

“In communities where we have had cap issues, we have to really look hard for shorter-length-of-stay patients to offset it,” Mr. Slager said. “It’s a never-ending nightmare.”
After being hit with $200 million in cap charges over four years — the equivalent of a year’s revenues — Mr. Slager said he chose to close or sell 16 of 58 hospices.

Some providers have survived only by aggressively recruiting new patients, using this year’s Medicare reimbursements to pay off last year’s cap charges, while stalling for Congressional relief. Ms. Youngblood, the Hometown Hospice nurse, said that after she visited her charges — doling out their pills, and turning the sweet potatoes in their ovens — she trolled for new patients at nursing homes and senior centers.

At the small hospital here, she said, the nurses joke about her “marketing” forays: “They’ll say, ‘Here comes Nurse Kevorkian. She has no shame.’ And I’ll say, ‘Look, I have to have a paycheck, too.’”

Art Buchwald Lives While Dying on Hospice

Saturday, August 2, 2008

Art Buchwald LIVES While Dying on Hospice
Art Buchwald's Last Lecuture: A touching video "Too Soon to Say Goodbye,"
but could also be entitled, "How to Live While Dying."

The Washinton, DC Hospice he was in for nearly a year must be a "pro-life" hospice,
as they did not terminally sedate and starve him to death, but let him keep his mind
and his mobility, and he used both to the fullest right up until the end. Good for you Art!
We miss you. (Mom & Dad both liked him)

Art Buchwald Wiki:

How to Respond to a Request to Hasten Death

Saturday, August 2, 2008
A Request to Hasten Death
And encouragement to live from a loved one. An educational video for professional health care workers and family members when a patient or a loved one requests to hasten death; and a lesson for us all: CHOOSE LIFE! Death is forever.

Click on title to se vid;

Sunday, October 19, 2008

....and Now, a "Duty to Die?!"

Fergetabout right to life, now, they are talking a "Duty to Die?!"

Solidifying her reputation as a “philosopher provocateur”, Lady Warnock, a long time advocate of euthanasia, whose previous work has included investigations of fertility treatments, and special education for disabled students, dares to say what has previously been unspeakable. According to an interview earlier this month in the Times Online:

“If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service,” she said.

See full article at:
or click on title above

Tuesday, August 19, 2008

The Danger of Living Wills

From an Article in the North Carolina Journal of Medicine, entitled "Palliative Care," by Phillip A. Sellers, MD (July / Aug 2004, Vol. 65, No. 4, Pg. 247;)

Here is what Dr. Sellers had to say about the dangers of living wills;

“Today some caregivers assume the presence of a living will or a DNR order is is also a “comfort care” order, when it clearly is not. Many health-care providers , including doctors, nurses, patients and families are unclear about the difference. At times, there is a tendency for the care giving medical staff to assume that is ok for the patient to die if there is a living will or a DNR order. The staff may not be as attentive to that patients needs and complaints as they would be to a patient with no living will or DNR order. Indicate3d or beneficial treatment may be delayed or not instituted.”

Thursday, August 14, 2008

An International Review of Hastened Death

Wednesday, July 30, 2008

An International Review of Hastened Death

Monday, July 21, 2008(Hopefully not a recurring feature)*Please read disclaimer at the end of post*The New York Times #6 most emailed article today is about the underground practice of hastened death via the procurement of barbiturates in Tijuana, where the medications are intended for euthanizing animals, not humans. It is interesting this practice fits under neither commonly used terms for hastened death by medical means:"euthanasia" - the administration by a medical professional (or other person) of a prescribed medication with the intent of causing a hastened death"physician-assisted suicide" - the self-administration of a medication prescribed by a physician with the intent of causing a hastened deathThis article describes people obtaining the medication without a doctor's prescription, therefore 'physician-assisted' is a disqualified descriptive. They merely need to show a picture of the medication they want at the Mexican veterinary stores. So I guess this is simply 'suicide?' Although I think 'suicide' is too broad to define the particulars about a situation where someone is in the terminal phase of a condition versus someone suffering from a severe depression but no terminal illness. But to label this 'terminal suicide', 'hastened death in the terminal phase' or some other contortion feels clumsy and is bound to cause even more confusion.Regardless of the term used, the issue has been made more relevant with a couple high profile cases of medicine and hastened death.In Australia, Exit International and Philip Nitschke have been making the papers and TV (and are featured in the NYT article) with a public campaign to legalize euthanasia including You Tube Videos, film screenings, book promotions (attempts at banning it are underway in Australia and New Zealand), workshops and political initiatives. More focus has been on Mr. Nitschke and his group since the recent manslaughter conviction of a woman who gave a barbiturate to her partner who had Alzheimer's. Another recent case is also being featured of a woman who was depressed but not terminally ill who supposedly relied on information form Exit International's materials to kill herself.In Germany, a lawyer/politician advised, and videotaped a 79 year old woman who prepared and self-administered a 'lethal cocktail.' The woman was not terminally ill but chose hastened death because she did not want to go to a nursing home. The politician, Roger Kusch, was inspired by Dignitas, a pro-euthanasia organization based in Switzerland who has many people from Germany requesting its services.In Scotland, a Member of Scottish Parliament, Margo MacDonald has filmed a documentary with the BBC and proposed legislation to adopt the euthanasia and assisted suicide laws similar to The Netherlands.In Italy, a case eerily similar to Terri Schiavo and Nancy Cruzan is being discussed publicly and was recently covered in TIME magazine. A 20-year old woman in a car accident (in 1992) now comatose and with a feeding tube that her father wants to have removed (and has fought for since 1999) was allowed by Italian courts to stop her artificial nutrition via feeding tube despite much opposition. The case is now pending appeal despite already having gone to the Italian Supreme Court in 2002.In Canada, Samuel Golubchuk, an 84 year old man whose family fought hard to continue aggressive life-prolonging measures died 9 months after doctors initiated discussions about end-of-life decisions. He died on full life support measures. If his life support was withdrawn it would have been illegal since a court ordered physicians and the hospital to continue partly based on the family's belief of hastening his death would be a sin under Orthodox Jewish law. The case was to be heard by a full court in September. Doctors refused to care for him, likening his medical treatment to 'torture.'In England, a man who was refused Sutent, a prostate cancer drug, by the National Health Service suffocated himself.So why is this all important to palliative care?Because guess who thinks about these things:your patientstheir familiesmedical professionals who consult youthe publicand they may never bring it up with you for a multitude of reasons. Or they may hint at hastened death, but never start an open discussion. Or they may make a sly joke about it, waiting to see how you respond. Or they may assume what is good standard palliative care is really euthanasia.Good hospice and palliative care practices can help people discover hastened death does not have to be the easy way out. If the lines are too blurred between the legal and illegal our field has significant trust to lose with the public and our peers. Being educated and aware of the public debate over hastened death is a responsibility for palliative medicine to ensure the safe, ethical, and legal care of the patients and families entrusted to us.(My Standard Disclaimer: Pallimed, Dr. Sinclair and his current and former employers and states do not endorse or practice euthanasia or physician-assisted suicide, but do encourage the open, non-judgmental discussion of these topics for educational and ethical discourse about this controversial area of medicine. Links do not represent endorsement.)Posted by Christian Sinclair, MD Labels: , , , , , ,

Hospice Killed My Sister

Friday, August 13, 2008


Another Hospice Horror Story / Another "Early" Death by Starvation & Malnutrition

HOSPICE KILLSPosted by deb on Sunday, March 18, 2007 2:01:28 AMI did not know anything about Hospice until my sister was recently put into Hospice. Not because she was dying, but because she was in pain. We thought she was dying because they told us the symptoms of dying were that they quit eating and started sleeping more, and their breathing rate slows down. So her children put her into Hospice. They did not tell us that these symptoms were all caused by being over-medicated. Her sleeping breath rate was down to 8 per minute. One day while she was in the hospital hospice, I told the nurses not to give her the Dilaudid which was in addition to the Phentynol patches she was on. Suddenly, my sister was alert and quite lucid, was able to eat, and drank more liquids in one day than she had in two weeks. When the doctor heard what I had done, she was very upset and told the nurses to put her back on the Dilaudid, because I was not a direct family member. We wrote the doctor a letter requesting that they try other medications that might not make her tired that she could not eat or drink. The doctor refused, saying she promised my sister to keep her from pain. My sister was not in pain - the patches were working well for her that day. She is now so drugged up that she has not eaten or able to drink anything for weeks, yet her vitals are normal, her blood oxygen is normal (LUNG CANCER).They are killing her from dehydration and malnutrition. She has been drugged up like this for two months now. How much quality life did she have left it she had been treated for the pain with the proper medications instead of being over-medicated to the point of not being able to talk, eat or drink.Do not put anyone into Hospice. They should be given treatment until the disease causes the body to shut down, not from being over-medicated which causes dehydrated and malnutrion.

How Could We "Not Know?"

Saturday, August 13, 2008

How Could We Not Know?

Another Family's Hospice Horror Story: HOW DID WE "NOT KNOW?" How did four highly educated adults not know that the purpose of hospice care was to kill our mother slowly and painlessly? Two weeks after enlisting the assistance of hospice, our mother whose only complaint was that it hurt to be turned, but not enough for pain meds was given a high dose of morphine by a hospice nurse of death. This was just minutes after a doctor had examined her and determined that her vitals were good, she was awake and not in pain. Now she cannot swallow or be fully aroused. Hours before the overdose I called to share how my first day of school went, because I am a teacher. She carried her end of the conversation asking appropriate questions and laughing at appropriate times. Now I cannot even have a conversation with her. The nurses have diagnosed my mother based on what? When she left the hospital she had just had surgery to remove a cancerous tumor. The doctors said that the cancer might have spread to her lungs or she might have pneumonia. The nurse determined two days later that she not only had lung cancer but that it had spread to her brain. WHAT!? Again I have to wonder what she is basing this on. And forget privacy. When I was leaving for a few days to return to my home 2,000 miles away, not sure that my mother would still be with us when I returned a few days later, the nurse found my wanting to spend my last few minutes at my mother's bedside inappropriate. In addition whenever we go into my mother's room everything we say to her is written down to be shared with others later. The nurse told my sister that I needed to come to terms with the fact that people die. "We are all dying," is her pat answer. I am an ordained minister and I accept that death is a fact of life. I know that I will die someday, but for now I am living, not dying. What kind of healthy person lives by the mantra that she is dying? So, you may be asking, "What's the point here?" Do your research. DO NOT USE HOSPICE unless you are looking for a way to speed up the death process albeit painlessly. If you feel that the best thing for your family member is to be heavily sedated so much so that they cannot eat and breathing slows to the point that their brain becomes deprived of oxygen then hospice is for you. If you happen to live in San Antonio, Texas and you use Vitas and better yet the nurse assigned to you is Phyllis, then you better start planning the funeral. Do your research. My family's experience is not unique. Now that it is too late, I have discovered thousands of others who have had similar experiences.

Monday, August 4, 2008


Hospice industry leaders and planners often explain public resistance to enrolling in hospice as being caused by the public "not understanding" what hospice is all about. While many individuals do not truly understand what hospice is all about, there are many who simply recognize the realities of the industry. Either through their own family's experience or the experience of a friend, they know that is becoming increasingly common for hospices to hasten a patient's death.The public is not as dumb as the professionals in the industry would like to think. The public knows that if they enter hospice, in some cases, their death may be hastened. Doctors in the community often comment, "if you enter hospice, you'll be dead in two weeks." Why? Because in many cases, patients are routinely given morphine and Ativan (a common sedative) even if their symptoms do not require it. The irresponsible administration of clinically inappropriate medications in order to make for a "nice hospice death" is seen by some as what it is: medical killing: