Catholic Health Association Research Articles

Psychiatrist Among Powerful Voices in Health Care

Back to table of contents Previous article Next article Members in the NewsFull AccessPsychiatrist Among Powerful Voices in Health CareRich DalyRich DalySearch for more papers by this authorPublished Online:19 Oct 2007https://doi.org/10.1176/pn.42.20.0014Deborah Peel, M.D.: “Even the threat of [patient record] exposure has a really negative impact on our ability to treat mental illness.”What does Texas psychiatrist Deborah Peel, M.D., have in common with Gov. Arnold Schwarzenegger and Sen. Hillary Clinton? For one thing, all three were voted among the most influential voices in the nation's health care system.The readers of Modern Healthcare magazine voted the practicing psychiatrist of 30 years and founder of the foundation Patient Privacy Rights fourth among the 100 “Most Powerful People in Health Care” in August. The sixth annual list was based on 12,600 reader-submitted nominations and final balloting for the 300 most-nominated people. Nearly 265,000 votes were cast.Peel was listed behind Sister Carol Keehan, president of the Catholic Health Association; former Massachusetts Gov. Mitt Romney; and California Gov. Arnold Schwarzenegger. The magazine's readers said they thought she was more powerful than health heavyweights such as Sen. Edward Kennedy, House Speaker Nancy Pelosi, and Bill Gates.Peel became known through her work with the nonprofit foundation she launched in 2003 in Austin, Texas, after realizing the implications of the privacy rule issued as part of the Health Insurance Portability and Accountability Act (HIPAA).The rule “legally authorized more than 4 million entities to use and disclose our personal health information without our consent and over our objections,” she said in an interview with Psychiatric News.Those users of health record information can include financial institutions or employers, who could use what they read in the records to reject loan applicants or job seekers, for example.“Information technology companies' business models are based on selling the patient data entered with their software, because [those data are] so valuable,” Peel said.In a world where more patient health records were becoming easily transferrable to many patients, Peel saw dire consequences for parties. And as a psychiatrist, the immediate and significant harm to her patients from even the fear of disclosure was obvious.“Even the threat of exposure has a really negative impact on our ability to treat mental illness,” Peel said.Her efforts to ensure the privacy of patient records has included educating the media about the daily sale of millions of individual health records, testifying before Congress on the need for federal protections, and working with health information technology businesses to change their practices.“This is a tremendous honor for one of our colleagues,” said Carolyn Robinowitz, M.D., APA president. “Dr. Peel's tireless work as a patient advocate is something to be admired.”Part of that work included her leadership in forming the bipartisan Coalition for Patient Privacy in 2006, which includes more than 40 organizations from across the political spectrum, including the Family Research Council, California Medical Association, and American Civil Liberties Union. The coalition was organized to present a united front to lawmakers to convince them of the need for individuals to control all access to their health records and the consequences of having those records easily accessible to third parties.The coalition has urged Congress to pass legislation that would ensure that the right to health privacy is guaranteed and protected in federal statute beyond the HIPAA law, which allows businesses to sell such data. Peel has also spoken out against legislation, such as the Wired for Health Care Quality Act (S 1814), because she and other privacy advocates maintain that it would undermine patient control of the health records it purports to protect because, in part, it would not recognize a patient's right to health information privacy in routine situations.She has urged health information technology companies to support the use of technology such as consent management systems and health record banking or trusts that allows consumers to have control of their personal health information.Peel also has held a range of leadership positions within APA, including membership in the APA Assembly Allied Organization Liaison Committee and the APA Assembly Committee on Planning. She was president of the Texas Society of Psychiatric Physicians, the state's APA district branch, from 2000 to 2001.More information on the Patient Privacy Rights foundation is posted at<www.patientprivacyrights.org/site/PageServer>.▪ ISSUES NewArchived

The Catholic Health Association's Response to the Papal Allocution on Artificial Nutrition and Hydration

The Catholic Health Association supports the use of the Ethical and Religious Directives for Catholic Health Care Services when making decisions about artificial nutrition and hydration. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

"Definite lines of influence": Catholic sisters and nurse training schools, 1890-1920.

Standard histories of the nurse training school movement have focused on national leaders and organizations and have generally not included Catholic sisters, even though nuns had established approximately 220 nursing schools by 1915. This study asks how Catholic sisters used their distinct understanding of nursing to shape their nursing schools and the nurse training movement in the United States between 1890 and 1920. Historical methodology draws upon primary sources in archives of three women's religious congregations, the Catholic Health Association, and the University of Notre Dame. These include nuns' constitutions and letters, hospital chronicles, journals, minutes of meetings, training school records, annual reports, yearbooks, census records, and educational reports. Secondary sources include nursing, hospital, religious, and labor histories. Catholic sisters adapted their nursing to bring it into line with modern society by establishing nurse training schools for both religious and secular women. This legitimized their nursing practice and enhanced their influence with students, physicians, and hospital groups. As nuns admitted laywomen into their schools and worked toward accepted standards of professionalization, they stamped their distinct understanding of nursing onto secular society. The development of professionalized nursing drew Catholic sisters' schools toward common goals with non-Catholic programs. On the other hand, the sisters' historical construction of nursing in the 19th century, their unique relationship with physicians, and the obstacles they faced later, such as the Roman Catholic clergy's attempt to control evaluation processes, indicate a distinct approach to Catholic nursing. Questions remain as to whether nuns could hold onto their authority later in the 20th century.

An Ethicist's Perspective on Health Care Reform

AT A TIME when this nation is scrutinizing numerous health care proposals for their economic, political, and legal palatability ( JAMA . 1992;268:2139-2141 and 1992;268:1635-1639), little emphasis has been placed, so it seems, on ethical considerations. In the eyes of one medical ethicist, the debate is not only about politics and economics, but about a fundamental moral issue of how we treat people, especially people who are least able to defend themselves. So contends Charles Dougherty, PhD, professor of philosophy and director of Creighton University's Center for Health Policy and Ethics. (Please see previous article.) Dougherty (pronounced DOCK er tee) is author or coauthor of five books and three dozen articles in scholarly journals on the ethics of health care. He has helped design the health care proposal of Sen Robert J. Kerrey (D, Neb) and also that of the Catholic Health Association, St Louis, Mo, whose more than 1200 facilities comprise

Book Review: Food for the Journey, Theological Foundations of the Catholic Health Care MinistryFood for the Journey, Theological Foundations of the Catholic Health Care Ministry by JulianaCasey IHM St Louis: Catholic Health Association, 1991. Pp. ix + 121.

Book Review: Food for the Journey, Theological Foundations of the Catholic Health Care MinistryFood for the Journey, Theological Foundations of the Catholic Health Care Ministry by JulianaCasey IHM St Louis: Catholic Health Association, 1991. Pp. ix + 121.

Medical Ethics: Sources of Catholic Teaching by Kevin D. O’Rourke, O.P. and Philip Boyle, O.P., and: Medical Ethics: Common Ground for Understanding by Kevin D. O’Rourke, O.P. and Dennis Brodeur, and: Healthcare Ethics: A Theological Analysis by Kevin D. O’Rourke, O.P. and Benedict Ashley, O.P.

BOOK REVIEWS 545 Haroutunian, would have balked at the notion that their " empiricism " could be abstracted from the christological and trinitarian confession 0£ the church. In general, it would seem that a genuinely " empirical" approach would seek to engage the actual truth claims of religious com· munities on their own terms-even when those claims conflict with historicist suppositions. Second, in so far as Dean thinks there is a uniquely American reli· gious experience or style of thought, privileging that style seems a dangerous move indeed. Dean is not unaware of the dangers. He specifically denies that he is engaging in any form of " American exceptionalism " (p. 25) ; it is simply that an " appropriately American historicism, centering on American culture, would have a greater chance of suggesting practices that work for and are true for America " (p. 24) . But I am skeptical that such disclaimers address the real problem. Near the very end of the book, Dean suggests that a modi· fied naturalism might lead to " a notion of God that was more genuinely American than anything earlier," culminating in the recognition that " American thought about God is really the thought of a national com· munity" (p. 144). Descriptively that may well be the case; but then the Christian theologian must seek norms elsewhere. History Making History does not show us how historicist insigh~ might be incorporated into ecumenical, trinitarian theology, but that does not mean the attempt will prove unfruitful. Meanwhile, this bit of philosophical tale-telling will hold the interest of readers theological and otherwise. JOSEPH L. MANCINA Yale University New Haven, Connecticut Medical Ethics: Sources of Catholic Teaching. By KEVIN D. O'ROURKE, O.P. and PHILIP BOYLE, O.P. St. Louis: Catholic Health Associa· tion, 1989. Medical Ethics: Common Ground for Understanding. By KEVIN D. O'RouRKE, O.P. and DENNIS BRODEUR. St. Louis: Catholic Health Association, 1989. Healthcare Ethics: A Theological Analysis. By KEVIN D. O'RouRKE, O.P. and BENEDICT ASHLEY, O.P. 3rd ed. St. Louis: Catholic Health Association, 1989. Sources of Catholic Teaching is a compendium of recent "official" statements by Roman Catholic ecclesiastical bodies on issues concern· ing medical ethics. Arranged alphabetically according to topics, this col- 546 BOOK REVIEWS lection of statements from the papacy, the Roman Congregations, and the conferences of Catholic bishops could prove to he a very helpful reference tool. It contains a brief introduction which seeks to explain the role of these statements in the Catholic moral theology and Catholic medical ethics, a table of contents of the statements included, and then the statements themselves. In most instances it does not contain the entire document or statement hut only excerpts therefrom. There are some weaknesses in this work. First, these statements are not self-explanatory; they are in need of interpretation and explanation in many instances. But the authors present only the bald text and do not offer any explanatory comments. They apparently presume that these statements are pellucid to the reader, hut this is an unwarranted pre· sumption. For example, clarifying comments should have been added to the statement from the Declaration on Euthanasia because the allocution of Pius XII about giving lethal doses of analgesia is not entirely clear. A second difficulty with this work is the brief and somewhat insubstantial introduction on conscience and the role these statements should play in the formation of conscience. This sort of work invites a substantial and extended commentary on the nature of moral judgments , the relationship of conscience to the natural law, and the authority of these statements. The authors note that not all of the official statements issued by various organs of the Church are of equal authority , hut they do not try to identify the specific authoritative status of the various statements they include in their work. The reader is thus left to his or her own devices to determine, for example, the relative weight of statements of the administrative hoard of the NCCB versus statements of state episcopal conferences. A still further problem is that some of the statements are of virtually no significant authority for Catholics. For example, the statement of the administrative hoard of the NCCB on AIDS is of questionable...

Feeding the Comatose and the Common Good in the Catholic Tradition

FEEDING THE COMATOSE AND THE COMMON GOOD IN THE CATHOLIC TRADITION ROBERT BARRY, O.P. University of Illinois Ohampaign-Urbana, IlUnoi8 AA RECENT convention :sponsored by the Catholic Health Associaition in Boston, Laurence J. O'Connell, vice-president for ethics and theology, ma.de the following comments: I am concerned that some of those who are legitimately alarmed by the potential abuses associated with the public policy that authorizes the withholding and withdrawing of mechanical means of nutrition and hydration are sometimes publicly misrepresenting the Catholic moral tradition. In other words, in their well-intentioned and perfectly legitimate efforts to avoid the slippery-slope-that is, the wrongful withholding or withdrawing of nutrition or hydration from vulnerable dasses of patients-those advocates are placing the Roman Catholic moral tradition itself on the slippery slope. It is mistaken to say it is the church's teaching that we may never withhold or withdraw artificial nutrition and hydration. It is mistaken to uncritically refer to the removal of medically engineered nutrition in all cases as starvation-that is, the willful withholding of nutrition as morally obligatory. It is mistaken to say that the ethical standards of a single Catholic hospital are necessarily coextensive with the ethical standards of the Catholic Church. Just because an individual Catholic facility, for whatever reason, uniformly refuses to allow the withholding or withdrawing of technological feeding, does not mean that the Church itself disallows such withholdings or withdrawals.1 It is not clear how the Catholic moral tradition can be put on the " slippery slope " by opposing certain forms of with1 "Church and State Overlap in Ethical Debate", American Medicai News. February 27, 1987. p. I. 1 ROBERT BARRY, O.P. drawal of feeding from specific classes of patients. Dr. O'Connell has misrepresented the thought of most of those who oppose the recent American Medical Association's new opinion which holds that artificially administered nutrition and fluids can be removed from terminally ill patients, even when they are not imminently dying.2 There are no Catholic moralists who claim that it is always and everywhere morally wrong to withhold or withdraw feeding from patients. However, there are a number of moralists as well as bishops who now hold it to be wrong to withhold or withdraw feeding in those cases where the withholding or withdrawal becomes the fundamental and underlying cause of death. O'Connell is p11obably correct in saying that the policies of one hospital do not necessarily deteJ1IDine the moral doctrines of the universal Church, but neither does one national organization such as the Catholic Health Association with only a loose affiliation with the magisterial hierarchy of the Church necessarily do this either. The debate over the provision of ,aissisted feeding is a debate over whether iit is morally legitimate ito withdraw feeding so 1tihat .t:he primary and fundamental reason why the person dies is that withdrawal. It is a debate over whether those with a certain " quality of life " can be permitted to be killed by omission. It is a debate over whether feeding provided by routine nursing measures that can significantly sustain the life is a medical treatment that should he governed by the criteria governing other treatments, or whether it is an 2 "Withholding or Withdrawing Life Prolonging :Medical Treatment" adopted by the Council on Ethical and Judicial .Affairs of the .Amercian Medical .Association on March 15, 1987, In its pertinent parts, it stated: The social commitment of the physician is to sustain life and relieve suffering. Where the performance of one duty conflicts with the other, the choice of the patient, or his family or legal representative if the·patient to act in his own behalf, should prevail. Life prolonging medical treatment includes medication and artificially or technologically supplied respiration, nutrition or hydration. In treating a terminally ill or irreversibly comatose patient, the physician should determine whether the benefits of treatment outweigh its burdens. .At all times, the dignity of the patient should be maintained .•. FEEDING THE COMATOSE 8 aspect of normal care, like protection from exposure or hygienic care, that is to be accorded to all patients. In this piece, I wish to review the thoughts of some...

Book Review: Medical Ethics: Common Ground for UndertandingMedical Ethics: Common Ground for UndertandingO'Rourke/BrodeurSt. Louis: Catholic Health Association, 1986, $16, paperback.

Book Review: Medical Ethics: Common Ground for UndertandingMedical Ethics: Common Ground for UndertandingO'Rourke/BrodeurSt. Louis: Catholic Health Association, 1986, $16, paperback.

Health Care Consent Manual: Policies, Laws, and Procedures. By Karen M. Engstrom, A.R.T. (Catholic Health Association, St. Louis, 1985), 127 pp., $13.50.

<i>Health Care Consent Manual: Policies, Laws, and Procedures</i>. By Karen M. Engstrom, A.R.T. (Catholic Health Association, St. Louis, 1985), 127 pp., $13.50.

Health Care Consent Manual: Policies, Laws, and Procedures. By Karen M. Engstrom, A.R.T. (Catholic Health Association, St. Louis, 1985), 127 pp., $13.50.

<i>Health Care Consent Manual: Policies, Laws, and Procedures</i>. By Karen M. Engstrom, A.R.T. (Catholic Health Association, St. Louis, 1985), 127 pp., $13.50.

To treat or not to treat: A working document for making critical life decisions

To treat or not to treat: A working document for making critical life decisions. Showalter, J.S., and Andrew, B.L. (The Catholic Health Association of the United States, St. Louis, Missouri, 1984), 107 pages, $15.00.