Thursday, March 31, 2011

How Does Archdiocese of St. Paul-Mpls Handle Sex Abuse Cases?

St. Paul-Minneapolis Chancellor for Civil Affairs Outlines the Policies and Procedures

What happens after an allegation of clergy sexual misconduct is brought to the attention of the archdiocese?

What policies and procedures does the archdiocese follow if the allegation is deemed credible?

Can a clergy member who has committed misconduct that doesn’t involve the abuse of a minor ever be returned to ministry? If so, how is that determination made?

During the last five months, two cases of alleged clergy sexual misconduct involving adults in the archdiocese have been the subject of local media reports. More recently, national reports have focused on the clergy abuse crisis in the Archdiocese of Philadelphia.

The reports have led some to question how the archdiocese handles misconduct cases, particularly if the alleged incident involves another adult.

Andy Eisenzimmer, chancellor for civil affairs, outlined the scope of the archdiocese’s sexual misconduct policies and explained how they are implemented during a March 24 interview with The Catholic Spirit.

The archdiocese’s current policies regarding sexual misconduct are rooted in the provisions outlined in the “Charter for the Protection of Children and Young People” and “Essential Norms,” approved by the U.S. bishops in 2002, as well as its own policies that date back to the late 1980s and were among the first of their kind in the nation.

The local policy was updated most recently in 2007, Eisenzimmer said, to incorporate the requirements of the “Essential Norms.” However, unlike many dioceses and archdioceses, the St. Paul and Minneapolis policy also covers sexual exploitation — defined as sexual contact between a church leader and an adult who is receiving pastoral care from the church leader — and sexual harassment, defined as unwanted sexualized conduct or language between co-workers in the church work setting.

When an allegation is made

When a report of sexual misconduct is brought to the archdiocese, the archbishop initiates an investigation as required by canon law. Should circumstances warrant, the priest or deacon may be temporarily restricted from ministry while the investigation is taking place, Eisenzimmer said.

Under the provisions of the charter, a report involving the abuse of a minor who is still a minor at the time the report is made must be forwarded to law enforcement authorities, Eisenzimmer said.

Minnesota law also has a mandatory reporting requirement. Under the statute, mandated reporters — including teachers, counselors and medical professionals — must report to authorities within 24 hours any knowledge of child abuse or neglect that has occurred within the prior three years.

Clergy members also are mandated reporters unless they receive the information under certain privileged and confidential settings, such as during sacramental confession.

The charter also states that if a diocese receives a report of abuse of a minor, but the person is no longer a minor, the diocese is required to cooperate with authorities if there is an investigation, Eisenzimmer said. These adults choose themselves whether or not they want to report an alleged incident to law enforcement.

“People [may] want to report something to us for a variety of reasons: They may want to get it off their chests, so to speak, because it’s been bothering them for a long time,” he said. “They may be concerned that the person is still in ministry, so sometimes they want to tell you they were abused by someone to make sure that person isn’t in a position to abuse others. . . . They oftentimes don’t want to go to authorities. They don’t want to be part of a police investigation.

“The way the policy is crafted,” he added, “is to try to honor their desire to not, in some instances, report it. But we make sure they understand they are free to report. We also make clear that if they want us to help them in some fashion, we’ll assist them to the extent they would like us to assist them.”

Next steps

What happens after a report of sexual misconduct is made and deemed cred­ible? A variety of factors come into play, Eisenzimmer said.

It may trigger a canonical investigation required by church law, he noted. Certain cases that involve the sexual abuse of minors or other misconduct — such as solicitation in the context of the sacrament of reconciliation — might require a report to the Vatican.

If the alleged perpetrator is still in ministry, the archdiocese typically removes the person from the post — at least temporarily — while it continues to investigate the allegation. The investigation determines if it is necessary to have a trial or other canonical process to determine guilt, at which time disciplinary action can be imposed. If the allegation can’t be substantiated, some effort might be required to restore the good name of the person accused.

When an investigation is initiated, the archdiocese often turns to outside investigators for assistance, he said. But the archdiocese is careful that its own investigation doesn’t interfere with any that law enforcement officials might be conducting.

“Each case will be handled a little bit differently.” Eisenzimmer said. “But we try to investigate quickly and determine the substance of any allegation right from the beginning and try to put some safeguards in place to make sure no further harm can be done to the alleged victim or anyone else. Then, we continue to decide what is the best course of action.”

Those making a report of sexual misconduct are referred to the archdiocesan office of advocacy and victim assistance, which can help them make a report to authorities, arrange counseling and provide financial assistance if needed for therapy.

In cases in which a pastor has been removed from a parish because of misconduct, the archdiocese works with the parishes to answer questions and offer support.

“Frequently there is some kind of meeting to help [parishioners] because we’ve recognized that even if they weren’t harmed individually by that particular member of the clergy, as a parishioner in that parish, there’s harm to everyone,” Eisenzimmer said. “It’s harm to the faith community. So you do really need to address that. There’s going to be anger and hurt. And there’s going to be a healing process.”

Return to ministry?

When sexual misconduct is substantiated or admitted on the part of clergy members, they are referred for psychological and psychiatric evaluation, treatment and aftercare, Eisenzimmer said.

If the case involves sexual abuse of a minor, the charter and the archdiocese’s policies preclude a return to ministry.

In cases of sexual misconduct that don’t involve child abuse, a return to ministry is possible in certain instances if treatment is deemed successful, Eisen­zimmer said.

“Our current policy does allow for a possibility of a return to ministry in some fashion,” he said. “What ministry that might be will depend on a host of circumstances, and it’s something that’s never contemplated until there are a variety of steps taken.”

One of those steps is getting a positive evaluation from therapists, Eisenzimmer said. For many years, the archdiocese has received two clergy evaluations — one by a therapist chosen by the archdiocese to provide an objective evaluation, and another by a therapist who is working closely with the clergy member as a part of treatment.

“We try to gather information from both sources — in essence a double check on what we can do with this person following a successful conclusion of any therapeutic process,” Eisenzimmer said.

If the therapists offer a positive report, the archbishop and others he consults must decide what, if any, assignment is appropriate. Typically, before any reassignment is made, the matter goes be-fore the Clergy Review Board, an advisory body to the archbishop that makes its own recommendations, said Eisen­zimmer, who is staff liaison to the board.

The “Essential Norms” require that each diocese have an independent review board to review accusations of sexual abuse of minors by clergy. However, the archdiocese has had a review board in place since 1995, and its scope is broader than the national requirement, allowing the board to also review cases involving clergy accused of sexual misconduct with adults.

Current members include two priests, a deacon who is a lawyer, another lawyer, a psychiatrist, a nurse educator at the University of Minnesota, social worker, psychologist, trauma surgeon and a retired University of Minnesota faculty member. Past members have included law enforcement officials, abuse victims and family members of victims.

Clergy Review Board members may ask for additional information or steps to be taken if they feel it is necessary before making a recommendation to the archbishop about whether a clergy member who has committed sexual misconduct can return to ministry, Eisenzimmer said.

The board may make additional recommendations for returning clergy members to ministry, such as insisting they continue to participate in an aftercare program. Board members also may recommend to what extent the misconduct should be disclosed publicly, Eisenzimmer said.

“Ultimately, it’s the archbishop’s role to make the decision,” he said. “But in virtually every case that I’ve seen, the archbishop has accepted the recommendation of the Clergy Review Board.”

Review, safe environments Eisenzimmer stresses that the archdiocese evaluates its policies and practices regarding sexual misconduct on an ongoing basis to ensure they are consistent with national best practices, the need for transparency, victims’ needs, community needs and the needs of the accused.

Over the years, policies and procedures have been changed and updated as the issue of sexual abuse has become better understood, he said.

“I will tell you from my own experience back in the 1970s that the therapeutic community said you could put priests back in ministry that had sexually abused minors,” he said. “You’re not going to find a therapeutic advocate . . . today that’s going to say that.”

In the last decade the Catholic Church has taken a lead role in addressing child sexual abuse and instituting safe environment programs to educate children and adults about the issue, which affects all segments of society, he said.

“What I’ve learned, especially this last decade, is that there’s no one doing more about it than the Catholic Church,” Eisenzimmer said. “We don’t get any credit for that, and maybe we don’t deserve any credit because of our failures in the past. But we have instituted procedures where we do criminal background checks on all clergy, all employees and any volunteers that have regular, ongoing contact with children.”

That amounts to 83,000 people, according to Rita Beatty, who helps coordinate the archdiocese’s safe environment program.

All students enrolled in Catholic elementary and secondary schools and those in parish religious education programs are educated on age-appropriate safe environment matters, Eisenzimmer added. Church employees and volunteers are also required to undergo safe environment training.

As a result of such training and the archdiocese’s misconduct policies, “We can safely say that today there’s no clergy in a ministerial position who have been credibly accused of child abuse,” Eisenzimmer said. “We know that for certain.”

As part of the national charter, the archdiocese and the other dioceses in the United States undergo an annual independent audit of their policies and procedures to ensure compliance with the charter’s provisions.
The audit is conducted on site once every three years; in the other years independent investigators gather data and a variety of other information, Eisenzim­mer said.

In turn, the archdiocese audits each of its locations — including all of its parishes and schools — twice a year, he said. In the fall, the archdiocese asks for plans for the school year regarding what will be done in compliance with safe environment and charter requirements. The spring audit shows what was accomplished.

Eisenzimmer said he has no argument with the public for holding the Catholic Church to a higher level of scrutiny when it comes to sexual misconduct. But he also adds that the church should get the credit it deserves for addressing the topic in the comprehensive way it has.

“Our belief is that preventing child abuse has become a core mission of this church,” he said. “It has to be. And we see the value of that broader than just in the church. There’s a community value to that. And if we want to fulfill that core mission, we have to continue to emphasize that we are ourselves following what we’re preaching, that we’re practicing what we’re preaching. We think that’s as important of a task as we can fulfill these days.” The Catholic Spirit

For more information

» Read more about the archdiocese’s Protection of Children and Youth Initiative.

» To contact Greta Sawyer, director of advocacy and victim assistance, call (651) 291-4497.

Wednesday, March 30, 2011

MCCL Blog: Comment on Errors in Star Tribune's Article on Proposed Ban on Human Cloning in Minn.


Wednesday, March 30, 2011

Star Tribune gets everything wrong about human cloning

It is difficult to point out all that is wrong with the Star Tribune's coverage today of the MCCL-backed human cloning ban (currently before the state Legislature). The reporter, Jenna Ross, is uneducated and obviously not qualified to be writing about this subject. Here are some of the mistakes in the order they appear.

The story starts by claiming that the bill would make human cloning a felony. False. The bill would make human cloning a misdemeanor. (Read the bill!)

Ross then writes:
The bill's advocates say it would still allow stem cell research that does not rely on destruction of embryos, including adult stem cells.
Actually, the bill would still allow not just research that doesn't destroy embryos, but also research that does rely on the destruction of embryos. All of the current embryonic stem cell research happening in the state would be unaffected, because it does not involve human cloning (according to testimony from the University of Minnesota's Stem Cell Institute).

Embryonic stem cell research (which requires the destruction of embryos) is not the same thing as human cloning, which is what the bill prohibits. Human cloning (via somatic cell nuclear transfer, or SCNT) is one possible way of producing embryos for use in research, but all the embryos currently used for research in Minnesota were not produced by cloning. Ross continues:
Opponents say the bill's language -- banning "human cloning" -- is purposely deceptive ...
Our use of "human cloning" -- using SCNT to produce a genetically virtually identical human organism, as precisely defined in the legislation itself -- has been the standard use. It is opponents of the bill who are shamelessly misleading by redefining cloning so that it includes only so-called "reproductive" cloning -- that is, allowing the resulting cloned embryo to live and grow, rather than kill it for research (so-called therapeutic cloning).
The U emphasizes that it has not and will not attempt to clone a human being, a process called reproductive cloning. Think Dolly the sheep, the first cloned mammal. "We have been crystal clear on this," said Dr. Aaron Friedman, the U's vice president for health sciences and medical school dean.
Again, the University has redefined human cloning. The University does support cloning human beings -- it simply opposes letting them live very long. Dolly the sheep was cloned by exactly the same technique that this bill prohibits.
Minnesota Citizens Concerned for Life's broader definition of "human cloning" also includes one kind of stem cell research called therapeutic cloning. In that process, a scientist would extract stem cells from a 5-day-old embryo and then destroy it in a test tube. This bill would ban that too.
The author seems hopelessly confused. Destroying an embryo for its stem cells is not the same thing as therapeutic cloning. Cloning is simply one possible means of creating an embryo for use in destructive research. Generally embryos destroyed for their stem cells are not produced by cloning, but are the result of in vitro fertilization. The bill does not affect this research.
But "there are reasons why I might want to do [therapeutic cloning] in the future," said Dr. John Wagner, clinical director of the Stem Cell Institute, who uses adult stem cells to treat a fatal skin condition in children. Therapeutic cloning offers the possibility of merging a patient's cells with embryonic cells, so there's less risk of rejection, he said.
"Merging a patient's cells with embryonic cells"? Perhaps Dr. Wagner didn't explain it very well. Therapeutic cloning offers the possibility of producing embryonic stem cells genetically matched to the patient, so theoretically there might be no rejection problems. Why are they genetically matched? Because they are derived from the embryo, which is a genetic clone of the patient.

What Dr. Wagner has not explained is what possible benefits therapeutic cloning could offer that (ethically uncontroversial) induced pluripotent stem cells (iPSCs) do not also offer. Indeed, iPSCs seem superior: they are also pluripotent (functionally identical to embryonic stem cells) and genetically matched, but they already exist, they are less expensive, and they are easier to produce. This is why some leading scientists like Dr. Ian Wilmut have switched from therapeutic cloning to iPSC research. And I imagine this is why the University of Minnesota is currently working with iPSCs but not with therapeutic cloning.
Minnesota Citizens Concerned for Life argues that scientists should abandon embryonic stem cells in favor of adult stem cells -- in particular, a process of reprogramming adult stem cells to mimic the flexible properties of their embryonic counterparts.

"In adult stem cell research, money is flowing like a river," Scott Fischbach said. "Money going into embryonic stem cell research is resulting in nothing but dead embryos."

But researchers argue that those methods are far from ready and might never work for certain diseases.
Actually, the process (for iPSCs) is to reprogram regular adult cells, not stem cells, to make them into pluripotent stem cells, just like embryonic stem cells. iPSCs seem to make obsolete the therapeutic justification for embryonic stem cell research and therapeutic cloning.

It's true that iPSCs, like embryonic stem cells, have not succeeded in treating anyone. But "iPSC research" does not equal "adult stem cell research," as the author apparently believes. Adult stem cell research is the only kind of stem cell research that actually is ready and actually has successfully treated medical conditions -- dozens of them. It is therapeutic cloning, and embryonic stem cell research more broadly, that is "far from ready and might never work."

A reporter should not write a story when she knows so little and gets so much wrong. And the Star Tribune is terribly at fault for publishing this. MCCL Blog (Minnesota Citizens Concerned for Life)

A bill that would ban human cloning in Minnesota has rekindled the heated dispute over stem cell research at the U.


David Joles, Star Tribune

In search: U lab tech Christopher Chapman, foreground, and freshman Taylor Millikan worked at stem cell diabetic research.

Stakes are high in new debate over cloning at U

A bill that would ban human cloning in Minnesota has rekindled the heated dispute over stem cell research at the U.

To one side, it's making research ethical. To another, it's a research killer.

A proposed Minnesota law that would make human cloning a felony offense is reigniting the contentious debate over cloning and stem cell research.

The bill's advocates say it would still allow stem cell research that does not rely on destruction of embryos, including adult stem cells. Minnesota ought to focus on that kind of "ethical" research anyway, said Scott Fischbach, executive director of the Minnesota Citizens Concerned for Life.

"We're going to find cures, and we're going to find treatments," he said. "But nobody's going to get killed as we do it."

Opponents say the bill's language -- banning "human cloning" -- is purposely deceptive but that its message would be clear: Minnesota opposes cutting-edge research.

Some University of Minnesota officials and researchers predict that the bill could decimate emerging fields of study. Families battling disease worry that it could slow the discovery of cures. Bio-tech business leaders say that it promotes an anti-innovation culture that will push business out of the state and discourage companies from locating here.

"If we put a bubble around our state, it will drive us out of the knowledge-based economy," said Dale Wahlstrom, CEO of the BioBusiness Alliance of Minnesota.

The ban could hit the floor this week as part of the health and human services omnibus bill. On Tuesday, the House and Senate approved other language that would ban state funding and some federal funding from being used for "human cloning."

Actors in this scientifically complex debate define "human cloning" differently.

The U emphasizes that it has not and will not attempt to clone a human being, a process called reproductive cloning. Think Dolly the sheep, the first cloned mammal. "We have been crystal clear on this," said Dr. Aaron Friedman, the U's vice president for health sciences and medical school dean.

Minnesota Citizens Concerned for Life's broader definition of "human cloning" also includes one kind of stem cell research called therapeutic cloning. In that process, a scientist would extract stem cells from a 5-day-old embryo and then destroy it in a test tube. This bill would ban that too.

When DFL lawmakers pushed Sen. Michelle Fischbach, R-Paynesville, the bill's author and Scott Fischbach's wife, to make it clear that her bill would also criminalize therapeutic cloning, she declined: "I think 'human cloning' is pretty clear," she said last week.

'A very loud message'

The U's Stem Cell Institute uses a variety of stem cells, including embryonic stem cells, to research treatments for diseases including Parkinson's, diabetes and heart disease. None of its 35 faculty members does therapeutic cloning now. They use embryonic stem cells copied from existing cell lines.

But "there are reasons why I might want to do it in the future," said Dr. John Wagner, clinical director of the Stem Cell Institute, who uses adult stem cells to treat a fatal skin condition in children. Therapeutic cloning offers the possibility of merging a patient's cells with embryonic cells, so there's less risk of rejection, he said.

"It's inconceivable for me to right now limit the types of stem cells I work with," he said.

The University of Minnesota has invested more than $30 million in the facilities, faculty and equipment for stem cell research, Friedman said. But if this bill becomes law, the loss could be greater, he said. Many U researchers also get grants in areas other than stem cell research, "but should they go, they take all of it."

Meri Firpo, an assistant professor in the Stem Cell Institute, first heard that Minnesota was considering a ban on cloning through a sudden burst of e-mails from colleagues across the country. Then, at meetings last week in Washington, D.C., she was asked by several people: "So, are you moving back to California?"

Firpo was born, raised and expected to conduct her career's research in California. She came to Minnesota in 2005 because "I thought that if we're going to cure diabetes, this is the place to do it."

Should Minnesota's bill pass, she's not so sure. California recently passed a set of laws banning reproductive cloning but specifically endorsing embryonic stem cell research.

"It sends a very loud message to the rest of the world that Minnesota is moving in the opposite direction scientifically," Firpo said.

Easy alternatives?

Minnesota Citizens Concerned for Life argues that scientists should abandon embryonic stem cells in favor of adult stem cells -- in particular, a process of reprogramming adult stem cells to mimic the flexible properties of their embryonic counterparts.

"In adult stem cell research, money is flowing like a river," Scott Fischbach said. "Money going into embryonic stem cell research is resulting in nothing but dead embryos."

But researchers argue that those methods are far from ready and might never work for certain diseases.

Firpo uses those reprogrammed adult stem cells for her diabetes research. Still, that research depends on embryonic stem cells for comparison: "It's not a separate technology."

Camille Nash of Edina worries about politicians making decisions about which methods to pursue. Nash's 22-year-old daughter was diagnosed with Type 1 diabetes when she was 12 years old. Nash promised her then that she would do everything she could to find a cure.

"I look to researchers and to doctors to find a cure or treatment that might make her life a little easier every day," said Nash, who works with the Juvenile Diabetes Research Foundation. "Therapeutic cloning might be the answer.

"Why would legislators think they know better?"

While the U is stuck here, Minnesota companies doing stem cell work can go elsewhere, said Wahlstrom of the BioBusiness Alliance. "These kinds of investments are not inexpensive," he said. "So if you're going to put money into research, where will you go? A place that says, 'Do it here'? Or a place that says 'Don't do it here?' "

Minnesota's economy is much more dependent on biosciences than other states, according to a recent report from the BioBusiness Alliance. "This means that Minnesota's future employment prospects are more dependent than most other states on what happens to its biobusiness sector," the report says.

But Rep. Bob Dettmer, R-Forest Lake, has said that those concerns are overblown and that several states and other countries have bans similar to the one he's proposed.

Other legislators disagree. "I was told by a Johns Hopkins doctor that in fact other countries are much farther ahead than we are" in stem cell research, said Sen. Terri Bonoff, DFL-Minnetonka. "From the financial aspect alone, having our university at a competitive disadvantage in this area is significant -- especially when we have stated that we have a commitment to identify the bioscience area as an area of growth. "This is the antithesis of that." Star Tribune

23 Days for Life: Day 5: When Are You Dead, Anyway?

Brain Death v. Cardiac Death?
When are you dead?

When are you dead?

Resurgent form of organ transplantation raises a new question

The young man had fallen off a cliff while hiking. Now he was in a coma. His doctors in Stanford’s intensive care unit determined that he had suffered massive, irreversible brain damage and would never make a meaningful recovery. His parents, who knew their son would not have wanted to remain in the zombie-like limbo afforded by a mechanical ventilator, decided to withdraw life support. They also wanted to donate his organs.

“It was an incredibly altruistic gesture in the midst of a tragedy,” recalls Carlos Esquivel, MD, PhD, chief of Stanford’s Transplantation Division, of the seven-year-old case.

But Esquivel also recognized that organ donation helps many parents cope with their grief over the loss of a child. So he was upset when David Magnus, PhD, director of the Stanford Center for Biomedical Ethics, arrived at the scene to inform the transplant team that the procedure could not go forward. “It was just the thought that we couldn’t fulfill the parents’ wishes,” Esquivel says.

Magnus, who is occasionally summoned to the hospital to advise doctors on end-of-life issues, including the advisability of organ donation, recalls the scene as “very tense.” At the time, Stanford permitted the removal of organs only from voluntary living donors — a mother donating a kidney to her daughter, for example — and from non-living donors whose deaths were based on the loss of all brain function. But this young man’s brain stem was still active, albeit barely, so donation was not an option.

A little more than 40 years ago, a partially functioning brain would not have gotten in the way of organ donation; irreversible cardiopulmonary failure was still the only standard for determining death. But during the 1970s, that began to change, and by the early 1980s, the cessation of all brain activity — brain death — had become a widely accepted standard. In the transplant community, brain death was attractive for one particular reason: The bodies of such donors could remain on respirators to keep their organs healthy, even during much of the organ-removal surgery.

Today, the medical establishment, facing a huge shortage of organs, needs new sources for transplantation. One solution has been a return to procuring organs from patients who die of heart failure. Before dying, these patients are likely to have been in a coma, sustained by a ventilator, with very minimal brain function — a hopeless distance from what we mean by consciousness. Still, many people, including some physicians, consider this type of organ donation, known as “donation after cardiac death” or DCD, as akin to murder.

Critics of DCD contend that some patients may still be alive five or even 10 minutes after cardiac arrest because, theoretically, their hearts could be restarted, and some of their brain function might still remain. In such cases, critics assert, the patients were clearly not dead because their condition was reversible. Advocates of DCD counter that do-not-resuscitate orders from a patient or family render the argument about irreversibility moot.

In any case, there would be little debate about DCD if organs in a body remained viable for transplantation 20 or 30 minutes after heart and lung failure. But they become damaged quickly, so surgeons have to act fast — ideally, within about 10 minutes of cardiac arrest.

According to the Uniform Determination of Death Act, which was drafted about 30 years ago and has since been adopted, in some form, by all of the states, you can be declared dead in one of two ways: Your brain can irreversibly cease functioning, or your heart and lungs can irreversibly stop working. “Irreversibly,” in this context, has fueled the controversy. Does it mean the heart is unable to spontaneously start by itself? Or does it mean that even resuscitation efforts fail to restart the heart?

To be certain that a heart does not have the capacity to start beating again on its own, most organ procurement organizations, including the California Donor Transplant Network, require that doctors observe patients for five minutes after cardiac arrest before declaring death and admitting the transplant team into the operating room. (Five minutes is the amount of time recommended by the Institute of Medicine, even though under typical end-of-life conditions no adult heart is known to have started beating again by itself two minutes after stopping.)

Ironically, not long before the injured hiker arrived at Stanford Hospital, Magnus had proposed creating a policy that would allow DCDs here. Magnus, who earned his doctorate in philosophy from Stanford in 1989, recognized that without a protocol, donation after cardiac death was fraught with ethical pitfalls.

In the end, that patient became brain dead, so he was allowed to be a donor. Several months later, the hospital’s board of directors approved the DCD protocol, which Magnus, Esquivel and other Stanford physicians helped craft. Nevertheless, Magnus is confident it was right to forgo DCD in that case.

“There’s no doubt Carlos was frustrated, but I think we eventually won him over,” Magnus says. “It was never a good idea to let a transplant team go in half-cocked, without a protocol.”

Indeed, as both would soon discover, half-cocked DCD efforts can end in criminal charges. But we’re getting ahead of the story.

More than 100,000 potential organ recipients idle on the waiting list maintained by the United Network for Organ Sharing, which manages the U.S. transplant system. An average of 18 people on the list die each day because of a shortage of donor organs. Meanwhile, demand for organs continues to grow, but the pool of brain-dead donors remains largely static, thanks in part to better automobile-safety measures, such as seat belt laws and air bags, as well as advances in treating neurological trauma.

DCD has gained popularity over the past two decades as a way of increasing the pool of potential donors. In 1995, only 1 percent of dead donors nationwide were DCD donors. That figure increased to almost 11 percent in 2008, according to the Scientific Registry of Transplant Recipients. The significant increase is probably due to greater awareness of DCD among members of the medical profession, as well as the procedure’s official sanction in the intervening years by influential medical organizations, including The Joint Commission and the Institute of Medicine.

‘In order to be dead enough to bury but alive enough to be a donor, you must be irreversibly brain dead.’

Yet some hospitals, including several dozen in Northern California — Dominican Hospital in Santa Cruz, Saint Francis Memorial Hospital in San Francisco, Sequoia Hospital in Redwood City, for example — refuse to act as a venue for DCD. And despite the success seven years ago of the first DCD procurement at Stanford, one respiratory therapist involved in the case refused to participate, citing ethical concerns.

David Crippen, MD, a critical care specialist at the University of Pittsburgh Medical Center, probably would have understood this kind of reaction. Crippen, who has written about end-of-life issues in ICUs, has been critical of how death is defined in the practice of DCD. He argues that whole-brain death is the only clear standard; it is based on the widely accepted definition of death as the irreversible cessation of the integrated functioning of an organism, in which the brain, as chief executive of the nervous system, is the key integrator.

In a 2008 article in the journal Critical Care Medicine, he faulted the “unfortunately vague” guidelines of the Uniform Determination of Death Act for opening the door to what he describes as the “creative interpretation” of death. The problem, as Crippen sees it, is that no one in 1980, when the act was formulated, was thinking about how “irreversible” cardiopulmonary failure would be interpreted in light of DCD.

“In order to be dead enough to bury but alive enough to be a donor, you must be irreversibly brain dead,” Crippen says in a telephone interview. “If it’s reversible, you’re no longer dead; you’re a patient. And once you start messing around with this definition, you’re on a slippery slope, and the question then becomes: How dead do you want patients to be before you start taking their organs?”

Crippen acknowledges the rising demand for organs and the importance of transplantation in saving lives. But, in the article, he argues “history has shown that where there are rules, there are usually reasons.” He continues: “The passionate and highly publicized desire for organs promotes utilitarian workarounds of the rules to obtain these organs.”

Magnus, a cautious advocate of the procedure, notes that even though the term DCD did not always exist, it was the de facto method of procuring transplant organs from dead donors until the 1970s. The notion of brain death did not even exist until about 1960 and, in the United States, was not formally recommended as an alternative method of determining death until 1968.

“DCD can be done ethically,” Magnus says, but must follow a strict protocol. Stanford’s protocol, which took effect in 2004, resembles most other hospitals’ in its basic outline.

First, the patient’s family must decide to withdraw life support. To avoid the appearance of conflict of interest, the physician caring for the patient must not propose or discuss the possibility of organ transplantation with the family. If family members want to talk about it, the physician must refer them to the California Donor Transplant Network.

Then a team of doctors must assess whether the patient would make a suitable DCD donor. If yes, Stanford Hospital’s Ethics Committee must submit its approval, and a representative of the donor network must explain the process to the family, including the fact that, prior to withdrawal of life support, doctors inject the patient with heparin, a blood thinner crucial to the health of organs removed for transplantation.

The patient is then wheeled into the operating room, given some heparin and detached from the respirator. If the patient’s heart does not stop beating within about an hour, he is brought back to the ICU to die; his organs, which would likely be damaged because of the decreased amount of oxygen they’re getting from the ebbing heartbeat, will not be viable for transplant. But if the patient’s heart stops for five minutes, the attending physician declares the patient dead and asks family members to leave the room. Then the transplant team enters to procure the organs.

“We have a very stringent protocol and a robust informed consent process,” Magnus says. “If we didn’t, that could be asking for trouble.”

Ruben Navarro was 9 when he was diagnosed with adrenoleukodystrophy. The rare wasting disease, the focus of the 1992 film Lorenzo’s Oil, damages the nerves and eventually leads to death. There is no cure. In late January of 2006, two weeks before his 26th birthday, Navarro was found unconscious at the assisted-care home where he lived in San Luis Obispo, Calif. The disease had ravaged his mental and physical health; he weighed only 80 pounds. He was rushed to nearby Sierra Vista Regional Medical Center and hooked up to a ventilator. Doctors determined that he had suffered irreversible brain damage. His mother, Rosa Navarro, agreed to allow his organs to be donated once life support was withdrawn.

On Feb. 3, the California Donor Transplant Network dispatched a San Francisco-based team to the hospital. It included Hootan Roozrokh, MD, a young surgeon who several months before had completed a transplant fellowship at Stanford School of Medicine and was now on the staff of Kaiser Permanente, and a senior surgeon, Arturo Martinez, MD, then-director of Kaiser’s kidney transplant program for Northern California. When they arrived at Sierra Vista, Navarro was wheeled into the operating room. But there was confusion among members of the hospital and transplant teams about their various roles, court records show. Sierra Vista had no DCD protocol, and no staff at the medical center had any training in the procedure, according to the records. In any case, after life support was withdrawn, Navarro remained alive for about eight hours, making his organs unsuitable for transplant.

One-and-a-half years later, Roozrokh found himself facing three felony charges. San Luis Obispo prosecutors accused him of prescribing large quantities of a painkiller and sedative in an effort to hasten Navarro’s death. (State law prohibits transplant surgeons from directing the treatment of potential organ donors until they have been declared dead.) During the trial, the defense argued that hospital staff members had failed to perform their duties and that Roozrokh stepped in only to try to relieve the patient’s suffering. Navarro had developed a tolerance to the drugs, which he had used to manage pain caused by his neurological disease, and so needed a relatively large dose to get any relief, Roozrokh’s lawyer said.

The judge in the case threw out two of the charges — administering harmful substances and prescribing controlled substances without a legitimate medical purpose — and the jury found Roozrokh innocent on the remaining charge: dependent adult abuse. In rendering its verdict, the jury included a note advising that the case “identified that donation after cardiac death is in desperate need of further identification of prescribed policy in order to continue successfully as a viable option for organ donation in this country.”

Roozrokh, now a transplant surgeon at Loma Linda University Medical Center, vows he will never go near a DCD case again. He says there should be a national DCD protocol and liability protection for physicians who perform the procedure in good faith. “It was a terrible ordeal for my family, and the cost of my defense was enormous,” he says.
Roozrokh, who has received a number of humanitarian awards, speaking invitations and professional awards, including the 2010 Northern California Kaiser Permanente Patients Recognition Award for Outstanding Service, says his reputation nevertheless has suffered because of the accusations. “Just Google me,” he says. “As a doctor, your reputation is pretty much all you’ve got.”

To Magnus, the Navarro case serves as a cautionary tale, and the jury’s note is the moral. The need for a protocol is especially important in DCD, Magnus says, because “there is no bright line” indicating the moment a person becomes a corpse. Magnus drew the analogy to how we define adulthood as beginning at 18. “We know that’s not how human development works — that at 17 years and 364 days you’re immature and the next day you’re magically a mature adult,” he says. “But we need that distinction for policy reasons. The same thing goes for death.”

For all the controversy around DCD, however, it has not been the panacea many donor advocates thought it would be, Magnus says. Stanford Hospital considers about one potential DCD donor a month. Over the past seven years, only three have actually made it as far as surgery, and only two of these successfully provided organs — kidneys in both cases.

“It’s a rare occurrence,” Magnus says. “The hope that UNOS [United Network for Organ Sharing] initially had was this might make up as much as 30 percent of all successfully recovered cadaveric organ donations.” While DCD was used for some 11 percent of dead donors in 2008, it accounted for only 7 percent of organs recovered from dead donors. (A DCD donor usually provides fewer organs than does a brain-dead donor.)

There is no ‘bright line’ indicating the moment a person becomes a corpse.

One reason DCD procurements haven’t risen more is that the majority of transplant centers will accept DCD organs only from donors who are middle-aged or younger — and, on occasion, the vigorous 60-year-old who runs marathons. This is because the organs must be healthy enough to withstand the dying heart’s decreasing blood flow, followed by a complete lack of oxygen for several minutes after cardiac arrest. (In almost all cases, hearts cannot be recovered in DCD procedures because they suffer too much damage during this process.) Then the organs must survive in a cold solution, which helps slow their deterioration, for at least several hours, but often much longer. Brain-dead patients, on the other hand, can be donors into their 80s: They remain on a heart-lung machine during most of the surgery, giving their organs all the oxygen-rich blood they need.

Another reason for the low numbers of potential DCD donors is simply that fewer young people die — because they are, well, young. And when a young person dies, family members may have trouble coming to grips with the loss and so neglect or scorn end-of-life considerations, such as organ donation. That’s unfortunate not only for potential recipients but for the family of the deceased, says Nikole Neidlinger, MD, the medical director of the California Donor Transplant Network.

“A lot of people think that it’s all about the organ recipient, but really, I think, the donors’ families get the biggest benefit,” Neidlinger says. “They have spent perhaps weeks dealing with the hardship of seeing loved ones on life support and coming to terms with their death. And the fact that the donor gets a chance to help another person live — it’s a legacy that counts so much for families.”

In 2005, the day after Thanksgiving, Pierre Bobet Erhard, 25, dined on leftover turkey and stuffing with his mother, Nancy Erhard, at her home in Stoneham, Mass. Bo, as everyone called him, had led a troubled adolescence. In seventh grade, he was arrested several times for minor delinquencies, such as vandalism, shoplifting and marijuana possession. He was expelled from school. “Bo had no sense of safety, but he was a likable, funny kid,” Nancy says. “He was like Robin Williams.” With the support of his family, Bo turned his life around. He graduated from high school and became a plumber.

After dinner, he said goodbye to his mom and drove to a house he shared with two friends in Billerica, a town along the Concord River, about 22 miles northwest of Boston. They had recently moved in together and were throwing a housewarming party. Around midnight, Bo was in his room, talking with some friends, when he collapsed and stopped breathing — suddenly and for no apparent reason, witnesses said. An ambulance rushed him to the hospital.

“When I got to the emergency room, it was practically empty, except for Bo,” Nancy says. “He was in a bed, intubated, with the guardrail down. He was completely motionless. I felt this sense of doom.”

Doctors said a tear on the inside wall of his carotid artery had caused a massive stroke. He had suffered severe brain damage and was breathing only with the help of a ventilator. Nancy asked a resident in neurology whether he had treated patients in this condition, and the resident said that he had, many times. She asked if any of these patients had survived. “No one,” the resident replied, and looked at the floor.

“I need to speak to the organ bank,” she said.

Several days later, as Nancy waited for doctors to remove Bo from life support so he could become a DCD donor, she recalled a conversation she once had with him in his late teens: “We were driving in the car, and I told him, ‘You have had more help than everyone else in town put together, and someday you have to give back.’ And he turned to me with a big smile and said, ‘Don’t worry, Ma. Someday I will.’

“The chances of families saying yes to DCD are about 50-50,” continues Nancy, who since her son’s death has volunteered for the New England Organ Bank. “More and more people are doing it, though, because more and more people realize the kind of gift it is. I know what Bo would have said about this situation. He would have said, ‘Mom, do some good.’”
Stanford U Medicine

Monday, March 28, 2011

23 Days for Life: Day 3: ProLife Across America "The Billboard People"


Home Page

The 2010 Campaign

May 18th Banquet with Vicky Thorn of Project Rachel

Billboard Questions

Radio Ads

Contact PLAM


To Contribute to the Placement

of these

ProLife Across America


More on Fargo Bishop Aquila's message on pro-abortion politicians receiving Holy Communion

Last Tuesday, I published excerpts of and links to Stella Bishop Samuel Aquila of Fargo's great talk on the reception of Holy Communion by pro-abortion politicians in the U.S.

Bishop Samuel Aquila of Fargo: How long will pro-abort politicians be able to receive Communion?

Since then it has received much further nation-wide coverage. Canon Lawyer Dr. Ed Peters of Detroit, formerly of the Diocese of Duluth, on Sunday published his comments on the same talk from the perspective of a canon lawyer.

A remarkable essay by the Eagle of Fargo .

One of the most important essays by a bishop on
Canon 392 (the norm setting forth a bishop’s fundamental duty to supervise the enforcement of ecclesiastical discipline in his diocese) never mentions Canon 392; one of the most important essays by a bishop on Canon 915 (requiring ministers to withhold holy Communion from certain public sinners) never mentions Canon 915; and in fact, one of the most important essays on canon law generally by a bishop since the 1983 Code came out, was not written by a canonist bishop and scarcely even mentions the Code.

Fargo ND Bp. Samuel Aquila’s remarkable essay “Good Shepherd: Living Christ’s Own Pastoral Authority” shows how a bishop who thinks with the Church can’t help getting the canonical big picture right at the same time. This should surprise no one, for canon law, in its turn, is all about getting the pastoral picture right.

Any bishop who thinks with the Church, who understands that lessons in ecclesiastical leadership are woven throughout the Scriptures, and who believes, in short, that “p. c.” stands for genuine “pastoral care”, and not for “politically correct”, is going to find solid guidance for his pastoral decision-making in canon law and objective defenses of his pastoral actions under the Code. Even if he doesn’t use canonical jargon.

I loved the way Bp. Aquila, for example, drawing on the model for graduated confrontation of wrong-doing in the Church cited in Matthew 18, didn’t mention that
Canon 1341, among others, sets out the same approach in canonical language. Or again, he asks, and not rhetorically, how many votes against basic Church values, performed over how many years, does it take to convince the minister of holy Communion that this Catholic politician or that is obstinately persevering in manifest grave sin, without ever using Canon 915's precise language?

The Eagle of Fargo delivered his remarks to seminarians, but they are well worth reading by priests and, need I say it?, by bishops who know that, someday, they will have to render an accounting of their office to Someone in a considerably more demanding setting than that of a pope during a quinquennial visit. + + +

And today, Father Z added his comments here on Dr. Peters' post.

Sunday, March 27, 2011

23 Days for Life: Day 2 --- Have You Heard of the Human Life Alliance


Click on the "4 arrows" at the bottom right to show full screen
Have you heard of the Human Life Alliance?

Promoting A Culture of Life

Human Life Alliance (HLA) is a non-profit, non-denominational, pro-life organization dedicated to protecting human life from the moment of conception until natural death.

Founded on April 2, 1977, by dedicated pro-life volunteers, HLA operates out of a small office in Minneapolis, Minnesota, employing only five full-time staff members. HLA keeps administrative and overhead costs to a minimum by relying on faithful volunteers and a student internship program as a vital part of the operational team.

HLA's priority project is to publish and distribute advertising supplements, focusing on abortion, euthanasia, and chastity, through mainstream media and college newspapers. Reaching a combined circulation of nearly 30 million copies over the past 14 years, these extremely powerful and creative advertising supplements are the cause of vigorous debate on high school and college campuses across the nation receiving widespread acclaim.

You Can Stop Injustice


You Can Stop Injustice encourages everyone to recognize abortion as the greatest social justice issue of all time! The solid pro-life content in You Can Stop Injustice challenges young people to re-evaluate their opinions about abortion, its impact on women and men, and the humanity of the preborn child.
12 pages.

She's a Child, Not a Choice


Equip pro-lifers in your community with the facts about the personhood of the preborn child and the consequences of abortion for women with the 20th anniversary edition of She’s a Child, Not a Choice. Learn the astonishing details of stem cell research, in vitro fertilization, eugenic abortion, and more. Great for your church or organization!

Did You Know?


Abortion is the leading cause of death among African Americans. Did You Know? is shattering the silence of this great tragedy. Written by African Americans for the African American community, Did You Know? contains powerful articles written by leaders such as Dr. Alveda King, niece of Martin Luther King Jr., Rev. Arnold Culbreath, Urban Outreach Director for Protecting Black Life, Dr. Johnny Hunter, National Director of Life Education and Research Network, Inc., and many others.
12 pages.

Endangered: Our Future in Peril


Endangered reaches out to men and women considering abortion and educates them on the humanity of the preborn child and the consequences of abortion for women and men. It also goes more in depth to examine forced abortion, maternal mortality, feminism, and the funders and providers of abortion. This publication is a great resource to be used around the world.
12 pages.

Just for Girls/Just for Guys


This trendy, double-sided flip magazine for teens presents the importance of abstinence until marriage. It covers a wide-variety of topics on sex, dating, and healthy relationships. You know teens will read both sides!
16 pages.

Imposed Death

Imposed Death

Imposed Death exposes common misunderstandings associated with Living Wills and end-of-life decisions. This publication documents society’s progress down the “slippery slope” of assisted suicide and euthanasia to dehumanize the elderly, disabled, and medically vulnerable.
12 pages.

Life Begins: An Amazing Adventure


Teach grade school children about the humanity of the pre-born child. Life Begins is a delightful walk through the first nine months of life, narrated by two adventurous bunnies, Carl and Tickles. Children will love the antics of the comical narrators while learning important life-affirming information about how a baby grows inside a mother’s womb.
16 pages.

Human Life Alliance Home Page

Saturday, March 26, 2011

23 Days for Life: Day 1: "Of Gods and Men"

40 Days for Life is a community-based campaign that draws attention to the evil of abortion through the use of a three-point program:
  • Prayer and fasting
  • Constant vigil
  • Community outreach
It's been around since 2007 and I have been vaguely aware of it but have neglected in the past to participate in it because I decided that I had a few ministries that I participate in, my prayer life, although needing work, was OK, and, etc, etc, etc. Always excuses.

This morning, I was browsing through some of the local blogs and came across Cathy of Alexandria's Recovering Dissident Catholic gem of a blog where she is famous for ranting (often) and wailing (occasionally) about one thing or another. This morning she was wondering if there was any merit to praying if God never seems to answer. Angela Messenger, one of Cathy's faithful minions commented in support of Cathy's conclusion that was "Yes, there is much merit" and that drew me to her blog, named after herself, with the patronage of Sts. Michael, Gabriel and Raphael, and where she was on Day 17 of the Forty Days for Life campaign for Lent.

"I could be doing that", I thought. But why wait until next Lent. I'm going to start it right now with only 23 days left. And I might cover other important and aspects of life, besides abortion.

I decided that after having gone to see the movie this evening of, "Of Gods and Men", the story of the martyrdom of seven Trappist monks in Algeria in 1996, by as yet undetermined perpetrators. The theorists are divided between blaming Islamic guerilla terrorists, or the Algerian government, possibly by mistake and covered up.

Local priest, composer and liturgist, Father Michael Joncas has written a
review on the Pray Tell blog of Of Gods and Men, that won the second prize at last year's Cannes Film Festival. The photography is stunning and the acting by North Africans and French actors unknown to me, was wonderful. Really great and understandable French subtitles.

It is a wonderful film and be sure to see it if it comes to a theater near you. It gives solid Catholic view of what life in an impoverished Trappist monastery is like in a third world country. In some respects, it is as moving as was "The Passion of the Christ" as the men saw a horrible death coming and decided to stay and face it. The faced it as weak men, somewhat like the 11 Apostles, most of them at first wanting to run, but eventually re-dedicating themselves to their God, their religious vocation, to their Trappist brothers and their ministry to the local, peaceful Muslim community,

Their martyrdom is not shown, but in actuality, their throats were slit. It is playing at the Edina Theater (reviews included) in that Minneapolis suburb.