Do not resuscitate. It can’t be simpler than that. And to avoid the chance of anyone not knowing his wishes when his time comes, 80 year old Australian doctor, Albert Cutter, had those words tattooed onto his chest. Kinda hard not to notice, when you rip open the shirt, ready to pound and defibrillate.

According to the story, Cutter says that he’s resuscitated enough people during his days as a physician to know that it is definately not something that he wants performed on him. And I suppose at his age, this decision makes sense to him.

Honor the prime directive. I certainly hope that Dr. Cutter, when his time comes to take his leave, doesn’t fall victim to an overzealous nurse, paramedic or physician, who thinks that a tattoo isn’t “official” enough.

It also seems that he is not the first person to make sure that his wishes are not missed, buried in a safe or under a heap of paper, or misunderstood by a frantic relative.

Two years ago, retired nurse Frances Polack, from Lyndhurst in Hampshire, England, spent £25 ($61) on a similar tattoo – but hers was set around a heart with a line through it.

“I don’t want to die twice,” Ms Polack told the Nursing Standard magazine at the time.

Yet another subversive study….darn those Danes, because they’re trying to put a crimp into the pesticide industry’s profits. The Danish Institute of Agricultural Sciences has released a new study showing that lab animals raised on organic produce had stronger immune systems, slept better and were slimmer than those raised on conventional produce. Dr. Kristen Brandt, one of the lead scientists in the study said they can’t say specifically why there were developmental variations between the two groups of rats, but “the difference was so big that it is very unlikely to be random.

The story appeared on Feb 18, 2005 in the Scotsman.com:

Dr Kirsten Brandt, of Newcastle University’s School of Agriculture, who last week published findings that carrots contained a cancer-fighting
chemical, helped her Danish colleagues devise the experiment.

She added: “We can say the reason why the rats have different health was clearly due to the fact that there was a different growing method, and this was enough for this result.”

Maybe I just missed it, but I don’t recall seeing any mention of this study in the U.S. press, mainstream anyway. I guess it’s not big news that organic produce may be healthier.

Another study done two years ago at UC Davis found that fruits and vegetables grown sans synthetic pesticides have higher levels of cancer-fighting nutrients than produce treated with the chemicals. Corn, blackberries and strawberries consistently contained higher levels of flavonoids, a type of anti-oxidant, when grown organically.

And of course, needless to say, organic is much better for the environment, and despite what the industry tells us, no one really knows what the “safe” level of pesticide residue is. We just really don’t know, and a number of studies have offered provocative evidence linking pesticides to numerous health problems, including cancer and birth defects.

It’s not a big surprise. I mean, the idea that limiting malpractice awards is going to somehow reform the system is ludicrous at best, dangerous at worst. But yet, that is what Bush has been calling for, in order to solve the “crisis.”

Well, not good news for Bush, because here comes a study from his good ‘ol homestate of Texas, which shows no evidence of a malpractice crisis or a connection between malpractice costs and doctors’ insurance premiums

The authors of the study, Stability, Not Crisis: Medical Malpractice Claim Outcomes in Texas, 1988-2002, wrote:

As far as medical malpractice cases are concerned, for 15 years the Texas tort system has been remarkably stable. Texas’s situation is not unique. One study of Florida’s experience from 1990 to 2003 also found declines in paid claims per 100 practicing physicians as well as per 100,000 population. Over the same period in Missouri, the total number of malpractice claims fell by about 40 percent and the number of paid claims dropped almost by half.

Malpractice premiums have risen sharply in Texas and many other states. But, at least in Texas, the sharp spikes in insurance prices reflect forces operating outside the tort system.

The medical malpractice system has many problems, but a crisis in claims, payouts and jury verdicts is not among them. Thus, the federal “solution” that Mr. Bush proposes is both overbroad and directed at the wrong problem.

“We find no evidence of the medical malpractice crisis that produced headlines over the last several years and led to legal reform in Texas and other states,” a group of four legal scholars concluded in a report being released today.

Texas was identified by the American Medical Association as one of more than a dozen states suffering from a malpractice “crisis.” But one of the co-authors, David A. Hyman, a professor of law and medicine at the University of Illinois, pointed out just the opposite, that “what we found is a sea of calm” in Texas malpractice claim cases from 1988 to 2002.” At least in Texas, the tort system was not the cause of rising rates of malpractice premiums.

Texas passed a law putting a cap on non-economic damages in 2003, same as what Bush wants to do now. But the study shows that the total number of claims per physician actually dropped between 1995 and 2002, with 80% of cases resolved without ANY payout from either physicians or a medical facility.

When these figures were adjusted for Texas’s economic growth, “total payouts fell by $6 million annually.” Overall, $515 million in malpractice payouts in 2002 represented only 0.6 percent of health care spending in Texas that year. Hmm, sounds a little different from the Bush rendition of things.

Basically, the authors found that the actual payout of awards was really quite modest, and just because a lot of doctors are getting sued, doesn’t mean that anyone is getting paid off. Lawsuits alone are not the cause of the dramatic rise in malpractice or health insurance premiums.

“Our point, which has been largely neglected in the furious battle over malpractice liability, is that attempts to avoid crises in malpractice insurance prices should focus on insurance, not litigation,” wrote the authors, who include two professors at the University of Texas Law School and William Sage, a physician and law professor at Columbia University.

The full study can be read online.

And just to note, the state of California is always dredged up as the poster child of tort reform. Of course, it is always conveniently omitted that tort reform did little to rein in the soaring rates of malpractice insurance rates until the state passed legislation that REFORMED the insurance industry.

Your see, tort reform, without putting any brakes or limits on the insurance industry is a dream come true for insurers. Not only will there be limits on payouts, but they are free to continue raising rates as they please. If Bush is pushing to get something passed, you better believe that some industry is going to clean as a result of it. He doesn’t do anything that benefits the poor schmuck in the street.

Are life-ending procedures for newborns acceptable, or should infants with severe disorders like spina bifida be kept alive even when their pain cannot be reduced?

In other words, is it okay to euthanize infants under some circumstances?

Such is the question posed by Dutch physicians Eduard Verhagen and Pieter J J. Sauer in an essay that appeared in this week’s New England Journal of Medicine. In case you were unaware, the Netherlands does permit euthanasia under certain circumstances, and I have to say, at least they are up front about it. Here we just choose to starve a person, and call it a “natural death.” Does the name Terri Schiavo ring a bell?

The doctors have developed guidelines, known as the Groningen protocol. “We are convinced that life-ending measures can be acceptable in these cases under very strict conditions,” the authors wrote.”

These conditions include the full and informed consent of the parents, the agreement of a team of physicians, and a subsequent review of each case by “an outside legal body” to determine whether the decision was justified and all procedures had been followed.

Newborns who might be considered for end-of-life decisions were divided into three groups. The first is made up of infants “with no chance of survival” because of severe underlying diseases. In the second group are babies who have “a very poor prognosis and are dependent on intensive care.” Although intensive treatment might help them to survive, “they have an extremely poor prognosis and a poor quality of life.”
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The third group has a “hopeless prognosis” and experience “what parents and medical experts deem to be unbearable suffering,” whether or not they need intensive medical care.

There are 15 to 20 cases of euthanasia each year in newborns who fall into the third group, in the Netherlands. The authors of this paper reviewed two cases about 10 years ago, and in both cases, the Dutch courts “approved the procedures as meeting requirements for good medical practice.”

I have seen quite a few infants die over the course of my nursing career. In the majority of cases, they were premature and just not viable. In other cases, the infants died after attempts at resuscitation–the full nine yards. And still in other cases, we pulled the plug on the ventilator.

There were yet other infants who arrived in the NICU only to die. We did nothing for them–they were either too small or too deformed. One that was particularly tortuous to look upon was a baby without a face. There was a small hole for a mouth, which allowed air to reach the lungs, and a gash in the head which I first mistook for an eye–then realized that it was bits of the brain peeking through. Yes, grotesque. The resident who brought the baby into the unit was white faced, like he was about to faint. It (sex was unknown due to lack of genitalia) was tightly swaddled, and the resident said that we were better off “not looking.” I thought so too, and didn’t.

But in a case like this, you have to wonder–was the baby suffering? Would it have been more humane to euthanize it? Or do we just let nature take its course?

I’m just throwing out questions, as I don’t have an answer. But matters of life and death because far less abstract when you have actually dealt with them up close. The faceless baby died about an hour or two after birth, but others like it can linger on.

What I admire about this paper is that the Dutch doctors have brought this issue out into the open. And they tell it as it is, and for what it is. They don’t try to pretend that they’re going to “allow a natural course of events” by not feeding the infants, for example. It’s euthanasia.

Now I know that people reading this are going to be horrified at the thought of intentionally killing an infant, no matter how badly the suffering, or how severe the deformities. But I once again must bring up Terri Schiavo, and the unnamed Terri Schiavos who have suffered a similar fate in our country. Why is humanely ending the life of an infant with a “hopeless prognosis” wrong or terrible, while starving a disabled woman to death fine and dandy? For anyone who thinks that killing the baby is wrong, but “passively” killing Terri Schiavo is right, I would be curious to hear the explanation.

And lest we be too critical of the Netherlands for their euthanasia policy, we have to remember that no one in that nation is denied healthcare. They have one of the lowest infant mortality rates in the world, as well as a very low rate of both abortion and unintended pregnancy. Citizens are cared for there, while in the US, we have over 40 million people without any type of health insurance.

No, I’m not talking about hookers plying their trade. This is about babies, infants of the female persuasion. A state in India, Andhra Pradesh, is offering couples 100,000 rupees (about $2,000 US) to have a single female child. The cash will be paid to the daughters when they reach the age of 20, provided that their parents have only one child, and provided that both parents undergo sterilization surgery. The reason is simple; a bid to counteract traditional preferences for sons and balance the sex ratio, which is now completely out of whack.

Other benefits for families having a single daughter include an annual education grant of more than $28 during grades nine to 12, and in the case of the death of either parent, the family would get up to $1,150 immediately.

The reasons for this are rather sad. Despite it being illegal, Indian women routinely undergo testing to find out the sex of their unborn child. If the unfortunate fetus happens to be a girl, there is a good chance she will be aborted. If the family is unable to afford testing, or for whatever reason, is unable to obtain it, then the newborn baby girl might find her life coming to an end shortly after birth. Female infanticide is still common in rural areas.

So after years of selectively choosing boys, what do we find? That there aren’t enough girls. The state of Andhra Pradesh has a sex ratio of 943 females to 1,000 males, and overall, the sex ratio in India is 927 females to 1,000 males. Ten years ago it was 945-to-1,000, one of the lowest female-to-male ratios in the world. Thus, things are getting worse and not better. The rate of aborted female fetuses is growing, not shrinking.

I suppose that eventually the people will realize what they are doing when there are no women to marry the sons that they wanted so badly. They’ll have to import brides from abroad, or send their boys overseas to find a wife.

At any rate, the social system in India is going to have to change before parents will be ready to forfeit sons. For an Indian couple, a son represents their security in old age. He will be around to care for them, whereas girls disppear to live with their husband’s family. Marrying off a daughter also requires a dowry in most parts of India.