Hamlet never imagined this
It’s long seemed as if this country is suffering a severe case of mass insanity. The truth is out there. It is more than QAnon, but please see that obligatory nonsense at the bottom later.
The occasion for revisiting societal mental breakdown is a couple of headlines this morning. This will take a moment.
Texas doctors do not need to perform emergency abortions, court rules (Washington Post)
A federal appeals court on Tuesday ruled that Texas hospitals and doctors are not obligated to perform abortions under a long-standing national emergency-care law, dealing a blow to the White House’s strategy to ensure access to the procedure after the Supreme Court overturned the constitutional right to abortion in 2022.
The federal law “does not mandate any specific type of medical treatment, let alone abortion,” the U.S. Court of Appeals for the 5th Circuit concluded, faulting the Biden administration’s interpretation of the Emergency Medical Treatment and Labor Act, or EMTALA. The law “does not govern the practice of medicine,” the court added.
The three-judge panel also faulted the Biden administration’s process of issuing its emergency-care guidance, saying that federal officials did not go through the proper rulemaking process when the administration instructed health-care providers that they were protected by EMTALA if they believed an abortion to be medically necessary. The panel further said that the federal emergency-care law did not “directly conflict” with a near-total abortion ban in effect in Texas, which was written by the state’s Republican legislators and includes exceptions for medical emergencies.
We know already that those Texas exceptions functionally do not exist.
The White House and federal health officials have invoked EMTALA — the 1986 law that requires hospitals and physicians to treat emergency medical conditions or risk fines, civil lawsuits and being blacklisted from federal health programs — in the wake of the Supreme Court’s June 2022 decision that overturned the national right to abortion and led to about two dozen state bans on the procedure. The Biden administration is now engaged in several lawsuits that are expected to set precedent over whether the emergency-care law applies to abortion access, including the Texas case.
Pregnant women in distress in Texas can just die untreated, says the 5th Circuit. No harm, no foul. Abortion rights advocates, the Post reports, “decried the ruling, which they said signaled a disregard for women in life-threatening pregnancy situations.”
Meanwhile, doctors must never stop treating anorexia patients.
Should Patients Be Allowed to Die From Anorexia? (New York Times, gifted)
Naomi “had been starving herself for 26 years.” Nothing was helping. “I’ll either die of anorexia or I’ll die of suicide,” Naomi told reporter Katie Engelhart when they first spoke. “I’ve accepted that.”
Should Naomi be allowed to check out of the hospital? Should she be allowed to stop medical and psychological treatments and seek palliative care until she dies?
The field of palliative care was developed in the 1960s and ’70s, as a way to minister to dying cancer patients. Palliative care offered “comfort measures,” like symptom management and spiritual guidance, as opposed to curative treatment, for people who were in pain and would never get better. Later, the field expanded beyond oncology and end-of-life care — to reach patients with serious medical illnesses like heart disease, H.I.V. and AIDS, kidney failure, A.L.S. and dementia. Some people who receive palliative care are still fighting their diseases; in these cases, the treatment works to mitigate their suffering. Other patients are actively dying or in hospice care. These patients are made “comfortable,” or as comfortable as possible, until the end.
But not for patients with unremitting anorexia whose conditions appear futile. Naomi’s doctor, Jonathan Treem, discussed options:
To Treem, it felt as if Naomi was asking for something more than his nonintervention; she wanted his mercy. His permission to let go, his compassion. It made him think about the other doctors who had treated her. “This is where it gets into a passionate discussion,” he told me. “If you are going to accept responsibility for the people you save, and you’re going to elevate them as examples of why everyone should undergo compulsory treatment, you had better recognize the blood on your hands. That, on some level, in order to ‘save everyone,’ you are perpetuating suffering in others.”
Yet Treem had his limits. He told Naomi that he could not look away if she was actively suicidal. Several times, after an especially unsettling appointment, Treem walked her down to the emergency room, where she was put on a 72-hour mental-health hold.
It is a very long, very complex story reminiscent of Whose Life Is It Anyway? (1981). It raises serious medical ethics questions:
What’s more, in somatic medicine, a patient didn’t need to have a good reason for stopping care. She didn’t even have to try getting better in the first place. A cancer patient could decline chemotherapy that would very likely save her life. Because she didn’t think the benefit was worth the pain. Because she wanted to go home to her children. Because she preferred to be treated by a homeopath. She could do what she wanted, just because she wanted to. Why should patients with mental illnesses be held to a different standard?
“It doesn’t make sense,” says Dr. Joel Yager. A paper he co-authored argues “that psychiatry needed its own subfield of palliative care: specifically for the 15 to 20 percent of patients whose anorexia developed a ‘chronic course’ and did not respond to standard treatment — and for the fraction of those patients who did not want to keep trying to get better.”
“They’re ‘incompetent’ unless they want treatment?” His critics, he said, had no data at all to back up their claim of universal incapacity among anorexic people. Existing studies showed the opposite. Yager thought his critics were suffering from “positive outcome bias”; they remembered the patients who were saved and were grateful for it, but not the ones who died slowly and suffered all the while.
“Absolutely unconscionable,” a Denver-based forensic psychiatrist focused on eating-disorder care ethics said of the paper’s ideas.
To be or not to be
So here we have America in 2024. U.S. states prevent doctors from easing the suffering of women with nonviable pregnancies, and the conservative 5th Circuit absolves them of responsibility should the women die. Meantime, the medical profession insists Naomi stay alive no matter how much and how long she suffers with anorexia. In both cases, women’s lives are not their own.
I don’t have answers. But excuse me for thinking we’ve gone around the bend.
Not to be missed, further evidence from The Hill:
House Republicans are beginning a crucial election year with a heightened focus on border issues as negotiations in the Senate on asylum policy changes drag on and the conference prepares to bring impeachment proceedings against Homeland Security Secretary Alejandro Mayorkas.
Rep. Marjorie Taylor Greene (R. Ga.) is on the case. Impeached for what, you ask?
Republicans have also claimed Mayorkas has violated the law, failing to meet the standards of the Secure Fence Act, which defines operational control of the border as a status in which not a single person or piece of contraband improperly enters the country.
But not a single secretary of Homeland Security has met that standard of perfection, something Mayorkas has pointed out as the GOP has grilled him on the law.
You were expecting electeds voted in by these people (below) to act reasonably or rationally?