Disability on Display

If nothing else, Sara Palin's nomination as Republican VP candidate has brought matters of disabled children to the forefront in this political season. Palin and her husband have welcomed a child with Down's Syndrome into their family.

Unfortunately not all are willing to accept children as they are rather than as they might be. Wesley Smith at SHS blog has a disturbing post about a mother who murdered her disabled child.

Joanne Hill, 32, planned the murder after her husband refused to allow their daughter, Naomi, to be adopted, it was alleged.

A jury heard how Mrs Hill struggled to cope caring for the youngster, who suffered with cerebral palsy. She wore callipers to help her walk and had poor hearing.

Opening the case for the prosecution Michael Chambers QC told Chester Crown Court that Mrs Hill was "ashamed and embarrassed" of her daughter's condition and murdered her in a "determined and planned act".

"Joanne Hill could not come to terms with the fact that her daughter Naomi was disabled," he said.

"Instead of seeking help from the social services, she quite deliberately and consciously acted to kill Naomi."

Mrs Hill allegedly planned the murder for the afternoon of November 26 last year knowing her husband Simon would not be home until 5.30pm.

After picking up Naomi from the childminder she drove them to the family home in Deeside, Flintshire, north Wales, poured herself a glass of wine then ran a bath.

Mr Chambers said: "When the bath was full she told Naomi she was having a bath, but Naomi didn't want one. The defendant carried her upstairs and undressed her.

"The defendant put her in the bath and drowned her by holding her head under the water for a long time until she was dead."

Smith writes:

Princeton University's Peter Singer and some other bioethicists argue that killing unwanted babies is perfectly fine since babies aren't persons. Babies born with disabilities and terminal illnesses are already being subjected to infanticide in the Netherlands--acts of murder under Dutch law that go unpunished, and which have been supported by prestigious medical and bioethics journals such as in an article published in the prestigious Hastings Center Report. Here in America, 90% of fetuses testing with genetic anomalies such as Down or dwarfism are not allowed to be born--a eugenics action sometimes encouraged by doctors and genetic counselors. In Canada, Robert Latimer murders his daughter Tracy because she had cerebral palsy and is embraced by many there as a loving and compassionate father. Meanwhile, some people savage the Palins because they are affronted by Trig's presence in the world and a Canadian medical official worries that it could mean more parents deciding not to abort their disabled babies.

We as physicians have wonderful opportunity to affirm life from conception until natural death. Our patients respect us and we can influence the debate. Our actions and words are noted. Set the example and frame the debate in a life affirming way.

Technorati Tags: Down's Syndrome,disability,ethanasia,suffering,Catholic,physician,cerebral palsy,infanticide

Welcome to a New Member

Catholic Physicians Blog is pleased to welcome a new member. Richard Kim blogs at http://catholicpsychiatrist.blogspot.com/. Great to have you onboard!

Psychiatry

I have recently finished a four-month rotation in Psychiatry. I wanted to impart some of the things I learned from this, which have inspired me towards a career in this noble art. The specific area of work was a community based outreach service called 'Early Intervention'. This service is basically aimed at young people (16-35) who are experiencing psychotic symptoms for the first time. These kind of symptoms are common features of Schizophrenia, which is a syndrome prominent in the public conscious. However, not everyone understands this devastating illness, or how it can be managed, so I was privileged to be able to gain an insight.

Schizophrenia was a term first coined by Eugen Bleuler (1857-1939) in 1908. Prior to this, the condition was called 'Dementia Praecox', as assigned by the German Psychiatrist Emil Kraepelin (1856-1926) who introduced a distinctly clinical outlook to Psychiatry. Bleuler correctly realised that it was not a dementia, and also not exclusively confined to young people. His new term, 'Schizophrenia', was derived from the Greek term meaning 'Split mind'. There is a common misconception, perhaps stemming from this etymology, that it is a syndrome of split personality. This is false, and not to be confused with Dissociative Identity Disorder.

The sort of symptoms which Schizophrenia involves are hallucinations and delusions. Typically an individual will hear voices, talking in a derogatory manner about or to the subject. Sometimes the voices will give a running commentary on what the person is doing. Less commonly hallucinations can be visual, or in other modalities.

An individual with Schizophrenia will often feel that their thoughts are not their own. They may believe that thoughts are being physically inserted into their head, or taken away, or that their thoughts are being broadcast for all to hear. Delusions often develop from these symptoms and can be quite complex, and reflect a fragmentation of their experience of reality. To be a delusion it has to be a false, unshakable belief which is out of keeping with their cultural context. Often these seem to be related to popular constructs around them. Sometimes they may have a religious content, other times about aliens, and quite commonly at the moment about government conspiracies. Particular to Schizophrenia, these delusions often contain contradictions, with a lack of logical consistency, and have an unpredictable series of actions which may flow from it. The Oxford textbook of Psychiatry(1), in relation to this, quotes Eugen Bleuler thus

"Kings, Emperors, Popes, and Redeemers engage for the most part, in quite banal work, provided they still have any energy at all for activity".

The result of these is that affected individuals display bizarre, erratic behaviour. Their speech often becomes rambling and incoherent, as they exhibit a 'loosening of associations' in their thought processes. Negative symptoms, like depression, withdrawal and a lack of motivation often predominate. People around them become increasingly baffled and worried. Fortunately current anti-psychotic medication, and services to improve social functioning, can return people to a normal and fulfilling life. The diagnosis 'Schizophrenia' is less commonly used, especially early on, since it is difficult to predict the course of the illness, and patients do not necessarily benefit from having a stigmatising label applied to them.

This can all obviously be incredibly distressing. I write the above because I find it all very fascinating, and because it is so poorly understood, even within the medical profession. My work with Early Intervention has brought me in touch with all kinds of people from a wide range of demographics, but in this case all young, often around the age of 17 and going through stressful life adjustments.

Perhaps another similarity with these young people is that many of them have smoked Cannabis heavily. It is difficult for people to understand what a serious problem this is, especially since it is a drug so commonly consumed at schools, colleges and universities. An initial study(2) suggested that those with a strong history of Cannabis use, especially in early adolescence, are up to 6 times more likely to develop the illness. Since about 1% of the population will suffer from psychosis at some point in their life, this is not a negligible risk. More importantly, those with the illness can relapse suddenly upon exposure to Cannabis, and it is often a factor in delayed recovery. This should come as no surprise, since Cannabis increases levels of Dopamine in the brain, which is the biochemical process believed to be most associated with Schizophrenia, and the target of most therapeutic drugs (which incidentally have much fewer side-effects than was previously the case).

It always astonishes me the sort of social pressures which impede the practice of Psychiatry. Rather than a noble and respected profession, it is often seen by outsiders as a threatening and arrogant speciality. In my experience Psychiatrists are the most thoughtful, friendly, and intuitive doctors around. Their communication skills are superb, and indeed have to be, since they are the only real diagnostic tools available. I see two social pressures to predominate: anti-Paternalism (and accompanying medical consumerism) and so-called human rights arguments. Perhaps I will expand upon these observations another time, but for now I just wanted to focus on the experience of mental illness, in particular one as devastating as psychosis. There is a tendency for people to view these patients with suspicion and apprehension, and to alienate them further. However, what they really need is to be valued and loved in the way Jesus instructed us. A great saint summed it up thus:

When her mother reproached her for caring for the poor and sick at home, Saint Rose of Lima said to her: "When we serve the poor and the sick, we serve Jesus. We must not fail to help our neighbours, because in them we serve Jesus."

Catechism of the Catholic Church 2449

We can therefore see in our brethren Christ himself, and be moved to compassion by hearing Christ say: "As long as you did it to one of these my least brethren, you did it to me." (St Matthew's Gospel 25:40)

Mental illnesses are like any other disease in that they have physical and psychological aetiology; we must not think they are due purely to social or spiritual factors, as important these are in any illness. We must certainly not think that something like psychosis is a manifestation of demonic activity; I hope very much that this sort of opinion is cast firmly aside. Yes, demonic possession does exist - but mental illness is something discrete and always to be excluded by a diocesan investigation. Ultimately though, amongst the indispensable drug treatment and psychological interventions, spiritual remedies will always be welcome. In a sense, Psychiatry is the one area of medicine where all components of the human being meet, and the scope is thus endless.

References:
1. Gelder M et al. Oxford Textbook of Psychiatry. Oxford University Press: 2000
2. Zammit S, Allebeck P et al. Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ 2002;325:1199

HHS Proposed Regulations to Protect the Conscience Rights of Health Care Providers

This is from the Priest for Life website.

The United States Department of Health and Human Services has publicized new proposed regulations to protect the conscience rights of health care providers. They are inviting comments from the public from now through September 19, and we ask you to do so today!

The HHS press release announcing this is at http://www.hhs.gov/news/press/2008pres/08/20080821a.html

Comments can be submitted at http://www.Regulations.gov or via e-mail to consciencecomment@hhs.gov.

“Many health care providers routinely face pressure to change their medical practice – often in direct opposition to their personal convictions,” said HHS Assistant Secretary of Health, Admiral Joxel Garcia, M.D. “During my practice as an OB-GYN, I witnessed this first-hand. But health care providers shouldn’t have to check their conscience at the hospital door. This proposed rule will help ensure that doesn’t happen.”

Be sure to register your comments with HHS.

Welcome!

Catholic Physicians' Blog welcomes Matthew Doyle who blogs at http://www.lacrimarum-valle.blogspot.com/. Welcome Matthew. Love your blog!

The Saint Song

As a child of the 60's, 70's, and beyond, I remember hearing Tom Lehrer belt out tunes on albums from "Wehrner von Braun" to "The Vatican Rag" to "National Brotherhood Week."  One of those memorable ditties was "The Elements Song," in which Tom went through all of the known elements up to that time sung to the tune of Gilbert & Sullivan's, "I am the very model of a Modern Major General."

The trials and tribulations of the Saints and how they sought and achieved holiness has been an interest of mine for quite some time, especially those Saints that we as physicians look to for patronage - Luke, Cosmas and Damien, Pantaleone, etc.  I thought of a way recently to introduce others to the Saints, in a "Lehrer-esque" manner.  This is the result.  Hope you like it.