I rarely use my blog for political reasons outside of higher education issues. I also try to take a national perspective since this blog is read by alumni/ae and friends from across the country. But today I want to share some thoughts on an issue that the citizens of Massachusetts will decide in a few weeks. And this issue raises significant moral and ethical questions about which we should all be concerned.
On November 6, the citizens of Massachusetts will vote on Ballot Question 2. A yes vote would legalize physician-assisted suicide in Massachusetts. In my opinion, and the opinion of many others, this ballot question not only threatens the dignity of life, but contains flaws, which would have unintended consequences to terminally ill patients and their families.
If passed, a patient who has been diagnosed with a terminal illness and given a prognosis of six months or less to live would have the ability to request a doctor’s prescription for medication to end his or her life. Jewish and Christian moral traditions have long rejected the idea of assisting in another’s suicide. Religious organizations are joined by secular groups including the Massachusetts Medical Society, Massachusetts Hospice and Palliative Care Federation, American Medical Directors Association, American Nurses Association, American College of Physicians, American Medical Association, and the Massachusetts Osteopathic Society in opposition to the practice of physician-assisted suicide.
Some of the key flaws in the Massachusetts ballot initiative which have been identified include:
- Doctors agree that terminal diagnoses of six months or less are often wrong. Many with terminal diagnoses live years longer.
- Patients requesting suicide do not need to be examined by a psychiatrist before receiving a prescription to commit suicide. Many terminally ill patients suffer from depression.
- Question 2 does not require a consultation with a palliative care or hospice expert.
- No doctor is present when the patient takes the lethal prescription. This is not a dignified way to die.
- There is no requirement that the patient notify family members. Compassionate care at the end of life should involve the loving support of family members.
- We should be supporting improved hospice and palliative care statewide, not legalized suicide.
In an open letter calling Question 2 “poorly written, confusing, and flawed,” five past presidents of the Massachusetts Medical Society- Leonard J. Morse, MD; Barbara A. Rockett, MD; Philip E. McCarthy, MD; Francis X. Rockett, MD; and Lynda M. Young, MD have cautioned that if the ballot question is passed, “the doctor/patient relationship will suffer and the way doctors deliver health care will be gravely changed.” Last month, the Massachusetts Medical Society posted,
“We are opposed to Question 2 for these reasons:
- The proposed safeguards against abuse are insufficient. Enforcement provisions, investigation authority, oversight, or data verification are not included in the act. A witness to the patient’s signed request could also be an heir.
- Assisted suicide is not necessary to improve the quality of life at the end of life. Current law gives every patient the right to refuse lifesaving treatment, and to have adequate pain relief, including hospice and palliative sedation.
- Predicting the end of life within six months is difficult; sometimes the prediction is not accurate. From time to time, patients expected to be within months of their death have gone on to live many more months — or years. In one study, 17 percent of patients outlived their prognosis. ”
Lynda M. Young, MD, MMS past president, testified about the MMS policy at a hearing of the Massachusetts House Judiciary Committee on March 6, 2012: “Allowing physicians to participate in assisted suicide would cause more harm than good. Physician assisted suicide is fundamentally incompatible with the physician’s role as healer. “Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. ... Patients must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication.”
Dr. Joseph Gravel, president of the Massachusetts Academy of Family Physicians has been quoted as saying the ballot initiative does not include adequate safeguards to protect poor people suffering from a terminal disease who may want to end their lives rather than become a financial burden to their families. (Eagle-Tribune). In a statement he issued on behalf of the more than 1,000 family doctors who are part of the academy, he announced the group’s opposition to Question 2. “The role of family physicians is to provide compassionate, high quality health care to all the patients, in each stage of life.”
He continued, “This certainly includes end-of-life care. It is clear that we need to continue to work to provide those suffering from serious illnesses, depression, and other conditions that can lead to hopelessness highly effective palliative and hospice treatments that are now available. To really address this patient need, we also need to work to assure that everyone has access to a pre-existing, trusting, personal relationship with a primary care physician that can be enormously important during these very difficult situations.” (State House News Service)
The question of legislation by referendum has also been called into question given the complexity of the legal, ethical and moral issues involved. If the ballot question passes in November, there will be no other steps or requirements to be fulfilled and the flaws and unintended consequences will be part of a new law. If passed by the voters, physician-assisted suicide will be legal in Massachusetts on January 1, 2013.
As you can see, this is more than a religious issue … it is a legal issue … it is a medical issue … and it is a fundamental moral issue related to all people of all faiths and traditions. For those in Massachusetts, I would hope that much thought and reflection would precede a decision on how to vote on November 6. For those outside of Massachusetts, issues like these need our attention and concern.
(As always, your comments and questions are welcome.)
This past week, the media has covered stories related to student debt and the challenges for recent college graduates. The student debt level in this country has risen to almost $1 trillion. Of equal concern, the delinquency rate on student loans has increased to 8.9%. Having written these past weeks about the issues of access and affordability, especially for first generation college students, I thought it might be helpful to clarify some of the data related to student debt.
I debated all last week whether or not to write about Penn State in this week’s blog. This story has received so much attention from the media and has been analyzed through multiple prisms. A day has not gone by that I don’t find myself engaged in conversation with someone about this issue. Everyone has a strong opinion.
No one disagrees about the horrific realities of child abuse. But one can find differing opinions about the role of the big-time athletic culture, the legacy of the football coach, the response from the NCAA, and on and on. I too have opinions about these aspects of the story, but wanted to share a different perspective … one that concerns me even more deeply.
The unanswered question for me is ... has the University’s accrediting body been involved? Every college and university in America is accredited by a regional accrediting body. For Anna Maria, the accrediting body is called NEASC (New England Association of Schools and Colleges). Penn State’s accrediting body is called Middle States (Middle States Association of Colleges and Schools).
While each of the accrediting associations differs slightly, they all serve the same purpose. They exist to insure that educational quality and integrity are maintained on every campus. In the Middle States statement of purpose, for example, we read that the association is “committed to excellence in all levels across the continuum of education, whose purposes are to encourage, advance, assist and sustain the quality and integrity of education.” (NOTE: The misspelling is really on their website!).
Middle States publishes a handbook which delineates the criteria for accreditation. It is called Characteristics for Excellence in Higher Education. There are 14 standards. Standard #6 is “Integrity.” The broad definition is, “In the conduct of its programs and activities involving the public and the constituencies it serves, the institution demonstrates adherence to ethical standards and its own stated policies, providing support for academic and intellectual freedom.” This section further describes integrity as being reflected and represented by values of honesty, truthfulness, equity and fairness, respect for all people, civility, etc.
Middle States may already be deeply involved in a review or an investigation of Penn State. If this is the case, it should be reported by the media, if only the higher education media. This past week’s activities by the NCAA continues to make this issue primarily a football story … an issue of the problems with a dominant athletic culture … and this is troublesome. For me, the questions are deeper and more pervasive and make me wonder about the fundamental integrity of a great academic institution.
Perhaps the alleged unethical behavior related to failures to report, cover ups, etc. are only related to the culture of big time football as the media reports. But could these behaviors and actions be a reflection of a more systematic problem and organizational culture? Should this situation cause us to wonder if there is a more pervasive integrity problem?
There are almost 80, 000 students enrolled at Penn State. There are almost 10,000 employees. There are untold numbers of community members who attend events, camps, activities and, of course, football games. If the University is committed to protecting all of their rights … and I hope they are … how does it act when students allege harassment or unfair treatment beyond athletics? How do they act if employees allege inappropriate behavior by supervisors, etc? Do their policies and procedures demonstrate the integrity of the institution?
I am neither judging Penn State University nor drawing any conclusions. I am simply expressing my concern that in the larger picture, the actions of the NCAA and the focus on the football program are less significant. And while we criticize the culpability of such a football culture, our focus on this as the primary or sole reason for these problems serves to perpetuate the problem.
For me, the heart of the question is the fundamental integrity of the University. I hope that this is being investigated by the accrediting body. Because it is this core value that links all colleges and universities together. And it is central to our commitment to all who study, work and visit our campuses.
For me, football does not define Penn State University. Academic integrity and excellence define Penn State and all colleges and universities. And the potential failure to uphold these values throughout the institution is the real issue. And the question needs to be answered!
(Your comments and ideas are always welcome.)
Last week I read a report summarizing a recent survey entitled, “Confidence in Institutions.” Conducted by Gallup since 1973, the survey asks Americans to share their level of confidence in a number of institutions in the United States. This most recent survey was conducted in early June by telephone with over 1000 respondents from across the country. The headline of the article was, “Confidence … at a New Low.”
According to these data, confidence is at a record low for public schools (only 29% express a high degree of confidence), church or organized religion (44%), banks (21%), and television news (21%). But while these were new records, there was an overwhelming lack of confidence in most institutions.
Ranking last in confidence for the third year in a row was Congress (13%). It is interesting to note that in 2010, Congress measured only an 11% confidence rating and this was the lowest measure ever for any institution. More on this in a minute.
But low levels of confidence were expressed for many institutions:
- HMOs – 19%
- Big Business – 21%
- Banks – 21%
- Organized Labor – 21%
- Television news – 21%
- Newspapers – 25%
- The Criminal Justice System – 29%
- Public Schools – 29%
In fact, the only three institutions with high degrees of confidence greater than half of the respondents were:
- The Military – 75%
- Small Business – 63%
- The Police – 56%
No institution has seen any significant increase in its confidence rating. Those rated the highest, for example, have simply maintained their previous confidence levels. The most dramatic declines in confidence have related to banks, organized religion, public schools, Congress and television news.
Lest anyone think that higher education is immune from this confidence gap, other surveys show overall confidence in higher education to be at about 50%, although significantly higher for those with a college degree (closer to 80%).
This report is not a surprise and reflects the general degree of dissatisfaction in this country. Every day we read reports about declining degrees of optimism about the economy and world events. With so much controversy and scandal with many of these institutions, it is understandable that confidence levels are low.
But the question for me is … what do we do about this? And apparently, the answer is … very little! While I have yet to find anything other than anecdotal evidence about many of these institutions, it seems clear that lack of confidence does not lead to change. And the best example of this that is irrefutable may be Congress.
Despite the extraordinary low levels of confidence in Congress, we continue to re-elect members to the House and the Senate. Since 1964, the lowest percentage of re-elected House members was 85%. In most elections, the percentage is at or above 90%. Senate re-elections have been more volatile (as low as 55% in 1980), but typically 80% or more.
If our confidence is so low, why do we re-elect the same people? The research says it is based on familiarity (name recognition) and money (advertising). But do we change our bank or financial services? Do we read a different newspaper or just stop paying attention to the news (in print and on TV)? Do we choose a different school or a private school?
Vince Lombardi once said, “Confidence is contagious. So is lack of confidence.” We have the ability to change our institutions. But it will take more than rhetoric. Maybe it’s just easier to complain.
(Your comments and ideas are always welcome.)
Most historians agree that the Second Vatican Council marked an important time in world history. The Council provided a new direction in the Catholic Church, connecting the Church to the world and contemporary issues of society. Whether Catholic or not, religious or not, Vatican II helped define the social responsibility we all share in service to the Common Good. And fifty years later, the Council provides important lessons at a time when mutual respect, understanding and civility are less evident in all walks of life.
Last week I shared the first important lesson that can be drawn from Vatican II … the value of dialogue. While I am a great believer in the usefulness of most technology, the impersonal nature of e-mail and texting has replaced conversation. And I am not sure why we think there is a value in limiting ideas to 140 characters on a Twitter account. Dialogue typically requires face to face interaction, the sharing of thoughts, ideas, feelings and perspectives. Dialogue leads to relationships. Dialogue leads to understanding. Dialogue is open and welcoming. How did 2500 bishops reach the conclusions that led to the Vatican II documents? They talked to each other. They listened to each other. They agreed and they agreed to disagree in a spirit of mutual respect. They welcomed and embraced dialogue.
In his essay entitled, “Conversation Starters: Dialogue and Deliberation During Vatican II” (America, February 13, 2012), Richard Gaillardetz, the Joseph McCarthy Professor of Catholic Systematic Theology at Boston College, suggests that there are two additional important “dynamics” that are instructive. One he defines as “humble learning.” This lesson teaches us that no one has a monopoly on truth and knowledge. A bishop doesn’t become an expert upon ordination; a politician doesn’t become an expert upon election; and a CEO doesn’t become an expert upon appointment (not even a college president!).
According to Gaillardetz, and I fully agree, we must all become students and be open to lifelong learning. One of the most surprising and remarkable things that occurred in Vatican II was the willingness of so many world leaders to listen to others and understand that they needed to learn from colleagues who were more knowledgeable and more experienced. But even more, the bishops at Vatican II demonstrated an openness to learning not only from each other, but also from both the theologians and observers who were in attendance.
And this openness to learning required a demonstration of humility. Gaillardetz states it clearly when he writes about Christianity, “Christ, our teacher, showed impatience only toward those who were arrogant in their certitude.” Humility is neither a sign of weakness nor a lack of confidence. Rather it is a recognition of the value of others, an openness to learning and a respect for the opinions and ideas of others. This sentiment can be found in the Hebrew Scriptures (Micah 6:8: “…what does the Lord require of you but to do justice, and to love kindness, and to walk humbly with your God?”) and in the writings of every religious tradition and ethical text. Justice, kindness and humility … wouldn’t that be an interesting paradigm for leadership.
The final lesson we can learn from Vatican II is inclusivity. In his essay, Gaillardetz discusses the value of “openness to the world.” He argues that Vatican II in general, and Pope John XXIII who oversaw the Council in specific, understood the value of “respectful yet critical engagement with the world.” While I think this is a critical lesson for the various religious organizations of the current times, it may be too limiting a perspective as we consider business, industry, government, etc.
To me the best way to translate this concept for broader applicability is to describe it in terms of the value of an inclusive approach. It seems to me that the dialogue is richer, more learning takes place, and the decisions are better with more voices not fewer. The lessons from Vatican II are more dialogue not less, a humble awareness that we can all learn more, and that divergent and varied views and perspectives can only help.
Too often when we look at political campaigns, Wall Street and our religious and civic leaders, we wonder why they act the way they do. We wonder why respectful disagreement looks more like disagreeable behavior. We wonder why difference of opinion seems to include ad hominem attacks. History can teach us important lessons. If we look back 50 years, we can learn a great deal from the process of the Second Vatican Council. And, you know, it wouldn’t hurt to re-read the documents, too!
(Your comments and ideas are always welcome.)