In 2006, the Terry Schiavo case attracted national attention in the United States, with a conflict between a woman's parents (who wanted to care for their daughter and keep her alive) and the woman's ex-husband (who wanted her feeding tubes removes so that she would die of dehydration, and who said that he was acting according to her wishes). Right now in Canada, a similar case is playing out, with one crucial difference: all of the man's family wants him to live, while his doctors want him terminated.
Samuel Golubchuk is an 84-year-old Orthodox Jew in Winnipeg, Manitoba. Hospitalized since October 26, he is believed by his doctors to be terminally ill, and to have suffered brain injuries which leave him unconscious. The doctors want him removed from his respirator and feedng tube. His family strongly objects on religious grounds, argues that where there's life there's hope, and says that he holds their hands during visits. It appears that Mr. Golubchuk has not been examined by a neurologist, or had tests performed which might confirm the Winnipeg doctors' belief about his brain function status.
Toronto professor Peter Singer, and of the rightfulness of killing humans with low degrees of self-consciousness, writes that forcing the doctors to continue to provide care for Mr. Golubchuk violates the doctors' rights. He argues that the family should be given time to find another hospital willing to care for Mr. Golubchuk, and if they cannot, then the family should accept his death.
Over the forceful objections of the Canadian Medical Association, a Winnipeg judge has issued a temporary injunction forbidding Grace Hospital from euthanizing Mr. Golubchuck. The doctors point to their own ethical standards against providing what they believe to be "futile" treatment, and claim that end-of-life decisions should be made by physicians, who have the patient's best interests at heart. Supporters of the family reply that doctors should not have the authority to over-ride a family's religious beliefs, liken the proposed euthanasia to Nazi tactics, and point to a recent case in Calgary, where a man believed by physicians to be irreversibly brain-damaged made an unexpected recovery.
The debate in Canada, which has been reported in international newspapers, does not yet appear to have dealt with the fact that the "physician rights vs. family rights" conflict is exacerbated by Canada's rigidly socialized system of health care. Unlike, for example, in the U.K. or Ireland, it is extremely difficult (although, thanks to a 2005 Supreme Court ruling, technically legal) for physicians to operate outside the government-run health care system. In a non-coercive system of health care, families could use their own money, or private insurance to pay for health care. Privately-funded hospitals could operate under the standards of their sponsors, such as religious organizations. A Catholic hospital could accept for Mr. Golubchuk as a patient (and provide him with medical care pro bono, if the hospital so chose), and keep him alive pursuant to Catholic beliefs about the sanctity of human life. Conversely, physicians who wanted to practice euthanasia could operate at hospitals which allowed the practice, and patients and families who accepted such practices could choose such hospitals.
There are many pro/con arguments about fully socialized vs. partially-socialized vs. non-coercive systems of health care. It does seem that one advantage of systems with less coercion is not forcing doctors or families to violate their ethical beliefs, or forcing health-care decisions into courts. In any case, it is fortunate for Mr. Golubchuk's family that Canada still has an independent judiciary.
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Yes, we certainly never have those problems in the American free-market system. What country did that Terri Schiavo thing happen in again?
The ethical issues here have little to do with socialized medicine.
What was the point of this post again?
For those of you interested, my link is a blog post from one of the individuals who helped draft the law in question. The author discusses the 6-month old mentioned in Crazy Train's post.
Actually, they have everything to do with socialized medicine. The idea that the physician has the "patient's best interest" at heart over that of his or her friends, family, and loved ones is laughable in today's cost-controlled medicine. It is almost as laughable as the idea that US medicine is a free market.
The reason you kill people like that is to save money. No more, no less. It is certainly not to save the patient any suffering -- by the definition of the people who kill them, they are not suffering. It is certainly not to save the suffering of the family -- they are killing people over the objections of their loved ones.
It is, purely and simply, because they have devalued life so much that they figure it's just not worth their bother and expense. It's a necessary extension of the secular ethic that separates humanity from personhood. A person who is damaged is less of a "person" than one who is not, and a person who is vegetative is not a "person" at all. The Nazis called it not having "a life worth living," and their ethic is having a grand resurgence.
Recently, there was a series of articles in the medical literature about how it was OK to use these people as experimental guinea pigs before killing them, since they were no longer "persons." I remember some years ago listening to a lecture by a bioethicist who told us that, as physicians, in the modern cost-controlled world we would have to learn that we no longer served our patients, but instead served society at large.
Now that it is society, and not the individual, who signs the checks in third party and single-payer systems, then our responsibility no longer lay with the patient, but with the society who writes the check. Given that ethic, we were told we had to recognize that the higher ethic may require that we do not do what's best for the individual patient -- that we should not advocate organ transplants or other expensive therapies for older people when that money should be better spend on preventative strategies for the young. It is more 'ethical" that the old and sick die in order to save resources for the more salvageable.
That is the future, and advocating the killing a few people whose lives are no longer "worth living" is just the first step. The only important step now is exactly how far the bar of "not worth living" will move.
It's so nice of Jonah Goldberg to join us. . . .
These issues would not arise were science not able to keep people alive for longer than ever before. They have little to do with the debate over the extent to which government should assist in the payment of medical costs; if there were no government assisted medicine, these issues would never arise because all but handful of people would be unable to afford to keep their loved ones alive for more than a few days/weeks on modern life-support systems.
The Peter Singer who commented on the Golubchuk case is the "Toronto" Peter Singer. utoronto.ca/jcb/genomics/html/directors_singer.htm
The Australian Peter Singer is the "Princeton" Peter Singer. princeton.edu/~psinger/
Two substantive comments:
1. This case is very different from Schiavo. While the husband wanted to stop life sustaining medical treatment (LSMT) and the parents wanted to continue it, both purported surrogates had to show that they were doing what was consistent with Terri’s preferences and best interests. Here, in contrast, the health care providers need not and do not make any such showing.
2. I wonder how practicable it would be for patients to go to religion-specific hospitals to get the EOL care that they want. For example, those who wanted to remove ANH would avoid the Catholic hospitals. Those who wanted to be sure to avoid unilateral termination of LSMT might go to the Orthodox Jewish or Muslim hospitals. But most people have no idea what EOL care they want. Neither do their families. Most people do not know what different hospitals are and are not prepared to provide. And there is rarely much of a choice given the structure of most markets.
I wrote and then deleted a multiparagraph post because I think I can sum it up better. When we take "total care" of a comatose patient (or end stage Alzheimers, or etc.) we do deeply invasive, painful, and humiliating things to them on a daily basis. You and I would only tolerate these things being done to us if their was some sort of payoff (i.e. a cure for something, a possible improvement in our condition). The clash comes in when the medical team does not perceive that there is a payoff. That all their care (in every sense of the word) will only continue to cause the patient more harm. And yes, most of us believe that we can cause more harm to a patient than death.
My sole point is that from the point of view of the health care workers it is deeply saddening to perform these acts on someone that we feel cannot benefit. While intellectually we understand that a particular patient may not be able to suffer, it is hard to shut off the empathy that brought us into the field while we watch a person literally rot away.
So I agree with you in that the "hospital system" may see it as a cost saving measure, the nurses that have to care for the patient do not.
That being said, what is the definition of "futile"? Another year of life, a month, a day, an hour. Last week I continued a full trauma code costing thousands of dollars to keep a 2yo "alive" long enough for her mother to hold her hand and sing her favorite song. It wasn't futile to me.
This is related, but certainly mostly off topic, I'd simply like to use this charming holiday season anecdote to remind folks to set an In Case of Emergency entry in their cell phone, and consider a "Vial of Life" in their fridge.
Small steps can make a big difference, and my experience is that most people don't know about these protocols, unless they happen to know an EMT or similar.
I think you mean "fully socialized vs. partially-socialized vs. insurance company-coerced systems of health care."
Yes. You missed that part.
Go back and read the next to last paragraph of the original post.
That option is not legally permitted in Canada.
How is this "euthanasia"? No one is "killing" anyone here: the proposal is to let the guy die naturally. Now, I am solidly in agreement that the family's wishes ought be taken into consideration, and I am very bothered by the fact that back-up tests for verification have not been performed (are there no malpractice attorneys in Canada?) But there is a huge difference between "killking" and "letting die" and we should not muddle the two. One Terri Schiavo media circus with fanatics on parade was enough, thank-you.
Also, according to what is stated here this appears to be a physician initiative, not something due to the bureaucrats of the Canadian health insurance system. It should not be presented as if it were. Indeed, it sounds as if the government, or at least one of its judges, has temporarily halted things for closer examination.
As for this case in Canada, let this be a cautionary for those advocating Hilary care. When you get old enough, sick enough you will no longer have the right to die, but the duty and obligation to die. That is the end of the line in a single pay, government funded closed to other options medical care system. Better to live fast, die young and leave a good looking corpse than to grow old and be killed with a casual indifference due to having a life not worth living or being be a useless eater as defined by the (national) socialist policy makers.
Ordinarily I would agree that there is a world of difference between euthanasia and withdrawal of treatment/support (and the latter was certainly the case in the Teri Schiavo matter) but the situation is complicated by Canada’s socialized medicine system that effectively prevents the family from getting alternative treatment.
If someone feeds you every day and then suddenly stops, they haven’t really “harmed” you – they’ve only stopped providing you with a benefit*. But if they also forcibly prevent you from being fed by someone else and effectively prevent you from feeding yourself, then they have harmed you not by longer providing you with food but by stopping you from buying food from anyone else or feeding yourself.
IMO it isn’t the fact that Canadian taxpayers aren’t paying for keeping this fellow on life support that’s wrong, it’s that their utterly barbaric single payer system forbids doctors from operating outside their single payer system. So long as that is the case, then “euthanasia” may be the best word to describe the situation.
* Unless of course you have some contractual right or special relationship entitling you the benefit–which one could argue applies in the case of the doctor-patient relationship.
The statement may be false, though. I find, through Snopes, the following statement from 2005 out of Newfoundland: "Private medical care is not illegal in Canada. But the provinces do employ a number of disincentives to discourage a parallel private system. The disincentives used vary from province to province. One of the main disincentives used is to deny physicians the opportunity to work under the public insurance plan and to also have eligible patients paying privately."
I do keep seeing statements that health insurance outside the gov't system is illegal, though.
Would it be too much to ask that people making wild assertions about the state of socialized medicine get their facts right? There are plenty of problems with Canada's health care system, but banning private medical care isn't one of them.
Pure individualism, sans insurers: doctors say you pay for the ride. Family chooses yes or no. In practice, lots of pressure on docs to eat the cost, or pass it on to others.
Individualism plus insurance: insurance pays, unless it has some outer limit on keeping a person alive where there is any doubt. Costs are passed on to other subscribers.
Nationalized health care: decisions are probably made by bean-counters, or doctors subjected to bean-counters, who figure that a dead patient is a cheap patient.
Under some situations, note that individualism plus insurance and nationalized health care can yield similar outcomes, e.g., expensive and allegedly "experimental" treatments. To the bean counters of both, a dead patient is a cheap patient.
A friend, a psychiatrist, has pointed out that under semi-nationalized insurance, i.e., social security and medicaid, there is a further problem.The bean-counters who pay for psychiatric medication are federal; those who pay for a mental committment are state. So the federal ones rule out use of the newest, best, medications, with the fewest side effects, because they are too expensive. Of course some people on the older stuff flip out -- but that's not their problem, since the committments may come off a budget, but not theirs.
"Letting die," means not intervening at all. That does not apply in this case because doctors would be intervening in order to halt the life sustaining medical treatment.
Look at it this way, if you are scuba diving and I cut your air hose so that you drown, did I kill you or did I "let you die"? After all, it's natural to die of drowning when you are underwater. The key is that I intervened to deny you air. If you were underwater drowning and I didn't share my own air with you, then that would be "letting die".
In fact, the mere fact that we can make reference to a "medical system" at all is testimony to how far down the slope of totalitarian oppression we have slipped.
Nobody's rights in this situation are more than marginally relevant at this point.
Doctor's rights to sell or not sell their services, and patient's rights to buy or not buy doctor's services are so gravely compromised already that to even find them in this tangled mess is an epic task.
Furthermore, the market price of any of these things is lost in the mist of memory and the confusions of the legal jungle.
I propose that we erect a wall between private and government medicine. Let the government and their insurance people compete against the private citizen on the open market for the attention of doctors.
Till then, good luck. Because we are hosed!
It appears that Manitoba is one of the more restrictive and prohibits private insurance contracts for services that are offered in the public system but, like in all the provinces, a physician can opt-out of the public system. However, an opted-out physician is subject to price controls (can't charge more than the public reimbursement rate for opted-in physicians).
Obviously, laws may have changed since this paper was researched. Also, this paper focuses on physicians rather than medical facilities which may be a factor in this case.
and families can disagree as to what constitutes futile.
Take an easy example: A patient ceases heart and lung functions for a good length of time, say thirty minutes. Yet, the family, stricken with grief, demands that the doctors continue performing CPR in the faint hope it might work.
Obviously, the doctors are not obligated to continue this futile treatment. The patient's dead.
Or say that a patient is definitively brain dead, under any definition you'd like to use. Even if the patient's family does not want to accept the diagnosis, the hospital should not be under an obligation to continue care indefinitely. Such care would be futile; the patient is dead, even if heart and lung functions can be continued theoretically forever.
In such cases, the doctors are undoubtedly right to say that the care should be discontinued, even if families object.
So there is nothing wrong with the /principle/ of discontinuing futile care, even over family objections.
The harder question is what is futile and what is not. Mary Anne Warren's quote seems good here:
Whether care is futile (as opposed to merely ill-advised) or not is a difficult question, but a difficult empirical one. It cannot just be resolved by moral philosophizing. Perhaps in hard cases, we should defer to families' wishes. But families' wishes cannot be the be-all end-all. Hospitals should not be obligated to provide useless care. Whether the care being provided in this case is useless may be quite unclear (it seems to be from the facts as I understand them), but we should be clear that this case is not about the general principle of doctors not having to provide futile care.
I presume the strike-outs reflect the comment regarding the two Peter Singers. However, the remaining text still depicts the article's author as the philosopher Peter Singer and links to the Princeton Singer's wikipedia page.
[DK: Thanks for spotting the incorrect link. I fixed the link, and removed the strike-out text. I also revised the line about outside-the-system health care being "illegal," to reflect the 2005 Supreme Court ruling.]
It's amusing to watch the mental gymastics of those who want to kill their patients. He is comatose and unresponsive, so the family's claim that he is responsive is wrong and it's OK to kill a vegetable. Oh, and by the way, he's in pain and is responsive to that, so it's OK to kill him because he's not a vegetable. Quite a dance.
"That being said, what is the definition of "futile"? Another year of life, a month, a day, an hour. Last week I continued a full trauma code costing thousands of dollars to keep a 2yo "alive" long enough for her mother to hold her hand and sing her favorite song. It wasn't futile to me."
What "health care workers" need to relearn is that it isn't all about *them* and how *they* feel. It's about the patient. The idea that it's OK to kill someone because it just doesn't feel as good as it used to to treat them is pretty bad. And, by the way, I'm a "health care worker" too, and as such I have as much or more right to kill my patients, too, right? So you don't need to tell me about how it feels to deal with the terminaly ill.
And, by the way, even though "health care workders" consistently discount it, most family members have had to deal with terminal illness of people they care about, too. Unfortunately, *that* experience is ignored by people who are so arrogant they think that they should ignore the wishes of their own patients and their families and kill for the sake of their convenience -- however much they rationalize it.
This seems to be as good a time as any for a "hurray, I'm Dutch!" comment, so here goes:
Review procedures for the termination of life on request and assisted suicide and amendment of the Criminal Code and the Burial and Cremation Act (Termination of Life on Request and Assisted Suicide (Review Procedures) Act), 2002. The link is to the bill as it was submitted to parliament, but as far as I can tell it was passed without any major amendments.
The pertinent part:
"1. In order to comply with the due care criteria referred to in article 293, paragraph 2, of the Criminal Code [which describes the necessity defence], the attending physician must:
a. be satisfied that the patient has made a voluntary and carefully considered request;
b. be satisfied that the patient's suffering was unbearable, and that there was no prospect of improvement;
c. have informed the patient about his situation and his prospects;
d. have come to the conclusion, together with the patient, that there is no reasonable alternative in the light of the patient’s situation;
e. have consulted at least one other, independent physician, who must have seen the patient and given a written opinion on the due care criteria referred to in a. to d. above; and
f. have terminated the patient’s life or provided assistance with suicide with due medical care and attention."
Prior to the signing of the Texas law, physicians in the state were allowed to terminate care at any time, upon their own volition, without consulting the family.
While the law that the then-Gov. Bush signed is highly imperfect, it was a radical step forward in terms of patient's rights. To criticise him for it mandates that one believe that a law meant to protect people, that improved upon the status quo, is one meant to harm the people of Texas.
It's called context. In context, the law is a pretty good thing. They did not realise until much later that it wasn't good enough.
"In the case of Terri Schiavo, the Florida state courts have consistently ruled that there is overwhelming medical evidence that she is in a permanent or persistent vegetative state, from which she cannot and will not ever recover." -----> Yeah, yeah, and what the Florida State courts failed to disclose until AFTER A. Scott Harrison had to sue them for letting his clients rot in jail while the Florida State Courts refused to comply with HIS rights under Title II of the Americans With Disabilities Act for which the Florida State Courts settled during 2007, was best recently admitted by Elizabeth Goodner, Florida State Courts Administrator:
"(1.) Goodner admitted in an e-mail delivered to Day-Petrano on October 29, 2007 that numerous persons with disabilities exist who “rely upon assistive technology” to access Florida State courts and court services: “One of the considerations in establishing an e-filing system is ensuring that the system is accessible to litigants with disabilities who rely upon assistive technology.”
(2.) The Merriam Webster Online Dictionary defines “rely” to mean “to be dependent,” at http://www.m-w.com/dictionary/rely. The Cambridge Dictionary of American English defines “rely upon” to mean “to depend on … something,” available at http://dictionary.cambridge.org/define. asp?key=rely*1+0&dict=A.
(3.) Goodner admitted in her October 29, 2007 e-mail to knowingly, intentionally, and with deliberate indifference excluding a group of persons with a particular disability who “rely upon assistive technology” for access to Florida State courts as Constitutionally mandated by Fla. Const., art. I, § 21 in the past, at present, and until some unspecified time in the future: “When electronic filing is formally approved and implemented in a court, you and other court users are welcome to electronically submit case documents in accordance with such policies and procedures as may be established.”
Terri Schiavo's doctors informed the State Court Judge of their belief she shoudl have a more recent fMRI and be provided pattern recognition-to-text assistive technology as an auxiliary aid and service under Title II of the ADA to express her own desire to live or die. We know the State Court Judge refused to follow the procedural requirements of Title II of the ADA due to the fact he NEVER ENTERED ANY ORDER GRANTING OR DENYING THE REQUESTED AUXILIARY AIDS AND SERVICES. Therefore, Terri Schiavo was euthanized in violation of Title II of the ADA.
Further, the ADA contains and express federal preemption statute that superceded conflicting Florida law under which Michael Schiavo acted as substitute proxy, the Florida law conflicting with the ADA's auxiliary aids ans services mandate.
The reason the Florida State Courts blatantly refused to comply with the requirements of Title II of the ADA with respect to Schiavo is because the Florida State Courts are refusing to comply with the ADA's Title II assistive technology auxiliary aids and services and reasonable rules modification mandates as to ALL Florida assistive technology users -- why? They are too lazy to implement electronic access to assistive technologies, and don't want to pay to train the Judges and Court personnnel in the FLorida State Courts system.
The Bush brothers did right by Terri Schiavo. They couldn;t help it if a Democratic-appointed wayward District Court Judge sneakily led David Gibbs, the Schindler's attorney, who (as so obvious from reading his pleadings) couldn't tell the difference between Title II and Title III of the ADA, to let the State Court Judge be dismissed from the federal challenge to keep Terri Schiavo alive -- THAT District Court Judge knows the requirements of Title II of the ADA, knew injunctive relief applied under Title II of the ADA to enjoing the State Court Judge's Order, and yet led David Gibbs to waive the very Title II ADA injunctive relief claim that woudl have saved Terri Schiavo's life.
It is a very sad commentary on the state of our Courts ability and willingness to protect disabled Americans or value their lives as having any worth. Significantly, if one simply reads the Federal Judicial Vacancy application for the two current openings for United States District Court Judge for the Middle District of Florida with all the physical and mental disability exclusion questions to ensure NO peer of the disabled will ever be appointed Federal District Court Judge in Florida, we can begin to see why our Federal Courts are not enforcing the ADA or valuing the lives of the disabled as having worth.
Ask yourselves -- has there ever been a person with autism appointed as a Federal United States District Court judge anywhere? And these high functioning IQ people with autism are our best and brightest.
I am not even sure there has ever been a person with autism on the Canadian Supreme Court, either.
Even in the Netherlands, it's hard to interpret a signed statement saying "Please don't kill me," as a "voluntary and carefully considered request" for euthanasia.
The question of assisted suicide is a different one than killing someone against their stated wishes and the wishes of the family. The latter is called murder in most places, except when done as a cost saving measure by a third party payer, or in order to make life more convenient for a health care worker. Then, such distinctions seem to disappear.
2. Do those who have the idividual's medical power of attorney have that right?
3. Do doctors have the right to refuse to take on a new patient?
4. Do doctors have the right to drop a patient if no other doctor is willing to take him?
5. Do societies have an obligation to provide all medical care an individual may desire?
6. Do societies have the right to prevent an individual from getting medical care?
I would answer yes, yes, yes, no, no, no.
Which is, of course, the problem with socialized medicine and the so-called "tyranny of medicine." If the government is paying for something, it gets to control it. And it the government is paying for your health care, then it gets to control everything that impacts your health -- which is *everything.* There is *no* aspect of your life that the government check doesn't entitle them to control. What you eat, what you do, where you go, what you wear, how you play, and in the end, they get to kill you.
You say "Hey, don't ask my neighbors to chip in when that's me at 84, okay?"
But what happens if you hit 84 and you aren't quite *ready* to die? I guess we can rename HillaryCare to "Logan's Run."
It's not clear that the law in Canada prohibits you from lining up your own health care -- though you can't do it through insurance, apparently. But there isn't enough demand to do it outside the government health care plan, so "out-of-network" health care exists there only for stuff like cosmetic surgery which has plenty of market support. W.O., you want it both ways, you know. You want to be taken care of by someone else when you're sick, but you don't want to be forced to pay for other people. That's not very interesting.
With all due respect, you don't know (blank) from (blank) about these neurologic matters, nor are you well-informed about the Schiavo facts. Years before at UCSF, she had had a indwelling electrode planted deep within her brain, which did nothing to help, but which precluded repeat MRI, or fMRI, studies.
"Bizarre" doesn't do justice to this. (Can you cite to anything in support of this factual assertion?) Which of Schiavo's doctors are you referring to, charlatans like William Hammesfahr of Tampa, a non-board certified practioner who goes around advertising himself as a Nobel Prize nominee because a Florida Congressman (Bilirakis) wrote a letter to the Carolinska Institute telling them that they had to award this quack one of their prizes? (Senator Frist's Harvard Medical School classmates wrote him a scathing letter, reaming him out for relying on the bogus videotape that purported to show "conscious" responses by Schiavo.)
For those of us in the medical profession without experience of autistic (PDD) individuals who might be able to serve on the federal (or state) bench but for "discrimination" against them, would you tell us what criteria support the diagnosis of "autism," which we include under "Pervasive Developmental Disorder"?
Now go ahead and report me to the HIPAA police, as you previously threatened to do.
"With all due respect, you don't know (blank) from (blank) about these neurologic matters, nor are you well-informed about the Schiavo facts. Years before at UCSF, she had had a indwelling electrode planted deep within her brain, which did nothing to help, but which precluded repeat MRI, or fMRI, studies." ----> Of course, the operative words in this dr-ego trip are the words "years before." ----->
"Years before" we also thought little girls got off sexually while riding their horses (Freud), that autism was caused by cold "refridgerator mothers" (Bettelheim), and persons with autism could be slapped and their feet electro-shocked silly to make them "read faster" (Lovaas circa 1965). So, neurodoc ADMITS he misprescribes "years before" medicine to an ever advancing medico-scientific-technological knowledge-based profession. Geez-us, neurodoc, don't come to my house with any of your *get well quick* mercury-based tonic and elixir quackery anytime soon! Spare me. I don't want to get a stomach ache.
And, no doubt, you would rely on the "refridgerator mother" diagnostics rather than newer 22q11, 22q13, and/or 15q11 genetic testing together with numerous characteristics such as facial dysmorphisms. Your's is an easy forumla for euthanasia violating the ADA: IGNORE the competent modern standard of care in the practice of medicine, and your can make up any basis in fact that suits your political agenda.
Oh, wait, did I mention your practicve of medicine over the Internet by your POLITICAL AGENDA, neurodoc? ----> "'Bizarre' doesn't do justice to this. ...Which of Schiavo's doctors are you referring to, charlatans like William Hammesfahr of Tampa, a non-board certified practioner who goes around advertising himself as a Nobel Prize nominee because a Florida Congressman (Bilirakis) wrote a letter to the Carolinska Institute telling them that they had to award this quack one of their prizes? (Senator Frist's Harvard Medical School classmates wrote him a scathing letter, reaming him out for relying on the bogus videotape that purported to show 'conscious' responses by Schiavo.)" -----> You made my point without any help from me: you practice medicine by POLITICS! I am surprised you are not a White House doctor.
Regardless of your politics, there was an affidavit, as I recall, submitted in the Schiavo case to the State Court Judge that opined that a newer more advanced fMRI should be done to demonstrate Schiavo's "minimally conscious state" to provide Schiavo with a form of electronic format assistive technology known as "pattern recognition-to-text" computer technology so she could speak her own mind about whether to live or die. To this, neurodoc baldly asserts it takes a "board certified practioner" to document a disability for purposes of providing the required auxiliary aids and services, reasonable rules modifications, and removal of communication barriers under the ADA. Unfortunately, neurodoc failed to conduct any diligent legal research on the subject of who else besides "board certified practictioner" M.D.s can provide documentation under the ADA. See Vinson v. Thomas, 288 F.3d 1145 (9th Cir. 2002).
Who needs to report you to the "HIPPA police," neurodoc; you have already made more of a fool of yourself than I ever could. It is called hoof-in-mouth disease.
Likewise, your malpracticed Internet diagnosis of myself as having PDD ignores the numerous diagnostic criteria I meet specified for autism. Perhaps you forgot, you have to take a famility and childhood history when diagnosing autism, not simply guess at it or speculate to achieve a political agenda.
If so, I believe your politicizing your quack medical diagnostics resulted in your conflating the mind-blindness theory of autism with the other kind of blindness where a person has a vision impairment to the point he or she completely cannot "see."