How would you judge this case?

[Gregory Matthews]

A comment on the antibiotics issue:

When a decision is made to allow a person to die, and to stop aggressive medical intervention that is not going to change the outcome, the decision is also made to let that person die comfortably. But, people do not always see this idea of comfortable death in the same manner.

One will may place that person in hospice. Here they will do everything that they can to provide a comfortable death. But, they will refuse to provide medical intervention that prolongs life, but does not change the outcome. What is that? There are different standards of hospice care that exist between the agencies.

Let me give you an example: Sam is dying, and wants to transfer to hospice. Sam has a fungal/yeast infection on the surface of his skin. Is this a quality of life issue, or is is medical intervention that will not change the outcome, and possibly will not lengthen his life? Hospice agencies will not necesarily have the same aproach to this question.

I have seen the above issue. It is an actual one. But, allow me to exapnd upon it. In multi-organ failure, as a person approches death, they will often become infected in their blood. That infected blood will be taking that infection througout their body. Do you give then an antibiotic? The typical answer will be, No, you do not. It is thought to be medical intervention that is not going to change the flinal result--death, even if it lengthens the life for a few hours, or days.

[bonnie]

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Bravus said:

I still suggest I didn't assume they don't, but asked whether they do. There's a difference there. I honestly didn't know, and don't yet know, whether on balance they do or not. All we have is anecdotal evidence and assertions.

It's not what I was thinking at the time, but there's a pretty high correlation between right to life beliefs and right wing politics, and right wing politics as a general thing says taxes and government services, including those for child protection, sjould be slashed. So it's not a completely out of the blue question to ask whether there is a link there.

One final point: I have never identified myself in any way as a right to die advocate, so you're making assumptions about who agrees and who disagrees with me.

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Raisng taxes rarely does anything to protect children thru government services. My husband and I were foster parents for years and as such worked closely with several social workers. At the time we were active only $.28 out of every dollar went for the actual care and prevention of abuse of these children. The rest went to "administration" It remained about the same for many years no matter how high the taxes were raised.

From the social workers we worked with and some were close to retirement and had seen many changes, one of the biggest problems and the BIGGEST drain on the budget were the many special interest groups that reared their "UGLY" heads beginning in the 70's. Their words not mine. Their agenda, not the children's were the number 1 prioity.

So YES, if you were to ask me about raising taxes for child protection in MN I would likely say no, however it goes far deeper than being hypocritical or not caring about the quality of life for a child. When they raise taxes for a child's welfare, I want the lion's share going to the child. Not some loudmouth running off at the mouth about his or her pet project.

Neil mentioned burnout of social service workers. Nothing new there either. Loaded down with mountains of useless paperwork/regulations they cannot possibly get to all the children they need to get to.

Case in point- We had 2 Native American brothers. This was at the time it became such a huge issue over the recognition and rights of their heritage. These boys came to us as a last chance

measure before being sent to a home for children that were classified as incorrigble. They needed a firm hand and yet once they knew the house rules did very well until... a new social worker took over. The previous social worker refused to work with a tribal council concerning these boys on top of all her other duties. The primary interest of the new social worker was Native American heritage, never mind the children. Everything they did, everything we did had to revolve around the importance of that issue. Naturally the boys took advantage of this and it became impossible to deal with them. Even something as simple as doing dishes. Finally when all of the progress that had been made with these boys had been overturned thru this agenda, the previous social worker was re-instated. Instead of dealing with the tribal council on the silliness of a native american boy doing the dishes, she agreed with him he should not, and instead should do as his heritage demanded. "W" was very pleased with that until he heard the rest...he could not sit down to dinner with us, until as a Native American brave had done, gone out ,tracked down, shot, and dragged home the dinner for the woman to prepare. The hours that was spent on this all important issue of whether or not Native American boys should be required to do household duties would astound most reasonable people. There was not a suitable home among their own people for these children and yet the need to dictate how mine should be run seemed only reasonable and fitting to the powers that be.

This is only one incident of complete waste of time, energy and money that should be going to these children. The culture of these children is important, but as in many things it gets utterly ridiculous, time consuming and expensive. Not the least of which is also detremental to the children themselves.

Another complete waste of money and sacrifiec of a child's life was a toddler 18 months old when she came to us. She had been beaten, starved, and left alone for hours on end by her natural mother. By the time she came to us she had been in 3 previous homes. Her mother showed zero interest in seeing her. We were told that she would not be regaining custody and this was to be considered longterm placement, meaning guardianship till she was of age. We had this child for 6 years before her mother even contacted her. Then she wanted her back. Guess what, SHE WON. After several months of time ,energy,and my tax dollar that was to go to the protection of children like her she was returned to a home that I doubt you would have allowed your pet to be placed in. WHY???? Again, it was the agenda of her heritage. Her mother was able to prove the little girl was 1/4 native american and as such fell under this cockamany worship of heritage before safety.

Her mother was living with a native american and had a child by him. As such this represented a family structure. The kicker to all this, just prior to the little girls return, the baby boy died of a massive hemmorhage of unknown cause. We felt surely they would not return this little girl to that. Wrong again.

Don't forget, MN has some of the highest taxes of any state, we shell out more money for welfare services than most, our children are no better protected because of it. So yes, I would not automatically favor higher taxes for child protection. Better, enforcable laws first and foremost would get my attention first. IMO, $.28 out of every dollar does not go far in reducing child abuse

[bonnie]

My husband and I were comfortable with the decision to withold antibioiotics. We knew that he would not be regaining his health and coming home again. Keeping him comfortable was all we asked.

Bonnie

[Gregory Matthews]

Let me mention another issue in medical ethics. Some of the best agents that we give to keep people comfortable while they are dying, also MAY (?) shorten their life by a SMALL amount.

Does one give that agent which allow a person to die a comfortable death, but may shorten their life by a small amount. Or, does one force them to die in discomfort, and live a little longer in that discomfort.

I atttend a Sabath School class that often discusses contemporary issues, and not the SS lesson. (They discuss the SS lesson sometimes.) We were discussing this issue one day, and I mentioned what I have just stated above. A MD in the classs verified what I have just stated.

Immediately a couple spoke up. They had been in such a situation where they were asked to approve the medication that I had just mentioned in the class. In that conversation they said that they had only been informed that it would allow thier relative to die comfortably, and they had not been told that it might shorten the life by even a small amount.

They did not say that they would have made a different decision if they had been told. They simply were upset that they had not been told.

Medical ethics are complex.

I have stated that I sit on a hospital Ethics Committee, and that we are a teaching hospital. That means that our medical staff consists of nationally recognized experts in their fields. They do not always agree. Acting as an Ethics Committee, we have sometimes asked these experts to come before our committee and testify in regard to a case that we were considering. Sometimes two experts have disagreed. We than have had to wade through the medical testimony, and formulate a recommendation that esponds to the issue.

NOTE: The Ethics Committee has medical providers on it, as well as non-medical, clinical, providers, such as myself. As such, we do not tell medical personnel what to do. We make a recommendation to them. I am not aware of any occasion where a medical provider has refused to follow our recommendation, even when that medical provider disagreed with it. In medecine in the USA, hospital Ethics Committees have considerable power to persuade, but not to dictate. A medical provider who could not follow our recommendation would likely withdraw from care and be replaced by someone who would follow our recommendation.

[bonnie]

I am well aware of that particular situation. We faced a identical one with my mother. As one that was narcotic sensitve it had always been necessary to be very cautious in any pain med she was given. Towards the end my mother was experincing pain, in part the DR felt because of dihydration which was cauing severe muscle cramping. For a time demerol took care of the pain more than adequetely. It was obvious when the time came that it was no longer doing the job. Even unconscious we knew she was in pain and the DR switched to morphine causing her to lapse into a deep coma. We are sure it shortened her life. How much?? An hour, 2, maybe a little more. Not important. It was important to us that she remain pain free if at all possible till her last breath.

Bonnie

[Dr. Shane]

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there's a pretty high correlation between right to life beliefs and right wing politics, and right wing politics as a general thing says taxes and government services, including those for child protection, sjould be slashed.

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I have never seen the arguement made by a "right wing" politician or political group that child protection services are not a legitamate role of government. It is an issue of law enforcement which is the government's role. However there is a lot of waste in these agencies and a lack of accountability. There needs to be significant reform before more funds are allocated. Propper administration would free up a lot of funds now being wasted which could be used to hire more social workers.

[Bravus]

Absolutely: in response to both Bonnie and Shane, I'd say I wasn't calling simply for higher taxes with no accountability. That's a straw man version of the values of the left. Absolutely, demand reforms in these agencies and accountability and reasonable policies. But it's a bit chicken and egg: you need to do this at the same time as adequately funding them, not as a condition before adequately funding them. A bureaucracy takes time to change, and more children can die while ufunded demands for reform percolate through the system. It doesn't even require increased taxes, it's a matter of priorities. There are plenty of government expenditures that are less important than this issue, and from which funding could be redirected.

The idea that some bureaucrats in social work are misguided should be cause to deal with those bureaucrats, not to withhold funding from child protection and social welfare agencies.

[Neil D]

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Propper administration would free up a lot of funds now being wasted which could be used to hire more social workers.

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Oh, but Shane, THAT's throwing money at the agencys!

If you look at one of the arguements that Gore has made in his January 16th speach, one of his arguements against this administration is that there are few oversight committees to keep the money spent where it is needed. As a result, the ethics of some departments become blantaintly questionable when crisis' arise...Concider the New Orleans and Katrina debuncle. No oversight committee. Instead, the press attacked the goverment for failing to do it's job.

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I have never seen the arguement made by a "right wing" politician or political group that child protection services are not a legitamate role of government.

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But I have seen that. I have also seen where those administration cut funding for things that are 'more important', or at least that is the excuse they give. We, as a society, don't want to admit that we are sick and need help. Instead, we let some govenemnt workers become over worked, burnt out, and extremely discouraged that nothing is done. Society needs to take an attitude that the military has- NO ONE gets left behind. If that means reorganizing the departments of goveerment to be leaner, more efficient, then so be it. But NO ONE gets left behind. Children, older generations of society, the orphan, the uninsured, the working poor, NO ONE. And everyone needs to pull a bit more to so that all can pull more efficently. CEO, CFO need to share thier millions...and hundred thousands of dollars salaries. [Did you know that the CEO of an Oregon Goodwill organization made $850,000 per year? Why does he need to make that much money??? ] Why do CEO of non-profit hospitals need to make millions of dollars [Legacy Emannuel hospital CEO made 2 million annually, until he 'retired', only to get a 6 million severance pay! Why is that???]

And we complain that we don't have enough money to reach those kids.....

I am sorry, I am getting but it makes me mad that this is rampant in this adminstration....Sure, it existed in the previous adminstration ...but not to this extent...

[bonnie]

Bravus,

Hate to tell you, but it isn't a straw man argument in MN. Don't know about other states but the money for welfare in this state is like a leaking sieve. People deliberately move here from other states so they may obtain more funds thru welfare. Just recently a member of my extended family did just that. Quite frankly she lives better than I do. I have to work, she does not.

It is not a matter of with holding funding, it is a matter of trying to get a handle on the more than adequete funding they already receive.

We have a five year welfare receipent rule here, recently past. Liberals and those receiving welfare were the ones yelling "against my constitutional rights" Excuse me, where does it say in the constitution that I must pay and pay as long as someone doesn't care to work. They are not automatically thrown on the street after five years either. Prior to that there are programs and educational opportunities, heavily subsidized daycare, medical insurance etc, till they are receiving an adequete wage. Guess what?? Not enough. They should not be forced to work after five years if they don't want to.

Subsidized housing is now inspected on a regular basis for damage and upkeep. Again, protests and demonstrations as this is against their rights as a welfare receipent. Altho, not against my right to damage property I pay for. Seems MN got tired of rebuilding subsidized housing complexes every few years. We kindly pay for, without choice of course some fairly decent homes. One family I did daycare for had a four bedroom townhome because she had five children. Incensed when they came to inspect and she had to pay for the damage her out of control children had caused.

True story concerning co-worker. I was responsible for getting her a part-rime job. Weekend work was always available for those who wanted it at premium pay for up to 12 hours a day. She worked for three weeks and one Sun. Lasted four hours on Sun and then had to go home and work on her relationship with the man she was living with as they had had a fight that morning. Translated, spent the afternoon at the legion getting drunk on my tax dollar.

When they can begin to get a handle on where the money goes and have it spent wisely to actually do what it is suppossed to by all means, raise my taxes. If they cannot do any better than they are doing now and have done in the past with the high taxes we pay, what would induce anyone to think more taxes would do a better job??

More money to be wasted is not always the answer.

[Bravus]

Agreed, but you've had a bit of topic creep. We weren't talking about welfare recipients but about things like child protection services. I'm actually in agreement with you (probably because I try to be a thoughtful, rather than a kneejerk, liberal - and because I've grown up working hard for everything I've got) that there are obligations on those receiving welfare payments to be actively looking for work and developing their skills to make themselves employable. Systems often undermine this because they can get paid to do nothing but not to study... and that needs to be dealt with.

But that wasn't the issue here. I'm talking about the services that respond when a doctor or teacher finds a child to be undernourished and bruised and reports her suspicions: what happens then, and how do we make sure that, if those suspicions are justified, the child is taken out of the situation and then perpertrator punished and kept away from other children. That's crucial, too often fails... and we can argue all we like about accountability, but the fact remains that it costs money to do that effectively.

(By the way, it could be that we're assuming a relationship between abuse and 'being on welfare'. That's a correlation but not a strong one - there's plenty of abuse also in middle-class and wealthy homes... one could argue that they have more skills and resources for masking it, and for fighting child protection services. I did mention 'welfare services', but I meant things like women's shelters and support for those who have had to flee abusers... and they may not have been poor to begin with.)

[Bravus]

And something I hope we can all agree on here: Jesus is the only real, long term solution. Conversion - real, deep conversion - is the only thing that finally stops abusers from being abusers. Everything else is only palliative... but that palliation (?) is still crucial.

[bonnie]

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Bravus said:

But that wasn't the issue here. I'm talking about the services that respond when a doctor or teacher finds a child to be undernourished and bruised and reports her suspicions: what happens then, and how do we make sure that, if those suspicions are justified, the child is taken out of the situation and then perpertrator punished and kept away from other children. That's crucial, too often fails... and we can argue all we like about accountability, but the fact remains that it costs money to do that effectively.

(By the way, it could be that we're assuming a relationship between abuse and 'being on welfare'. That's a correlation but not a strong one - there's plenty of abuse also in middle-class and wealthy homes... one could argue that they have more skills and resources for masking it, and for fighting child protection services. I did mention 'welfare services', but I meant things like women's shelters and support for those who have had to flee abusers... and they may not have been poor to begin with.)

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You may find it hard to believe but at least here in Mn if I had been inclined to abuse my children I would have stood a better chance of getting by with it as a welfare recepient than as middle class.

Had I been the one(actual occurrence within my extended family)

to be living with a known drug dealer, actively working his trade, my children, 8 years old, finding bags of coke under the mattress, being left alone for long periods of time,physical abuse (those are the good parts}, I would have lost my children. Instead, this welfare mother didn't get so much as a hand slap.

And yes, it was known and reported. Finally the family took a chance and took matters into their own hands and recued the children.

The money is available, once it quits being poured down this never ending hole. But, I doubt if that will happen. In the words of a rather grizzled old vetren of social services, "abuse of woman and children provide a cash cow for to many special interest groups to ever change".

[Dr. Shane]

Child and family protection is the role of the stae and local governments. The federal government is not involved in this. It has absolutely nothing to do with the President or Congress.

The federal government does have a role in disaster relief but even then the primary role is to be assumed by local and state government. The White House was guilty of not anticipating the incompentance of New Orleans' local government and that of the State of Louisiana. However Texas did an fine job for Huricane Rita and Florida has done as well with various huricanes that have hit it over the years.

Child and family protective services are something we should want to keep at the state and local level. We don't need big brother getting involved that.

[Dr. Shane]

We need not get welfare programs and child protection programs mixed up. These are two different departments.

There are states that have good agencies. These should be used as a model for others. Not every states' child protect services is messed up. Money in the government's pocker rarely solves the problem. Every law enforcment agency will always claiim it needs more.

[bonnie]

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Shane said:

We need not get welfare programs and child protection programs mixed up. These are two different departments.

There are states that have good agencies. These should be used as a model for others. Not every states' child protect services is messed up. Money in the government's pocker rarely solves the problem. Every law enforcment agency will always claiim it needs more.

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I don't think I have disagreed with you. I can only speak for MN and the many years experience we had dealing with child welfare and child protective services, which do happen to be closely aligned agencies. Almost every child we took into our home required that we deal with both agencies as both had been involved. Children are not removed from their home because all is well. I have repeatedly said more money will not solve the problem. More money is just more money to waste. For every increase there is never a decrease in need. Never happens that more money ensures better protection from domestic violence or abuse of any kind. For every time taxes have been increased here under the guise of better protection for women, minorities and children, the next sentnece to follow is you have not given enough. Never an explaination of what has been done with the mountains of money they obtained.