miércoles, 18 de octubre de 2017

Breaking the golden thread | MercatorNet |October 18, 2017| MercatorNet |

Breaking the golden thread

MercatorNet |October 18, 2017| MercatorNet |





Breaking the golden thread

A palliative care physician says that very, very few people ever ask for euthanasia
Ghauri Aggarwal | Oct 18 2017 | comment 



Associate Professor Ghauri Aggarwal
Last month palliative care specialist Ghauri Aggarwal spoke at a seminar on palliative care and assisted dying organised by MercatorNet at the New South Wales Parliament building. This is a slightly abridged version of her presentation. 
********
We are lucky to live in the 21st Century. Curing and prevention of disease and prolongation of life are achievable. We look to medicine to save our lives and to live longer.
The consequence, however, is that the community expects this, even demands this. And if it is not available they are terrified.
What is it that they are terrified of? Dying badly, dying without control.
People often ask me why I chose Palliative Care as my medical specialty. I was drawn to this area of death and dying when I was a medical student, even before it was recognized as a specialty in Australia. Palliative care had certainly been practiced in hospices and hospitals for decades but it was not mainstream medicine or a discipline of its own.
Even as a student I saw that people at the end of life were not adequately cared for, their dying was often not diagnosed, and distressingly they were avoided by doctors if they did not know how to care for them. When the rest of medicine was rapidly moving forward, the dying were often neglected. Their suffering was not a priority.
As a young clinician I saw the art of caring for people. I witnessed the distress that disease, symptoms and the terminal state may bring -- not to all but to some. What I learnt was that I had a precious commodity: time, conversation and the building of trusting relationships. I then laboured hard to marry the science of medicine and the art of caring.
After 22 years as a senior palliative care specialist, I know the tremendous healing power of my relationship with my patients. My expertise is needed to help, to heal, to comfort, to palliate. We palliative care specialists need to educate all health care workers.  
Alleviating pain 
Often pain and other symptoms are cited as the biggest areas of concern for people approaching the end of life. But significant advancements have occurred. Patients are often surprised that pain and symptom control can be managed well until the end. We have the ability through good, evidence-based medicine, determination, and expertise in using drugs.
But the suffering that is most common at the end of life is usually beyond physical pain. It is the fear of losing independence, the fear of being a burden to others, the fear of dying.
Let me give you an example.
A thin, cachectic woman dying from bowel cancer lies in our palliative care unit surrounded by her daughters. There is laughter in the room, chatter of memories from before, love and stories.
When I walk in, the atmosphere changes to a serious one. “I want it to end now,” she says. “I wish you could do something for me. I don’t want to carry on.” We spend the next half hour or so teasing out the symptoms, the pain, and the fears. She does not have much pain, although she is weak and tired, so we adjust the medication. She is a lot more comfortable now.
After we walk out, the laughter, conversations, and memories continue. And every time the nurses or the social worker or the doctors walk in, the request is repeated. Soon there is banter between patient, staff and family.
The request is less robust now. I suspect that she is saying it out of habit. The family continues to keep vigil. The daughters say: “This is a precious time for us with Mum. We’ve talked about things that we had forgotten. We remember now.” She dies a few days later.
We hadn’t dismissed her request; we hadn’t avoided her room. We engaged with her and she began to trust us. Her original request was because she feared losing her independence, being a burden to the family and staff and not being as active as she once was. She endured and continued to engage during a very precious time. She was comforted by the certainty of knowing we would be there to provide the care she needed. For her daughters their bereavement will be easier because they were able to spend that precious time with their mother.
A web of care
Over the last three years our department has looked after 1,200 people who have died --  400 deaths every year, at least one every day. The experience that my staff and I have is significant. And despite the large number of people we look after, 99 percent of our patients will never ask for their lives to be ended prematurely. And if it is mentioned once, often it is not repeated.
Palliative care requires experience, expertise, communication skills, and a deep understanding of patients’ true fears and concerns. It is a relationship of trust. If this sacred trust breaks, the healing, the care, and the expertise are lost. So much can be gained by this trust, and so much lost if there is fear instead of trust.
The story of M
When I met M, she said to me, “I know I have cancer, I know I have a short time to live and I want euthanasia. I come from the Netherlands, my son lives there, I have no one here. If I was there, I would be able to, but I’m here, so help me.”
She looked well when we first met. Over the next few weeks we met on a regular basis. She decided that she would not accept further treatment and that was an appropriate choice for her. She decided what medications she would consider.
I got to know her as a person. Every time we met she would say, “when the time comes I will have euthanasia.” We talked about her goals and priorities in life.
She was terrified of dying in pain and terrified of dying alone, a burden on people she did not know to have to take care of her. Within a month of the diagnosis of lymphoma (a potentially treatable disease, but she decided not to have any treatment, a choice we supported), she started to become weaker.
Our conversations grew deeper and I understood her more, but she still asked for euthanasia on most occasions. Her son from the Netherlands came and went back home. She did have pain but she accepted pain relief.
And then she stopped requesting euthanasia. She was not in physical pain; it was the notion of “on her own terms” that she wanted. In the end she died under our care, not neglected, not abandoned, not alone and not in terrible pain.
Because euthanasia was part of the care offered in the Netherlands, there was an expectation that she would and even should request it. She wasn’t aware of the alternatives. Our conversations explored her fears, her care needs and her options. She was comfortable with this at the end, but it took time, effort and expertise.
What if her life had been truncated because she believed that it was expected of her, even before the symptoms emerged and even before she needed care?  
Who asks for euthanasia?
As I said, of the thousand patients that I care for each year, very few ask for euthanasia or physician-assisted suicide. Most ask us to stop aggressive treatments that aren’t helping them or that are causing side-effects. Sometimes they are frightened of the end and want reassurance of care or they insist on a natural completion of life. “Don’t do anything to prolong my life.” they say. This is appropriate; this is a good choice for them. This is not euthanasia.
“You wouldn’t let your dog or cat die like this, why can’t you end it now?” the daughter of Mr N screams. The wife sits by his bedside exhausted. The vigil continues. He is not in pain, he is asleep, he is not agitated, but there is grief in the air. The daughter asks again and then she says, “I can’t take this” and runs out. The mother comments, “she is struggling but he would never have wanted it” (euthanasia, that is). “I cherish the time we have together till his last breath”.
There are many agendas in that room; the dying man, his wife, the daughter, the doctor, the nurse. Whose voice is the loudest? Who dictates what should happen? This is often the scenario. The request does not originate with the patient but with the grieving family waiting for the pain to end.
So, when the community calls for the premature termination of life, let us remember the grief is often our own personal loss, our own sorrow, our own fears.
When those rare requests are asked of me, most actually come from relatives of dying patients. There is grief, there is sorrow and it is deep and difficult for them to bear.
But our relationship reassures them that we will never abandon them. They become more comfortable in their dying weeks and days with this empowerment. They don’t ask again because we have a care plan; we have developed a relationship; we have responded to their deep fears. Often with the touch of care and the art of deep conversation, a tremendous trust is built up that becomes hugely therapeutic.
The suffering does not go away completely but patients find answers, care and the strength in the relationships that they still have.
The myths surrounding palliative care
There are so many fears and myths around palliative care. This is what we face more often than a request to end one’s life. The fear of starting morphine, the fear that palliative care means euthanasia, the fear of not having everything done for them.
There is increasing research and evidence in this area of medicine that show these views to be incorrect. But the myths prevent patients from accessing the good care and expertise that they need.
Many patients come to us with the thread of trust and faith in health care already broken and frayed because of broken promises of a cure or longer survival or toxic treatments. Most are due to a lack of honest discussion, expertise in deep conversations, dismissing of what cannot be fixed.
It is our job to repair these fractures. Time, education of colleagues and resources are required. Surely this is important, worth investing in, worth finding resources. This is my call for action: let us care for people, not end their lives prematurely because our society cannot budget the time, resources, and expertise for this vital work.
Voluntary assisted dying is the ultimate medicalisation of death. It is added to the list of clinical options when doctors lack the time and expertise to deal with complex suffering. It becomes an easy, off-the-shelf procedure for time-poor, resource-poor, expertise-poor physicians. Is that the kind of society we want to live in?
The golden thread of trust between patient and doctor must never be broken. If the option of prematurely ending lives become available, this will increase the fear for most of our patients. It will prevent me from developing this vital trust with all my patients.
This thread of trust gives comfort, security, and symptom control. And those few that still suffer will not be abandoned. We will continue to walk beside them in the most private and vulnerable journey of their lives.
Associate Professor Ghauri Aggarwal is Head of Department, Palliative Care, at Concord Hospital, in Sydney.
MercatorNet

October 18, 2017

"Of all the dispositions and habits which lead to political prosperity, religion and morality are indispensable supports." This ought to ring a bell for American readers; it is drawn from George Washington's Farewell Address to the nation.

Pat Fagan, of the Marriage and Religion Research Initiative, points out in our lead story today that "Just as calcium is needed for strong bones religious practice is needed for good citizens. The monetary costs of extra burdens will be enormous."

As the proportion of religious "nones" rises in the US and other Western countries, can we be sure that it will lead to Washington's "political prosperity"?








Michael Cook
Editor
MERCATORNET
After Weinstein, what?

By Michael Cook
One path leads to bigger rulebooks. The other leads to a revival of chastity

Read the full article
The rise of the ‘nones’ spells disaster for human capital

By Patrick F. Fagan
Without religion other human goods are at risk.

Read the full article
The UK must be stopped from pushing transgenderism on children

By Simon Marcus
Dramatically rising numbers of children are already coming out as transgender

Read the full article
Breaking the golden thread

By Ghauri Aggarwal
A palliative care physician says that very, very few people ever ask for euthanasia

Read the full article
Taking apart the news cycle merry-go-round

By Heather Zeiger
How can we escape from the nagging anxiety that we’re not worrying enough?

Read the full article
Why is there a mental health crisis?

By Nicole M. King
Lack of government funding is blamed, but research points to family connections.

Read the full article
His standards or hers? How men and women define success

By Susan Pinker
Do we still expect the majority of women to adopt male-determined goals as their own?

Read the full article
This college professor is under siege for challenging transgender orthodoxy

By Jarrett Stepman
But almost no one is engaging with his ideas

Read the full article
The New Zealand baby dearth

By Marcus Roberts
Another example of declining birthrates in a western country.

Read the full article





MERCATORNET | New Media Foundation
Suite 12A, Level 2, 5 George Street | North Strathfield NSW 2137 | AU | +61 2 8005 8605
Breaking the golden thread

The UK must be stopped from pushing transgenderism on children | MercatorNet |October 18, 2017| MercatorNet |

The UK must be stopped from pushing transgenderism on children

MercatorNet |October 18, 2017| MercatorNet |





The UK must be stopped from pushing transgenderism on children

Dramatically rising numbers of children are already coming out as transgender
Simon Marcus | Oct 18 2017 | comment 1 



Earlier this summer Justine Greening, the UK's Secretary of State for Education and Minister for Women and Equalities, announced that gender could be legally changed without any medical diagnosis, promising publication of a consultation on her proposed Gender Recognition Act this autumn.
Her initiative has rightly been criticised, see here and here, for uncritically following the new gender ideology (pushed by various interest lobbies, some of which are state-funded) which has it that some people are born in the wrong body and we are (and should be able to be) the gender we feel ourselves to be.
Medics have already described her zeal in applying this thinking to policy as unscientific, dangerous and part of a wider social strategy.
It is a strategy that is already having a disturbing effect. As if in a self-fulfilling prophecy, dramatically rising numbers of children are coming out as transgender. Instead of viewing this as a cause for concern, Greening plans to push these ideas on even younger children. Her Children and Social Work Bill will make sex education, along with 'personal, social and health education’, compulsory in all primary schools in Britain. It might sound relatively innocuous, but the Women and Equalities Committee which advises Greening says, in paragraph 361 of a recent report, that this means teaching 'trans issues’.
Further, some of the trans activist groups who have influenced this report may be doing the teaching. The Gender Identity Research and Education Society (GIRES) is a transgender (TG) support charity that offers training to schools, police, law firms and health professionals. Their lessons, for children as young as three, are designed to be read out loud by a teacher. One such is about a penguin ‘whose gender identity as a girl was not immediately understood by her family; they thought she was a boy’.
For seven-year-olds they have a story about Peter, whose parent ‘has transitioned to live as a woman’, and for 11-year-olds there are lesson plan debates on ‘the Gender Question’ in which ‘one pupil could be given the task of defending the decision to operate on the infant to create a female appearance and to raise the child as a girl’.
Another trans advocate group, Gendered Intelligence, advises the Women and Equalities Committee. Their booklet for 16-year-olds explains that 'A woman is still a woman, even if she enjoys getting blow jobs. A man is still a man, even if he likes getting penetrated vaginally. How you have sex need not affect your identity’.
It beggars belief that Justine Greening or any member of the Women and Equality Committee think such a casually crude discussion of sex, for trans people or otherwise, is appropriate.
GIRES has also produced an e-learning module, funded by the NHS, for teachers and health professionals. It gives as an example a little girl called Masie who says she is a boy. Trainees are given no option to ask why. Masie's belief is automatically to be accepted with name, clothing and pronoun changes in a process known in the USA as 'social transitioning'  to reinforce this belief through peer groups, parents and school.
Children’s brains are vulnerable and suggestible, which is exactly why law courts are so cautious before children are asked to testify on this matter. From around the age of three children both mimic adults and trust their authority. Children also follow the group’s behaviour. They cannot fully understand cause, effect or consequences. It is frightening that the Department for Education has so little understanding of children’s development stages.
It should know that children as old as six use ‘magical thinking’, form false concepts and perceive fantasy as reality, Father Christmas being the prime example.
It should know too about the neuroplasticity of the brain as it develops. This is the scientific term to explain the process by which our brains experience lasting change in response to environment, a process which continues into and through teenage life. By the time Masie approaches her teens, 'social transitioning' may well have hardwired her brain. She will ‘know’ she is really a boy and be desperate to avoid puberty.
Some believe the ‘social transitioning’ process builds in a need for each new stage of transition, as the fear of being trapped in the wrong body grows – firstly with puberty blockers, then with cross-sex hormones and finally with surgery.
It is no surprise, then, that kids are ‘coming out’ in clusters where schools promote the trans agenda, and that therapists are seeing patterns of 'social contagion' in ‘sudden onset gender dysphoria’ where teenagers binge on Tumblr, Reddit or YouTube. TV may well have had an impact, too, with several clinicians noting how children claimed the BBC documentary Transgender Kids 'made me realise’.
From school to gender clinic, a pipeline is under construction and medical treatment is changing too. Until recently, most therapists in the USA took a cautious approach to children with the condition described by medics as gender dysphoria.
The view was that by looking at deeper problems patients could be helped to accept their own bodies, and that the evidence showed most such children grew out of their feelings.
But after years of lobbying by trans activists in the US, a frightening new orthodoxy has taken over which decrees that children as young as three know their internal gender identity but which, at the same time, fails to acknowledge that ‘transitioning’ can lead to depression and even suicide later on.
Many leading health professionals in America are now advocating this new approach, ‘gender affirmation’, which unquestioningly accepts a child’s claim they are in the wrong body. Some therapists are even introducing this idea to children who may not have thought of it.
Further, in an act of inverted logic, nine states in the US have banned therapy aimed at changing the 'sexual orientation' of minors . If a five-year-old girl feels she is a boy it may be illegal for a therapist to question this, and some have been sacked for doing so.
This legal, medical and political lock-out of dissent in the US is covering up serious problems. Firstly the entire premise is false. Long-standing research into identical twins shows the ‘wrong body’ concept simply has no basis in science Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation.
Secondly there is the question of the increasing numbers who realise that changing their gender was not the answer and now want to de-transition. There are also reports of botched surgery, and some are left unable to achieve orgasm. The risks of hormone treatment, too, are dangerously under-researched, while many patients simply don't understand the reality of gender transition. This consent form from a UK transgender clinic tells you all you need to know about the world of unknowns that they are signing up to.
Thirdly, up to 75 per cent of children with gender dysphoria can have pre-existing mental disorders such as anxiety, anorexia, depression or autism. Some feel they were misled by therapists who ignored these underlying issues, using transition as a cure. Many remain depressed and suicidal after surgery. Also disturbing is the rise in young girls coming out as transgender, given the high levels of body disorders among this group.
Finally, the internet is a source of dangerous advice too. Some sites advise on how to bind your chest, and then there are the internet chat rooms, described as cult-like, where confused youngsters are encouraged to hate their bodies.
No wonder some medics in Europe remain cautious and others in America believe there is a better way.
Doctors at Britain’s leading children’s gender clinic are also increasingly concerned about early intervention, as is Dr James Barrett of the Charing Cross clinic. Thankfully, the NHS still prioritises psychotherapy for children with gender dysphoria. Doctors at the Tavistock Clinic, too, remain cautious about physical intervention, and emphasise that ‘most prepubescent children with gender dysphoria will have a different outcome in adulthood’.
Yet parents are being given a misleading choice of suicide or transition for their children. UK trans activists, often with no medical qualifications, are pressing ahead. Professionals in both public and private sectors are under huge pressure to accept their trans agenda. Most recently reported is a ‘Memorandum of Understanding’ drawn up by a working group of health professional and trans lobbyists, to take effect next month in the UK, which will effectively prevent a therapist from exploring any reasons underlying a referring patient.
Politicians hungry for the youth vote or keen to be seen as 'social justice warriors' need no persuasion. Greening’s Children and Social Work Act is going through Parliament, so it may not be long before 'wrong body' theories with little more scientific evidence than creationism are taught to every child in the country.
There is time still. Justine Greening must wake up and look at Australia, which saw a spike in confused and depressed children after state schools introduced this agenda. Dr John Whitehall of West Sydney University called it a ‘massive intrusion into the minds and bodies of children . . . It’s a collective madness. There, parents led a petition and funding was withdrawn.
Here, an apparently irresistible force of politicians and activists is on the march, determined to turn a medical condition into learned behaviour and teach it to every child in the country. Vulnerable and lonely youngsters caught up in Britain’s mental health crisis risk seeing gender transition as the answer. Unable to give truly informed consent, many will embark on a life of hormone treatment, surgery and untold difficulties. Some may be happy with their new identity. But others will have been sacrificed for a political ideology; never be able to reclaim the bodies that they could have learned to be happy with, while all our children will be forced to live the lie that you can choose your gender.   
Simon Marcus is co-founder of the Boxing Academy and a former Government adviser on education policy. This article was first published on The Conservative Woman and is republished with permissin.

MercatorNet

October 18, 2017

"Of all the dispositions and habits which lead to political prosperity, religion and morality are indispensable supports." This ought to ring a bell for American readers; it is drawn from George Washington's Farewell Address to the nation.

Pat Fagan, of the Marriage and Religion Research Initiative, points out in our lead story today that "Just as calcium is needed for strong bones religious practice is needed for good citizens. The monetary costs of extra burdens will be enormous."

As the proportion of religious "nones" rises in the US and other Western countries, can we be sure that it will lead to Washington's "political prosperity"?








Michael Cook
Editor
MERCATORNET
After Weinstein, what?

By Michael Cook
One path leads to bigger rulebooks. The other leads to a revival of chastity

Read the full article
The rise of the ‘nones’ spells disaster for human capital

By Patrick F. Fagan
Without religion other human goods are at risk.

Read the full article
The UK must be stopped from pushing transgenderism on children

By Simon Marcus
Dramatically rising numbers of children are already coming out as transgender

Read the full article
Breaking the golden thread

By Ghauri Aggarwal
A palliative care physician says that very, very few people ever ask for euthanasia

Read the full article
Taking apart the news cycle merry-go-round

By Heather Zeiger
How can we escape from the nagging anxiety that we’re not worrying enough?

Read the full article
Why is there a mental health crisis?

By Nicole M. King
Lack of government funding is blamed, but research points to family connections.

Read the full article
His standards or hers? How men and women define success

By Susan Pinker
Do we still expect the majority of women to adopt male-determined goals as their own?

Read the full article
This college professor is under siege for challenging transgender orthodoxy

By Jarrett Stepman
But almost no one is engaging with his ideas

Read the full article
The New Zealand baby dearth

By Marcus Roberts
Another example of declining birthrates in a western country.

Read the full article





MERCATORNET | New Media Foundation
Suite 12A, Level 2, 5 George Street | North Strathfield NSW 2137 | AU | +61 2 8005 8605
The UK must be stopped from pushing transgenderism on children