VERMONT ALLIANCE FOR ETHICAL HEALTHCARE Newsletter #13October 18, 2003
Hi Folks,
The 2-hour Vermont Medical Society annual business meeting yesterday afternoon evolved (or devolved) into a long, challenging, intense 4 hours. It was preceded by (a) an excellent panel discussion on palliative care where 3 difficult cases were discussed by 2 MD's, a hospice nurse, and the VT Attorney General, and (b) an informal luncheon address by Gov. Douglas during which he said clearly that he thought legalization of PAS was not a good idea.
The business meeting was better attended than most years; about 80-85 member MD's and lots of press. The early part of the meeting was pro forma, getting the essentials out of the way expeditiously to get to the main event.
UVM medical students gave a report of the opinion survey they did of all VT physicians. It was well done, free of bias, consistent with rigorous research methodology. They mailed 2770 surveys to all physicians licensed in VT (not just the 1400 VMS members), had 561 returned as undeliverable for a total "n" of 2208. They had a 48% response rate which is very good for a survey of this sort (the DWD survey of VMS members got a 16% return, and the VAEH survey 23%). The results:
(a) 38.2% of respondants thought PAS should be legalized
(b) 16% thought it should be made illegal
(c) 26% thought there should be no law
(d) 15.7% were undecided
Thus 38% of responding VT physicians support legalization of PAS and 42% oppose (b+c). Important numbers to have in hand.
There ensued 2 hours of discussion on procedure for determination of the VMS position, focused on 2 points:
(1) whether the resolutions should be decided at the meeting or via a mailed ballot to the membership;
(2) whether the DWD resolution was a valid resolution at all; someone brought an opinion from an attorney that the "neutrality" resolution did not meet the definition of a resolution found in the VMS by-laws because it did not "suggest a significant course of action". The chair rejected the motion to dismiss the resolution, this was challenged, and heated debate ensued. Though I believe the motion had legal merit, in retrosepect I am glad it was defeated. Overturning the DWD resolution on a technicality, could have resulted in cries of "foul" from the DWD camp and from the public. The Free Press editorial this past Tuesday said the public wants to know what VT doctors really think of this legislative proposal. Their point was that a "neutral" position was not satisfactory; the public wants a "support" or "oppose" position. I think an end-run around that neutral position with an "oppose" by default would not have satisfied this legitimate request.
The DWD "neutrality" resolution survived this challenge and goes forward for a mailed ballot with no amendments. In my testimony against this resolution I reminded those in attendance that the Hemlock Society's stated goal right from the beginning has been legalization of euthansia. They recognized that this will not be politically feasible until society first accepts PAS. And that will not be accepted by the general populace until the opposition of the medical profession is neutralized.
[The Hemlock Society has finally realized that naming itself after a poison is probably not a good idea, so they have morphed into End of Life Choices. It should now be clear that the national EOLC is behind this VT campaign; their main office in Denver has mailed a fund-raising letter to 130,000 Vermonters, which probably represents 2/3 of all VT households.]
The resolution updating the 1997 VMS position will also go forward, but it had a couple of amendments. [Just a reminder that the bulk of the resolution is a strong endorsement of palliative care.] I had been in contact with the authors prior to the meeting to request changing the important sentence from "VMS does not support passage of laws for or against PAS" to "VMS opposes". They were not willing to accept that, but did agree to return to the 1997 wording "VMS believes there should be no laws concerning PAS" and they made that change when introducing the resolution. This is a small, but I think important, change. The "does not support" language could have been interpreted to mean merely that the VMS would not testify to the legislature in support of the DWD bills, with no requirement to testify in opposition. The "believes there should be no law" means VMS would have to testify against the bills. This was made clear in the discussion and will appear in the minutes. I then offered another amendment to expand the reason for VMS opposition from "might discourage efforts to provide good palliative care" to "might discourage efforts to provide good palliative care, could pose serious societal risks, and would be difficult to control." I didn't want the VMS spokespersons restricted in their testimony to the single reason; though it is an import reason, the others are more persuasive.
Several members of the Franklin County Medical Society were strong voices in the debate, clearly wanting the VMS to take a firm stance of opposition to PAS. They had voted at their county meeting to urge the VMS to adopt the much stronger AMA position, and they introduced a new resolution yesterday to that effect. They realized it would likely not pass (resolutions introduced at the meeting without being properly "warned" beforehand require a 2/3 vote to be entered into debate and a 3/4 vote to pass), but they wanted to go on record with their firm stance. I commend them for their stance and thank them for their help in the arduous process yesterday.
So --- the VMS office will prepare a mail ballot to be sent out no later than 10/27, and the results will be tallied on Nov 12th.
VAEH needs to send another letter to the 1400 VMS members since the DWD folks sent one (their second letter) challenging the credibility of several statements in our first. I have prepared a response with references and quotes to substantiate the info in the first letter. I probably should have done that in the first place, but I was trying to be succinct, save space, paper, and weight; I had no idea they would try to say that white is black. Contributions of stamps, envelopes, checks, etc to help with this expensive endeavor are, of course, always welcome.
Sorry for the length of this missive, but I thought many of you would want to know the details of the VMS meeting. "Gotta get back to work" (borrowed from Willem Lange)
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Bob Orr
Vermont Alliance for Ethical Healthcare
P.O. Box 2145
So. Burlington, VT 05407
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