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Kavanaugh, Women Soldiers
& Palliative Sedation



Was Kavanaugh a Good Choice?

TIA,

There are REAL Catholics in more than name only and there are frauds masquerading as Catholic. The frauds are well known as far as I'm concerned with Kennedy, Roberts and Sotomayor in that category.

Kennedy is about as Catholic as a cockroach. He authored some of the most horrendous decisions trashing a moral order rooted in obedience to "the laws of nature, and of nature's God" that the founders of our country realized was necessary for its survival, which is why, for me, Trump's stupidity about this creep being praiseworthy was nauseating. For the love of God, history tells us that civilizations die when the moral order is trashed and anarchy prevails!

We don't need any more swing votes. As I see it now, we have only Alito, Thomas and Gorsuch to be confident of consistently doing the right thing. It would be nice to have a warm feeling about Kavanaugh, but I don't. To say that he will NEVER be a Souter is premature in the extreme as I see it. It's a pity that we will have to wait to see what he will really do, and hope and pray that he will do the right thing, instead of coming out of the chute confident that he will. I didn't vote for Trump for more "swing" votes!

Bottom line, I'm very leery of a nominee that clerked for Kennedy as opposed to Scalia when the latter was available, especially when that nominee came with Kennedy's warped blessing!

Time will tell. I only hope that I'm wrong, but right now, I fear I'm right! We know what happened with the last Bush recommendation with the unconscionable unconstitutional ruling in support of Obama's death care, lest we forget.

     Gary Morella


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Dolan & Altar Boys


Dear Tradition in Action,

Regarding your article entitled, “Card. Dolan with Pro-abortion Homosexual Irish PM,” what’s wrong with these pictures? Did you notice that Cdl Dolan has the altar boy in a near headlock? How very possessive! He has his hand on a second boy in another photo. These really bother me. It’s as bad as photos/videos I’ve seen in the past of Joe Biden groping little girls!

My two younger brothers (who are in their 50’s now) were altar boys. Not once have I ever seen a single priest handle my brothers in this manner!

I wanted to call it to your attention.

     With prayers,

     M.C.

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Women in the Military


TIA,

Regarding women in combat, this is one place where any studies or statistics that don't say what the feminists want to hear are just disregarded. It makes me sad to see this line of women in the Marines. A study confirms - they don't belong there. But the study doesn't fit the politically correct dictates.

Below is a letter to the Washington Post Editor I thought was quite good. It is from 2015, but its conclusions are still very timely.

     M.G.

Letters to the Editor

Study confirms: Women don’t belong in combat


Women soldiers


September 13, 2015 - Regarding the Sept. 11 Politics & The Nation article “Women lag in many combat tasks, study finds”:

I was struck by Navy Secretary Ray Mabus’s reaction to the Marine Corps’s findings on the performance of women who were tested in infantry skills. Despite the women’s poor showing, which consistently degraded the combat performance of their integrated teams, Mr. Mabus did not “see a reason” to exempt women from combat arms. That position ignores the study’s findings.

The essence of battle at the tactical level is to kill as many of your enemies as necessary while minimizing your side’s casualties. According to the study, integrating women into combat arms reverses this timeless principle by weakening the Marines. We cannot wish war away; it is unconscionable not to do everything possible to maximize our troops’ chances for battlefield success while minimizing their risks.

Let’s not succumb to the politically fashionable idea that men and women are equal in all things, including battle. Let’s continue to exclude women from the infantry, artillery and armor branches of our armed forces. Perhaps Mr. Mabus should poll the mothers, daughters and wives of Marines to find out what they think about the increased risks that their sons, brothers and husbands will face on the battlefield if women are integrated into combat arms.

     E.G.


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Palliative Sedation = Euthanasia


TIA,

This article in the Pittsburg Post-Gazette makes it clear that at least the 'Palliative Sedation' part of palliative medicine is hardly any different from physician-assisted suicide. But there are few articles to explain the death hastening nature of palliative care in general. Most Catholics do not know that the Pontifical Academy for Life is funding the Pal-LIFE program which promotes “Palliative Care, Everywhere and for Everyone.”

Folks, the time for sitting on the sidelines had passed. I truly regret saying that the Catholic Church is now a major player in the global campaign to institutionalize the legalization of euthanasia. The tsunami is here. Palliative care is not what it used to be! Those who are building the field of palliative medicine need to be exposed. This article makes it easier to begin to educate.

     We pray the Holy Spirit will guide in battle.

     E.W.

Palliative sedation, an end-of-life practice that is legal everywhere


WASHINGTON – July 5, 2018 – Toward the end, the pain had practically driven Elizabeth Martin mad.

By then, the cancer had spread everywhere, from her colon to her spine, her liver, her adrenal glands and one of her lungs. Eventually, it penetrated her brain. No medication made the pain bearable. A woman who had been generous and good-humored turned into someone hardly recognizable to her loving family: paranoid, snarling, violent.

Sometimes, she would flee into the California night in her bedclothes, “as if she were trying to outrun the pain,” her older sister Anita Freeman recalled.

Ms. Martin fantasized about having her sister drive her into the mountains and leave her with the liquid morphine drops she had surreptitiously collected over three months – medicine that didn’t relieve her pain but might be enough to kill her if she took it all at once. Ms. Freeman couldn’t bring herself to do it, fearing the legal consequences and the possibility that her sister would survive and end up in even worse shape.

California’s aid-in-dying law, authorizing doctors to prescribe lethal drugs to certain terminally ill patients, was still two years from going into effect in 2016. But Ms. Martin did have one alternative to the agonizing death she feared: palliative sedation.

Under palliative sedation, a doctor gives to a terminally ill patient enough sedatives to induce unconsciousness. The goal is to reduce or eliminate suffering, but in many cases the patient dies without regaining consciousness.

The medical staff at the Long Beach acute care center where Ms. Martin was a patient gave her phenobarbital. Once they calibrated the dosage properly, she never woke up again. She died within a week, not the one or two months her doctors had predicted before the sedation. She was 66.

“At least she got into that coma state versus four to eight weeks of torture,” Ms. Freeman said.

While aid-in-dying, or “death with dignity,” is now legal in seven states and Washington, D.C., medically assisted suicide retains tough opposition. Palliative sedation, though, has been administered since the hospice care movement began in the 1960s and is legal everywhere.

Doctors in Catholic hospitals practice palliative sedation even though the Catholic Church opposes aid-in-dying. According to the U.S. Conference of Catholic Bishops, the church believes that “patients should be kept as free of pain as possible so that they may die comfortably and with dignity.”

Since there are no laws barring palliative sedation, the dilemma facing doctors who use it is moral rather than legal, said Timothy Quill, who teaches psychiatry, bioethics and palliative care medicine at the University of Rochester Medical Center in New York.

Some doctors are hesitant about using it “because it brings them right up to the edge of euthanasia,” Dr. Quill said.

But Dr. Quill believes that any doctor who treats terminally ill patients has an obligation to consider palliative sedation. “If you are going to practice palliative care, you have to practice some sedation because of the overwhelming physical suffering of some patients under your charge.”

Doctors wrestle with what constitutes unbearable suffering, and at what point palliative sedation is appropriate – if ever. Policies vary from one hospital to another, one hospice to another, and one palliative care practice to another.

The boundary between aid-in-dying and palliative sedation “is fuzzy, gray and conflated,” said David Grube, a national medical director at the advocacy group Compassion and Choices. In both cases, the goal is to relieve suffering.

But many doctors who use palliative sedation say the bright line that distinguishes palliative sedation from euthanasia, including aid-in-dying, is intent.

“There are people who believe they are the same. I am not one of them,” said Thomas Strouse, a psychiatrist and specialist in palliative care medicine at the UCLA Medical Center. “The goal of aid-in-dying is to be dead; that is the patient’s goal. The goal in palliative sedation is to manage intractable symptoms, maybe through reduction of consciousness or complete unconsciousness.”

Other groups such as the National Hospice and Palliative Care Organization, which advocates for quality end-of-life care, recommend that providers use as little medication as needed to achieve “the minimum level of consciousness reduction necessary” to make symptoms tolerable.

Sometimes that means a light unconsciousness, in which the patient may still be somewhat aware of the presence of others. On other occasions it might mean a deep unconsciousness, not unlike a coma. In some cases, the palliative sedation is limited; in others it continues until death.

Whether palliative sedation hastens death remains an open question. Pain-management doctors say sedation slows breathing and lowers blood pressure and heart rates to potentially dangerous levels.

In the vast majority of cases, it is accompanied by the cessation of food, drink and antibiotics, which can precipitate death. But palliative sedation is also administered when the underlying disease has made death imminent.

“Some patients are super sick,” Dr. Quill said. “The wheels are coming off, they’re delirious, out of their minds.”

In that circumstance, palliative sedation doesn’t accelerate death, he said. “For other patients who are not actively dying, it might hasten death to some extent, bringing it on in hours rather than days.” He emphasized, however, that in all cases the goal isn’t death but relief from suffering.

One review of studies on palliative sedation concluded that it “does not seem to have any detrimental effect on survival of patients with terminal cancer.” But even that 30-year survey acknowledged that, without randomized control trials, it’s impossible to be definitive.

There is widespread agreement that palliative sedation is appropriate for intractable physical pain, extreme nausea and vomiting when other treatments have failed.

Doctors are divided about whether palliative sedation is appropriate for alleviating suffering that is not physiological, what medical journals refer to as “existential suffering.” The hospice and palliative care group defines it as “suffering that arises from a loss or interruption of meaning, purpose, or hope in life.”

Some argue that such suffering is every bit as agonizing as physical suffering. Existential suffering is the motivation that prompts many to seek aid-in-dying.

Terminally ill patients who took their own lives under Oregon’s aid-in-dying law were far less likely to cite physical pain than psychosocial reasons such as loss of autonomy, loss of dignity or being a burden on loved ones.

Using palliative sedation to relieve existential suffering is less common in the United States than it is in other Western countries, according to UCLA’s Dr. Strouse and other American practitioners. “I am not comfortable with supplying palliative sedation for existential suffering,” Dr. Strouse said. “I’ve never done that and probably wouldn’t.”

In states where aid-in-dying is legal, terminally ill patients rarely choose between aid-in-dying and palliative sedation, said Anthony Back, co-director of the University of Washington’s Cambia Palliative Care Center of Excellence. In Washington, patients with a prognosis of six months to live or less must make two verbal requests to their doctor at least 15 days apart and sign a written form. They also must be healthy enough to take the legal drugs themselves.

“If you are starting the death-with-dignity process, you’re not at a point where a doctor would recommend palliative sedation,” Dr. Back said. “And with terminal sedation, the patient doesn’t have that kind of time and is too sick to take all those meds orally,” he said of the aid-in-dying drugs.

But Dr. Back does tell terminally ill patients who don’t want or don’t qualify for aid-in-dying that, when the time is right and no other treatments alleviate their symptoms, “I would be willing to make sure that you get enough sedation so you won’t be awake and miserable.”

Whether palliative sedation truly ends suffering is not knowable, although doctors perceive indications that it does.

“You might be able to tell if their blood pressure goes up. Same with their pulse,” said Nancy Crumpacker, a retired oncologist in Oregon. “And you read their faces. If they are still bothered somehow, it will show in their facial expression.”

Harlan Seymour didn’t need to rely on those signs after his wife, Jennifer Glass, a well-known San Francisco public relations executive, received palliative sedation in 2015. A nonsmoker, she had metastatic lung cancer and faced a miserable death from suffocation brought on by fluids filling her lungs, her husband said.

She desperately wanted to die, he said, but aid-in-dying, which she advocated for, wasn’t yet legal. Instead, she received palliative sedation.

“The expectation was this cocktail would put her into a peaceful sleep and she would pass away” within a day or two, Mr. Seymour said. “Instead, she woke up the third night in a panic.”

Doctors upped her dosage, putting her into a deep unconsciousness. Still, she didn’t die until the seventh day. She was 52. Mr. Seymour wishes aid-in-dying had been available for his wife, but he did regard palliative sedation as a mercy for her.

“Palliative sedation is slow-motion aid-in-dying,” he said. “It was better than being awake and suffocating, but it wasn’t a good alternative.”


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Posted July 10, 2018
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The opinions expressed in this section - What People Are Commenting - do not necessarily express those of TIA

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