Friday, August 28, 2009
It was easier to potty-train the cat, frankly. I mean, show kitty where the litterbox is, and done. No worries. Not so with the humans.
But anyhow, before Clare and Brent left for TX, I decided to just unilaterally usher in the grand new era of big-girl pottying. Took Clare shopping, bought a dozen or so panties (in our house, "pannies," and Clare will correct you) of Clare's choice (Elmo, Dora and Little Mermaid) and put her in them and just dealt with the, uh, fallout.
About three days later and several pee-puddles and poopy pants later, she was as reliable as I am, and went off to Texas where other people reinforced the new regime on my behalf for three weeks.
Monday, August 24, 2009
CYBORGS FOR EARTHLY SURVIVAL
The concluding scene of the SciFi Channel’s revival of the short-lived 70’s TV series Battlestar Galactica shows a line of defeated but indomitable human beings, shouldering packs and trudging slowly but determinedly into a wilderness, away from their spaceships, their computers, their technologies. The scene visually tropes an earlier one, in which these spacefaring refugees from a nuked planet observe a primitive hominid family group moving single file across the plain in much the same way, unknowingly the objects of a technologically mediated, curious vision of alien kindred.
What could prompt such a dramatic and counterintuitive conclusion to a narrative of remnant humanity’s exodus from ruin, led by a faithless Moses and a dying Miriam, whose existence had depended so intimately for so long on the technologies now being decisively repudiated? What message lies in this conclusion for us, as we ponder the various possibilities, both frightening and liberatory, of the posthuman future?
The complexity of the narrative universe of Battlestar Galactica belies such a simplistic ending. For these human beings, the posthuman future has already arrived, and with a vengeance—literally. The opening scene of the series gives us a question posed by a sexy blonde machine to a middle aged, befuddled soldier/diplomat: “are you alive?” she asks. Yes, is the stuttered answer, but the machine doesn’t care, or perhaps, does not believe this answer—after all, this must have been the very question put to it, in the years that sowed the seeds of the conflict that would shortly destroy not only this man, but his whole civilization as well, in a retributive genocidal impulse.
The problem goes far beyond the pragmatic difficulties caused by the fact that “the Cylons look like us now.” The problem, in short, is that the Cylons are us: down to our very blood. And not just “us” in biological facsimile, but in nature. Violent, retributive, obsessive, sinful, human nature.
This is where the story begins: with an ontological confusion, a question of humanness not simply in terms of status but fundamental nature, and a question of what constitutes the difference between person and machine, when machines can also think and feel. The only difference seems to be, frankly, that the machines are determined to kill the humans. One can only speculate why; but, after all, machines made in imago hominis are likely to be pretty dangerously untrustworthy.
Things get more complicated when it turns out you can have sex with those machines, and get them pregnant. Beyond begging the question of the definition of species, interbreeding produces a more obvious hybrid, a child who is simultaneously threat and promise. Named for a goddess and literally a savior, this miracle child becomes blood sisters with the dying Miriam and saves the prophet’s life; revived, the leader of the human remnant rescinds the savior’s imminent execution but fakes a death to remove her from her Cylon mother’s care—machines can’t be trusted.
Things get more complicated still when it turns out that the Cylons themselves are a stratified society: Cylon fighters are bred like animals, “toasters” take orders from “skin jobs,” and everyone alike is conveyed through space by sentient ships piloted by those whom the Cylons themselves refer to as hybrids—human brains hardwired into their ships, simultaneously pilot and vehicle.
But things only get really weird when it turns out that there really are angels walking among us.
How to make sense of this strange, unsystematic, non-taxonomy of unclassifiable creatures, none of them natural, and all of them, somehow, kin? There’s no certain path through this wilderness, no telos, no heaven, and no real Earth; the only thing certain, in this narrative, is that it has all happened before, and it will all happen again. The final, looming question is, simply, will it happen the same way? Or will we, somehow, construct a path through the wilderness that aims toward making that new world a liveable world, in which anthropoids, humans, Cylons, hybrids, and angels alike, dwell?
Saturday, August 22, 2009
When we lived in Chicago (1994 - 97) we worshipped with a very small congregation. There were two men who took turns leading singing, although neither of them had any musical training to speak of. Our congregation had conducted a study of women's roles in the church, focused on Scripture, and there seemed to be general agreement that many of the traditional restrictions against women's participation were not well-founded.
As it came to pass, there was a Sunday coming up when one of the regular song leaders was scheduled to preach, and the other was going to be absent. I was asked (ahead of time) to lead singing. Some time before, I had visited a friend's music store in Tupelo, Mississippi, and bought that pitch pipe. Just in case, I thought. It couldn't hurt to have one, I thought.
That certain Sunday, I put my pitch pipe in my pocketbook and when we arrived at church, our friend who was assigned to preach, took me aside and told me that he had spoken too soon in asking me to lead singing. The congregation was not ready. He had mentioned it to some who declared themselves "offended." (Don't get me started about what "offended" means in this situation.) He would have to preach and lead singing. I understood. (He is a dear friend, and he was embarrassed and upset by this development. I really did understand.)
I have never had a calling to preach, but when we lived in New Haven we worshipped at the Whitney Avenue Church of Christ, and at that time (1990 - 93, for me) that congregation allowed women to serve communion, which I did. Women also took an active role in worship planning and could serve as trustees of the congregation (we had no elders). I was proud to serve as one of the trustees there.
The thing I have most wanted to do at church--and feel I'm qualified to do--is lead singing. I have always loved to sing, and I sang in Lipscomb's A Cappella for four years. I am confident that any of the men who spent that much time in A Cappella have been asked to lead singing in their congregations.
Once a year, Chris and I attend the Society of Biblical Literature convention the weekend before Thanksgiving. There is always a Church of Christ worship service that takes place at the meeting; it is listed in the program as the "Churches of Christ Professors Meeting." The worship service is unplanned, except for the communion devotional. There is no sermon. At the beginning, someone calls the service to order and invites anyone who has a prayer, a hymn, or a reading to participate. Several years ago, D'Esta Love asked the organizer of the meeting if the announcement really meant, "anyone." And the answer was, yes. That year, D’Esta read the Annunciation as part of the service. It seemed to me the perfect choice, and it seemed strange and yet perfectly natural to hear those words spoken aloud by a woman’s voice.
The following year, several of us planned to participate in the worship service. We talked about it. There are a number of women who attend the conference as academics; they teach religion. Some of those women teach in places where their public participation in worship would not be welcome. There are others who attend as spouses. My husband does not teach at a Church of Christ school. It was safe for me to participate, safe in a way it would not be for others.
I thought long and hard about which song to lead. It had to be something I was comfortable with, vocally. It had to be an old standard, a song that everyone knows by heart--there are no song books. The words should be appropriate, but not self-aggrandizing. (I love the song, “Purer in Heart,” but that didn’t seem right. “It is Well With My Soul”--again, one of my favorites, but in this context, it seems a little too self-satisfied.) After much consideration, I chose “Whispering Hope.”
Soft as the voice of an angel,
Breathing a lesson unheard
Hope, with a gentle persuasion,
Whispers her comforting word.
Wait til the darkness is over
Wait til the tempest is done
Hope for the sunshine tomorrow
After the shower is gone.
Oh how welcome thy voice
Making my heart
In its sorrow, rejoice.
--by Alice Hawthorne
That Sunday morning, I was one of the first to lead a song. I wanted to go early, before I lost my nerve. My friend read a scripture next, I can’t remember which one. My heart was beating so loudly, I could barely hear her.
It is now 2009. I have led singing once in our church building, on ladies day a few years ago (we do not have ladies day every year). Several ladies made a point of telling me how beautiful the singing was, how meaningful my song choices were, and what a good job I did. Standing up there and hearing those women's voices singing, was one of the proudest moments of my life.
I have read scripture once, in a church. I was asked to read the scripture at my friend Bev’s wedding. She is a Methodist, and got married in a Methodist church. She asked me to read because she knows I am a Christian, and she wanted me to be involved in her wedding. I doubt if she realized that I had never read scripture in public before. I practiced ahead of time.
The congregation where we worship now (and have for the last 10 years) is very small and very traditional. Women prepare the communion trays, but they do not pass them in the assembly. Women do not preach, or lead singing, or pray in the worship service. They are a group of good and loving people, and they love us, despite our strange ideas.
When I go to church now I see the worship service partly through my father’s eyes. He is 86 and has Alzheimers, but he loves to go to church, and we take him with us most Sundays. Our little, small town church is familiar to him in a way that a more progressive church would not be. The hymns are familiar, and give him comfort. The rhythm of the service fits his needs. I am grateful that our congregation is accommodating to him, and feels like home.
The Church of Christ is my church, and I do not plan to leave. It is mine as much as theirs, and they cannot force me out. I was baptized at a gospel meeting in 1972. My mother, my father, my maternal grandfather, and my great-grandmother were all members of the Church of Christ. I grew up going to church three times a week and having the visiting preacher stay at our house every summer when he came to hold a meeting. Clyde Miller was the preacher at the Gideon Road Church of Christ when I was a baby, and Frances Miller was my first Sunday school teacher. I remember my father selling copies of Pat Boone’s books out of the back of his pickup at the Midwestern Children’s Home annual fundraiser. I went to Lipscomb and attended the Ashwood Church of Christ for four years, listening to Rubel Shelly preach the sermons that turned into the book, “I Just Want to Be a Christian.” I married into a family whose Church of Christ roots are deeper than mine, and I love them for it.
I have heard Katie Hays preach at the Cahaba Valley Church of Christ in Birmingham, at the West Islip Church of Christ on Long Island, and at the Lawrenceville Disciples of Christ. She is a wonderful preacher, and I wish I could hear her preach more often. I was so, so glad to be at several of the sessions at the Christian Scholars Conference where Katie, and André Resner, and Kathy Pulley, and D’Esta Love and others talked about their faith journeys.
Some folks who are dear to me have left the Church of Christ because their gifts were not welcome. I mourn the loss of those people. I do not need to know everyone’s reasons for going or staying; it is not mine to judge. I hope that in my lifetime, change will happen.
I still have the pitch pipe. I keep it in my sock drawer.
--Mary Lou Hutson
Friday, August 21, 2009
Last night Jon Stewart's interview of Betsy McCaughey was equal parts maddening and enlightening. The Daily Show cut off the interview when they ran out of time, but the uncut version is below (in two parts).
|The Daily Show With Jon Stewart||Mon - Thurs 11p / 10c|
|Exclusive - Betsy McCaughey Extended Interview Pt. 1|
|The Daily Show With Jon Stewart||Mon - Thurs 11p / 10c|
|Exclusive - Betsy McCaughey Extended Interview Pt. 2|
Note that Jon makes my point about epistemic trust. The issue is less about the actual wording of the bill than it is about the presumptions that control the interpretation of the wording of the bill. At issue: do you assume that the people writing health care reform bills are trying to reform health care, i.e. extend and improve access to health care for the citizens of this country, or, do you assume, like Betsy McCaughey, that this health care bill is a "Trojan Horse" for the nefarious intent to deny access to health care for those who now have it?
Unfortunately, though Stewart did ask "do you really distrust doctors that much?" to which McCaughey answered, "I distrust politicians"--he didn't follow up much further. Cynicism about politics I get. But surely it's not in the self-interest of career politicians to make nefarious plans to kill off their constituents--so how, even in the twisted worldview of those who believe human beings only ever act in intelligent and ruthless self-interest--how does it make any sense at all to assume that the writers of HR 3200 want to kill old people?
Regardless, there are two points of McCaughey's regarding the content of the bill that I want to respond to. First, she indicates more than once that there is a long list of specified interventions that the bill mandates that your doctor try to talk you out of. Here is the part of section 1233 I think she is referring to:
‘(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—.
‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;
‘(iii) the use of antibiotics; and
‘(iv) the use of artificially administered nutrition and hydration.’
Of course, there are other issues about whether this is "mandated" (I don't see that it is, and her arguments regarding indirect financial incentivizing seem a little stretched to me), and whether or not your doc is asking what you want versus talking you out of interventions (again, that trust thing. If you're that scared of your doctor, I suggest you find a new one). But on the single point of whether a bullet list of four item introduced with the phrase "may include indications respecting, among other items" constitutes a long list of specified interventions your doc must address? I don't see it. "May" still, I believe, remains a modal auxiliary verb indicating, among other things, permissibility, but not obligation (that would be "must"). I suppose though, like the word "mandatory," someone who's got skillz in reading this stuff can see where those words are crammed into the invisible subtext even when they're not there. (Ah, but that's that trust thing again.)
The second point she makes that I want to take issue with is that doctors will somehow be financially penalized if their patients don't adhere to the advance directives they create in consultation with their doctor, thus creating a situation in which people can't change their minds later if they want to. Leaving aside the discussion about financial incentivizing--which Stewart challenges her on--if her concern truly is to provide for a situation in which someone might change their mind about their advance directive, the bill itself provides for this:
‘(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.'
So there's no sense in which you only get one shot at making an advance directive, after consultation with your doctor which you don't have to pay for out of your pocket--paragraph 1 provides you can revisit this in any case every five years, but the paragraph above specifies that you can revisit your advance directive, in consultation with your doctor, more often in the event of getting terminally ill. So the scenario she paints, of your doctor collaborating with the evil politicians to talk you out of life-sustaining measures which you then cannot change your mind about later, is the opposite of what this bill actually says. Further, if you buy her financial incentivizing bit, you might could even argue that doctors have an incentive to revisit this issue with you at least every five years, and more often in the case of your getting terminally ill in some way. (But, you might not want to argue that to Betsy McCaughey; she would probably take it as further evidence that your doctor's being bribed by your government to kill you.)
P.S. I really hate the way she mugs for the camera.
Thursday, August 20, 2009
And apparently it's not just liberal kooks like me who find gun-toting to be disruptive to discourse in the public square.
From Bernard Kerik, 40th police commissioner of the City of New York and Iraq’s interim minister of interior following the fall of Saddam Hussein:
Allowing armed protesters to show up where the president is speaking is irresponsible and could cause a catastrophic security nightmare for those charged with protecting him.
It endangers the protective agents, the protesters, the public, and the president. It creates an immediate distraction as each armed protester then becomes a focus of observation for the agents.
Although Arizona and other states may allow the possession of these weapons, who can tell that the person carrying them at the time is not a threat to the president or others? An unidentified man who had a rifle slung over his shoulder told a reporter for the Arizona Republic, that “I still have some freedoms,” and he may be right. But freedom to create alarm and a possible threat to the president is not one of them.
Use some common sense.
That man may have no ill intent and possess his weapon legally, but what if someone not so nice takes it away? Why create scenarios where the protective agents focus is instinctually aimed at the weapon’s carriers? What if there is an accidental discharge by someone who is not that proficient with his or her weapon that creates a stampede or serious distraction?
No responsible gun owner, law enforcement executive, or public official should endorse or allow these armed protests anywhere near the president.
The president and his staff should let the Secret Service do its job, regardless of political correctness, and Department of Homeland Security Secretary Janet Napolitano should ensure that the president is protected at all cost . . . and if that includes stepping on some protester’s toes, so be it.
I’m all for the Second Amendment and our right to bear arms, but not at the cost of endangering the president. This is a dangerous practice and it must be stopped.
Wednesday, August 19, 2009
One minor thing I personally hope for out of health care reform? No more sexist commercials for nasal spray on my TV. And maybe even no more ads for meds, period: depression meds, weight loss, aspirin regimens, erectile dysfunction pills, hormone replacement therapies, osteoporosis treatments, you name it, quit telling me to ask my doctor about whatever drug you want me to pay exorbitant amounts of money to put in my body that I probably don't need.
But especially, quit with the sexist commercials about how armies of masculine meds can fix my permanently out-of-whack female body. Vaginas, even analogical ones, ought to be off-limits for TV commercials.
Here's why, no matter how much I agree with Frank's outrage, his reaction was the wrong one.
She's still "crazy," and even more convinced that 1) she's justified in her "crazy" and 2) she was not given a fair hearing by Frank (and by extension, Obama and his administration).
That Hitler-mustachioed Obama poster is more important to her than ever. She's more entrenched in her opinions than ever. She's more convinced that the gov't is fundamentally untrustworthy and indifferent to her opinion than ever. She's more afraid of her perceived encroaching disempowerment and marginalization than ever. So she, and everyone else who fits this description, will be shouting louder, about Nazis and death panels and abortion mandates and whatever, than ever.
It's just more dialectically and epistemologically complicated than people in favor of health care reform want to admit. Olbermann wants to ask "why are people believing these lies?" without delving into the fact that this is the wrong question, or at the very least, the wrong way to ask this question. It's an alienating question, and perceived alienation is precisely the problem! Why don't you just dump some lighter fluid on the conflagration of crazy, then, and act all outraged when what you get back is an out-of-control wildfire.
Rachel Maddow did a better job last night on this, putting together the fact that these wildly divergent perceptions on health care are demonstrably linked to which information sources are trusted. But all the way through the segment, it's "off-the-kook-end theories" and "it's wrong, it's just not true, they exist in their own mini-verse." And then, it's Bill Maher who's invited to comment on this phenomenon, who of course is not at all provocative, and is totally nuanced. (snort.)
Can we please, please, please stop giving people excuses--no, rational justifications--for remaining in their epistemic mini-universe? Don't we want them to come out of the mini-verse? Why should they, when at every opportunity, we mock them and call them crazy and insult their FoxNews and their trusted pundits? When we say to them, "what planet do you spend most of your time on?"
I'm not saying we shouldn't be challenging these demonstrable falsehoods. Of course that needs to happen. But it flat-out doesn't matter if that's the first and only thing that happens. It doesn't matter if someone you don't trust anyway tells you that the people you do trust are lying. It doesn't matter if someone you don't trust tells you your firm beliefs and perceptions are false and distorted. It doesn't matter. It gets tuned out. And when the frustration mounts and the people you don't trust call you crazy, well, that just goes to show that you shouldn't be trusting them anyhow.
So next time, when someone like Frank confronts someone like that woman in the video, and says, "I'm going to answer your question with a question," please, please let it be this question:
"What do YOU want out of health care reform? Because I'd like to know."
Tuesday, August 18, 2009
Why I'm in favor of health care reform--Crunchy Con
The author of the article linked above quotes at length from an interview of Wendell Potter, the former Cigna exec who's been saying to everyone who will listen why he favors health care reform. From the interview:
Guernica: Shifting to President Obama's plan: critics often say that Obama's healthcare plan would be detrimental to care because it would take decisions away from doctors and patients and put them in the hands of a government bureaucrat. Is this a legitimate concern?
Wendell Potter: No. But it is one of those talking points the industry repeats every time we have a debate about reform. They said it in 1993. They say it whenever the industry is under threat of increased government involvement. What I'm telling people is that our current reality is far scarier than the fear-mongering. What people have now is a corporate bureaucrat who stands between a person and his or her doctor. That's much scarier than the specter of more government. In any event, there is nothing in any healthcare plan that is being proposed that would put a government bureaucrat between a person and his or her doctor.
Guernica: Why is a corporate bureaucrat scarier?
Wendell Potter: Because every person who works for a for-profit company knows that the company has to meet Wall Street's expectations. Every manager of the company has to pull his or her weight to make sure he and his team are doing all that they can to help the company meet that objective. That includes medical directors. Same with the nurses. They know what the company has to do to meet Wall Street's expectations and to stay in the good graces of investors.
Guernica: So in other words, corporate bureaucrats have a profit incentive to deny care to people who are enrolled in their plans.
Wendell Potter: Absolutely. It doesn't have to be stated directly to them that you will be paid a particular bonus if you deny X number of claims; it's known, and it's part of the culture.
It's also worth re-posting here a bit from factcheck.org:
We would note, as does Obama, that denials of coverage are routine among private health insurance companies and under Medicare in our current system, and we asked McClusky [of the Family Research Council] about that. Why would such decisions about care be more objectionable under a public plan, for instance, than they are when Aetna or UnitedHealthcare denies coverage? "We find it more troubling when the federal government is doing it," he said. "It’s the 800-lb gorilla."
Of course, the 800 lb. gorilla claims it wants to provide, not deny, access to insurance and health care coverage, but hell--who believes what the 800 lb. gorilla says? Oh, unless it's the unlikely spokes(notquite)person for an insurance company chatting you up in the sauna. That 800 lb. gorilla, you can trust. He's got a profit motive, after all.
Monday, August 17, 2009
Well, if I were the one in charge of the secret lethal army of Metal Ones, I certainly would send them out for the babies and the old people first. That would leave all the angry able-bodied people around for a nice Terminator-style fight for the earth. It's good strategery.
All right, so I know that the sarcasm isn't really being very nice. There's a reason my sister gave me the secret super-hero name of "Sarcastro." I try to delete all such commentary when engaging in real dialogue with people who disagree--it's hard, and sometimes I miss my aim, but I do try. But this is my blog, which I began, after all, as a venue for saying whatever the hell I wanted in a desperate experimental attempt to really find my voice. Which, as it turns out, is really sarcastic. Who would've thunk.
Anyhow, I was reminded again today that US health care stats include a shamefully high infant mortality rate.
And I can't help but think of the awful, awful irony of people so completely convinced that it's reforming this health care system that's going to kill babies.
Get it straight. I love babies. I want to have more of them myself. I want to have more babies in the same serene, beautiful way that I gave birth to my first ridiculously healthy little girl. I want every woman who has a baby to be able to give birth in that same empowering way I did--that is to say, with her agency intact, with say-so over her environment and her body, celebrating the advent of life into the world. I want this for every woman regardless of the circumstances of conception. I want this for every woman regardless of whether or not she can pay for it or has insurance for it. I want every pregnancy and every birth to be the beautiful, spiritual, bodily experience it should be. I want every pregnancy to culminate in that. Every single one.
That's not how it is.
And, of course, that's not how it will be, no matter what kind of reform finally gets enacted, because that's my ideal. But I think we could be a helluva lot closer to that ideal than we currently are.
And the first step to moving closer to the ideal is simply recognizing how far we currently are from it, recognizing that having the highest mortality rate of any developed country means that babies are dying. And maybe that, in some undesired, unintended way, if we do nothing about it, if we refuse to recognize that, then we are all baby-killers.
Friday, August 14, 2009
You can find the full text of this bill online here. The "death panel" section follows below.
SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
(A) in subsection (s)(2)--
(i) by striking ‘and’ at the end of subparagraph (DD);
(ii) by adding ‘and’ at the end of subparagraph (EE); and
(iii) by adding at the end the following new subparagraph:
‘(FF) advance care planning consultation (as defined in subsection (hhh)(1));’; and
(B) by adding at the end the following new subsection:
‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
‘(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
‘(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--
‘(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
‘(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--
‘(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--
‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;
‘(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;
‘(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
‘(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
‘(2) A practitioner described in this paragraph is--
‘(A) a physician (as defined in subsection (r)(1)); and
‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.
‘(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).
‘(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
‘(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.
‘(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--
‘(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.
‘(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—
‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;
‘(iii) the use of antibiotics; and
‘(iv) the use of artificially administered nutrition and hydration.’.
(2) PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting ‘(2)(FF),’ after ‘(2)(EE),’.
(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--
(A) in paragraph (1)--
(i) in subparagraph (N), by striking ‘and’ at the end;
(ii) in subparagraph (O) by striking the semicolon at the end and inserting ‘, and’; and
(iii) by adding at the end the following new subparagraph:
‘(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;’; and
(B) in paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’.
(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.
(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-
(1) Physician’S QUALITY REPORTING INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:
‘(3) Physician’S QUALITY REPORTING INITIATIVE-
‘(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.
‘(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.’.
(c) Inclusion of Information in Medicare & You Handbook-
(1) MEDICARE & YOU HANDBOOK-
(A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:
(i) An explanation of advance care planning and advance directives, including--
(I) living wills;
(II) durable power of attorney;
(III) orders of life-sustaining treatment; and
(IV) health care proxies.
(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including--
(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);
(II) website links or addresses for State-specific advance directive forms; and
(III) any additional information, as determined by the Secretary.
(B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.
Don't forget: April 16, it's time to dust off that Grim reaper costume and go scare some old people.
Okay, joking aside. This is the kind of information that ought to make a difference. If you can get past the fact that I picked it up from Rachel Maddow, whom I consider to be the awesomest chick on TV, and have a little "trust, but verify" attitude with the following, maybe the whole death panel thing can finally, um, be laid to rest. (RIP.)
WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions.
WHEREAS, in Alaska, Alaska Statute 13.52 provides the specifics of the advance directives law and offers a model form for patient use.
WHEREAS, it is estimated that only about 20 percent of people in Alaska have executed an advance directive. Moreover, it is estimated that less than 50 percent of severely or terminally ill patients have an advance directive.
WHEREAS, it is likely that a significant reason for these low percentages is that there is both a lack of knowledge and considerable confusion in the public about Advance Directives.
WHEREAS, one of the principal goals of Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities, and hospices to participate in a statewide effort to provide clear and consistent information to the public about advance directives, as well as to encourage medical professionals and lawyers to volunteer their time and efforts to improve public knowledge and increase the number of Alaska’s citizens with advance directives.
WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives.
WHEREAS, as a result of April 16, 2008, being recognized as Healthcare Decisions Day in Alaska, more citizens will have conversations about their healthcare decisions; more citizens will execute advance directives to make their wishes known; and fewer families and healthcare providers will have to struggle with making difficult healthcare decisions in the absence of guidance from the patient.
NOW, THEREFORE, I, Sarah Palin, Governor of the state of Alaska, do hereby proclaim April 16, 2008, as:
Healthcare Decisions Day in Alaska, and I call this observance to the attention of all our citizens.Dated: April 16, 2008
Wednesday, August 12, 2009
The folks behind Ameritocracy, which I blogged about last year, have been developing an app called "Insight" for use on individual websites which provides a space for the same kind of feedback ameritocracy.com did, only this time, it's website content that can be responded to, questioned, and evaluated by your readers.
It's not really meant for a little personal blog like this one, probably. But as it's in beta testing and free right now I thought it would be fun to use for awhile.
Look down at the bottom of the page, and you should see a little bar that invites you to highlight text and give your feedback. I think you will need to become a part of my "group," which I named "posthumans for a liveable world," and feedback, in the form of questions or comments or facebook-like quick ratings (think the "like" button Facebook status updates, only with more options) is displayed on the group's page.
I think what I like most about the app is that is highlights some of the basic functions of any epistemic community and the way that knowledge is collectively constructed by those that are a part of it. All of the same things happen in the commentary already to be sure, but the app makes it a little more obvious how/why pieces of knowledge get constructed the way they do, by making explicit evaluations and sources of info, etc.
So, if you're as into social epistemology as I am, enjoy! If not, you can still join us posthumans in our attempt at constructing a liveable world. I mean, the more the better...seriously.
Dance of the Devoted Daughter, by Rhesa Higgins.
What do you know about the proposed health care reform? Where did you learn it from? What's your source, and how do you know they're trustworthy?
Because here's the thing, right. I'll visit www.healthreform.gov, and read there that
"President Obama is committed to working with Congress to pass comprehensive health reform this year in order to control rising health care costs, guarantee choice of doctor, and assure high-quality, affordable health care for all Americans. The Administration believes that comprehensive health reform should:
- Reduce long-term growth of health care costs for businesses and government
- Protect families from bankruptcy or debt because of health care costs
- Guarantee choice of doctors and health plans
- Invest in prevention and wellness
- Improve patient safety and quality of care
- Assure affordable, quality health coverage for all Americans
- Maintain coverage when you change or lose your job
- End barriers to coverage for people with pre-existing medical conditions."
This issue of epistemic trust is huge. When it's present, honest, productive exchange of ideas really can occur, because even if there's disagreement there's a common sense that all participants are honest, that they are representing themselves truthfully, and that you can trust what they say is what they mean. And this is precisely what we do not have right now.
That's the diagnosis. What's the solution?
Frankly, I'm at a loss. I don't know what could possibly fix this. But here's my attempt. Let's stop the shouting for a minute and just ask ourselves: is there a reason to distrust each other?
Is there a reason to distrust each other?
Is there a reason to trust each other?
Here's mine: we all live here. We all live here, and the laws that the representatives we've elected and empowered enact affect all of us. We all have a stake in this, and when we're talking about something as personal and basic and life-and-death as health care, we all have a huge stake in it. This seems to me to be reason to trust. Reason to assume that everyone has an interest in seeing this come out well. Reason to trust that it benefits everyone to sit down and list out what currently doesn't work about our system, and that it benefits everyone to brainstorm ways to fix it, and then talk about it until the best one of those ideas surfaces through the process of collective discernment. Or, as it is also known, democracy.
Monday, August 10, 2009
I can't help but think of the difference between the Christian principles being lived out by Mission Lazarus folk and the outcry against healthcare reform in our own country--an outcry which, in its myopic focus on the bottom line (and that's skipping the idiocy of unfounded clinging to false rumors about ridiculous things like "death panels"--I mean, really? hey, did you know the Metal Ones are also coming for you? anytime now, and they'll be funded by Obama's health care death panel) forgets that the bottom line is not money, it's sick people. I can't help but wonder if some of the same people who support Mission Lazarus and efforts like it are protesting health care reform for the American poor, even while they applaud my sister and her coworkers for taking care of the poor and the sick--somewhere else. I can't help but wonder if pointing out the irony will force a reconsideration of the Christian principles at stake here.
But then, not that many people read this blog. And those that do probably aren't afraid of the Metal Ones anymore. :)
Saturday, August 08, 2009
The outline form didn't paste in very well, so the structure of my sections and sub-sections is a little unclear, sorry. But I'm assuming no one will really care. I'm just posting this as a little bit of unashamed self-congratulation.
Part One: The Posthuman: Two Manifestos
Chapter One: The Cyborg Manifesto
Of This and/or That: the cyborg as transgressor of boundaries
Of (Mother?) Nature: nature and the posthuman
Of God the Father: religion and the posthuman
Of Mice and Men: politics and the posthuman
Chapter Two: The Transhumanist Manifesto
On Being Better than Well: Transhumanism
The Hedonistic Imperative
On God the Father: transhumanism and religion
On (Mother?) Nature: transhumanism and nature
On Mice and Men: transhumanism and politics
Part Two: Theological Anthropology and the Posthuman
Chapter Three: Post-anthropologies
Heart & Soul: materialism/dualism
Know Thyself: epistemology
Thy Sister’s Keeper: kinship
Chapter Four: Theological anthropologies
Imago Dei: the plastic image of God
The Bible tells me so
Thing, Action, Relation?
Human Nature, Mind, and Soul: substantive interpretations
We are what we do: functional interpretations
Not I, but We: relational interpretations
Human Uniqueness: Alone in the World?
Human Agency: Sin and Redemption
Chapter Five: Transversing: theologians engaging posthumans
Cyborg and theology
Anne Kull: TechnoNature
Elaine Graham: Theological Anthropology On the Edge
H+ and theology
Elaine Graham: Transcendence into an ‘Imaginary of Death’
Brent Waters: Just Say No
Ted Peters: Techno-optimism and the Doctrine of Sin
Steven Garner: The Hopeful Posthuman
Chapter Six: Constructing a Theological Post-anthropology
Relational, Embodied, Hybrid
The Turn to Relationality
“Medical Cyborg” Theologies
Queer Cyborg Theologies
Postcolonial Cyborg Theologies
Part Three: Christology and the Posthuman
Chapter Seven: Christology and the Posthuman
The Cyborg Christ
A Little Talk about Jesus
Trickster Figure and Hybrid Creature
Quest for the Hybridized Jesus
The Mestizo Future
The FemaleMan and the GodMan
The Ultimate Human
Wednesday, August 05, 2009
Baptist Leaders Face Challenge on Women's Roles
h/t to jonmower.com
Tuesday, August 04, 2009
Brent called from the plane after it landed, and Clare took the phone and said, "I love-love-LOVE you Mommy all the time!" This is something I say to her a lot: that I love her all the time, all day long, all night long, when I can see her and when I can't, when she's far away and when she's near, when she's mad or frustrated, or when I'm mad and frustrated, all the time, everywhere, no matter what.
It was nice to hear it back. Even if it has to be over the phone.
Sunday, August 02, 2009
There's also a widget in the sidebar that will take you to the Just Love Coffee Roasters website. Just Love Coffees is more than just a place to get your fair trade, specialty coffees--the vision behind it is both personal and global. You can read about my cousins, Rob & Emily Webb, their story of adoption and the motivation for starting Just Love Coffees, here.
I was thrilled to be able to meet my new first-cousins-once-removed on my recent visit back home to middle TN. Communication mostly took place in shy smiles and grins, since my Amharic is, well, non-existent. Can't wait till next time, and neither can Clare.
Till then, Just Love Coffees is, I hope, going to be our coffee-supplier-of-choice as soon as it's up and running in the Fall. So if any of you are needing a supplier, well, I know a guy. Yeah, my cousin, just lemme know, I can hook you up. (imagine me imitating Jon Stewart's NJ routine here)
I know I'm not the only in need of a daily morning and afternoon fix. Let's use our addiction to make the world a more just and loving place, shall we?