The War Against Crisis Pregnancy Centers Escalates

When the Dobbs v Jackson Women’s Health Organization draft decision by the US Supreme Court to return abortion law to the individual states was outrageously leaked, I wrote about the pro-abortion violence perpetrated on crisis pregnancy centers and the threats against Supreme Court judges.

Now, Senator Elizabeth Warren of Massachusetts is not only strongly protesting the final ruling but also states:

“With Roe gone, it’s more important than ever to crack down on so-called ‘crisis pregnancy centers’ that mislead and deceive patients seeking abortion care,” said Massachusetts senator Elizabeth Warren, promoting her bill. “We need to crack down on the deceptive practices these centers use to prevent people from getting abortion care, and I’ve got a bill to do just that,”

Her bill titled the “Stop Anti-Abortion Disinformation Act” or “SAD Act” directs the Federal Trade Commission to “promulgate rules to prohibit a person from advertising with the use of misleading statements related to the provision of abortion service.” It would also allow charities to be fined $100,000 or “50 percent of the revenues earned by the ultimate parent entity” for disinformation, although the legislation itself does not define the prohibited speech.

Joining Senator Warren on the bill are Senators Hirono, Schatz, Booker, Smith, Klobuchar, Sanders, Murray, Merkley, Blumenthal, Feinstein, Wyden, Gillibrand, Markey, Warner and Markey.

Speaking with reporters in July, Senator Warren stated that:

“In Massachusetts right now, those crisis pregnancy centers that are there to fool people who are looking for pregnancy termination help outnumber true abortion clinics by 3 to 1. We need to shut them down here in Massachusetts, and we need to shut them down all around the country. You should not be able to torture a pregnant person like that” (All emphasis added)

This pronouncement was met with derision, even from some reporters.

A CRISIS PREGNANCY DIRECTOR RESPONDS

Heidi Matzke, who heads a Crisis Pregnancy Center in Sacramento, California was eloquent in describing the violence her center has faced as well as responding to Senator Warren’s point that centers like hers must be shut down:

We have had to stop operations of our mobile clinic. We’ve had to hire 24-hour onsite security. We’ve had to add cameras. We’ve had to arm our staff with pepper spray,” she said, adding last week a man with a machete showed up and was stopped before he could inflict any harm or damage.”

She also called Ms. Warren statements “horrific”:

“Pregnancy centers give away $266 million of free medical services and resources to communities all over this incredible country. And her words are just incredibly hurtful.” (Emphasis added)

She also said her center provides fully licensed OB/GYN care with medical professionals and that “most of the women working at her clinic have had an abortion before and many believe their lives would be ‘so much different’ if they had gone to a pregnancy center.”

CONCLUSION

Personally and as a nurse, I have had experience with women considering abortion as well as women (and men) who relate how they were damaged by an abortion. They need compassion and real help.

Crisis pregnancy centers are a wonderful resource and even Sen. Warren acknowledges that crisis pregnancy centers outnumber well-funded abortion clinics by 3 to 1. There’s a lesson in that.

But most importantly, I wish that all of us would realize that abortion is a tragic loss of a life regardless of the circumstances, not a political cause to celebrate!

Pain, Choice, and Canada’s now “most permissive euthanasia legislation in the world”

In his excellent July 10, 2022 blog, Alex Schadenberg, chair of the International Euthanasia Prevention Coalition, reveals that now “Canada’s medical assistance in dying (Maid) law is the most permissive euthanasia legislation in the world”.

He says “Canada’s MAiD law currently allows suicide facilitation for persons with disabilities and is on track to expand in March 2023 to those living with mental illness. “ (Emphasis added)

How did assisted suicide/euthanasia laws get so far and so fast down the proverbial “slippery slope”?

In my December, 2016 blog “Pain and ‘Choice’”,  I wrote about how I saw the warning signs when I was a new nurse in 1969.

Here is my blog:

PAIN AND “CHOICE”

December 15, 2016 nancyvalko 

It was 1969 and I was fresh out of nursing school when I was assigned to a patient I will call “Jenny” who was thirty-two years old and imminently dying of cancer. She was curled up in her bed, sobbing in pain and even moaned “just kill me.” The small dose of Demerol I injected into her almost non-existent buttocks every four hours “as needed” was not helping. I reassured Jenny that I was immediately calling the doctor and we would get her more comfortable.

However, I was shocked when the doctor said no to increasing or changing her medication. He said that he didn’t want her to get addicted! I told him exactly what Jenny said and also that she was obviously very close to death so addiction would not be a problem. The doctor repeated his no and hung up on me.

I went to my head nurse and told her what happened, but she told me I had to follow the doctor’s order. Eventually, I went up the chain of command to the assistant director of nursing and finally the Chief of the Medical Staff. The verdict came down and I was threatened with immediate termination if I gave the next dose of Demerol even a few minutes early.

I refused to abandon Jenny so for the next two days before she died, I spent my time after my shift sitting with her for hours until she fell asleep. I gave her whatever food or drink she wanted. I stroked her back, held her hand and told stories and jokes. I asked her about her life. I did everything I could think of to distract her from her pain and make her feel better. It seemed to help, although not enough for me. I cried for Jenny all the way home.

And I was angry. I resolved that I would never watch a patient needlessly suffer like that again.

So, I educated myself by reading everything I could about pain medicine and side effects. I also pestered doctors who were great at pain control to teach me about the management, precautions, and rationale of effective pain management. I used that knowledge to advocate and help manage my patients’ pain as well as educating others.

I was delighted to see pain management become a major priority in healthcare and even called “the fifth vital sign” to be evaluated on every patient. I saw new developments like nerve blocks, new drugs, and regimens to control pain and other techniques evolve as well as other measures to control symptoms like nausea, breathlessness, and anxiety. Now we also have nutritional, psychological, and other support for people with terminal illnesses and their families.

Best of all was that I never again saw another patient suffer like Jenny despite my working in areas such as ICU, oncology (cancer) and hospice.

TWENTY-FOUR YEARS LATER

When my oldest daughter was 14, she attended a public high school where the science teacher unexpectedly started praising the infamous Dr. Jack Kevorkian and his public campaign for legalized assisted suicide and euthanasia.  Kevorkian’s first reported victim was Janet Adkins, a 54 year old woman with Alzheimer’s in no reported physical pain who was hooked up to a  “death machine” in the back of a rusty van. Mrs. Adkins was just the first of as many as 130 Kevorkian victims, many if not most of whom were later found to have no terminal illness. Kevorkian escaped prosecution-even after he harvested a victim’s organs and offered them for transplant-until the TV show 60 Minutes aired Kevorkian’s videotape showing him giving a lethal injection to a man with ALS (Lou Gehrig’s disease). Shockingly, Kevorkian served only 8 years in prison before he was paroled and eventually became a media celebrity peddling assisted suicide and euthanasia.

My daughter, who never before showed any interest in my speaking and writing on the topic of assisted suicide, now stood up and peppered her teacher with facts about Kevorkian. The teacher asked her where she learned her information and she answered, “From my mom who is a cancer nurse”.

Sarcastically, he responded “So your mother wants to watch people suffer?” My daughter responded “No, my mother just refuses to kill her patients!” End of discussion.

CONCLUSION

But not the end of the story. Tragically, we now have legalized assisted suicide in several states and serious efforts  to expand it to include people without physical pain but with conditions like Alzheimer’smental illness or other psychological distress as well as even children.

As Wesley Smith recently and astutely observed:

 “Moreover, the statistics from Oregon and elsewhere show that very few people commit assisted suicide due to physical suffering. Rather, the issues are predominately existential, such as fears of being a burden or losing dignity

The public is being duped by groups like Compassion and Choices that campaign for legalized assisted suicide on the alleged basis of strict criteria for mentally competent, terminally ill adults in unbearable physical pain to freely choose physician-assisted suicide with (unenforceable) “safeguards”.

The emerging situation throughout the world is more like Kevorkian’s dream of unfettered and universal access to medical termination of the lives of “expendable” people. How much easier is that when people with expensive mental health problems, serious illnesses or disabilities can be encouraged to “choose” to be killed?

A Crisis Pregnancy Close to Home

A few days ago, I read an article from one of the medical news sites I subscribe to titled Would You Like to Keep This Pregnancy?’ I Asked My 13-Year-Old PatientHaving a choice can help end cycles of poverty among marginalized teen patients”.

Of course, the doctor/author was pro-abortion and the article was horrifying to me. I thought how differently a pro-life healthcare provider would handle the situation and remembered a news article I wrote in March, 1998 for the National Catholic Register newspaper.

Here is the news article:

A Crisis Pregnancy Close to Home

When it’s your own unmarried teenage daughter facing a staggering ‘choice,’ are you still pro-life?

“Mom, I’m pregnant.” When these words are uttered by your unmarried teenage daughter, it’s a heart-stopping moment for any parent. When the parent is a committed pro-lifer, the shock is often overlaid with stunned disbelief, shame, and guilt. “Hasn’t she been listening? This isn’t supposed to happen to my daughter!” and “How did I fail her?” are common first reactions. I know.

This Christmas, my 18-year-old daughter quietly told me that two at-home pregnancy tests came out positive.

Marie, named after the Blessed Mother, had long been my “worry child.” A brittle crust of teen rebellion had long covered a soft, sensitive heart, leading to a constant round of minor and not-so-minor infractions and arguments. Lately, though, her life seemed to be coming together. A“B” average at college and a job she loved lulled me into a sense that the worst was over. She confided that she thought she was falling in love and we talked about the pressures and temptations such strong emotions bring. Street-wise and assertive, I thought she was “safe.” But, as countless other parents have also discovered, my child lives in a world that too often considers virginity a disability and chastity an old-fashioned ideal.

The one bright spot in that night of tears and fears was that abortion was never considered an option by Marie: “Mom, I couldn’t kill my baby!” Although I was heartbroken by the circumstances of this pregnancy, I couldn’t help but feel proud of her for having the courage and common sense to reject the abortion “option.”

Surprisingly, she said all her friends were against her having an abortion and a few who had been leaning “pro-choice” were now rethinking their position. Two of her friends actually threatened to physically stop her from having an abortion even before she told them that she would never abort.

We didn’t resolve everything that first night or even later. Adoption or keeping the baby is still the big question and one that will involve a lot of prayer, thought, and discussion. It hasn’t been easy, but facing this crisis together has taught both of us so much already. What the future holds for Marie and her baby is uncertain but, with prayer and love, it is still a future bright with promise for both of them.

A Common Stereotype

A January 1998 New York Times article, “Many Women Make No Link Between Abortion and Politics,” perpetuates a common stereotype-the pro-lifer who chooses abortion when a crisis pregnancy hits home. Writer Tamar Lewin states, “Almost every abortion-clinic counselor can reel off stories of patients who say that they have always opposed abortion but that their own situation is different, or men who bring their pregnant wives or teenage daughters to the very same clinics that they have long spoken out against.”

But conversations with people active in the pro-life movement reveal a very different picture. Not surprisingly, pro-life people willing to help total strangers with a crisis pregnancy are also ready to help and support their own sons and daughters facing the same crisis.

“You think it’s the blackest day in your life when your daughter tells you she’s pregnant,” Lucy R., long active in the pro-life movement, says. A smile lights her voice. “But it’s really the beginning of a great blessing. That little boy (now six years old) is the light of our lives.” She credits prayer and pro-life principles for that happy ending.

Janet B. was a young professional when her sister told her that she had had an abortion without their parents’ knowledge because although their mother and father were strongly pro-life, the sister was sure they “just couldn’t take it (an unwed pregnancy).”

When Janet herself became pregnant out of wedlock, her parents became her biggest supporters. “We became so much closer,” she says. “My sister was wrong.” Interviews with pro-life supporters around the country reveal that this kind of family support during a crisis pregnancy appears to be the norm, not the exception.

Marcia Buterin RN, founder of Missouri Nurses for Life and active in the pro-life movement for 25 years, has had broad experience with pro-life parents whose daughters or sons have had crisis pregnancies. “It almost seems like an epidemic sometimes,” she says. “Pro-lifers are not immune from what is happening in the rest of society.”

But, she says, the reaction of the parents she has known has been invariably positive despite the heartache at discovering a son or daughter has been sexually active. She also says that, in the vast majority of cases, the young women keep their babies rather than releasing them for adoption. This echoes statistics which show that more than 90% of unmarried mothers keep their babies, almost the opposite situation of a generation ago when most of these mothers chose adoption. Thus, pro-lifers are not only supporting their daughters and sons during their pregnancies but also are usually involved in helping to raise their grandchildren.

Waning Support for Abortion

Not only do pro-lifers appear to routinely reject abortion for their unmarried children, society seems to be slowly starting to change its attitude toward abortion and the unmarried. According to the latest New York Times/CBS News poll, not only has support for abortion-on-demand eroded by an estimated 8% since 1989, but public support for abortion when pregnancy threatens to interrupt a woman’s career or education has also dropped 14% and 8% respectively.

A clear majority of the people polled did not feel these circumstances justified abortion. Undermining a basic abortion rights tenet that familiarity with abortion increases public acceptance, the same poll showed that “personal experience” was twice as likely to be given as a reason for becoming less favorable towards abortion rather than more supportive of abortion.

At the same time, a new wave of pro-life sentiment appears to be rising in a most unexpected place-the young people who have grown up under the shadow of Roe. The Times/CBS News poll showed even less support for abortion on demand among 18-29 year olds (29%) than among the general public (32%). The Alan Guttmacher Institute, the research arm of Planned Parenthood, has noted that “in recent years, fewer pregnant teens have chosen to have an abortion.” Even the media is beginning to notice. In a Jan. 21 New York Times article “A New Generation Rising Against Abortion,” writer Laurie Goodstein interviewed an eclectic group of young people attending a Rock for Life concert and found thoughtful and strong pro-life support even among those sporting tattoos and punk-style clothing.

Some explained that they began considering the value of life after losing friends to suicide, drug overdoses, and automobile accidents.

Goodstein also noted that many of the concert-goers she interviewed said that they arrived at a “right to life” position on their own and that, to be consistent, they also opposed the death penalty and assisted suicide and supported abstinence.

Countering Rock for Choice and other groups which help raise money for abortion rights groups, Rock for Life is a relatively recent phenomenon which reaches young people through the potent medium of music. Concert organizer Bryan Kemper told Goodstein that 15 concerts have already been staged and that there have been 110 bands “willing to perform for gas money.” Rock for Life is not the only sign that the pro-life movement is connecting with a new generation. Teens for Life, started in 1985, is a national organization run by young people encouraging teens to speak up for life and get involved in community activities. It has chapters throughout the country and continues to grow in numbers.

Another positive sign is the increasing number of pro-life groups springing up on college campuses. And not just on religiously-affiliated college campuses. MIT, Princeton, and the University of Texas are among colleges which not only have pro-life groups but also have websites on the Internet.

What Helps, What Hurts

But trends and statistics do not meet the needs of the individual young woman and her family suddenly facing a crisis pregnancy. The first reactions of parents and others to the news is extremely important to the woman and can even make the life-or-death difference for the unborn baby. When the first reaction is anger or a stern lecture about premarital sex, the young woman can feel abandoned and, in her despair, decide that eliminating the baby will make everyone feel better.

Parents and friends of young men and women coping with an unwed pregnancy are often unsure of what to say or how to handle the situation. One newer resource developed to help with this problem is a video and pamphlet called First Words: Can Our First Reaction to an Unplanned Pregnancy Save a Child’s Life? produced by American Life League.

The video tells the stories of four young women who faced an unwed pregnancy and encountered a range of reactions from friends and family. In their own words, these young women share how these reactions influenced their decisions about whether or not to abort their babies. The pamphlet is written by Cathy Brown who candidly tells her own story and offers helpful advice to parents and others.

But deciding against abortion is only the first step in a crisis pregnancy. The decision about whether to keep the baby or release him/her for adoption is often the most agonizing question for a young woman. Questions about insurance coverage and prenatal care, maintaining or losing a relationship with the father, the reactions of other children in the family, etc. are some of the practical and immediate concerns. Birthright and other pro-life pregnancy counseling centers can be a big help to families struggling with a crisis pregnancy.

Members of the family’s church can also help provide much needed spiritual and emotional support as well as involving the community in the nurturing of a new life.

For parents, especially pro-life parents, embarrassment and feelings of failure are common and understandable. It’s hard to put aside such feelings and concentrate on the feelings and needs of a son or daughter. But, as Donna B., a long-time pro-life activist and herself the mother of a pregnant teen, says, “Abortion is the real failure. It’s OK to be proud when your daughter chooses life.”

Nancy Valko writes from St. Louis, Mo.

WHILE PRO-ABORTION VIOLENCE AGAINST PRO-LIFE CRISIS PREGNANCY CENTERS INCREASES, THE WORLD HEALTH ORGANIZATION SAYS CONSCIENCE RIGHTS REGARDING ABORTION MAY BECOME “INDEFENSIBLE”

We have been witnessing the rage and misinformation dividing Americans after the outrageous leak of Supreme Court Justice Alito’s draft decision on the Dobbs v Jackson Women’s Health Organization returning abortion laws back to the states since it was reported on May 2, 2022.

Many pro-life crisis pregnancy centers are now being attacked with paint, firebombs, etc. by pro-abortion groups like “Jane’s Revenge”. But as Nicole Ault of the Wall Street Journal points out:

“No woman is forced to go to one of these clinics, where more than 10,000 licensed medical professionals worked or volunteered as of 2019, according to the pro-life Charlotte Lozier Institute. In addition to providing ultrasounds and pregnancy tests, the centers help women get supplies and counseling.”

But then, on June 8, 2022 and during the night, U.S. Marshals protecting the home of Supreme Court Justice Brett Kavanaugh from illegally picketing protesters apprehended an individual with a gun and a knife who readily admitted that he was there to kill Justice Kavanaugh in response to the leaked draft opinion that indicated the Court might be preparing to overturn Roe v. Wade.”

Now, Jane’s Revenge has issued a call to ‘riot’ against the Supreme Court if it does overturn Roe v. Wade.

Their flyer “DC CALL TO ACTION NIGHT OF RAGE” declares “THE NIGHT SCOTUS OVERTURNS ROE V. WADE HIT THE STREETS YOU SAID YOU’D RIOT. TO OUR OPPRESSORS: IF ABORTIONS AREN’T SAFE, YOU’RE NOT EITHER.’ JANE’S REVENGE.” (Emphasis added)

THE WORLD HEALTH ORGANIZATION ON ABORTION

On March 8, 2022, the World Health Organization (WHO), the international body responsible for public health and part of the United Nations involved in many aspects of health policy and planning, issued its’ “Abortion Care Guideline.

In the Guideline, WHO recommends “the full decriminalization of abortion” and calls conscientious objection to abortion a major obstacle to making abortion freely available.

According to the WHO recommendations:

“If it proves impossible to regulate conscientious objection in a way that respects, protects and fulfils abortion seekers’ rights, conscientious objection in abortion provision may become indefensible.” (Emphasis added)

CONCLUSION

Personally, when my daughter Karen, born with Down Syndrome and a severe heart defect, died at 5 1/2 months in 1983, my grief was substantially lessened by donating Karen’s clothes, formula, etc. to our local Birthright organization, one of the many pro-life organizations providing help to pregnant women.

Since Karen and as a nurse and mother, I have been able to help advocate for distressed mothers and their families, children and adults with disabilities and, best of all, my own daughter who found she was pregnant in her first year of college and gave birth to my first grandchild.

And I know that the WHO is absolutely wrong in calling conscientious objections to abortion “indefensible”. Conscience rights are critically important for all of us, whether or not we are healthcare providers.

As I wrote in my December 13, 2019 blog “Are We Witnessing the Coming Extinction of Conscience Rights?”:

“With the current support of a predominantly sympathetic mainstream media, well-funded and politically active groups like Planned Parenthood and Compassion&Choices are also putting pro-life health care providers and their supportive institutions in grave danger of becoming an endangered species in law, politics and health care.

If this happens, our health care system will radically change-especially for the unborn, the elderly and people with disabilities.

When dedicated and compassionate people are denied entry into the health care professions because they refuse to deliberately end lives, harassed and/or fired when they refuse to participate in a deliberate death decision and efforts to make religiously based healthcare institutions to allow lives to be ended by “choice”, will any of us ever be able to trust our healthcare system when we need it the most?” (Emphasis added)

Rest in Peace, “Melissa”

I have written blogs about my elderly friend “Melissa” (not her real name) and some of her health care experiences to explain some of the pitfalls elderly people may encounter when they get seriously ill.

I have known “Melissa” for decades and, with her permission, she agreed to my writing about her in my blogs. She was thrilled to hear about my 2018 blog “Covid 19 and Nursing Homes”   and my 2020 blog Don’t Write Off the Elderly”.

She even told me she like the name “Melissa” better than her real name!

I first met Melissa when she was in her 80s through her daughter who is also one of my favorite people.

Both were involved in planning the beautiful wedding reception at my home when my second husband and I were married in 2008. Melissa even remembered my favorite flower and made beautiful centerpieces with them for every table.

After Melissa could no longer drive, I took her to Mass at her parish and then to Chic-Fil-A on Fridays for breakfast with her daily Mass friends until she couldn’t physically make it.

I then visited her on Fridays and was inspired when she accepted hospice care and the care of her family with grace and gratitude.

Eventually, she spent her last days in a bed near a large window where she could watch the birds at her birdfeeder and have some of her beloved flowers at her bedside.

During that time, Melissa and I laughed a lot, prayed together, chatted about current events and family, and watched funny videos and old episodes of TV shows she enjoyed like “Barney Miller” and “Bewitched”.

She also told me many of the fascinating stories behind the pictures of her and her family covering the walls of her room.

Melissa died peacefully on May 6, 2022, at her home at the age of 99 years, 9 months and 5 days, lovingly cared for by her family and great home health and hospice providers.

A devout Catholic, Melissa was unafraid of death and knew she would meet her late husband and her son who died at age 4. Another son unexpectedly died at 56, shortly before Melissa.

Melissa generously donated her body to Logan College to help future doctors with their education.

After her funeral Mass, her family had a Celebration of Life event with pictures and stories about her life. There was a lot of laughter and some tears as we all talked about Melissa and what she meant to us.

CONCLUSION

Melissa and her family are an inspiration to me and an example of how to have a good death, something that seems impossible to many people.

I visited her the day she died peacefully and comfortably, but not awake.

She died just as she hoped.

We will miss you Melissa but we will never forget you!

Rest in peace.

THE TRAGIC DIVIDE ON THE ROE V. WADE ABORTION DECISION

It has been almost physically painful to watch the tidal wave of rage and misinformation dividing Americans after the outrageous leak of Supreme Court Justice Alito’s draft decision on the Dobbs V Jackson Women’s Health Organization returning abortion laws back to the states.

But this is not the first time I saw such division about abortion.

I was a young intensive care unit nurse when the Roe v. Wade decision came down in 1973. Like most people I knew, I was surprised and shocked when abortion was legalized.

However, I quickly found that my medical colleagues were split on the issue, and I was vehemently attacked for being against abortion. I was even asked what I would do if I was raped and pregnant. When I replied that I would not have an abortion and would probably release the baby for adoption, I was ridiculed. Our formerly cohesive unit began to fray.

But I was professionally offended by the pro-life argument that legalizing abortion would lead to the legalization of infanticide and euthanasia.  

It was one thing to deny the truth with an early and unobserved unborn baby, but it was quite another to imagine any doctor or nurse looking at a born human being and killing him or her.

How wrong I was!

As I wrote in my 2019 blog “Roe v. Wade’s Disastrous Impact on Medical Ethics” , it wasn’t until the 1982 Baby Doe case and my daughter Karen’s birth and death opened my eyes and changed my life.

HARD TRUTHS ABOUT ABORTION

Because I am a nurse and mother, I have personally learned some hard truths about abortion and the abortion industry. Here are some of my experiences.

A young relative came to me after visiting a Planned Parenthood clinic for a suspected sexually transmitted disease. She said the clinic told her that she didn’t have an infection but the girl continued to get worse-and scared.

I arranged for her to see my own pro-life ob-gyn who discovered that the infection had damaged her cervix so much that part of it had to be removed and, even worse, she would probably have to have her cervix sewn shut until delivery if she became pregnant in the future.

Learning that Planned Parenthood had apparently missed the diagnosis, my doctor never charged for his services.

KNOWLEDGE IS ESSENTIAL

I will never forget the Christmas day my 18-year-old daughter told me she was pregnant.

We talked for hours, and I told her that I would support any decision she would make-except abortion.

She laughed and told me that abortion was not an option because she “knew too much”, especially from the prenatal pamphlets I showed my children with each pregnancy. They all were excited about how their brother or sister was developing and asked almost daily what their unborn sibling was now able to do.

My first grandchild is now 23 years old and has a loving family who allows us to be part of her life.

And we know even more now about pregnancy, as I wrote in my 2019 blog “An Amazing Video of a Living, First Trimester Unborn Baby” . The video shows an approximately 8 week old unborn baby moving its’ tiny head and limbs remarkably like a newborn baby. Unfortunately, the video was both heartbreaking and beautiful since this little one was developing outside the mother’s womb (ectopic pregnancy) and had to be removed surgically. He or she could not survive for long but this recognizable baby was obviously not a “clump of cells”!

POST-ABORTION TRAUMA IS REAL

Many years ago when I worked in home health and hospice, I cared for a very cranky, elderly woman I will call “Rose” who had rejected all the other nurses in our agency. Even her own doctor had problems with her and told me that he could not understand why she was even still alive because her end stage congestive heart failure was so severe. Part of my assignment was to measure her abdomen and legs to adjust her diuretics (water pills).

As I got to know Rose over a few visits, she softened towards me and began telling me about her life. But one day, while I was measuring her abdomen, she burst into tears and told me she hated looking 9 months pregnant because of the fluid retention in her abdomen. Rose said she knew it was God punishing her for the abortion she had 60 years before!

Rose had never told anyone, not even her late husband, about the abortion she had before marrying him. She felt that baby was the boy she never had but she didn’t feel worthy to even name him. She also told me that she knew she had committed the “unforgivable sin” and was afraid to die because she would be sent to hell. My heart went out to this woman who was suffering so much, more emotionally than even physically.

We talked for a long time and in a later visit about forgiveness and God’s love. I told her about Project Rachel, a healing ministry for women (and even men) wounded by abortion. I gave her the phone number and offered to be with her to meet a counselor or priest but she insisted that my talking with her was enough to help. I felt it wasn’t but she seemed to achieve a level of peace and she even started smiling.

I wasn’t surprised when Rose died quietly and comfortably in her sleep about a week later.

OFFERING HELPFUL INFORMATION IS CRUCIAL

In 1989, I had just started working as an RN on an oncology (cancer) unit when we discovered that one of our patients had CMV (Cytomegalovirus).

One of our nurses was pregnant and tested positive for the virus. Her doctor told her how her baby could die or have terrible birth defects from the virus and he recommended an abortion.

“Sue” (not her real name) was frantic. She had two little girls and worked full time. She said she didn’t know how she could manage a child with serious birth defects.

I told her that it was usually impossible to know if or how much a baby might be impaired before birth. I also told her about my Karen who was born with Down Syndrome and a critical heart defect and died at 5 months. I told her that I treasured the time I had with her and later babysat children with a range of physical and mental disabilities.

Most importantly, I also told her that I would be there to help her and her baby.

“Sue” decided against abortion and told the other nurses what I said.

The other nurses were furious with me and said if the baby was born with so much as an extra toe, they would never talk to me again.

But slowly, the other nurses came around and also offered to help Sue and her baby.

In the end, we all celebrated when Sue had her first son who was perfectly healthy!

CONCLUSION

Many people don’t understand is that being pro-life isn’t just being against abortion, infanticide and euthanasia. What being pro-life really means is truly caring about all lives, born or unborn.

What I have found most helpful is a  sincere interest and willingness to help when encountering people struggling with an abortion decision for themselves or someone close to them.

Why talk about abortion? Because we never know who may need to hear the truth and we need to help heal the tragic divide in our nation by our example.

Baby Tinslee Lewis Finally Goes Home after Beating the Texas 10 Day Rule

In 2019, Baby Tinslee Lewis was born prematurely with a rare heart condition called Ebstein’s anomaly and underdeveloped lungs at Cook Children’s Medical Center in Texas. She needed life support, including a ventilator to help her breathe.

The medical team began talking to her family soon after her birth about possible end-of-life care. Eventually, the medical team met with the hospital’s ethics committee and the committee agreed that it would be inappropriate to continue to treat Tinslee.

As HALO (Healthcare Advocacy and Leadership Organization) explains, this met the Texas 10-day rule for removing Tinslee’s life-sustaining treatment:

TEXAS 10-DAY RULE
  The 10-Day Rule is a part of the Texas Advance Directives Act (§166.046). Basically, this “rule” allows a hospital ethics committee to decide to remove life-sustaining treatment from a patient against the patient’s or family’s wishes. The patient or patient’s decision maker (usually family)    most likely, not professionals and are generally ill-equipped to defend their position. The committee follows with a written notice of its decision that life-sustaining treatment is “inappropriate.” Receipt of this notice marks the start of a ten-day countdown. “The physician and the health care facility,” states the law, “are not obligated to provide life-sustaining treatment after the 10th day after the written decision.” Finding another facility that will honor the patient’s/family’s treatment wishes and transferring the patient—at the expense of the patient and/or family—are monumental tasks which often prove impossible within the ten-day window.

The family was told they had until Nov. 22 to find a new hospital willing to take Baby Tinslee.

However, Tinslee’s family fought for her and they won a last-minute reprieve from a judge to stop the Texas hospital from taking the now 9 month old off life support against their wishes.

The hospital spokesperson stood by the hospital’s decision to end life support, saying:

“In the last several months, it’s become apparent her health will never improve,” and

“Despite our best efforts, her condition is irreversible, meaning it will never be cured or eliminated.” and

“Without life-sustaining treatment, her condition is fatal. But more importantly, her physicians believe she is suffering.

In July 2020, the hospital again wanted to take Tinslee off life support while Tinslee’s mother asked for another specialist to see her. The specialist recommended a tracheostomy to help her.

With help from individuals, lawyers and groups like Texas Right to Life and HALO (Healthcare Advocacy and Leadership Organization), Tinslee’s case was eventually taken all the way up to the Texas Supreme Court. Finally, this court ruled to keep Tinslee on life support. The US Supreme Court upheld the Texas courts decision.

Now, Tinslee has so steadily improved (see the pictures) that the hospital released her to go home to her family. She is now on a portable ventilator with a tracheostomy and home health care.

Texas Right to Life states:

“Tinslee’s success story shows that in the absence of an anti-Life countdown, families and hospitals can work together for the benefit of the patient. Tinslee has received excellent care from Cook Children’s Medical Center. It is with their efforts that Tinslee will now transition to home health care. Meanwhile, Texas Right to Life is committed to doubling our efforts in the Capitol and with our full-time patient advocacy team to combat and stop the deadly 10-Day Rule from destroying the lives of more vulnerable patients like Tinslee. “

CONCLUSION  

I have been writing about medical futility problems for decades, especially about Simon’s Law to protect medically vulnerable children and their parents from medical discrimination, including my own daughter.

We need to send a strong message that medical discrimination against medically vulnerable or disabled people of any age based on subjective judgements of “medical futility” and/or predicted “poor quality of life” is wrong.

Homicide is a Leading Cause of Death During Pregnancy-How Can We Help?

A February 22, 2022 USA Today articleHomicide is a leading cause of death during pregnancy. These women are more likely to be killed.”, cited a 2021 study in Obstetrics and Gynecology that found that homicide exceeded all top cause of maternal death “by more than twofold” in 2018 and 2019.

Surprisingly, it wasn’t until 2003 that the United States required death certificates to include information on whether the person who died was pregnant at the time or had recently given birth. Then the CDC paused on releasing reports on U.S maternal mortality rates “over concerns that the data collect was incomplete and potentially incorrect” until 2017 when all 50 states included some type of checkbox on death certificates allowing officials to track maternal mortality.

Pregnancy-associated homicide covers the perinatal period (pregnancy and up to 1 year postpartum) and when the perpetrator of the homicide is identified, the assailant is most often an intimate partner. Most of the victims were found to be black or younger than 25.

The USA Today article states that:

“Experts say the alarming statistics reflect a grave nationwide public health concern, with the inequity adding urgency to widen the lens on maternal mortality causes, track them better and raise domestic violence awareness.”

Dr. Andrea Jackson, an obstetrician and gynecologist and professor at the University said the findings felt like a call to action for all of us in obstetrics” and that the “whole system needs to be built with the most vulnerable at the center”.

WHAT CAN WE DO?

While clinicians are encouraged to be “more proactive in screening for signs of domestic violence during prenatal appointments”, the rest of us should be aware that many women are afraid to tell others about domestic abuse-whether or not they are pregnant.

Both personally and professionally, I have seen women hide their domestic abuse problems from others with a happy face for years before the abuse was evident.

When we encounter women considering abortion, we need to be aware that some women may be in abusive situations and need help beyond food insecurity, lack of child care, transportation barriers to health care, etc.

Live Action, a pro-life group, published a March 2022 article “Love Them Both: How to help a pregnant mother in a crisis situation” that has helpful information on numerous resources available to help pregnant women facing a crisis situation like domestic violence, homelessness, drug addiction and more.

As Live Action says:

“Pro-lifers can help any woman considering abortion by helping her out of the crisis with real solutions.”

And we all need to know about the resources available to help women-pregnant or not-with these serious problems.

A New Profile in Courage

I will never forget turning 13 and watching President John F. Kennedy on television during the 1962 Cuban Missile Crisis.

My whole family was watching when the president told us that a nuclear war with Russia could be imminent.

I was terrified, especially since my parents were leaving for a golf trip the next day and I was left in charge of my younger brothers and sister.

I tried to be calm and brave like President Kennedy so that my siblings wouldn’t be upset. It was very hard.

When the threat was over and my parents returned home, I read President Kennedy’s book “Profiles in Courage”. I was so inspired by these stories of brave politicians standing up for their principles that I started reading the two newspapers (one liberal, one conservative) and news magazines that came to our house to try to better understand politics, economics, etc.

But over the next several decades, it sadly seemed that real courage was often in short supply-especially in politics-until now.

PRESIDENT VOLODYMYR ZELENSKY AND THE UKRAINIAN PEOPLE

President Volodymyr Zelensky is a 44 year old former actor and comedian, who is now the sixth and current president of Ukraine. President Zelenskyy grew up as a native Russian speaker in Kryvyi Rih, a major city in central Ukraine. He is Jewish and married with three children.

In 2015, he played the lead in the tv series “Servant of the People”, a satire about an ordinary history teacher who is caught on camera ranting about his country’s rampant corruption and cynicism and surprisingly becomes the president of Ukraine.

His characterization of the honest and dedicated teacher-turned-politician amazingly resulted in Mr. Zelensky’s own election to president of Ukraine in 2019 in a landslide. (Subtitled episodes of his show “Servant of the People” are available on YouTube.)

Then, when Russia invaded Ukraine on February 24, 2022, President Zelensky became the face-and heart-of the beleaguered country of Ukraine.

In an interview just after the Russian invasion began and he was offered help to safely get out of the country, President Zelensky famously said “I don’t need a ride [out of the country]. I need more ammunition.”

Instead of hiding from the Russian attacks and by using social media videos,  President Zelensky went out into the streets to show that he was with his people despite the personal danger to himself. He also called for the US and other countries to help him and his people fight the unprovoked Russian invasion.

So far, President Zelensky has survived 3 assassination attempts to continue communicating with his people and the world. On March 8, he addressed the UK Parliament by video and spoke emotionally about his country’s attempt to stop the Russian invasion and how the Ukrainian citizens have rebelled against the Russian forces. President Zelenskyy received a standing ovation from the UK parliament with many members wearing pins with the Ukrainian flag colors.

 Despite overwhelming odds, the Ukrainian people have been able to survive and fight back for weeks so far.

Many other countries have now sent reporters to Ukraine where they have chronicled both the atrocities of the Russians and the bravery, kindness, and resolve of the Ukrainians trying to save their country.

CONCLUSION

Like many other people, I have been riveted while watching this new war on tv and seeing the terrible suffering of the Ukrainian people. It is heartbreaking to watch.

But what has surprised and inspired me is the conduct of President Zelensky and his people.

Despite the terrible hardships and suffering, President Zelenskyy and his people have shown tremendous resolve and determination not to respond with anger or with the same cruelty that they receive. They just ask to live in peace in their own country.

The news videos of caring citizens helping the elderly, mothers with small children, the wounded, etc. to get food, water, and medical care as they try to escape to a safe country are unforgettable.

President Zelensky continues to be composed but emphatic about what he and his people need to survive and save their homeland.

Those of us who can help through prayers, donations through organizations like the Red Cross, etc. should do so.

No one yet knows what the final result of this terrible invasion will be but the we should never forget the bravery and dedication of Ukraine’s president Zelenskyy and his people.

I know I won’t.

A DISTURBING BUT IMPORTANT LOOK INTO THE TRAINING OF DOCTORS FOR MEDICALLY ASSISTED SUICIDE

Most people seem to assume that medically assisted suicide is a simple matter of getting a doctor to prescribe a lethal overdose, taking a pill or two and then go to sleep and die. Many seem unaware that a second consulting doctor (or other healthcare provider in some states) must agree.

This view, abetted by polls, well-funded groups like Compassion and Choices as well as a mostly sympathetic mainstream media, is disastrously wrong.

A stunning February 2022 article in Medscape for healthcare providers titled  “Medical Aid in Dying: Your Clinical Guide and Practice Points” exposes some very real problems with medically assisted suicide that are largely hidden from the general public.

But while citing a Gallup poll showing that 74% of the American public support legalizing “medical aid in dying” (their preferred term for medically assisted suicide) as well as 58% of doctors, the article admits that:

“Study data, however, have revealed a discrepancy between attitudes about legalization and willingness to practice. Only 15% to 22% of physicians in favor of legal access to medical aid in dying would be willing or likely to provide such assistance” (Emphasis added)

And citing Oregon, the first state to legalize assisted suicide, the article claims that:

“Pain management and hospice use have improved in Oregon since passage of the Death with Dignity Act” but also that “Opponents of medical aid in dying express concern that in Oregon, more than 70% of patients who elect medical aid in dying are elderly and have cancer–both being commonly associated with depression–but fewer than 5% are referred for psychiatric evaluation”. (Emphasis added)

Tellingly, the article recognizes the toll assisted suicide can take on the medical professionals involved:

“A Mental Note for the Healthcare Provider: Discussion of end-of-life options represents a profound event for both the patient and the healthcare provider. Do not neglect your own self-care while guiding your patient through the emotionality that can be brought on by end-of-life decision-making.” (Emphasis added)

THE MEDICALLY ASSISTED SUICIDE PROTOCOL IS COMPLICATED

It is recommended that the patient does not eat or drink for 6 hours before ingesting the lethal dose called D-DMAPh.

Anti-nausea medication and a gastric motility medication is to be taken 1 hour before ingesting the life-ending medication.

A large dose of Digoxin to slow the heart is taken 30 minutes later and then a compound of anxiolytic, opioid and tricyclic medications are to be swallowed in less than 90 seconds.

Recommendations include:

– adding a favorite liquor may counter the bitterness of the mixture

– a small amount of sorbet can be ingested to avoid potential post-ingestion esophageal burning or distress

-Prepare for the possibility that the medication may not work if not quickly and fully ingested; it is crucial that the patient who self-administers not fall asleep before consuming the full dose-Patients should not take the medicine when alone or in a public place

-kept carefully out of the reach of children and vulnerable adults

-and must be disposed of properly. (Emphasis added)

For special circumstances:

“It is legal in all jurisdictions for physicians, other HCPs, or family members to assist in medical aid in dying but not to administer medical aid-in-dying medications.[1-9] The law requires that the patient self-administer the medication through ingestible means, which may include:

•         Drinking the medication mixture

•         Ingesting through a nasogastric tube

•         Ingesting the medication through a feeding tube, or

•         Insertion through a rectal catheter

Patients are permitted to receive help in preparing or mixing the medication for self-administration, but the patient must take a voluntary, affirmative act (i.e., swallowing or pushing a syringe) and administer the medication him- or herself. Medical aid-in-dying laws do not allow physicians, family members, or anyone else, including the dying person, to administer medical aid-in-dying medication by intravenous (IV) injection, parenteral injection, or infusion.” (Emphasis added)

The article states that decision-making capacity is the basis of informed consent and that:

“Guidance begins with assessment of the patient’s decision-making capacity and understanding of palliative measures as alternatives to or concurrent with medical aid in dying. No matter the practice specialty, HCPs (health care providers) are trained on the art of assessing a patient’s medical decision-making capacity and their ability to understand the situation, appreciate the consequences, reason rationally, and express a choice.” (Emphasis added)

If there is a concern, the patient:

 “must be referred for additional evaluation by a licensed psychiatrist, clinical psychologist, or clinical social worker. The request for aid-in-dying medication does not proceed unless the mental health professional affirms that the patient is free of mental illness, acute psychological distress, or demoralization.” (Emphasis added)

COMPLICATIONS

The article admits that complications such as regurgitation and seizures can occur but says they are infrequent.

Prolonged dying can also occur so the “families should make contingency plans for how to manage such circumstances” and “remain calm and engage with hospice or other support services as needed. Families should understand that to help avoid unnecessary deployment of police and emergency medical personnel, they should not call 911.” (Emphasis added)

The article also warns that:

“Those present at the death may witness the following changes, which frequently occur during the natural dying process: snoring; gurgling noises; changes in rate of breathing; and fluctuations in body temperature that may leave their skin cool, warm, moist, or pale. Physical movements or other external signs of distress are sometimes exhibited, but the internal peace of the person is not disturbed.” (Emphasis added)

Sadly, the article reports that 4% of patients in Oregon “chose not to inform their families of their decision” even though support groups “strongly recommend that at least 1 other person be present” but not the doctor.

LEGAL REQUIREMENTS DIFFER WIDELY BETWEEN STATES

The article illustrates how dramatic the differences are in state laws such as the eligible medical providers in New Mexico to include APRNs (advance practice registered nurses) and physician assistants and no consulting provider is required if the patient is in hospice.

and

“In Hawaii, a mental health evaluation is mandatory for all patients requesting medications under the law. In New Mexico, a mental health evaluation is also required if the patient has a recent history of a mental health condition or intellectual disability.” (Emphasis added)

Required waiting periods to make the second request varies from as little as none in Oregon and New Mexico if the patient is unlikely to survive the waiting period to at least 20 days in Hawaii.

The article also recommends that health care providers familiarize themselves with the assisted suicide group Compassion and Choice’s Doc2Doc helpline that “offers free, confidential telephone consultation with clinicians who are experienced in providing end-of-life medical care”.

Right now, 9 U.S, states (California, Colorado, HawaiiMaine, New Jersey, New Mexico, Oregon, VermontWashington)  and the District of Columbia have medically assisted suicide laws and 12 states (Massachusetts, Delaware, Minnesota, New York, Pennsylvania, North Carolina, Indiana, Kentucky, Rhode Island, Virginian, Arizona and Utah) have bills in their legislatures.

And there are more states seeking to expand their existing assisted suicide laws such as Vermont S 74  that threatens conscience rights by defining assisted suicide as a “healthcare service” and allows assisted suicide by telemedicine and Washington state HB 1141 that expands the prescriber to PAs (physician assistants), advanced registered nurse practitioners and allows the lethal dose to be sent by mail or courier.

CONCLUSION

Our neighbor Canada is a cautionary tale about the inability to limit medically assisted suicide.

In a June, 2021 article in the Psychiatric Times titled “First, Do No Harm: New Canadian Law Allows for Assisted Suicide for Patients with Psychiatric Disorders , Dr. Mark Komrad chronicles the expansion of the 2016 MAID (medical aid in dying) law allowing medical euthanasia (the doctor directly administers a substance that causes death, such as an injection of a drug) and physician-assisted suicide for the terminally ill to expand to those “with nonterminal chronic illnesses and permitted euthanasia for those whose psychological or physical suffering is deemed intolerable and untreatable”.

Now, those Canadians “whose only medical condition is a mental illness, and who otherwise meet all eligibility criteria, will not be eligible for MAID until March 17, 2023″. (Emphasis added).

As a nurse with over 50 years of personal and professional experience in hospice, critical care, oncology, etc., I am willing to do anything for sick people– except kill them or help them kill themselves. These people deserve better!

Medically assisted suicide is a dangerous proposition that has proven to be impossible to strictly limit. It also corrupts the essential element of trust we must have in the health care system and makes suicide more attractive to vulnerable people as a way to solve life’s problems.

Finding Hope, Healing and Purpose after a Devastating Tragedy

I met Polly Fick a few years ago after I gave a talk about physician-assisted suicide and my own daughter’s suicide in 2009.

Polly told me the tragic story of her and her husband’s loss of their daughter, son-in-law and baby granddaughter. She also told me what she and her husband were doing to bring awareness of postpartum depression because of this loss. She and Frank hope this information may help or even save another mother and her family.

Polly has been spreading this message on local radio and most recently in the December 22, 2021 St. Louis Review Catholic newspaper article titled “St. Francis of Assisi couple finds hope through tragedy in spreading awareness of postpartum depression”

THE TRAGEDY

Polly and Frank were very close to their daughter Mary Jo Trokey and son-in-law Matthew and celebrated with them when their new granddaughter Taylor Rose was baptized in 2018.

Tragically, all three of them were found dead when Taylor Rose was 3 months old. Investigators believed “that Mary Jo, possibly suffering from postpartum psychosis, killed her daughter and husband, then died by suicide.”

Polly Fick and her husband, Frank, were stunned. “We had no idea she was going through this,” Polly Fick said.

The Ficks have since dedicated themselves to raising more awareness of postpartum depression and related illnesses. Now the members of their parish are also spreading the word about resources through their involvement with Postpartum Support International (PSI) as well as local groups mentioned in the article.

“When this sort of thing happens, you either grow from it or you end up being broken by it,” Frank Fick said. “As horrible as it was, we wanted something positive to come from it.”

POSTPARTUM ILLNESSES

According to PSI,:

“While many parents experience some mild mood changes during or after the birth of a child, 15 to 20% of women experience more significant symptoms of depression or anxiety. Please know that with informed care you can prevent a worsening of these symptoms and can fully recover. There is no reason to continue to suffer.”

“Postpartum psychosis is a rare illness compared to the rates of postpartum depression or anxiety. It occurs in approximately one to two out of every 1,000 deliveries, or approximately .1% of births. The onset is usually sudden, most often within the first 2 weeks postpartum.” 

Postpartum Support International runs a helpline (1-800-944-4773), in-person and online support groups, a mentor program and a directory of care providers. See http://www.postpartum.net/

GRIEF SUPPORT

The Ficks were moved when their parish held a prayer service the evening the family learned about the deaths.

“People that I didn’t even know stepped forward,” Polly Fick said. “Left things on the porch. All of the South County deanery (parishes) really stepped up to the plate. And people prayed for us.”

“We would not be sitting here right now without the support,” she said. “It’s only by the grace of God.”

CONCLUSION

Polly and Fred Frick’s willingness to publicly talk about their tragedy has led to significant new information.

As the St. Louis Post-Dispatch October 28, 2018 article titled “Following tragedy, St. Louis hospitals renew commitment to postpartum mental health” reported:

“Until recently, mental health screenings were not standard for pregnant women and new mothers even though at least 20 percent will experience depression or anxiety that can be exacerbated by hormonal surges, lack of sleep and the demands of an infant.

The screenings can be lifesaving — as many as one in five deaths of women in the postpartum period is caused by suicide.”

and in 2018, “the American College of Obstetricians and Gynecologists issued new “fourth trimester” recommendations for women’s ongoing care after childbirth, including a full assessment of their emotional well-being. The American Academy of Pediatrics also recommends depression screenings for new mothers at all of the baby’s checkups during the first six months.”

Nothing can bring back our deceased loved ones but Polly and Fred Frick are an inspiring example of how help, hope and healing can be brought out of even the most devastating tragedy.


Our “Covid” Christmas

My husband and I were excitedly looking forward to finally having all our blended family members to our home for Christmas this year but Covid 19 almost ruined it. We will forever remember it as the “Covid” Christmas.

We felt fortunate that one of our families was driving to Ohio for an early Christmas with their vaccinated in-laws before driving home in time for our Christmas celebration, especially after we saw other people around the country waiting in lines for hours to get a Covid test before the holidays. We were also glad that they decided to drive when we saw thousands of airline flights delayed or cancelled because of Covid, bad weather and staffing shortages.

However, it turned out that one vaccinated in-law in Ohio attended a large rock concert a few days before the Christmas celebration. Although he showed no symptoms at the time, our youngest grandchildren started to cough and get sick on the ride home.

Early on Christmas morning, the parents were notified that the in-law now tested positive and they tried frantically to get covid tests for themselves and the grandchildren, one of whom was recently diagnosed with asthma. But there were no covid testing kits available and the pediatric emergency room near them told the parents that they could not do a covid test unless the children were admitted.

After two days, they all finally got their covid tests and were negative.

They missed the Christmas party with the other relatives but celebrated with us grandparents a few days after Christmas and it was wonderful.

HOW COULD THE DEARTH OF COVID 19 TESTS HAPPEN ON CHRISTMAS?

As I wrote in my January 7, 2021 blog “When Can We End Lockdowns for Covid 19?”:

“the FDA (food and Drug Administration) approved the use of several rapid Covid 19 tests, some that can even be done at home. This can be a gamechanger with some experts saying that the massive distribution of rapid self-tests for use in homes, schools, offices, and other public places could replace harmful sweeping lockdowns with knowledge.

And as the FDA (Food and Drug Administration) itself has reported:  

“Since March 2020, the FDA has authorized more than 400 COVID-19 tests and sample collection devices, including authorizations for rapid, OTC at-home tests. The FDA considers at-home COVID-19 diagnostic tests to be a high priority and we have continued to prioritize their review given their public health importance.” (All emphasis added)

However in a December 21, 2021 interview, President Biden was said to “express some regret that he didn’t ramp up necessary supplies before the nation got hit with yet another winter coronavirus surge” and announced a plan for the government to “distribute 500 million free rapid in-home test kits in an effort to slow the spread of the virus” and admitted  that ““I wish I had thought about ordering half a billion [tests] two months ago”.

However, as reported on December 24, 2021 at webmd.com:

“President Biden has promised Americans that 500 million coronavirus tests will be available for free, but the kits won’t arrive for several weeks or longer”

and

“the Biden administration hasn’t yet signed a contract to buy the tests, and the website to order them won’t be available until January, according to The New York Times.

CONCLUSION

I have been writing blogs on the various aspects of the Covid 19 pandemic for almost 2 years and I am frustrated by the missteps, lack of accountability and the constantly changing rules that often seem to often be more based on politics rather than science.

We need to demand better from ourselves, our leaders and our country to become a healthier nation mentally, physically and spiritually.

What is a “Death Doula” and Why is Compassion & Choices so Interested?

Most people have heard of doulas, specially trained people who help pregnant women during pregnancy, labor, birth, and immediate postpartum by providing “emotional, physical, and informational support”.

My daughter used a doula for both of her children and was so happy with the results that she is considering taking the training to become a doula in the future.

But now, there are “death doulas” that have nothing to do with birthing.

As Wesley Smith wrote about in a 2014 article titled “Good Grief: Now It’s “Death Doulas”, there was an op-ed in the LA Times about the Hippocratic oath and the terminally ill by a journalist and medical professor who wrote:

“If we allow medicine to prolong life, should we also allow it to shorten life for the terminally ill?

We could, however, skirt the controversy entirely: What if we created another class of medical professionals known as death doulas, who could fill a gap between treatment doctors and hospice workers?” (All emphasis added)

But “death doula” idea continued and in 2017,  the “National End-of-Life Doula Alliance (NRDA) was formed and even more importantly in 2018:

“a special council within The National Hospice and Palliative Care Organization (NHPCO), the leading hospice and palliative care membership organization in the US, was held. The purpose of the special Council is to provide information and resources to its members, affiliated organizations, and the public regarding the role of end-of-life doulas.” (Emphasis added)

Unfortunately, while the NHPCO “opposes MAID (medical aid in dying) as “a societal option to alleviate suffering”, the American Academy of Hospice and Palliative Medicine (AAHPM) has had a position of “studied neutrality” on the issue of medically assisted suicide since 2007.

According to a New York Times June 2021 article “Death Doulas’ Provide Aid at the End of Life” , there are nearly 800 members in the National End-of-Life Doula Alliance with membership nearly doubling in the past year and increasing interest in training programs such as the International End-of-Life Doula AssociationDoulagivers, and the Doula Program to Accompany and Comfort.

Death doulas do not have to be medically trained and death doula training and certification programs can cost as little as the $189.00 holiday special online course at the International Association of Professions Career College for 6 weeks part-time.

According to the New York Times, death doulas “don’t get involved in medical issues” but rather, “they support clients emotionally, physically, spiritually and practically.” Prices for these services “range from $25 an hour on up, although many do it voluntarily.”

WHY IS COMPASSION & CHOICES INTERESTED IN DEATH DOULAS?

Last month, Compassion & Choices (the largest organization attempting to pass assisted suicide laws in every U.S. state) filed an amicus brief in the federal court case Full Circle of Living & Dying v. Sanchez in support of a lawsuit to protect “to protect the First Amendment free speech rights of death doulas in California.”

The plaintiff Full Circle of Living & Dying is described by Compassion & Choices “as a non-profit organization that provides death doula services and home funerals”.

The defendant in the Full Circle of Lining & Dying lawsuit is the California Cemetery and Funeral Bureau which issued a 2019 order to the death doula plaintiffs to:

“immediately discontinue advertising and operating as a funeral establishment until a license is issued by the Bureau” and “threatened fines of up to $5,000 if Full Circle continued to operate without a license.”

Compassion & Choices’ chief legal advocacy officer Kevin Diaz argues in the amicus brief that:

Full Circle “has a disclaimer on its website that they are not funeral directors, do not offer funeral home services, and do not operate out of a funeral home”; that “Full Circle does not need a physical location for its services and the cost of obtaining such a location far exceeds the non-profit’s small budget.”

and added that

“a ruling in favor of the California Cemetery and Funeral Bureau “will force most, if not all, death doulas out of practice.” (Emphasis added)

As Kim Callinan, the President and CEO of Compassion & Choices explains in her 2021 article “Medical Aid in Dying: The Role of Death Doulas” for the National End-of-Life Doula Alliance newsletter:

“Death doulas can play a key role in shifting end-of-life care from a paternalistic to patient-directed system by bringing non-judgmental support to patients and serving as their advocate. This is particularly needed for patients who would like the option of medical aid in dying. All too often, interested and eligible patients are unable to navigate the complicated, multi-step process to access medical aid in dying (aka medically assisted suicide); too many unfortunately die suffering. (All emphasis added)

CONCLUSION

Over more than 52 years, I have cared for many dying people, both personally with friends, my mother and daughter and professionally in cancer units, critical care and home hospice. The people I have cared for range from babies to the very elderly.

My interest in people with terminal or life-threatening illnesses started when I first became an RN in the late 1960s and saw people with terminal cancer routinely secluded in in a private room at the end of a hall.

I asked the more experienced nurses how I should approach these patients and if I should be cheerful or solemn.

These nurses said they didn’t know the answer either so I had an idea. I decided to go visit these patients after I finished my shift and just ask to sit down and speak with them. Many of these wonderful people told me how isolated and lonely they felt when friends and family members treated them differently and we would talk about what they wanted both before and after their expected deaths.

I shared what I learned with the other nurses and family members who were relieved to know how they could help.

Whether or not these people were in hospitals, institutions or at home, the goal was always to help them live as well as possible until death. It was imperative that these people felt loved, respected and cared for even when they seemed to be unconscious. I also saw that the person’s relatives and friends also needed understanding and support. It helped that I personally knew how hard it can be to lose a loved one.

I feel privileged to have cared for my loved ones, friends, patients and their families and I never witnessed an excruciatingly painful death or was tempted to help end a life because I knew how to help.

It will be interesting to see what happens in the Full Circle of Living & Dying v. Sanchez case but I know that no matter whether a person is physically healthy or terminally ill, assisting a suicide is never good healthcare!

Six Problems with Covid 19 Vaccination Mandates

When the Covid 19 vaccine was first authorized for emergency use in December, 2020, President-elect Joe Biden said that he wouldn’t impose national mandates to get vaccinated for Covid 19.

But on September 9, 2021 and in a televised speech, President Joe Biden announced a federal Covid 19 vaccination mandate affecting as many as 100 million Americans “in an all-out effort to increase COVID-19 vaccinations and curb the surging delta variant.”

Calling Covid 19 “a pandemic of the unvaccinated” and that “our patience is wearing thin” with the estimated 80 million Americans who have not been vaccinated, President Biden announced new rules that:

“mandate that all employers with more than 100 workers require them to be vaccinated or test for the virus weekly, affecting about 80 million Americans. And the roughly 17 million workers at health facilities that receive federal Medicare or Medicaid also will have to be fully vaccinated.”

and signed

“an executive order to require vaccination for employees of the executive branch and contractors who do business with the federal government — with no option to test out. That covers several million more workers.” (Emphasis added)

PROBLEM ONE

There are different rules for different groups people, leading to confusion and further divisiveness.

For example, while international travelers visiting the US must provide proof of vaccination before being allowed into the country, the hundreds of thousands of people illegally crossing our southern border and being released into our country are not required to have the Covid 19 vaccine.

What scientific justification is there for this?

PROBLEM TWO

Now the Biden administration just unveiled its new 490 page Occupational Safety and Health Administration’s (OSHA) “emergency temporary standard” that also requires companies with 100 or more employees to mandate that workers get vaccinated, or tested weekly and wear a face mask

But surprisingly, as a November 4, 2021Wall Street Journal editorial article titled “OSHA’s Vaccine Mandate Overkill notes:

“Separately, the Centers for Medicare and Medicaid Services issued a vaccine mandate for health-care facilities with no testing option.” (Emphasis added)

and

“According to a Kaiser Family Foundation survey last week, 37% of unvaccinated workers said they would leave if their employer required them to get a vaccine or be tested weekly.“(All emphasis added)

PROBLEM THREE

Firing unvaccinated employees in a tight labor market when so many employers are desperate to hire hurts not only employees but also businesses.

In addition, these vaccine mandate rules have led to vaccine refusal by some essential workers like police, garbage collectors and healthcare workers in cities like New York who then lose their jobs. This not only affects these workers and their families but also the delivery of these essential services to the populace.

PROBLEM FOUR

Religious or medical exemptions from taking the vaccine are often difficult to obtain.

For example, a hospital system in Arkansas maintains that the “majority of religious exemption requests cited the use of fetal cell lines in the development of vaccines” but counters that the “practice uses cells grown in labs to test many new vaccines and drugs, including common antacids and cold medications.”

Therefore, the hospital’s religious exemption form “includes a list of 30 common medications that used fetal cell lines during research and development” and asks employees to attest that they:

“truthfully acknowledge and affirm that my sincerely held religious belief is consistent and true” and that they won’t use the medications listed.” (Emphasis added)

PROBLEM FIVE

Now the CDC has announced emergency use authorization of Covid 19 vaccine for children 5-11. If mandated, what will that mean for schools and parental rights to refuse or consent to medical treatment?

PROBLEM SIX

So far, 68% of Americans have received at least one dose of a vaccine and 59% are fully vaccinated.

At the same time, at least 27 states so far have decided to take legal action against the new rules, claiming the mandate is an example of federal overreach and both “unlawful and unconstitutional.” And on November 6, 2021, a US federal appeals court temporarily halted President Biden’s COVID-19 vaccine mandate for businesses, citing potentially “grave statutory and constitutional” issues.

CONCLUSION

Unfortunately, the Covid 19 vaccination mandates have caused some severe divisions between those who have been vaccinated and and those who refuse to be vaccinated for various reasons.

My husband and I are fully vaccinated but some of our adult children are not. We encouraged them to take the vaccine but we have to respect their decision. We believe that people who refuse or are hesitant about the vaccine should not be vilified or treated as second class citizens.

We are all Americans and we need to work together.

And there may be hope on the horizon as new Covid 19 pills are being developed and showing promise with Pfizer’s pill said to be 89% effective for mild to moderate Covid 19 symptoms. Pfizer now plans to ask the Food and Drug Administration to authorize the pill’s use this month. Another Covid 19 pill from Merck & Co. was cleared for use in the U.K. this week.

These pills could be a gamechanger and help heal not only Covid 19 but also our fractured country.

Why “Living Wills” Are Not Working Well

In a stunning October 8, 2021 article titled “What’s Wrong With Advance Care Planning? in the prestigious Journal of the American Medical Association, three prominent supporters of “living wills” and other advance care documents admit that after 30 years of the promotion of such advance care plan (ACP) documents:

“The assumption that ACP will result in goal-concordant end-of-life care led to widespread public initiatives promoting its use, physician reimbursement for ACP discussions, and use as a quality measure by the Centers for Medicare & Medicaid Services, commercial payers, and others. However, the scientific data do not support this assumption. ” (Emphasis added)

Drs. R. Sean Morrison, Diane E Meier, and Robert M. Arnold are prominent doctors and ethicists at prestigious institutions who have long promoted the advance care documents that are asked about when people enter hospitals, nursing homes, long care facilities, etc.

I have been writing about such documents and their uses and hazards for decades.

ACPs were promoted as essential to document a person’s healthcare wishes like Do Not Resuscitate orders and forgoing interventions like feeding tubes and ventilators in the event that the person is unable to speak for himself or herself. Many such documents also designate a trusted friend or relative to assist in the potential future decision-making process.

All adults have been encouraged to make such documents regardless of their health status because it was assumed that such ACPs would lead to higher quality care at the end of life.

But, as the authors now admit: “The inability of ACP to achieve its desired outcomes represents the gap between hypothetical scenarios and the decision-making process in clinical practice settings.” (Emphasis added)

After 52 years of experience working in ICUs, oncology (cancer), dialysis, hospice and home health as well as caring for relatives and friends, I wholeheartedly agree with the authors that:

“Treatment choices near the end of life are not simple, consistent, logical, linear, or predictable but are complex, uncertain, emotionally laden, and fluid. Patients’ preferences are rarely static and are influenced by age, physical and cognitive function, culture, family preferences, clinician advice, financial resources, and perceived caregiver burden (eg, need to provide personal care, time off from work, emotional strain, out-of-pocket or noncovered medical costs), which change over time.” (Emphasis added)

WHAT DOES WORK?

The authors point to the patient having a trusted person in advance to act as a surrogate decisionmaker and improving the communication with healthcare providers in real time. They also point to:

“training clinicians and preparing patients and families to engage in high-quality discussions when actual (not hypothetical) medical decisions must be made is needed to achieve the outcomes that ACP has not.” (Emphasis added)

However, pitfalls still remain.

Patients and their decisionmakers do need accurate information about their conditions and potential treatments.

However, as I found as a nurse, patients and their surrogate decisionmakers often have negative preconceptions (often reinforced in the media) about treatments such as cardiopulmonary resuscitation, ventilators, feeding tubes, etc.

Unfortunately in hospital situations, the advance care plans with the common DNR (do not resuscitate) directive are sometimes misinterpreted as not wanting to live  or “do not treat” when the person had assumed it would apply only in extreme circumstances. And some healthcare institutions have medical futility policies that allow doctors to overrule the person’s decisionmaker.

In addition, we have well-funded organizations like Compassion and Choices that not only work to get assisted suicide laws passed in every state but also promote their own advance directive to allow the lethal “healthcare option” of VSED (voluntary stopping of food and water) to ensure death.

Particularly in the frail elderly, it can be difficult to determine whether or not a person is truly dying. And while we are never required to accept treatment that is medically futile or excessively burdensome to us, sometimes this can be hard to determine. Far too many times, feeding tubes and other interventions are automatically assumed to be futile and/or burdensome. But there is another alternative that is often ignored: trying an intervention with the option of stopping it if it truly is futile or burdensome.

There are no guarantees in life or death but even finding out that something doesn’t work can be a step forward and can relieve any guilt in the surviving relatives.

CONCLUSION

I was surprised but very pleased to read that the three prominent doctors writing the article “What’s Wrong With Advance Care Planning?” after years of promoting “living wills” and other end of life documents.

But, in the end, the real answer is a return to the traditional medical ethics of “First, do no harm”, a presumption for life and excellent, unbiased information.

That is why my husband and I made our own healthcare directives to require full information about all options, risks and benefits before making medical decisions.

And, most importantly, that we believe that “quality of life” is something to be improved, not judged.

My 2000 Voices Magazine Article: Who Wants a “Defective” Baby?

This month, it was revealed that President Joe Biden “wants Congress to pass a law making abortions legal up to birth” after the US Supreme Court refused to temporarily block the Texas Heartbeat Law.

While talking to a friend about this, I remembered a 2000 Voices magazine article I wrote about why every unborn child deserves protection and she asked that I send it to her. Sadly, this magazine is no longer publishing.

This is the article I wrote that appears on my other blogsite that contains articles, op-eds, etc. that I wrote up to 2014, when I started this blog. The reflection at the end of this article was published by the National Down Syndrome Association and was-to my surprise-eventually reprinted in several other countries.

Voices Online Edition
Summer 2000
Volume XV, No. 2 – Jubilee Year

Who Wants a “Defective” Baby?

by Nancy Valko, R.N.

“Of course, no one wants to adopt a defective baby. ” This was said with much emotion (and not much charm) by an older gentleman in a class at a local university where I was speaking this past April. I had been invited to discuss the legalities and effects of Roe v. Wade from a pro-life point of view to a class of senior citizens studying the Constitution and the Supreme Court.

While several of these senior citizen students defended abortion as a matter of complete privacy for the mother, their arguments centered around the “need” for legalized abortion as a solution for social problems.

Since I had told the story of my daughter Karen, born in 1982 with Down Syndrome and a severe heart defect, the pro-abortion students were extremely vocal about the personal and societal justifications for aborting a baby like Karen. Hence the statement about no one wanting to adopt a “defective” baby.

“Happily, sir,” I told the senior student, “You are wrong. Even back when I had Karen, I found out from the National Down Syndrome Association that there was a list of people waiting to adopt a baby with Down Syndrome. Just the night before, I added, I had found a new website for matching prospective parents with children who had chromosomal and physical defects.”

The student refused to believe that this could be true.

The effects of Roe v. Wade
Life of the mother, incest, rape and fetal defect are the four hard cases usually cited to justify what has now become abortion on demand. All of these are uncommon reasons given in the estimated 1.3 million abortions every year; but the possibility of having a child with a birth defect is a common fear nearly all expectant mothers experience and, not surprisingly, polls show that the majority of the public support abortion in this circumstance.

Although I have always been pro-life, I could understand the fear underlying these poll results — until my own daughter was born.

Just two weeks before the birth of my daughter Karen, I saw a mother trying to pry her young son with Down Syndrome away from a display case at the supermarket. She looked exhausted.

“Please, Lord,” I silently prayed, “Let this baby be ok. I can handle anything but Downs.”

When Karen was born with Down Syndrome, I was stunned. But I was quickly put in touch with mothers from the Down Syndrome Association who replaced my fears with information and realistic hope.

Then a doctor told me the truly bad news. Karen had a heart defect, one so severe that it seemed inoperable and she was not expected to live more than 2 months. That certainly put things in the proper perspective.

What “pro-choice” really means
It turned out later that Karen’s heart defect was not quite as bad as originally thought and could be corrected with one open-heart surgery, but I was shocked when the cardiologist told me he would support me 100% if I decided not to agree to the surgery and allow her to die. This was especially hard to hear because, as a nurse, I knew that the doctor would have been otherwise enthusiastic about an operation offering a 90% chance of success — if my child didn’t also have Down Syndrome. Apparently, even though Karen was now a legal person according to Roe v. Wade by the fact of her birth, this non-treatment option could act as a kind of 4th trimester abortion.

It was then that I realized what pro-choice really meant: Choice says it doesn’t really matter if a particular child lives or dies. Choice says the only thing that really matters is how I feel about this child and my circumstances. I may be “Woman Hear Me Roar” in other areas according to the militant feminists, but I was not necessarily strong enough for a child like this.

I also finally figured out that Roe v. Wade’s effects went far beyond the proverbial desperate woman determined to end her pregnancy either legally or illegally. The abortion mentality had so corrupted society that it even endangered children like my Karen after birth. Too many people, like the student in Supreme Court class, unfortunately viewed Karen as a tragedy to be prevented.

Medical progress or search and destroy?
In the late 1950s, a picture of the unborn baby using sound waves became the first technique developed to provide a window to the womb. Ultrasound in recent years has been used to save countless lives by showing women that they were carrying a living human being rather than the clump of cells often referred to in abortion clinics.

But while expectant parents now routinely and proudly show ultrasound pictures of their developing baby, there is a darker side to prenatal testing. Besides ultrasound, which can show some birth defects, blood tests like AFP testing and the Triple Screen to test for neural tube defects or Down Syndrome are now becoming a routine part of prenatal care. Amniocentesis and chorionic villus sampling are also widely available tests to detect problems in the developing baby. It seems that every year, new testing techniques are tried and older ones refined in the quest to find birth defects prenatally.

97% of the time, women receive the good news that their baby seems fine; but the tests are not foolproof, and they can only test for hundreds of the thousands of known birth defects. Relatively few such birth defects can be treated in the womb at the present time. Some women want testing so that they can prepare for a child who has a birth defect, but when the tests do show a possible problem like Down Syndrome, up to 90% of women will abort.

While some hail prenatal testing as a way to prevent birth defects, the effects of such testing has led to what author Barbara Katz Rothman calls the “tentative pregnancy” in her 1993 book of the same name. Although Rothman calls herself pro-choice, her studies of women considering amniocentesis led to her conclude that such testing has changed the normal maternal-child bonding in pregnancy and the experience of motherhood, usually for the worse.

“I might not be pregnant”
I observed this firsthand several years ago when I ran into an acquaintance and congratulated her on her obvious pregnancy. I was stunned when she replied, “Don’t congratulate me yet. I might not be pregnant.”

Diane, the mother of a 5-year-old boy, went on to explain that she was awaiting the results of an amniocentesis and said, “I know what you went through with your daughter but I can’t give up my life like that. If this (the baby) is Downs, it’s gone.”

I reassured her that the test would almost surely show that her baby was ok, but I added that if the results were not what she expected I would like her to call me. I promised that I would give her any help she needed throughout the pregnancy and that my husband and I or even another couple would be willing to adopt her baby. She was surprised, as I later found out, both by my reaction and the information about adoption.

Diane gave birth to a healthy baby girl a few months later and apologized for her comments, saying that she probably would not have had an abortion anyway. But I understood her terrible anxiety. Society itself seems to have a rather schizophrenic attitude towards children with disabilities.

On one hand, people are inspired by the stories of people who have disabilities and support organizations like the Special Olympics; but, on the other hand, many people consider it almost irresponsible to bring a child with disabilities into the world to suffer when prenatal testing and abortion are so available.

But as the vast majority of parents who are either natural or adoptive parents of children with disabilities will attest, all children are born with both special gifts and special limitations. No child should be denied birth because of a disability or even a limited life expectancy.

Women who do abort after a diagnosis of a birth defect are also hurt. Besides depriving themselves of the special joys — which occur along with the difficulties — of loving and caring for such a child, these women often experience unresolved grief, guilt and second-guessing instead of the relief and peace they expect.

A few years ago, a local hospital which performs late-term abortions for birth defects asked a miscarriage and stillbirth counseling group to help with their distressed patients. The group declined, citing the fact that the most reassuring message they give grieving mothers is that there is nothing they did or didn’t do that caused the death of their babies. Obviously, that was not a statement they could make to mothers who abort. There is a very real difference between losing and terminating a child.

How many of these mothers knew before their abortions that, in practical terms, there has never been a better array of services and support for children with disabilities and their parents? Or that their children were dearly wanted by prospective adoptive parents? Such information might have been just the support they needed to choose life for their children.

Final thoughts
Despite the best medical care, my Karen died at the age of 5 and 1/2 months, but the impact of her life has lived on. At her funeral Mass, the priest talked about how this child who never walked or talked had transformed the lives of those who met her.

Especially mine.

After Karen died, I sat down and tried to put into words what Karen and all children with disabilities have to teach the rest of us. The following reflection was published in the National Down Syndrome Association newsletter in May, 1984.

THINGS NO TEACHER EVER TAUGHT
In 1982 my daughter, Karen, was born with Down Syndrome and a severe heart defect. Less than six months later she died of complications of pneumonia. Karen may have been retarded but she taught me things no teacher ever did.

Karen taught me:

That life isn’t fair — to anyone. That self-pity can be an incapacitating disease. That God is better at directing my life than I am. That there are more caring people in the world than I knew. That Down Syndrome is an inadequate description of a person. That I am not “perfect” either, just human. That asking for help and support is not a sign of weakness. That every child is truly a gift from God. That joy and pain can be equally deep. That you can never lose when you love. That every crisis contains opportunity for growth. That sometimes the victory is in trying rather than succeeding. That every person has a special purpose in life.

That I needed to worry less and celebrate more.


Sources:

1. “Prenatal Testing”, by Nancy Valko, R.N. and T. Murphy Goodwin, M.D., pamphlet, Easton Publishing Co.

2. “Doctors have prenatal test for 450 genetic diseases” by Kim Painter. USA Today, 8/15/97

3. Rothman, Barbara Katz. The Tentative Pregnancy. Revised, 1993. WW Norton and Co.

4. “Advances, and Angst, in a New Era of Ultrasound”, by Randi Hutter Epstein. New York Times. May 9, 2000.

Nancy Valko, R.N., a contributing editor for Voices, is a former president of Missouri Nurses for Life who has practiced in St. Louis for more than thirty years. An expert on life issues, Mrs. Valko writes a regular column on the subject for Voices.


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What You Should Know about the New Federal Covid 19 Vaccine Mandate

In my December 17, 2020 blog “Should a Covid 19 Vaccine be Mandatory?, I wrote that “it seems unlikely that there will be a federal mandate for the Covid 19 vaccine.”

But on September 9, 2021 and in a televised speech, President Joe Biden announced a federal Covid 19 vaccination mandate affecting as many as 100 million Americans “in an all-out effort to increase COVID-19 vaccinations and curb the surging delta variant.”

Calling Covid 19 “a pandemic of the unvaccinated” and that “our patience is wearing thin” with the estimated 80 million Americans who have not been vaccinated, President Biden announced new rules that:

“mandate that all employers with more than 100 workers require them to be vaccinated or test for the virus weekly, affecting about 80 million Americans. And the roughly 17 million workers at health facilities that receive federal Medicare or Medicaid also will have to be fully vaccinated.”

and signed

“an executive order to require vaccination for employees of the executive branch and contractors who do business with the federal government — with no option to test out. That covers several million more workers.”

However, it turns out that some groups of people are not required to get the Covid 19 vaccine, including the US Congress and people illegally crossing our southern border.

Even worse and back in an August, 2021, an NBC News article titled “18 percent of migrant families leaving Border Patrol custody tested positive for Covid” stated that:

“More than 18 percent of migrant families and 20 percent of unaccompanied minors who recently crossed the U.S. border tested positive for Covid on leaving Border Patrol custody over the past two to three weeks, according to a document prepared this week for a Thursday briefing with President Joe Biden. (Emphasis added)

MORE POTENTIAL PROBLEMS WITH THE COVID 19 VACCINE MANDATE

Some hospitals are now telling healthcare workers to get vaccinated or lose their jobs. And in New York, there are now worries that a vaccine mandate “will exacerbate staffing shortages dogging medical facilities.”

And although some U.S. businesses welcome President Biden’s COVID-19 vaccination mandate for firms with 100 or more employees, some small businesses are bristling, saying that the order “imposes yet another burden that could intensify historic worker shortages and supply-chain bottlenecks.

Already, legal challenges are looming for the covid 19 vaccine mandate.

WHY VACCINE HESITATION OR REFUSAL?

From the start of the Covid 19 pandemic, the rules seemed to keep changing: first gloves and no mask, then lockdown, mask and social distancing. Different states had different rules about opening and closing businesses and schools.

It was frustrating when the scientific data behind the changing rules was often lacking or contradictory. And some people are concerned about some of the reported rare side effects of the vaccines as well.

However, experts say that few people are medically exempt from getting the Covid 19 vaccine.

Now, there is an emphasis on providing booster Covid 19 vaccines for the fully vaccinated. However, it is concerning to now read in the Business Insider that “18 leading scientists, including 2 outgoing FDA officials, say COVID-19 booster shots lack evidence and shouldn’t yet be given to the general public”.

CONCLUSION

My husband and I received our Covid 19 vaccinations in March without any problems and recommended the vaccinations to our children with the caveat that they check with their doctors first, especially since some of our children and grandchildren have special situations.

We are open to receiving the Covid 19 vaccine booster shot but we would like to see more scientific data and hopefully a consensus among the experts.

The Powerful Effect of the US Supreme Court’s Decision Refusing to Block the Texas Heartbeat Act

When the Texas Heartbeat Act was signed into law by Governor Gregg Abbot in May 2021 to abolish elective abortions as early as six weeks (when the unborn child’s heartbeat is “detectable using methods according to standard medical practice”), abortion rights supporters were furious and began challenges to the law.

But on September 2, 2021 and surprisingly, the U.S. Supreme Court ruled 5-4 against a request from pro-abortion groups to temporarily block enforcement of the pro-life law.

Pro-abortion groups and almost all mainstream media vigorously denounced the decision and groups like the American Civil Liberties Union, Planned Parenthood, Whole Woman’s Health, and other abortion groups were ready to mount more legal challenges to the law.

Most recently, now a Texas Judge has issued a temporary restraining order barring Texas Right to Life and “100 unnamed individuals” from suing Planned Parenthood, writing that the Texas Law creates a “probable, irreparable and imminent injury” to Planned Parenthood if sued by the nonprofit Texas Right to Life and others.

At the same time, pro-life advocates continue to reach out to pregnant women offering resources and emotional support to help them and their babies while Texas lawmakers had already budgeted in the spring for $100 million specifically to help pregnant and parenting mothers and babies

But while even the Wall Street Journal raised legal questions about enforcement of the law by civilians and the exclusion of rape or incest exceptions, the Supreme Court’s decision to refuse to block the Texas Heartbeat Act (and the torrent of national publicity surrounding the decision) forces a recognition of the the humanity of the unborn baby and the fact that even the Mayo Clinic recognizes: the heart begins to beat at 6 weeks.

Unfortunately, many people are unaware of this fact and Planned Parenthood continues to deny this fact.

MY EXPERIENCE WITH ROE V. WADE

I was a young nurse working in a critical care unit in 1973 when the U.S. Supreme Court decision Roe v. Wade, legalized abortion for any reason in the first trimester of pregnancy.

When other doctors and nurses asked my opinion about the decision, I said I was surprised and horrified. Some of the nurses and doctors angrily disagreed with me and asked what I would do if I were raped and pregnant.

I said I would be upset about the rape but also that I couldn’t deliberately end another human life, born or unborn. That was medical ethics.

A few years after the Roe v Wade decision, I was married and pregnant with my first child. I loved the standard prenatal development pamphlet I was given but I couldn’t help but think about how painful this pamphlet could be for a woman who had aborted before becoming pregnant with a wanted child.

I decided that when I finally had some time, I would volunteer at our local Birthright to help women and their babies.

With my subsequent pregnancies, my older children were obsessed with the development of their unborn brother or sister and asked what the baby had or could do almost every week of the pregnancy. It was touching to see how excited they got with each new phase of the baby’s development.

When one of my daughters became pregnant and unwed at age 18, she said she could never have an abortion because she knew so much about prenatal development.

Recently, I was delighted to view the “Meet Baby Olivia” video, a beautiful and “medically accurate, animated glimpse of human life from the moment of fertilization” produced by Live Action. I highly recommend this video and sharing it widely.

CONCLUSION

Until Texas, other state heartbeat laws have been blocked in court. The Texas Heartbeat Act is facing more legal challenges but it has already changed minds and hearts in Texas: An April poll by the University of Texas-Austin found that 49 percent of Texans support making abortions illegal after six weeks of pregnancy, while 41 percent oppose it.

Education about abortion and outreach to help women struggling with an unexpected pregnancy can save lives!

An Unexpected Recovery and What We Can Learn from It

When 28 year old Jacob Haendel was rushed to an emergency room in Massachusetts four years ago, the doctors thought he was having a stroke but brain scans showed something very different. Instead, his brain scans showed that his “brain seemed to be unplugging itself from the rest of his body”. One doctor described it as “The wires weren’t sending signals from place to place.”

The doctors were unsure what was going on until Jacob revealed that he had been doing drugs, mostly opioids, until he turned to street heroin. The medical team thought he might have ingested a toxin which led to their diagnosis of a very rare condition called: Toxic Acute Progressive Leukoencephalopathy. Only a few dozen people had ever been diagnosed with this.

Six months later, Jacob deteriorated to what the doctors thought was a “vegetative state” and completely unaware of himself or his surroundings. He was sent to an extended care facility on a ventilator to breathe and a feeding tube. Eventually, he was put in hospice and by Christmas, his family told that he probably would die in a couple of days. Jacob’s father whispered to him that it was “ok to let go”.

But Jacob didn’t die and slowly his brain started to sputter back to life.

The first sign was a small twitch in his wrist. Some thought this meant nothing but his family thought otherwise.

A few weeks later, everyone was stunned when Jacob started moving his tongue and his eyes, “almost imperceptibly at first, but enough to use a letterboard to spell out a message he’d been desperately trying to send for almost a year. His message was I can hear you. (Emphasis added)

As Jacob began communicating, the doctors realized that he had not been unconscious but rather awake the whole time. Jacob remembered nurses calling him “brain dead” and that visits slowed over time.

In a July 25, 2021 CBS Sunday Morning tv segment, Jacob told CBS correspondent Lee Cowan that “I couldn’t express anything to anyone. No one knew what was going on in my head, and I just wanted someone to know, like, that I was in there.”

He also said that he talked to himself a lot and felt pain. Jacob also revealed that “he would do math problems in his head just to help keep himself from the guilt that his drug use has caused all of this.”

Jacob’s mother had died of breast cancer and Jacob said he started using drugs to cope.

Jacob’s road to rehabilitation has been long and still ongoing. However, Jacob has “come back with such a profound understanding of what a second chance really means. “I am an improved Jake,” he said. “And I’m a happier Jake. I don’t want to give up.”

Although Jacob still has limitations of speech and movement, he now was a website and writes updates.

WHAT WE CAN LEARN FROM JACOB’S STORY

Over my years in mostly critical care nursing, I spoke to all my patients patients-regardless of a diagnosis of coma, “vegetative state”, etc.-as if they were totally awake and explained everything I was doing as well as the time and date, visitors who came, etc.

I also closely watched for any sign of voluntary movement or reaction. Like Jacob, even almost imperceptible movement could be a sign of awareness and I encouraged my patients to repeat the movement.

I was often teased and asked if I spoke to my refrigerator too but the teasing stopped when some of these patients started to respond or even recovered. Some of them later related what they heard and/or felt when they were assumed to be unaware. My point was that speaking empathetically to all our patients was a matter of respect that could even help them get better.

Hopefully, Jacob’s story will be an encouragement for all healthcare providers as well as people with severe brain injuries and their families.

CONCLUSION

But Jacob has another big message for every one of us in our daily lives: simplicity.

In Jacob’s own words:

“My life was never a walk in the park, but I never truly appreciated how important the simplicities of life are until I began my journey to recovery. My reasoning for this word is multi-focal just like my case. The only word that can accurately describe my case is “complex” and I am un-ironically striving for just the opposite; simple. After surviving and overcoming locked in syndrome, all I want are the simplicities in life; things like talking, connecting with friends and family, enjoying solid foods, breathing on my own, going outside instead of being locked in a hospital, being able to feed myself and even taking a walk in the park. All of these simple things I took for granted are now goals I am working towards being able to enjoy again”

Especially at a time of such discord in our society now, we all need to remember and celebrate the so-called “little things” that make us grateful for our own precious lives.

Covid 19 Vaccine Refusal?

Last December, I wrote the blog Should a Covid 19 Vaccine be Mandatory? and concluded that:

“It is more likely that only certain groups of people may be required to take the vaccine like healthcare workers, universities and some employers. Even then, the Civil Rights Act of 1964 may help people who have a religious objection to a vaccine as well as anti-discrimination laws and exemptions for medical reasons. An employer would have to make a reasonable accommodation as long as it’s not too costly for the business.

It is also possible that airlines, stores and stadiums could also make vaccination a condition of doing business with a person.”

In March 2021, a Monmouth University poll showed that 25% of those polled would refuse the vaccine.

VACCINE REFUSAL NOW

After a concerted public effort to encourage Covid 19 vaccination, about 67 percent of Americans 18 and older had received at least one dose of a vaccine by July 4.

So far, the CDC (Centers for Disease Control and Prevention) recommends that everyone 12 years and older should get a Covid 19 vaccination but has not issued guidance on COVID-19 vaccines for children under 12.

But even though there is no federal requirement for Covid 19 vaccination, there are many colleges that require students have the Covid 19 vaccinations before arriving on campus.

However, according to CNN:

“at least seven states– Alabama, Arkansas, Florida, Indiana, Montana, Oklahoma and Utah — have enacted legislation this year that would restrict public schools from requiring either coronavirus vaccinations or documentation of vaccination status

and

“(a)s of June 22, at least 34 states had introduced bills that would limit requiring someone to demonstrate their vaccination status or immunity against Covid-19″

with

At least 13 states — Alabama, Arkansas, Florida, Indiana, Iowa, Kansas, Missouri, Montana, North Dakota, Oklahoma, Tennessee, Texas and Utah — have passed them into law.” (All emphasis added)

In addition, more than 150 staff members at Houston Methodist Hospital were fired or resigned in June after refusing to get vaccinated for COVID-19. They are now appealing a judge’s ruling that sided with the hospital’s right to terminate their employment.

According to an April 27, 2021 American Academy of Family Physicians article, four reasons for some health care workers’ hesitancy to get the vaccine are safety and efficacy concerns, preference for physiological immunity, distrust in government and health organizations and autonomy/ personal freedom.

Some people say they are worried about the reported side effects and adverse events on sites like VAERS (Vaccine Adverse Event Reporting System) included on the CDC (Centers for Disease Control) website as “an early warning system used to monitor adverse events that happen after vaccination” and “one of several systems CDC and the US Food and Drug Administration (FDA) use to help ensure all vaccines, including COVID-19 vaccines, are safe.” (VAERS’ reported adverse events can be found at Open VAERS.)

LEGAL CONSIDERATIONS

The March 5, 2021 National Law Review article Declining a Shot in the Arm: What Employers Should Do When Employees Refuse Vaccines regarding health care workers points out that:

“Remember that we are still under the vaccines’ Emergency Use Authorization (EUA) period. The EEOC has indicated that employers can require that employees get vaccinated, but the EUA statute contains some language saying that people have a right to refuse any vaccine during the EUA period. Courts have not yet decided the issue. So, there’s some legal risk for employers that choose to mandate that employees get vaccinated.

Most health care employers have decided to strongly encourage – but not require – employees to get vaccinated, partly out of concern that mandating the vaccine might lead to staffing shortages if enough employees refuse to get vaccinated and quit or are fired.”

The article also discusses religious and medical exemptions.

CONCLUSION

My husband and I received our Covid 19 vaccinations in March without any problems and recommended the vaccinations to our children with the caveat that they check with their doctors first, especially since some of our children and grandchildren have special situations.

Some received the vaccinations and some didn’t but we ultimately had to leave the decision up to them.

I am pleased that Covid 19 infections appear to be waning and that our family is healthy at present but I know that this is no time for any of us to be complacent about our health or our rights.

The “Population Bomb” Fizzles, but Now There is a Birth Dearth with Grave Consequences in Many Countries

 Dr. Paul R. Ehrlich was an entomologist (a scientist who specializes in the study of insects)  at Stanford University when he published his bestseller “The Population Bomb” in 1968.  Although initially ignored, it incited a worldwide fear of overpopulation and ultimately became one of the most influential books of the 20th century.

In his book, Ehrlich predicted that unless population decreased, “hundreds of millions of people are going to starve to death” in the 1970s.

That did not happen but 50 years later in a 2018 interview with Smithsonian magazine writer Charles C. Mann, Paul Ehrlich claimed that the book’s main contribution was to make population control “acceptable” as “a topic to debate.”

However, as Mr. Mann wrote:

” But the book did far more than that. It gave a huge jolt to the nascent environmental movement and fueled an anti-population-growth crusade that led to human rights abuses around the world.” (Emphasis added)

But even 50 years later and with the population declining in many countries, Paul Ehrlich continued to insist that:

“Population will fall, either when people choose to dramatically reduce birthrates or when there is a massive die-off because ecosystems can no longer support us. (Emphasis added)

THE HARSH REALITY TODAY

In 1980, China began a strict one child per married couple policy that even included forced abortions for women who did not comply.

In 2015, China raised the limit to two children, citing a “rapidly aging society and a shrinking working-age population”.

China has now increased the number of children to 3 children but as a June 3, 2021 Wall Street Journal article states “China Delivers Three-Child Policy, but It’s Too Late for Many.

Even with years of declining birthrates, there are fewer young people willing to buck the trend of postponing or forgoing marriage and children.

The result is an aging population with a shortage of children. In one Chinese province almost 40% of the province’s population of 880,000 are 60 or older and there is a surging demand for nursing homes. The local government is looking for private investors to help some 7,000 elderly residents who cannot take care of themselves.

Even beyond China, a May 22, 2021  New York Times article titled Long Slide Looms for World Population, With Sweeping Ramifications recognized that:

“All over the world, countries are confronting population stagnation and a fertility bust, a dizzying reversal unmatched in recorded history that will make first-birthday parties a rarer sight than funerals, and empty homes a common eyesore.” (Emphasis added)

HUNGARY FIGHTS BACK

A replacement rate of about 2.1 is necessary to sustain a population but the population in Hungary had been declining since 1981. It reached an all-time low of 1.23 in 2011.

Katalin Novák, the Minister for Family Affairs in Hungary, has facilitated a family-friendly approach that has seen birth rates start to rise. The birth rate is now up to 1.56, still low but improving.

As Minister Novak states:

“The government’s measures of the past ten years have evidently moved demographics in the right direction. The number of childbirths, abortions, the infant mortality rate, marriages, and divorces have all moved in a favorable direction. This also proves that we have made the right decision when we made family-centered governance a priority and are now on the right path. Families are enjoying government support, and we are helping our youth by giving them the opportunity to start a family whenever they want.” (Emphasis added)

THE SITUATION IN THE UNITED STATES

As of 2019 (the latest year for which data is available), the U.S has the lowest fertility rate on record and the lowest number of births in 35 years.

As the New York Times noted in its article about population decline:

“The change may take decades, but once it starts, decline (just like growth) spirals exponentially. With fewer births, fewer girls grow up to have children, and if they have smaller families than their parents did — which is happening in dozens of countries — the drop starts to look like a rock thrown off a cliff. (Emphasis added)

CONCLUSION

The “population bomb” theory has had unintended and disastrous consequences, even in the U.S. and despite immigration.

In 2018, a US Census Bureau article predicted “The Greying of America: More Older Adults than Kids by 2035 for the first time in US history-joining other countries with large aging populations.

As the US Census Bureau states:

“With this swelling number of older adults, the country could see greater demands for healthcare, in-home caregiving and assisted living facilities. It could also affect Social Security. We project three-and-a-half working-age adults for every older person eligible for Social Security in 2020. By 2060, that number is expected to fall to two-and-a-half working-age adults for every older person.” (Emphasis added)

A country with more older people than children can unbalance a society socially, culturally and economically.

Even worse, legalizing abortion and assisted suicide/euthanasia will only make the situation more dire the US.

Since the US Supreme Court legalized abortion in 1973 with the Roe v. Wade decision,  more than 62,000,000 abortions have been performed and now the new Biden administration wants to roll back restrictions on abortion  and make abortions taxpayer-funded

And as efforts by groups like Compassion and Choices to legalize assisted suicide throughout the US has now spread to 9 states and the District of Columbia despite pro-life and disability rights opposition, we should not be surprised if there is another US Supreme court case in the future like the 1997 Vacco v Quill Supreme Court case  that attempted to establish physician-assisted suicide as a fundamental right for the terminally ill like the Roe v. Wade abortion decision legalizing abortion for (initially) just women in the first three months of pregnancy. 

Instead of threats to human beings at the beginning and end of life, we should be welcoming new lives and families as well as caring for the elderly, disabled and poor to improve and stabilize ourselves and our country.

Rethinking Brain Death and Organ Donation

I have been writing for many years about the implications of brain death, the lesser known “donation after cardiac/circulatory death”, diagnosed brain death cases like the supposedly “impossible” prolonged survival and maturation of Jahi McMath, the unexpected recoveries like Zack Dunlap’s and even that some mothers declared “brain dead” were able to gestate their babies for weeks or months to a successful delivery before their ventilators were removed.

Last August, I wrote about the World Brain Death Project and the effort to establish a worldwide consensus on brain death criteria and testing to develop the “minimum clinical standards for determination of brain death”. (Emphasis added)

I also wrote about the current effort “to revise the (US) Uniform Determination of Death Act (UDDA) to assure a consistent nationwide approach to consent for brain death testing” that could otherwise lead to a situation where ”a patient might be legally dead in Nevada, New York, or Virginia (where consent is not required). But that same patient might not be legally dead in California, Kansas, or Montana (where consent is required and might be refused)”. (All emphasis added)

The Uniform Declaration of Death Act (UDDA) was drafted in 1981 by a President’s Commission study to brain death and approved by both the American Medical Association (AMA) and the American Bar Association (ABA). It was intended to provide a model for states to emulate.

It offered 2 definitions of when a person could be declared legally dead to align the legal definition of death with the criteria largely accepted by the medical community:

“Irreversible cessation of circulatory and respiratory functions (the traditional definition of death); or

Irreversible cessation of all functions of the entire brain, including the brain stem (brain death)” (Emphasis added)

The UDDA in some form has since been adopted by all US states and the District of Columbia.

THE PUSHBACK TO REVISE THE US UNIFORM DETERMINATION OF DEATH ACT (UDDA)

But now, 107 experts in medicine, bioethics, philosophy, and law, are challenging the proposed revisions to the UDDA. While they admit that they “do not necessarily agree with each other on all aspects of the brain-death debate or on fundamental ethical principles”, they do object to three aspects of the revision to:

“(1) specify the Guidelines (the adult and pediatric diagnostic guidelines) as the legally recognized “medical standard,” (2) to exclude hypothalamic function from the category of “brain function,” and (3) to authorize physicians to conduct an apnea test without consent and even over a proxy’s objection.” (All emphasis added)

These experts’ objections to those proposed revisions are that:

” (1) the Guidelines have a non-negligible risk of false-positive error, (2) hypothalamic function (a small but essential part of the brain helps control the pituitary gland and regulates many body functions) is more relevant to the organism as a whole than any brainstem reflex, and (3) the apnea test carries a risk of precipitating BD (brain death) in a non-BD patient….provides no benefit to the patient, does not reliably accomplish its intended purpose”… and “should at the very least require informed consent, as do many procedures that are much more beneficial and less risky.” (All emphasis added)

And these experts further state that:

“People have a right to not have a concept of death that experts vigorously debate imposed upon them against their judgment and conscience; any revision of the UDDA should therefore contain an opt-out clause for those who accept only a circulatory-respiratory criterion.”

CONCLUSION

Many years ago, I served on a hospital ethics committee when a doctor complained that he could not arrange an organ transplantation from an elderly woman in a coma caused by a stroke because she “failed” one of the hospital’s mandated tests for brain death. He said he felt like he was “burying two good kidneys”.

Although I already knew that the medical criteria used to determine brain death vary — often widely — from one hospital to another, one young doctor checked our area hospitals and came back elated after he found a hospital that did not include the test the elderly woman “failed”. He suggested that our hospital adopt the other hospital’s criteria to allow more organ donations.

When I pointed out that the public could lose trust in the ethics of organ donations if they knew we would change our rules just to get more organ transplants, I was told that I being hard-hearted to people who desperately needed such organs.

Unfortunately, now some countries’ healthcare ethics have degenerated to the point where euthanasia by organ donation is legally allowed.

Personally, I am all for the ethical donation of organs and tissues. Years ago, I volunteered to donate a kidney to a friend and one of our grandsons was saved in 2013 by an adult stem cell transplant.

But I do not have an organ donor card nor encourage others to sign one because I believe that standard organ donor cards give too little information for truly informed consent. Instead, my family knows that I am willing to donate tissues like corneas, skin and bones that can be ethically donated after natural death and will only agree to that donation.

The bottom line is that what we don’t know-or allowed to know-can indeed hurt us, especially when it comes to organ donation. We need to demand transparency and accurate information because good medical ethics are the foundation of a trustworthy healthcare system.

NEW MEXICO GOVERNOR SIGNS LATEST US LAW TO LEGALIZE ASSISTED SUICIDE AS ARKANSAS GOVENOR SIGNS THE “MEDICAL ETHICS AND DIVERSITY ACT”

On April 8, 2021, New Mexico became the latest and ninth state (along with Washington D.C.) to legalize “medically assisted suicide”.

Note the new terminology used is no longer called “physician-assisted suicide”. This is no accident but rather reflects the persistent expansion of assisted suicide law to allow even non-physicians like physician assistants and nurse practitioners to determine that a requesting patient has six months or less to live and provide them with the suicide drugs.

Ironically, Medicare benefit rules for certifying a terminal illness with a life expectancy of six months or less to be eligible for hospice states that “No one other than a medical doctor or doctor of osteopathy can certify or re-certify a terminal illness”. (Emphasis added) And having worked as a home hospice, ICU and oncology nurse, I know how difficult it is to predict when a patient is expected to die.

And, like other assisted suicide laws, New Mexico’s law also has unenforceable and easily circumvented “safeguards’ like mental health evaluations that are required for any other suicidal patient.

The law also requires that terminally ill patients has “a right to know” about all legal options including assisted suicide and that healthcare providers who refuse to participate in medically assisted suicide must refer that patient to another willing provider.

Nevertheless, New Mexico Gov. Michelle Grisham said she signed the law HB0047 to secure the “peace of mind and humanity this legislation provides.”

THE MEDICAL ETHICS AND DIVERSITY ACT

In a striking contrast to New Mexico’s assisted suicide law, Governor Asa Hutchison signed the “Medical Ethics and Diversity Act” just days earlier on Friday, March 26, 2021 which expanded conscience rights in the state.

As the statute eloquently states:

“The right of conscience is a fundamental and unalienable right.

“The right of conscience was central to the founding of the United States, has been deeply rooted in the history and tradition of the United States for centuries, and has been central to the practice of medicine through the Hippocratic oath for millennia … The swift pace of scientific advancement and the expansion, of medical capabilities, along with the notion that medical practitioners, healthcare institutions, and healthcare payers are mere public utilities, promise only to exacerbate the current crisis unless something is done to restore the importance of the right of conscience.

It is the public policy of this state to protect the right of conscience of medical practitioners, healthcare institutions, and healthcare payers. It is the purpose of this subchapter to protect all medical practitioners, healthcare institutions, and healthcare payers from discrimination, punishment, or retaliation as a result of any instance of conscientious medical objection.”

However, opponents of the law like the Human Rights Campaign and the American Civil Liberties Union, have argued that it would allow doctors to refuse to offer a host of services for LGBTQ patients.

In response to this criticism, Governor Hutchinson stated:

“I have signed into law SB289, the Medical Ethics and Diversity Act. I weighed this bill very carefully, and it should be noted that I opposed the bill in the 2017 legislative session. The bill was changed to ensure that the exercise of the right of conscience is limited to ‘conscience-based objections to a particular health care service.’ I support this right of conscience so long as emergency care is exempted and conscience objection cannot be used to deny general health service to any class of people. Most importantly, the federal laws that prohibit discrimination on the basis of race, sex, gender, and national origin continue to apply to the delivery of health care services.”

CONCLUSION

As a nurse myself, I would not and never have refused to care for any patient. Discrimination has no place in healthcare.

However, I have been threatened with termination when I have refused to follow an order that would cause a patient’s death. It wasn’t the patient I objected to but rather the action ordered.

Conversely, I would not want a healthcare provider caring for me who supports assisted suicide, abortion, etc. This is why I ask my doctors about their stands on such issues before I become their patient.

Our country and our healthcare systems need laws, healthcare providers and institutions that we can trust to protect us. Conscience rights protections are a critical necessity for that to happen.

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The Assisted Suicide Juggernaut Continues in the U.S.

Since Oregon passed the first physician-assisted suicide law in 1997, 8 more states and the District of Washington, D.C. passed assisted suicide laws by 2020. They are:

  • California (End of Life Option Act; approved in 2015, in effect from 2016)
  • Colorado (End of Life Options Act; 2016)
  • District of Columbia (D.C. Death with Dignity Act; 2016/2017)
  • Hawaii (Our Care, Our Choice Act; 2018/2019)
  • Maine (Death with Dignity Act; 2019)
  • New Jersey (Aid in Dying for the Terminally Ill Act; 2019)
  • Oregon (Death with Dignity Act; 1994/1997)
  • Vermont (Patient Choice and Control at the End of Life Act; 2013)
  • Washington (Death with Dignity Act; 2008)

So far in 2021, 13 more states have new proposed assisted suicide bills and 4 states with assisted suicide laws are facing bills to expand their assisted suicide laws.

These 13 states are  Arizona , Connecticut, Indiana, Iowa, Kansas, Kentucky, Massachusetts, Minnesota, Nevada, New Mexico, New York, North Dakota and Rhode Island. Most of these states have been repeatedly hounded for years to pass an assisted suicide law.  

The 4 states with bills expanding their assisted suicide laws are California , Hawaii , Vermont, and the state of Washington.

The expansions range from expanding “qualified medical providers” from doctors to a range of non-doctors including nurses to eliminating so-called “safeguards” such as 15 day waiting periods, in person requests and even to allow electronic prescribing and shipping of lethal overdoses. Compassion and Choices (the former Hemlock Society) and other assisted suicide supporters have long portrayed assisted suicide “safeguards” as “burdensome obstacles”.

CONSCIENCE RIGHTS AND CENSORSHIP

Conscience rights for health care providers has been a very real problem since the 1974 Roe V. Wade U.S. Supreme Court decision legalized abortion in the U.S. The legalization of assisted suicide in several states has made this even worse for nurses, doctors, pharmacists and other healthcare workers. Even healthcare institutions have faced discrimination problems.

The Christian Medical and Dental Association even compiled a long list in 2019 of “Real-life examples of discrimination in healthcare” .

Now, we are seeing censorship. A March 28, 2021 Wall Street Journal op-ed titled “Big Tech Censors Religion, Too stated that:

“In January, Bishop Kevin Doran, an Irish Catholic, tweeted: “There is dignity in dying. As a priest, I am privileged to witness it often. Assisted suicide, where it is practiced, is not an expression of freedom or dignity.” Twitter removed this message and banned Bishop Doran from posting further. While the company reversed its decision after public opposition, others haven’t been so lucky.” (Emphasis added)

CONCLUSION

Back in 2014, I wrote a blog “Should a Pro-Life person Become a Nurse” about a worried pro-life student nurse who wrote me asking “what area of nursing can I move into that does not demand that I do things that I absolutely will not do?”

I wrote her back and told her that I had that challenge in several areas I worked in over 45 years but was able to live up to my ethics despite some difficult situations and that I never regretted becoming a nurse.

However, conscience rights are a not a luxury but rather a necessity.

That is why some of us nurses in Missouri worked so hard to get a conscience rights law passed in 1992 after the Nancy Cruzan starvation and dehydration death that, although not as strong as we wanted, is still in effect today. And I was thrilled when the Trump administration announced a new Conscience and Religious Freedom Division  in 2018 to enforce “federal laws that protect conscience and the free exercise of religion and prohibit coercion and discrimination in health and human services”.

Society has long insisted that health care professionals adhere to the highest standards of ethics as a form of for society. The vulnerability of a sick person and the inability of society to monitor every health care decision or action are powerful motivators to enforce such standards. For thousands of years doctors (and nurses) have embraced the Hippocratic standard that “I will give no deadly medicine to any one, nor suggest any such counsel.” Should that bright line to separate killing from caring now be erased by legislators or judges?

Without a strong resistance movement, the assisted suicide movement will only keep expanding. So far, much of the public has been shielded from the real truth by euphemisms and false reassurances from assisted suicide supporters, a mostly sympathetic mainstream media and often spineless professional and health care organizations.

We all must educate ourselves to speak out before it is too late.

A Light at the End of the (Covid 19)Tunnel?

My husband and I just returned from a trip to Florida where we were happily surprised to find the closest place to normal since the Covid 19 pandemic started. Everyone wore masks (except one young man we saw at a distance) and everyone was careful about social distancing. Hand sanitizers were everywhere.

Best of all, people seemed happy and we saw very few stores closed.

When we returned home, we both finally received the first of our 2 Covid 19 vaccination doses.

Is it possible that there is a light at the end of the Covid tunnel?

I am cautiously optimistic but aware that Covid 19 may still be a problem in the long term, especially since some younger family members-including children-contracted Covid despite precautions. Thankfully, they all had mild cases with no hospitalizations. My husband and I will continue to follow Missouri’s guidelines of masks, social distancing, etc. even after we receive our next dose of vaccine.

IS FLORIDA A HARBINGER OF GOOD NEWS?

Florida was among the last states to go into lockdown and one of the first states to ease restrictions.

Florida’s Governor Ron DeSantis was vilified by many of the media for adopting something similar to Sweden’s strategy of protecting the vulnerable while keeping businesses and schools open but a year after the pandemic hit the US, that strategy seems to be working.

Despite having the second largest number of elderly people by state, Florida’s Covid death rate numbers are better than New York’s and California’s. And, unlike so many other states, Florida’s economy is thriving.

Now, Governor Abbott of Texas and Governor Reeves of Mississippi have announced that they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates.

WHAT HAPPENED?

It has been almost a year since the U.S. went on lockdown for Covid 19 when President Trump declared Covid 19 a national emergency on March 13, 2020.

At first, the lockdown was only supposed to be for a few weeks to “flatten the curve” of infections and prevent hospitals from being overwhelmed by Covid patients.

However, as the lockdowns wore on for months, some doctors and other experts started warning about the emotional and health damage occurring.

Although it received little media notice, a May 19, 2020 letter to President Trump signed by over 600 doctors detailed the physical and mental impact of the lockdown in the US due to Covid 19, calling it a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non-COVID patients. 

The doctors’ letter also stated that:

“Keeping schools and universities closed is incalculably detrimental for children, teenager and young adults for decades to come.”

Then on October 4, 2020, the Great Barrington Declaration was written and released and eventually signed by thousands of doctors and experts from around the world. The Declaration encouraged governments to lift lockdown restrictions on young and healthy people while focusing protection measures on the elderly, stating:

“Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice. “

Unfortunately, Covid 19 rules and lockdowns have become a political football in many states, especially with school and small business reopenings.

CONCLUSION

We know a lot more about Covid 19 now than when the pandemic started, especially from watching U.S. states and other countries use various strategies to try to contain the virus. And now, of course, it appears we have several promising vaccines.

Although there is much more to learn, we indeed might be seeing a light at the end of the Covid 19 tunnel.

Can You Tell “Fake News” from Real News?

In 2019, Nick Sandmann, a Catholic high school teenager in a MAGA hat from Covington, Kentucky was filmed allegedly showing the teen confronting an elderly Native American man after a big pro-life rally in Washington, D.C.

The tape was shown on mainstream media outlets and the young man and his classmates were then vilified in the media.

Later, a longer version of the video instead showed that it was the Native American man who confronted the teen, chanting and banging a drum in his face.

But by July 2020, after Mr. Sandmann sued several news outlets for defamation, both CNN and the Washington Post settled the cases for undisclosed amounts.

The rush to judgment by so many of the mainstream media over such an arguably small but politically potent news item was eventually exposed as “fake news”.

What caused this and how can we tell the difference between trustworthy news and so-called “fake news”?

An advanced practice nurse friend of mine recently revealed that she had studied journalism in college for three years before dropping out in 1990s. She felt that her professors were enforcing their viewpoints on students’ writings rather than promoting non-biased news reporting. She is happy now that she changed her major to nursing but said she is sad and appalled to see the biased state of journalism now.

Getting trustworthy information from news outlets can be a daunting and time-consuming effort now with the great political and cultural divide that has been occurring in the US, especially in the last few years. Even worse, we now see the rise of an Orwellian-like “cancel culture” that is enforcing new speech codes and concepts with the threat of silencing other views and even people.

WILL THE NEWS LITERACY PROJECT HELP OR HURT?

Recently, I read about the News Literacy Project (NLP) that states it is:

“a nonpartisan national education nonprofit, provides programs and resources for educators and the public to teach, learn and share the abilities needed to be smart, active consumers of news and information and equal and engaged participants in a democracy. ” It declares that “The lack of news literacy is a threat to our democracy. (Emphasis added)

NLP says it plans to build:

“By 2022, a community of 20,000 news literacy practitioners who, using NLP and resources, will teach news literacy skills to 3 million middle and high school students each year. NLP will also lead efforts to increase public awareness of news literacy and to equip people of all ages with the ability to discern fact from fiction.” (emphasis added)

NLP also has a “Theory of Change” with four pillars that will:

“Pillar One: Increase the use and the measurable student impact of NLP programs and resources (Change educator behaviors),

Pillar Two: Develop a national community of news literacy practitioners as advocates of systemic change (Change general will),

Pillar Three: Raise awareness of NLP and increase news literacy among the general public. (Change public mindsets),

Pillar Four: Build the infrastructure and fiscal sustainability to realize this plan in the short term and our vision in the longer term.” (Emphasis added)

NLP also states that since its start in 2008 ,  “More than 30 news organizations across the United States, from local outlets to internationally known print and digital publications, support NLP in a variety of ways “. NLP also states that it “has a role to play assisting others around the world who are working to expand news literacy in their countries.

This was news to me and rather concerning because so many of these same news organizations have been involved in “fake news” stories like Nick Sandmann’s. If the NLP so concerned about this, why doesn’t it also work to enforce the standard of accurate, non-biased reporting with its own news outlets instead of trying to teach children and the public how to differentiate between trustworthy news and “fake news”?

MY JOURNEY AND WHY I AM SO CONCERNED

I grew up in a mixed political family. My mother was a passionate Democrat, and my father was an equally passionate Republican. Their arguments were epic, but they spurred my interest in understanding local and national news, even as a child.

I wanted to know what was true and spent lots of time reading different viewpoints in magazines, newspapers and our local library. Back in the 1960s, there was no internet.

Not surprisingly, I wound up as an independent.

My parents and teachers wanted me to go into journalism, but I chose nursing and never regretted it.

However, I began writing again when my late first husband asked me to help him write his medical research papers. I learned a lot but was shocked by the politics of publishing medical research. Certain projects and results were taboo. I learned to have a degree of skepticism when evaluating medical research and I am no longer surprised when many papers are retracted after publication.

After my daughter Karen was born with Down Syndrome and a severe heart defect, I started researching and writing again, first in a journal and then eventually for other publications including a national newspaper.

My newspaper editor was superb, and he enforced strict journalistic principles such as reporting different viewpoints without bias and with meticulous sourcing.

I found I was not immune from occasional mistakes, but I was expected to correct them as soon as possible. Accuracy was paramount. I doubt any journalism school back then could have been better than my experience writing for that newspaper.

Today, I become immediately skeptical when I read or hear sensational news items or intense personal attacks, especially on social media sites.

And with the NLP teaching millions of students every year, I am also concerned about the power of schools and how they educate our children.

Years ago, when my children were in public high school, mandatory school sex education with the promotion of “safe sex” was a concern for many of us parents but dismissed by the school. Now, Planned Parenthood boasts it is the single largest provider of sex education in the United States.

Now, many younger parents are worried about what their children are learning and believing when their schools teach the “1619 Project” and “Critical Race Theory”.

CONCLUSION

We must and should be able to have a high amount of trust in our media, especially with the current Covid 19 pandemic, but now polls show the public’s trust in media has “hit a new low”.

“Fake news” can take many forms from bias and distortions to ignoring major news stories for political reasons. This kind of manipulation is very harmful and even dangerous to achieving a safe and well-informed society. I personally have eliminated most social media.

I also recommend keeping an open mind rather than just reading or watching news outlets with which you agree. Take the time to really try to understand and use critical thinking about contentious issues. Be skeptical when reading shocking news items and check the sources and other verification.

And just as important, we still need to stand up for what we believe and explain our positions without hostility towards those who disagree and without fear of reprisals for our convictions.

Correction to “How Missouri Became the First Abortion-free State in the U.S.”

CORRECTION: It appears that this blog and articles about “How Missouri Became the First Abortion-free State in the U.S.” are premature and inaccurate. My apologies.

Now, according an article in the January 21, 2021 St. Louis Review:

“The archdiocesan Respect Life Apostolate recently issued a statement responding to reports circulating that Missouri may be the first “abortion-free” or “abortion clinic-free” state. However, the apostolate noted that the last freestanding abortion facility in the state, Reproductive Health Services of Planned Parenthood of the St. Louis Region, is still a legally licensed abortion facility by the state of Missouri, with many Missouri women being referred to the Planned Parenthood clinic in Fairview Heights, Illinois. Abortions also continue to be offered by at least one health care system in the St. Louis area.”

How Missouri Became the First Abortion-free State in the U.S.

Although the pro-life movement has faced seemingly insurmountable obstacles since the 1973 Roe v. Wade decision legalizing abortion in the U.S., the movement continues to make legal and cultural gains.

This is one of the latest.

In July 2019, I wrote the blog “The Last Planned Parenthood Clinic in Missouri Again Evades Closure” about how the lone Planned Parenthood clinic in my home state of Missouri received multiple court-ordered reprieves from closure after the Missouri Department of Health and Senior Services (DHSS) decided not to renew the facility’s license because of dozens of serious health and safety violations.

Public records showed numerous problems at the clinic including unreported failed abortions, life threatening complications, an illegal abortion at 21 weeks, insufficient supervision of medical residents (students) performing abortions and inaccurate medical records among the many other violations.

Yet the St. Louis abortion clinic continued to get court-ordered reprieves.

But this month, Operation Rescue confirmed that now no abortions have been performed there for months.  Instead, all abortion appointments are now being referred to the Fairview Heights Planned Parenthood facility across the Mississippi River in Illinois.

How could this happen?

While Missouri has long been a strongly pro-life state with legislation like the 2019 “Missouri Stands for the Unborn Act” and many active pro-life organizations, Defenders of the Unborn president Mary Maschmeier, who has led a peaceful, prayerful and life-saving ministry outside the St. Louis Planned Parenthood clinic for many years, wrote an email also giving credit to the:

“ordinary citizens who would not take no for an answer. Who persevered day after day, year after year, decade after decade. Ever present on the front lines. In the streets. In the halls of our state legislature. Sidewalk counseling. Prayer warriors…Manning pregnancy aid centers. Staffing Ultra Sound vans. Rain, snow, heat, cold- ever vigilant.”

Mary also wrote that “We will not stop until the that unjust practice is banished from our land and encourage our fellow citizens to end abortion in their respective states. “

CONCLUSION

In 1989, I had just started working as an RN on an oncology (cancer) unit when we discovered that one of our patients had CMV (Cytomegalovirus).

One of our nurses was pregnant and tested positive for the virus. Her doctor told her how her baby could die or have terrible birth defects from the virus and he recommended an abortion.

“Sue” (not her real name) was frantic. She had two little girls and worked full time. She said she didn’t know how she could manage a child with serious birth defects.

I told her that it was usually impossible to know if or how much a baby might be impaired before birth. I also told her about my Karen who was born with Down Syndrome and a critical heart defect and died at 5 months. I told her that I treasured the time I had with her and later babysat children with a range of physical and mental difficulties. Most importantly, I also told her that I would be there to help her and her baby.

“Sue” decided against abortion and told the other nurses what I said.

The other nurses were furious with me and said if the baby was born with so much as an extra toe, they would never talk to me again.

But slowly, the other nurses came around and also offered to help Sue and her baby.

In the end, we all celebrated when Sue had her first son who was perfectly healthy!

My point is that what many people don’t understand is that pro-life doesn’t mean just being against abortion, infanticide and euthanasia. What being pro-life really means is truly caring about all lives, born or unborn.

When Can We End Lockdowns for Covid 19?

When the Covid 19 pandemic hit the U.S. early last year, little was known about this new infection.

But as the highly contagious Covid 19 virus was spreading around the world, President Trump issued a proclamation on March 13, 2020 declaring a national emergency with “preventive and proactive measures to slow the spread of the virus and treat those affected” and state lockdowns began.

Regular healthcare became virtually suspended as states went to lockdown with rules to shelter in place except for essential errands or work. Schools and many businesses were closed. 

On March 18, the Centers for Medicare and Medicaid Services recommended that hospitals cancel all elective surgeries and nonessential medical, surgical and dental procedures to prepare for the expected deluge of patients with Covid 19 and the health system complied.

Then, although it received little media notice, a May 19, 2020 letter to President Trump signed by over 600 doctors detailed the physical and mental impact of the lockdown in the US due to Covid 19, calling it a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non-COVID patients. 

The doctors’ letter stated that:

“Suicide hotline phone calls have increased 600%,” the letter said. Other silent casualties: “150,000 Americans per month who would have had new cancer detected through routine screening.”

“Patients fearful of visiting hospitals and doctors’ offices are dying because COVID-phobia is keeping them from seeking care. One patient died at home of a heart attack rather than go to an emergency room. The number of severe heart attacks being treated in nine U.S hospitals surveyed dropped by nearly 40% since March. Cardiologists are worried “a second wave of deaths” indirectly caused by the virus is likely.

“The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

“It is impossible to overstate the short, medium, and long-term harm to people’s health with a continued shutdown,” the letter says. “Losing a job is one of life’s most stressful events, and the effect on a person’s health is not lessened because it also has happened to 30 million [now 38 million] other people. Keeping schools and universities closed is incalculably detrimental for children, teenagers, and young adults for decades to come.” (All emphasis added)

Then on October 4, 2020, the Great Barrington Declaration was written and released by three public health experts from Harvard, Stanford, and Oxford. The Declaration was eventually signed by thousands of doctors and experts from around the world. The Declaration encouraged governments to lift lockdown restrictions on young and healthy people while focusing protection measures on the elderly.

These experts surmised that this would allow COVID-19 to spread in a population where it is less likely to be deadly, encouraging widespread immunity that is not dependent on a vaccine.

The Declaration stated:

“Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice. “

The Declaration was swiftly met with intense criticism from other medical experts who called the plan “practically impossible and highly unethical”.

As the numbers of people with Covid 19 and who died from Covid 19 went up and down over the months, various U.S. states and counties ordered different degrees of lockdown and now many states seem to be guided more by politics than science when it comes to lockdowns.

HOPE ON THE HORIZON

We now have more people with Covid 19 surviving and leaving the hospital sooner due to a better understanding of what treatments work best in comparison to what was known when the pandemic started in the US.

And although seemingly impossible at first, new vaccines have been developed for Covid 19 and began being distributed in December 2021 due to Operation Warp Speed. Despite the controversy about some Covid 19 vaccines, it is hoped that the widespread use of vaccines may help the U.S. end the lockdowns.

In addition, the FDA (food and Drug Administration) approved the use of several rapid Covid 19 tests, some that can even be done at home. This can be a gamechanger with some experts saying that the massive distribution of rapid self-tests for use in homes, schools, offices, and other public places could replace harmful sweeping lockdowns with knowledge.

CONCLUSION

Lockdowns have caused enormous economic, physical, social and mental upheaval in the US.

When lockdowns are intermittent in intensity and duration in some states without clear scientific evidence that the lockdowns are working, it seems we need a reevaluation of their usefulness as we evaluate other measures to help end the Covid 19 pandemic.

Should a Covid 19 Vaccine be Mandatory?

As the first Americans are receiving a Covid 19 vaccine, a December 5 2020 Gallup poll reports that 63% of Americans say they are willing to take the vaccine. 37% are less willing, including some groups like non-white people and Americans age 45-64. But the percentage of Americans currently willing to get vaccinated may still be below where public health experts want it.

Now, there is a proposed bill in New York to make getting the vaccine mandatory to get sufficient immunity if not enough people are voluntarily getting them.

Why are some people unwilling to get the vaccine?

As I wrote in my last blog “Ethics and the Production of Covid 19 Vaccines”, many people are concerned about the use of aborted fetal cells in some vaccines. I also included two lists of vaccines and whether or not such fetal cells were involved in their production. One list is from the Charlotte Lozier Institute and one is from the Children of God for Life organization. (The Charlotte Lozier Institute does disagree with the Children of God for Life organization on the Moderna vaccine.)

Other potential concerns are about the safety, side effects and the effectiveness of the vaccines.

EFFECTIVENESS AND SAFETY

A December 3, 2020 MedPage investigative article “Want to Know More About mRNA Before Your COVID Jab? states that “While an mRNA vaccine has never been on the market anywhere in the world, mRNA vaccines have been tested in humans before, for at least four infectious diseases: rabies, influenza, cytomegalovirus, and Zika.”

The Covid 19 vaccines use a synthetic mRNA, which is genetic information used to make the SARS-CoV-2 spike protein. When injected, the body produces a strong response to that protein to produce an immune response.

How long that response lasts is still unknown.

But, especially for certain groups of people, there are also concerns about safety.

According to the CDC (the U.S. Center for Disease Control) regarding immunocompromised patients such as those with HIV or who take immunosuppressive medications or therapies may take the vaccine but should be counseled about:

“– Unknown vaccine safety and efficacy profiles in immunocompromised persons
– Potential for reduced immune responses
– Need to continue to follow all current guidance to protect themselves against COVID-19″

Also according to the CDC, “There are no data on the safety of Covid 19 vaccines in pregnant women” but “Animal developmental and reproductive toxicity (DART) studies are ongoing” and more studies are planned.

Regarding breastfeeding, the CDC states that “There are no data on the safety of COVID-19 vaccines in lactating women or the effects of mRNA vaccines on the breastfed infant or milk production/excretion”

SIDE EFFECTS

In a Nov. 23, 2020 CNBC article “Doctors say CDC should warn people the side effects from Covid vaccine shots won’t be ‘a walk in the park, a group of doctors told the CDC to warn people that the Covid 19 vaccine shots now being rolled out may have “some rough side effects so they know what to expect and aren’t scared away from getting the second dose.”

And a December 9, 2020 article in the Wall Street Journal “Covid-19 Vaccines Pose Potential Side Effects, Doctors Say” reported that “U.K. authorities warn people with severe allergies against receiving the Pfizer-BioNTech shots, after two Britons experience allergic reactions.”

But a STAT news article a few days later on December 13, 2020, now reports that the CDC has changed its position from Persons who have had a severe allergic reaction to any vaccine or injectable therapy (intramuscular, intravenous, or subcutaneous) should not receive the Pfizer-BioNTech vaccine at this time(emphasis added) to that people who had “severe reactions to prior vaccines or injectable drugs can still get the Pfizer/BioNTech vaccine for Covid-19, but should discuss the risks with their doctors and be monitored for 30 minutes afterward”.

Another concern is that although states rely on the percentage of positive Covid 19 tests for lockdown and other orders, there are many kinds of tests and both false positive and false negative results have been reported.

No wonder many people are confused and anxious!

SHOULD COVID 19 VACCINES BE MANDATORY?

Now we are seeing Covid 19 vaccines being rapidly distributed and more Covid 19 vaccines are coming, including a Johnson and Johnson single dose Covid 19 vaccine that is in testing and the results may be known by January.

Currently, the health care workers and residents and staff of long-term care facilities have first priority for a Covid 19 vaccine.

Although states have the authority to regulate public health and they have in the past mandated vaccines for diseases like smallpox and some mandatory vaccines are required by states before children can attend school, it seems unlikely that there will be a federal mandate for the Covid 19 vaccine.

It is more likely that only certain groups of people may be required to take the vaccine like healthcare workers, universities and some employers. Even then, the Civil Rights Act of 1964 may help people who have a religious objection to a vaccine as well as anti-discrimination laws and exemptions for medical reasons. An employer would have to make a reasonable accommodation as long as it’s not too costly for the business.

It is also possible that airlines, stores, stadiums could also make vaccination a condition of doing business with a person.

CONCLUSION

The Covid 19 pandemic has taken a serious toll on everyone and we will not get back to “normal life” anytime soon, even with the Covid 19 vaccine.

But we still must make sure that any Covid 19 vaccines we take are ethical, effective and safe.

Ethics and the Production of Covid 19 Vaccines

I am hopeful that the new Covid 19 vaccines that are being approved soon will help stop Covid 19 but, like many people, I only want to take a vaccine that does not use cell lines from aborted babies.

But that information can be hard to find, confusing and the facts are sometimes disputed.

For example, a November 18, 2020 article from the Associated Press titled “Lung tissue from aborted fetus not used in AstraZeneca vaccine development” disputes an online video that claims tissue from an aborted baby was used. I discovered later that this AP headline was inaccurate.

And there are disputes even in Catholic and other religious circles.

For example, some Catholic bishops and priests questioned the use of some vaccines before Archbishop Naumann and Bishop Rhoades from the USCCB (the US Catholic bishops conference) wrote a memo citing three Vatican documents and stating that:

“Neither the Pfizer nor the Moderna vaccine involved the use of cell lines that originated in fetal tissue taken from the body of an aborted baby at any level of design, development or production. They are not completely free from any connection to abortion, however, as both Pfizer and Moderna use of a tainted cell line for one of the confirmatory lab tests of their products.”

“There is thus a connection, but it is relatively remote,” they continued. “Some are asserting that if a vaccine is connected in any way with tainted cell lines, then it is immoral to be vaccinated with them. This is an inaccurate portrayal of Catholic moral teaching.”

and

“Most importantly, they all make it clear that, at the level of the recipient, it is morally permissible to accept vaccination when there are no alternatives and there is a serious risk to health.”

However, other articles like the National Catholic Register’s Nov. 25, 2020 Measuring Moderna’s COVID-19 Vaccine: Now’s the Time to Press Hard for Ethical Options” by Stacy Trasancos, PhD, MA and Children of God for Life’s Nov. 16, 2020 article “Moderna Covid-19 Vaccine – Facts – Not Fiction say that kidney cells from aborted babies were used in the development of the Moderna Vaccine but also adds that there are plenty of other ethical vaccines being developed.

CONCLUSION

After weeks of investigation, I found the simplest explanation of the vaccine production process and its’ potential problems at The Charlotte Lozier Institute website.

I also found the most expansive list of current potential vaccines at the Institute’s Update: COVID-19A Vaccine Candidates and Abortion-Derived Cell Lines. (The Institute does disagree with Dr. Trasancos and the Children of God for Life organization on the Moderna vaccine.)

For myself, I do want the Covid 19 vaccine when it is available but I will make sure that I am given one of the ethically uncontroversial vaccines. I will also insist on adequate information on the safety of such vaccines before I take the vaccine.

ADDENDUM:

I am adding this addendum to my latest blog after I discovering some new information from both a medical and a pro-life website (LifeSiteNews December 4, 2020 article “Pfizer COVID jab warning: “No breastfeeding, avoid pregnancy for 2 months, unknown fertility impacts” about the possible effects of the Pfizer Covid 19 vaccine on pregnant and breastfeeding moms.

This disturbing news and another link from a blog reader made me realize that we must have confidence that any Covid 19 vaccine will be safe as well as ethically produced.

Therefore, I have added a final line to my blog:  “I will also insist on adequate information on the safety of such vaccines before I take the vaccine.”

Nancy Valko, RN ALNC

Caring for an Elderly Relative who Wants to Die

I was disturbed but not really surprised when I read the October 21, 2020 New England Journal of Medicine article by Scott D. Halpern, M.D, Ph.D., titled “Learning about End-of-Life Care from Grandpa”.

Dr. Halpern, a palliative care doctor and ethicist at the University of Pennsylvania, wrote about his elderly grandfather who had been widowed for the third time and wrote “My life was over too, only existence remained,” in a memoir for his family.

As Dr. Halpern writes, “It was downhill from there” as his grandfather coped with challenges like blindness, deafness and arthritis.

Family members offered to care for him but the grandfather chose to go into an assisted living facility where family members could visit him frequently. But then, Covid 19 visitations cut him off entirely from the outside world.

Eventually, the grandfather was allowed to see relatives one at a time outdoors at the facility.

Nearing his 103rd birthday, the grandfather started asking Dr. Halpern about “any plausible option to hasten death”.

New Jersey had recently approved physician-assisted suicide, but Dr. Halpern was “ambivalent” about that option. In addition, his grandfather did not have a terminal illness but rather was “dying of old age, frailty, and more than anything else, isolation and meaninglessness”.

Alarmingly, Dr. Halpern found that the medical code for this diagnosis called “adult failure to thrive” was being used not only used to access hospice but also to access physician-assisted suicide in some states.

Unable to find a New Jersey doctor willing to use physician-assisted suicide on his grandfather anyway, Dr. Halpern offered his grandfather the option of VSED (voluntarily stopping of eating and drinking) to hasten or cause death that the pro-assisted suicide group Compassion and Choices touts as “natural” and legal in all states.

THE TRUTH ABOUT VSED

Dr. Halpern wrote that his grandfather had trouble refusing food and water on his own. He started and stopped the process a few times.

Dr. Halpern was not surprised, writing that:

“ For people with a consistent desire to end their life, unencumbered by mental illness or immediate threats to their survival, the only alternative — to stop eating and drinking — is just too challenging. Hospice experts around the country had warned me that less than 20% of people who try to do so “succeed,” with most reversing course because of vicious thirst.” (Emphasis added)

Finally, Dr. Halpern’ write that his grandfather said “I just want it over with. Scott, do whatever you need to do.”

Dr. Halpern writes that he consulted his hospice team and began treating his grandfather’s thirst “as I treat other forms of discomfort — with morphine and lorazepam” (Emphasis added)

Even then, it took 12 long days for his grandfather to finally die.

The lessons that Dr. Halpern says he finally learned were that:

“despite many problems with physician-assisted dying, it may provide the most holistic relief possible for people who are not immediately dying, but rather are done living.”

And

stopping eating and drinking is largely impossible without knowledgeable family members and dedicated hospice care.” (All emphasis added)

CONCLUSION

Dr. Halpern obviously loved his grandfather and tried to meet his grandfather’s emotional and physical needs before telling him about the VSED option and eventually adding terminal sedation. And it seems that the imposed isolation because of potential Covid 19 infection was especially devastating for his grandfather.

But his justification for physician-assisted suicide as “the most holistic relief possible for people who are not immediately dying, but rather are done living” is chilling.

Unfortunately, that is an attitude seen all to often in medical professionals that has led to the expansion of some assisted suicide laws from terminal illness to non-terminal conditions like “completed life” and disabilities.

Both personally and professionally as a nurse, I know how difficult it can be on families when caring for a family member-especially an older relative-who says he or she wants to die.

But I also know that while we all can have sympathy for someone who says they want to die, the word “no” can be a powerful and loving response. The real answer is to help make living as good and meaningful as possible until death.

For example, I became the only caregiver when my elderly aunt developed diabetes and late-stage pancreatic cancer in 2000.

I went to doctor visits with her and went over the options with her. My aunt rejected chemo and radiation that had only a small chance of even slowing the cancer. She also refused hospice.

I offered to care for her in my home with my 15 year old daughter who also wanted to help. However my aunt felt it would cramp my daughter’s lifestyle so she decided to stay in her own home until she died.

So I helped her at home and purchased my first cell phone so that she could contact me at anytime. At that time, I was a single parent and worked full time nights in an ICU.

However, one day my aunt asked me about stopping her insulin to die faster. I told her how that could put her at risk for a heart attack or stroke from high blood sugar with no one there to help.

So she changed her mind and then even began opening up about her condition with others. She was stunned when people told her how inspiring she was and offered to help her in any way.

My aunt became happier than I had ever seen her.

Eventually, my aunt did accept hospice care at a facility she knew. I visited and called often. My aunt was physically comfortable and alert.

One day when my daughter and I went to visit her, we found that she had just died quietly in her sleep. The nurses had just stepped out to call me.

My daughter later wrote a beautiful essay about her first experience with death for her high school and received an A+. Her essay was later published on a nursing website.

In the end, causing or hastening death does not really solve anything but rather can be seen as an abandonment of the suffering person and a destroyer of the necessary trust we all must have in the ethics of our healthcare system.

We must never discriminate when it comes to helping anyone contemplating suicide.

.

Shout Your ADOPTION!

The National Association of Pro-life Nurses (NAPN) has loved to feature stories about adoption and wants to feature more such stories on our website.

As our president Sue Meyers has written:

“We have named the program, “Shout Your Adoption.”

We would like to include more stories of adoption in our newsletter. Pro-Life people are all about offering alternatives to abortion and many adopt babies, children with disabilities and hard-to-place children. As a grandmother to a three-year-old, adorable (just ask me) grandson, I cannot imagine life without Andrew.

Please send your stories to me at lmeyers@nethtc.net .Don’t worry about getting it written perfectly, we will polish it, if necessary. We won’t use names unless you give us permission. Thank you so much! I can’t wait to read your stories!”

When a new life is unexpected and in difficult circumstances, women are often encouraged or even coerced into an abortion and not considering the adoption option.

I saw this myself when my 18 year old daughter became pregnant in 1998.

But when my daughter received help and support, she chose adoption and never regretted knowing her daughter was in loving hands.

These stories may not only help future mothers and babies but also their families and other loved ones. And, especially today, with Planned Parenthood’s “Shout Your Abortion” promotion, our society really needs to hear these pro-life stories.

In 2012, I wrote an article about my my daughter’s and our family’s adoption story for Voices magazine titled “Open Adoption: A Love Story” in the hope that other women and their families would be helped by our story.

I hope you will consider writing yours!

Protecting Premature Babies and Abortion Survivors

On September 25, 2020, President Donald Trump signed an Executive Order on Protecting Vulnerable Newborn and Infant Children” that states:

“Every infant born alive, no matter the circumstances of his or her birth, has the same dignity and the same rights as every other individual and is entitled to the same protections under Federal law. “

This executive order came after Speaker NancyPelosi and House Democrats refused to allow a vote on the “Born Alive Abortion Survivors Protection Act” over 80 times.

ELLIOT AND EMERY

The new executive order protects not only babies who survive abortions but also those babies born prematurely like twins Emery and Elliot who were denied medical treatment after being born at 22 weeks and 5 days, despite a doctor’s prior assurances and despite the parents’ desperate pleas for treatment after the boys were born.

In an interview, the twins’ mother Amanda told me that the doctors predicted the babies would be stillborn or die shortly after birth because of their prematurity. However, the doctors were wrong: one of the boys lived for 45 minutes and the other for 2.5 hours.

Amanda and Shaun Finnefrock, the twins’ parents, have been active ever since their boys’ deaths in 2017 , advocating for “equal protection, equal treatment, the equal opportunity for survival — whether they survived an abortion or their mothers wanted them to live, like I did mine.”

They have been working on an Elliot and Emery’s Law for their home state of Ohio to protect other prematurely born babies.

Unfortunately, a 2015 University of Iowa study found that infants born at 22 weeks received potential lifesaving treatment at fewer than one in four hospitals. Almost all hospitals, the researchers found, will treat infants born at 25 weeks, but there is substantial variation among hospitals on whether they actively treat infants born at 23 or 24 weeks.

One obstacle is the fear that premature babies will be at an increased risk of disability as a result of the prematurity. But it is impossible to know at birth if the newborn will have disabilities because of prematurity. 

The good news is that studies are now finding that the majority of premature babies born at 22 weeks survive if given care.

CONCLUSION

When I started my nursing career over 50 years ago, babies more than 3 months premature routinely died because of breathing problems. But when ventilators and especially surfactant to protect the babies’ lungs were developed, “preemies” started to be saved at earlier and earlier stages with good results.

But most importantly, this progress was made because of the willingness of both parents and doctors to try to save these babies that made all the difference.

Think the Political and Cultural Divisions in Our Country are Bad? The Divisions in Medical Ethics Could Cost Your or a Loved One’s Life!

I wanted to be a nurse since I was 5. I was drawn to nursing not only because I wanted to help people but also because medical ethics standards were so high, especially in contrast to some of the corrupt business practices that I saw.

I graduated from a Catholic nursing school in 1969 and spent the next 50 years working mostly in intensive care but also in home health and hospice, oncology (cancer), kidney dialysis, volunteer work and on ethics committees.

I first noticed the change in medical ethics when the US Supreme Court’s Roe v. Wade decision in 1973 legalized abortion for the first three months of pregnancy. I was working in intensive care at the time and found that my fellow medical professionals who supported the abortion decision angrily rebuked those of us who were shocked that the first rule of medical ethics we were taught-First, Do No Harm-was eroding.

Then in 1982, my doctor husband and I were shocked by the Baby Doe case where the parents received a judge’s approval to let their newborn son with Down Syndrome die instead of repairing an easily correctable hole between the tube that leads from the throat to the stomach and the  tube that leads from the throat to the windpipe and lungs.  While lawyers were appealing his case and many parents (including my husband and me) wanted to adopt Baby Doe, the newborn starved and dehydrated to death without the desperately needed surgical repair.

My husband asked “What has happened to medical ethics??” but we both knew the answer: babies with Down Syndrome are often unwanted and aborted.

Five months after Baby Doe died, our third child Karen was born with Down Syndrome and a reparable heart defect but the heart doctor gave us a choice to “let” our baby die without surgery. We refused but my former trust in the medical system was shattered.

After I suddenly became a single parent in 1988, I had to return to a paid nursing job to support my three children but found a drastically different medical ethics system.

I found that during the 1970s, medical ethics began to evolve into the newer “bioethics”, even in Catholic hospitals.

This new bioethics has essentially four principles:

1. Respect for autonomy (the patient’s right to choose or refuse treatment)

2. Beneficence (the intent of doing good for the patient)

3. Non-maleficence (not causing harm)

4. Justice (“fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation”) Emphasis added.

Unfortunately, those principles are malleable and then used to justify actions and laws that would have been unthinkable when I graduated from nursing school. That bioethics mindset changed not only medical and nursing education but also the principles that informed our work.

Even the Hippocratic Oath, the oldest and most widely known treatise on medical ethics that forbade actions such as abortion and euthanasia that medical students routinely took upon graduation, has now been revised or dropped at many medical schools.

SOME MEDICAL ETHICS DIVISIONS THAT CAN COST YOU OR A LOVED ONE’S LIFE

Abortion

The American Medical Association, the American Congress of Obstetricians and Gynecologists and the American Nurses Association and other healthcare organization that used to condemn abortion are now supporting “abortion rights”.

Abortion on demand and taxpayer-funded has now been deemed a “civil right” by Planned Parenthood and many Democratic politicians throughout pregnancy to birth and even beyond. Alternatives to abortion such as free pregnancy tests, counseling, ultrasounds, maternity and baby clothes, diapers, car seats, bassinets, etc. are not options at Planned Parenthood but rather at non-profit crisis pregnancy centers.

As a parent of an unwed teenage daughter, I support these services and give thanks for my now 22 year old granddaughter.

Assisted suicide/euthanasia

In the early 1970s when I was a young ICU nurse, none of us medical professionals had even heard of a “living will”. There was a universal presumption for life and “quality of life” was something to be improved, not judged.

Nevertheless, sick people could and did refuse treatment and even check themselves out of the hospital against medical advice. When patients appeared to be dying, they or their families could agree to a “do not resuscitate” (DNR) order. Treatments could be ethically refused when such measures were considered medically futile or excessively burdensome for the patient. But one thing we didn’t do was offer to withhold or withdraw medical care like tube or even spoon feedings to cause or hasten a patient’s death. And it was unthinkable that medical professionals could assist even a dying patient’s suicide.

Unknown to us, all this began to change after Louis Kutner, a Chicago lawyer, wrote a 1969 article in the Indiana Law Journal titled Due Process of Euthanasia: The Living Will, A Proposal” in 1969. (emphasis added).

By 1970, The Euthanasia Society of America (later renamed the Society for the Right to Die) distributed 60,000 living wills. In 1976, California passed the nation’s first “living will” law and in 1990, The US Congress passed the Patient Self-Determination Act that requires information to be given to patients about their rights under state laws governing advance directives (commonly called “living wills), including the right to accept or refuse medical or surgical treatments.

Now, 8 states and the District of Columbia have assisted suicide laws and Compassion and Choices, the largest advocacy group for medically assisted suicide, is using the Covid 19 pandemic to push for telehealth (the provision of healthcare remotely by means of telecommunications) for medically assisted suicide.

Infanticide

In my nursing school 50 years ago, we were taught medical ethics and one example used was the case of a newborn with Down Syndrome who needed life-saving surgery but whose parents refused, choosing to let him die. We were told that the law would protect such children from medical discrimination-even by the parents.

Now we have cases like Charlie Gard and Simon Crosier and others whose parents chose life for their babies with disabilities but were thwarted by doctors and courts.

Organ donation

When I started working in an ICU in 1971, I had questions about the brain death diagnosis for organ harvesting but was told not to worry because there were strict rules.

However and over subsequent years, I discovered that the rules for organ donation have been changing from brain death to other criteria including severe brain injury. There have even been proposals for “presumed consent” state laws where people would have to register an “opt-out” or be automatically presumed to consent to organ donation.

I do not have an organ donor card nor encourage others to sign one. Instead, I once offered to give a friend one of my kidneys as a living donor. Although I was not able to donate then, my family knows that I am willing to donate tissues like corneas, bone, etc. that can be ethically donated after natural death and will only agree to that donation

Conscience rights

Doctors and nurses used to be protected when asserting their conscience rights when refusing to deliberately hastening or causing a patient’s death.

Now, even that protection-which protects both patients and medical professionals-is under attack.

I discovered this personally several years ago when I was almost fired for refusing to increase a morphine drip “until he stops breathing” on a patient who didn’t stop breathing after his ventilator was removed.

CONCLUSION

The bottom line is that everyone must remain vigilant when they or a loved one becomes seriously ill, regardless of the hospital or institution. It is also important not to be afraid to ask questions.

There are also non-denominational, non-profit groups like the National Association of Pro-life Nurses, the Healthcare Advocacy and Leadership Organization and state and national pro-life organizations that have much useful information and resources for patients, families and the public.

The bottom line is that what we don’t know-or allowed to know-can indeed hurt us. We need to demand transparency and the highest ethical standards from our doctors and healthcare system before they can earn our trust.

And without a change in laws, policies and attitudes promoting deliberate death as an answer to human suffering, those of us medical professionals who believe we should never cause or hasten anyone’s death may become an endangered species-as well as our medically vulnerable patients.

Surprising New Test for Predicting Recovery after Coma

An April 29, 2020 Nature Journal article titled “Olfactory sniffing signals consciousness in unresponsive patients with brain injuries” found that nasal response to odors (sniffing) by 43 severely brain-injured patients predicted the likelihood of recovery and long-term survival.

According to Noam Sobel, PhD, of the Weizmann Institute of Science in Rehovot, Israel, one of the authors of the article and speaking to MedpageToday:

“If you sniff at an odorant, then it’s 100% you will regain consciousness to at least a minimal level, and you will likely live for years,” he told MedPage Today. “If you don’t sniff at an odorant, that is a bad sign, but not all hope is lost.” (Emphasis added)

Amazingly, he said that 37.5% of the unresponsive patients who didn’t sniff did eventually regain consciousness.

Dr. Giacino, PhD of Harvard Medical School who helped write the 2018 American Academy of Neurology guidance on disorders of consciousness told Medpage that this study is “a cleverly and carefully designed study that adds another much-needed tool to the consciousness-detection toolbox” even though “Between 30% and 60% of patients who sustain severe TBI (traumatic brain injury) have diminished or complete loss of smell due to the mechanics of the injury.”)

He also noted that, based on available evidence, about four in 10 patients who are deemed unconscious on bedside examination actually retain conscious awareness and that “A significant portion of these patients have covert consciousness — preserved cognitive function that cannot be expressed through speech or movement.” (Emphasis added)

WHY IS THIS STUDY SO IMPORTANT?

As Dr. Giacino said in the Medpage article:

“Published evidence from Canada in a large cohort of ICU patients with traumatic brain injury [TBI] found that approximately 70% of the deaths were due to withdrawal of treatment and in about 60% of cases, the decision to stop treatment was made within 72 hours,” he said. “It’s possible that a positive sniff test might delay this decision, which is important since we know that about 20% of TBI patients who survive what appears to be catastrophic injury recover to a functionally-independent level by 5 years post-injury.” (Emphasis added)

As we have seen over the past decades, whether or not a severely brain-injured person is or can become conscious has become a life and death matter. We have seen this in the cases of Nancy Cruzan, Terri Schiavo and Zach Dunlap even though, as I wrote in my August 18, 2018 blog, “Medical Experts Now Agree that Severely Brain-injured Patients are Often Misdiagnosed and May Recover”.

THIS ISSUE HAS BEEN CLOSE TO MY HEART FOR DECADES.

Just before Drs. Jennet and Plum invented the term “persistent vegetative state” in 1972,  I started working with many comatose patients as a young ICU nurse. Despite the skepticism of my colleagues, I talked to these patients as if they were awake because I believed it was worth doing, especially if it is true that hearing is the last sense to go. And why not do it to respect the patient as a person?

Then one day a 17 year old young man I will call “Mike” was admitted to our ICU in a coma and on a ventilator after a horrific car accident. The neurosurgeon who examined him predicted he would be dead by morning or become a “vegetable.” The doctor recommended that he not be resuscitated if his heart stopped.

But “Mike” didn’t die and almost 2 years later returned to our ICU fully recovered and told us that he would only respond to me at first and refused to respond to the doctor because he was angry when heard the doctor call him a “vegetable” when the doctor assumed ‘Mike” was comatose!

After that, every nurse was told to treat all our coma patients as if they were fully awake. We were rewarded when several other coma patients later woke up.

Over the years, I’ve written about several other patients like “Jack”“Katieand “Chris in comas or “persistent vegetative states” who regained full or some consciousness with verbal and physical stimulation. I have also recommended Jane Hoyt’s wonderful 1994 pamphlet “A Gentle Approach-Interacting with a Person who is Semi-Conscious  or Presumed in Coma” to help families and others stimulate consciousness. Personally, I have only seen one person who did not improve from the so-called “vegetative” state during the approximately two years I saw him.

CONCLUSION

But I never even thought to give any of my patients a sniff test. What a simple test for medical professionals to do!

And even though this study is small and needs to be replicated and validated, I believe it is further evidence that we need to reevaluate our current medical ethics and laws that allow life-sustaining treatment to be withdrawn from people with severe brain injuries on the premise that such brain-injured people have no “quality of life” and that such injuries are routinely hopeless.

And I hope that the sniff test can become a standard part of all medical evaluations of people with severe brain injuries.

The World Brain Death Project: What It Means

THE HISTORY OF BRAIN DEATH

In December of 1967, the first successful heart transplant was performed in South Africa by Dr. Christian Barnard. At that time, there were no guidelines for the diagnosis of death for beating heart donors.

In September of 1968, the Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death was published with the purpose of defining irreversible coma as a new criterion for death.

This was done for two stated  reasons:

  1. “Improvements in resuscitative and supportive measures have led to increase efforts to save those who are desperately injured. Sometimes these efforts have only partial success so that the result is an individual  whose heart continues to beat but whose brain is irreversibly damaged. The burden is great on patients who suffer permanent loss of intellect, on their families, on the hospitals and on those in need of hospital beds already occupied by these comatose patients.
  2. “Obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation.” (All emphasis added)

This report was quickly accepted by many and in 1968, the Uniform Anatomical Gift Act was passed in the US  as a regulatory framework for the donation of organs, tissues and other human body parts. The Act allowed the donation of whole or part of a human body to take effect upon or after the death of the donor.

The Uniform Declaration of Death Act (UDDA) was drafted in 1981 by a President’s Commission study to brain death and approved by both the American Medical Association (AMA) and the American Bar Association (ABA). It was intended to provide a model for states to emulate.

It offered 2 definitions of when a person could be declared legally dead to align the legal definition of death with the criteria largely accepted by the medical community:

  1. “Irreversible cessation of circulatory and respiratory functions (the traditional definition of death); or
  2. Irreversible cessation of all functions of the entire brain, including the brain stem (brain death)” (Emphasis added)

The UDDA in some form has since been adopted by all US states and the District of Columbia.

However, in the June 2020 issue of the American Journal of Bioethics,  the well-known lawyer/ethicist Thaddeus  Mason Pope wrote about a current effort “to revise the Uniform Determination of Death Act (UDDA) to assure a consistent nationwide approach to consent for brain death testing.” (Emphasis added)

Why just consent to brain death testing?

According to Mr. Pope:

“Right now, a patient might be legally dead in Nevada, New York, or Virginia (where consent is not required). But that same patient might not be legally dead in California, Kansas, or Montana (where consent is required and might be refused). (Emphasis added)”

Instead, Mr. Pope proposes adding this to the Uniform Determination of Death Act (UDDA):

“Reasonable efforts should be made to notify a patient’s legally authorized decision-maker before performing a determination of death by neurologic criteria, but consent is not required to initiate such an evaluation”. (Emphasis added)

Mr. Pope states that typically, the Uniform Law Commission (ULC) follows a four-step process to change a law but notes that the Healthcare Law Committee has already skipped the first three steps and is ready for drafting the new language in the fourth step.

Ironically, there was a case last year in Michigan where the parents of a teenager  pushed for a Bobby’s Law after their son was taken off life support after being declared brain dead despite their objections. The law would “require a minor’s parents to consent to withhold or withdraw life-sustaining treatment or to give do-not-resuscitate orders before medical professionals could end life support for a juvenile” and also allow the parents to defer an apnea test (taking the person off a ventilator to see if the person is able to breathe on his or her own) required to determine brain death. (Emphasis added)

THE WORLD BRAIN DEATH PROJECT

In an August 3, 2020 article in the Journal of the American Medical Association (JAMA) titled “Determination of Brain Death/Death by Neurologic Criteria- The World Brain Death Project” , the authors state that due to “inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries”, there is a need to “formulate a consensus statement of recommendations on determination of BD/DNC”. (Emphasis added)

In a August 3, 2020 Medpage article “Brain Death: What Does It Mean?” on the World Brain Death Project, the writer notes that the “guidelines recommend that consent not be required for apnea testing because of concerns over prolonged somatic support” while quoting a doctor who disagreed:

“Ostensibly, families should be asked to provide consent because the apnea test may lead to cardiovascular collapse in some patients, classifying it as procedure with risk,” (All emphasis added)

MY JOURNEY TO DISCOVER THE FACTS ABOUT BRAIN DEATH

Back in the early 1970s when I was a young intensive care unit nurse, no one questioned the new innovation of brain death organ transplantation. We trusted the experts and the prevailing medical ethic of the utmost respect for every human life.

However, as the doctors diagnosed brain death in our unit and I cared for these patients until their organs were harvested, I started to ask questions. For example, doctors assured us that these patients would die anyway within two weeks even if the ventilator to support breathing was continued, but no studies were cited. I also asked if we were making a brain-injured patient worse by removing the ventilator for up to 10 minutes for the apnea test to see if he or she would breathe since we knew that brain cells start to die when breathing stops for more than a few minutes.

I was told that greater minds than mine had it all figured out so I shouldn’t worry.

It was years before I realized that these doctors did not have the answers themselves and that my questions were valid.

I discovered that some mothers declared “brain dead” were able to gestate their babies for weeks or months to a successful delivery before their ventilators were removed and that there were cases of “brain dead” people like Jahi McMath living for  years after a diagnosis of brain death or even recovering like Zack Dunlap

If the legal definition of brain death is truly “irreversible cessation of all functions of the entire brain, including the brain stem”, these cases would seem to be impossible.

CONCLUSION

The World Brain Death Project is riddled with potential problems in establishing a worldwide consensus on brain death criteria and testing using a “set of criteria that satisfies the lowest acceptable standard for practice”. (Emphasis added) And changing the US Uniform Determination of Death Act to supersede states requiring consent before brain death testing will not inspire trust in the healthcare system or the law.

Personally, I will not sign an organ donor card or allow my organs to be taken by donation after cardiac death (DCD), a new category of severely brain-injured people who are not brain dead but who are on ventilators (breathing machines) and considered hopeless in terms of survival or predicted “quality of life”. The ventilator is removed and the patient’s heart is expected to stop. (However, a 2016 study showed that 27% of potential donors did not die within the window specified for organ recovery.)

Instead, my family knows that I am willing to donate tissues like corneas, skin, bones, etc. that can be ethically donated after natural death.

It is vitally important that everyone understands all the facts before signing an organ donor card.

And we all should demand transparency and rigorous medical ethics from our healthcare system.

 

 

 

Strongest “Simon’s Law” Yet is Passed in Iowa

When baby Simon Crosier was born with Trisomy 18  and a heart defect in 2010, his parents and brothers fell in love with him despite his life-threatening diagnosis and the medical community’s opinion that Trisomy 18 is “incompatible with life”.

However, just days before three month old Simon was scheduled to see a cardiac surgeon, his parents begged for help at the Catholic hospital treating Simon when his condition started to deteriorate. They were shocked when the staff did not intervene. They did not know that the hospital had made their baby a Do Not Resuscitate and that Simon was given only so-called “comfort feeds” due to a secret futility policy. They had to helplessly watch as Simon died in their arms.

Heartbroken and outraged but determined that this would not happen to another child, the Crosiers went to legislator Bill Kidd who formulated Simon’s Law. After five long years of frustration even getting the bill out of committee, Simon’s Law was finally and unanimously passed in the Missouri legislature and signed by Governor Mike Parson last year.

The law prohibits “any health care facility or health care professional from instituting a do-not-resuscitate or similar order without the written or oral consent of at least one parent or legal guardian of a non-emancipated minor patient or resident.”

I testified on Simon’s Law myself because when my own daughter Karen was born in 1982 with Down Syndrome and a heart defect, I was tipped off that my pediatrician had secretly given Karen a Do Not Resuscitate order against my expressed wishes because she felt I “was too emotionally involved with that retarded baby”. I protested and the order was withdrawn.

During the fight for Missouri’s Simon’s Law, other states passed similar laws. Some require only that parents be informed that doctors plan to write a DNR order for a child while others prohibit writing the order over parental objections. Hospital ethics committees are usually involved, especially when such cases go to court. And some states like Texas have problematic laws that give objecting parents 10 days to find a new healthcare facility if they disagree with doctors and ethics committees who decide to take a child off life-sustaining treatment.

However, the strongest type of “Simon’s Law” yet was just signed into law in Iowa on June 29, 2020 by Governor Kim Reynolds.

The law states that:

A court of law or equity shall not have the authority to require the withdrawal of life-sustaining procedures from a minor child over the objection of the minor child’s parent or guardian, unless there is conclusive medical evidence that the minor child has died and any electronic brain, heart, or respiratory monitoring activity exhibited to the contrary is a false artifact.” (Emphasis added)

This is stunning, especially since it requires conclusive medical evidence that the child has died using the most stringent criteria of no brain, heart or respiratory activity. (As one legislator explained in a video, the “false artifact” provision would prevent a “crooked parent” from keeping the child on life support indefinitely in a felony murder situation.)

In recent years, we have seen court cases like the teenager Jahi McMath who lived for years and even seemed to improve after a diagnosis of brain death and now the case of Baby Tinslee with heart and lung problems whose doctors want to remove her ventilator against the parents’ wishes.

At the very least, this new Iowa law illustrates the necessity of better legal protections for both medically vulnerable children and their parents.


Palliative Care and Artificial Intelligence for Predicting Death

Working in areas like critical care, oncology (cancer) and hospice for over 45 years, I know that it is often hard to predict how long someone may live or when that person may die.

I have seen very ill or injured people with an optimistic prognosis  unfortunately die and I have seen people expected to die very soon who recovered and went on to live for years. Back then, we used pain and other specialists, social workers, ministers, etc. for all our patients when needed. Some of our patients went into hospice.

In recent years, a new specialty called palliative care was developed to improve the quality of life for patients who have a serious or life-threatening disease with the goal of preventing or treating as early as possible, the symptoms and side effects of the disease and its treatment, in addition to any related psychological, social, and spiritual problems.

So I was very interested to read a July 1, 2020 article in StatNews titled “An experiment in end-of-life care: Tapping AI’s cold calculus to nudge the most human of conversations about using cutting-edge artificial intelligence (AI) models in palliative care that scan patient hospital medical records and generate emails to doctors about their patients considered most likely to die within a year.

In the case of one doctor who received such an email,  she “was a bit surprised that the email had flagged” her patient who was in his 40s and seriously ill with a viral respiratory infection and too sick to leave the hospital. She thought “Why him? And should she heed the suggestion to have that talk?”

As the article states, those kinds of questions are increasingly cropping up among health care professionals at the handful of hospitals and  clinics around the country using such AI models in palliative care, stating that:

The tools spit out cold actuarial calculations to spur clinicians to ask seriously ill patients some of the most intimate and deeply human questions: What are your most important goals if you get sicker? What abilities are so central to your life that  you can’t imagine living without them? And if your health declines, how much are you willing to go through in exchange for the possibility of more time? (Emphasis added)

Some clinicians and researchers defend this AI by saying that doctors are “stretched too thin and lacked the training to prioritize talking with seriously ill patients about end-of-life care”.

Not surprisingly, the leaders of this palliative care AI discourage doctors from mentioning to patients that they were identified by an AI system because, as one doctor put it, ”To say a computer or a math equation has predicted that you could pass away within a year would be very, very devastating and would be really tough for patients to hear.”

Shockingly, while this AI is built around patients’ electronic health records, this article admits that some AI models also “sample from socioeconomic data and information from insurance claims.” (Emphasis added)

CAN AI RELIABLY PREDICT DEATH?

As the article admits, AI predictions of death “are often spotty when it comes to identifying the patients who actually end up dying” and that there has not been “a gold-standard study design that would compare outcomes when some clinics or patients are randomly assigned to use the AI tool, and others are randomly assigned to the usual strategies for encouraging conversations about end-of-life care.” (Emphasis added)

Nevertheless, using AI death predictions for earlier palliative care interventions is now also being tried for conditions like dementia. And last year in Great Britain, AI was touted as “better than doctors” in analyzing heart tests to determine which patients would die within a year.

ARE THERE OTHER AGENDAS?

The idea of basing medical decisions on a computer program to predict death is disturbing enough but there may be other agendas involved.

For example, in a May, 2020 Cancer journal article titled  “Leveraging Advances in Artificial Intelligence to Improve the Quality and Timing of Palliative Care”, the authors called palliative care “a discipline of increasing importance in the aging population of the industrialized nations.”  (Emphasis added

And according to a Hospice News article last year:

“Studies have found that palliative care saves health plans, health systems, and accountable care organizations close to $12,000 per person enrolled, as well as reducing hospital readmissions, emergency department visits, and hospice lengths of stay. “

Now Compassion and Choices (the former Hemlock Society) is not only fighting to legalize medically assisted suicide throughout the US, it has also been active in promoting training and expansion of palliative care with federal funding and now calls assisted suicide “one option in the palliative continuum” and that knowing assisted suicide “is an option is in itself palliative care.” (Compassion and Choices already maintains that VSED (voluntary stopping of eating and drinking) is already an ethical and legal means of ending life in the US.)

Even worse, a large and growing number of medical organizations-including the American Academy of Hospice and Palliative Medicine (AAHPM)-have endorsed or taken a neutral position on the issue of physician-assisted suicide.

CONCLUSION

An artificial intelligence program predicting death cannot replace the importance of an ethical healthcare provider who knows and truly respects the lives of his or her patients.

Good palliative care can be wonderful but, as I have written before, palliative care can go horribly wrong when misused.

We need to know the difference before we are able to trust that our own healthcare providers will  give all of us the care we need and deserve, especially at the end of our lives.

 

Home Health Care and Safety in the Age of Covid 19

In the 1990s, I reluctantly had to leave my hospital position in oncology after an  operation on my right foot surgery that left me unable to stand on my feet for even just a few hours. I decided to go into home health  to support my children and possibly help my foot heal.

Surprisingly, I found that I loved home health nursing and I learned a lot that even helped my patients when I was finally able to resume hospital nursing some years later.

Home health nursing wasn’t an easy job even back then. I drove up to 200 miles some days to care for just about every kind of patient from medical patients just needing blood work to hospice patients and even a young man unable to move below his neck after a diving accident. But I loved the independence and really getting to know my patients and helping them in their own environment.

In May, I wrote a blog “Covid 19 and Nursing Homes” about friends of mine who refused to go to extended care nursing facilities because of the outbreaks of Covid 19 which are especially dangerous to the elderly. Instead, these friends chose to stay home with help from home health caregivers, family and/or friends.

I wondered how home health nursing was now coping with the pandemic.

HOW COVID 19 IS CHANGING HOME HEALTH CARE

A May 18, 2020 article written by 3 geriatricians and titled “How coronavirus could forever change home health care, leaving vulnerable older adults without care and overburdening caregivers” reveals how Covid 19 is now changing a sector of health care that has received little attention during the pandemic.

According to the article, over 5 million people in the US are currently receiving paid home care from personal care assistants, home health aides, nurses and therapists. But even before Covid 19, there were not enough of these health care workers.

As the geriatricians write:

 “(N)ow, not only must home care continue for older adults, and for those with disabilities, but many people with COVID-19 will need it too”.

While home health care reduces the stress on hospital systems, Covid 19 means that home health care is facing new challenges.  Because home health workers travel to multiple homes and people, this increases the risk of possible Covid 19 transmission both for the workers and their often frail and older patients. How can health care workers and their patients both stay safe during the pandemic?

The geriatricians researched the problem and came up with 10 recommendations to  deal with Covid 19 and also improve home health care.

These recommendations include access to personal protective equipment (PPE), regular COVID-19 testing for both staff and patients,  Centers for Medicare and Medicaid Services (CMS) expanding the definitions of “home health” and “homebound” to include “personal care” to help more patients, as well as increasing federal funding for community health workers.

They also recommend more flexibility using options like telehealth which has been particularly useful for one of my older friends.

ONE BIG REASON WHY I LEFT HOME HEALTH NURSING

Although this article did not address this issue, one of the big reasons I finally left home health when my foot improved was the danger of working in a large city like St. Louis that has several high-risk areas as well as the roving packs of wild dogs  that were a problem at the time.

I often saw patients in these areas and sometimes even during the night when I was on call for the agency. On occasion, even the police stopped some of us nurses when were going in to see a patient in these high-risk areas and they offered to wait outside until we returned. I especially appreciated this because as a single mother, I was concerned about what could happen to my children if anything happened to me.

Personally, I saw guns in some households, was cut off by some young men trying to stop my car, dealt with some suddenly psychotic patients, tried to mitigate domestic disturbances, etc. Some areas were so high-risk that I took the fire escape for safety reasons rather than use the elevator to get to my patients’  apartments.

It took many attempts before we nurses finally got our agency to help us get pepper spray and provide a security person to accompany us nurses to high-risk areas when we felt it was necessary.

But sadly, I could never consider going back to home health now with the protests, riots and escalating violence we are seeing in many cities like St. Louis and other areas.

I fervently hope and pray that the important issues that are tearing our country apart will soon be resolved for the safety of all of us.

Especially because I am a nurse, I do know how much every life matters.

Sweden and Covid 19: Families Complain That “Palliative Care” Instead of Treatment Is Being Given to the Elderly

A June 18, 2020 article in the Wall Street Journal titled “Coronavirus is taking a high toll on Sweden’s elderly. Families blame the government”  starts with a disturbing story:

“When 81-year-old Jan Andersson fell ill with Covid-19 at a nursing home in the Swedish town of Märsta, a doctor consulted by phone ordered palliative care, including morphine, instead of trying to help him fend off the infection.

Mr. Andersson’s son, Thomas Andersson, says he was told his father was too frail for other treatment. The younger man disagreed and, after arguing with the physician, summoned journalists and insisted his father be given lifesaving care. Mr. Andersson has since recovered.

The county that runs Mr. Andersson’s nursing home said all decisions on medical treatment for the residents were made by doctors employed by a company that provides medical services. (All emphasis added)

The Wall Street Journal reports that cases like this have sparked a public outcry from not only relatives but also from some doctors and nurses. There is now an investigation by Swedish national health-care authorities into the treatment of older patients in nursing homes and Stockholm hospitals. There are now 5,041 people in Sweden who have died from Covid 19 with about half being nursing home residents.

“Many people have died unnecessarily,” said Yngve Gustafson, a geriatric-medicine specialist in Sweden, who looked into more than 200 cases in which people were denied care. He said that doctors were too quick to put patients on palliative care. He also said that he believed many would have survived and lived year longer had they been provided basic care.

Furthermore, a June 12, 2020 British Medical Journal article “Has Sweden’s controversial covid-19 strategy been successful?” stated that Dr. Gustafson also spoke to the Svebsja Dagbladet newspaper and “expressed concern about the increasing practice of doctors recommending by telephone a “palliative cocktail” for sick older people in care homes.

He also was quoted as saying:

“Older people are routinely being given morphine and midazolam, which are respiratory-inhibiting,” … “It’s active euthanasia, to say the least.”

Thomas Linden, chief medical officer of Sweden’s National Board of Health and Welfare, said the triage guidelines for Covid 19 were developed to prepare the health-care system for a potential crisis while ensuring best-possible treatment for all patients.

However, the Wall Street Journal article reports that Swedish critics say these guidelines have too often resulted in older patients being denied treatment, even when hospitals were operating below capacity.

“Dr. Cecilia Söderberg-Nauclér, a physician at Karolinska University Hospital in Stockholm, said that “the ICU wards were comparatively empty “because elderly people were not taken to hospitals—they are given sedatives but not oxygen or basic care.”

The Wall Street Journal article also notes that “About 90% of nursing-home residents who succumbed to Covid-19 in Sweden were never admitted to a hospital, according to official estimates. ” (Emphasis added)

Most poignantly, Latifa Löfvenberg, a nurse  for a company providing medical services to several nursing homes, said she sought treatment for residents with Covid-19 and was told by company physicians to administer morphine and a sedative.

She  described what happened:

People suffocated, it was horrible to watch. One patient asked me what I was giving him when I gave him the morphine injection, and I lied to him,” said Ms. Löfvenberg, who is now working at a hospital in the Swedish capital. “Many died before their time. It was very, very difficult.” (Emphasis added)

COULD-OR HAS-THIS HAPPENED IN THE US?

As I wrote in my May 20, 2020 blog “Covid 19 and the Culture of Death” about the dangerous and unethical responses to Covid 19 in the US:

“(T)he National Hospice and Palliative Care Organization (NHPCO) has a new resource for Crisis Standards of Care for the “ethical allocation of scarce medical resources during a disaster” that:

‘provides a framework for healthcare professionals to utilize a predetermined framework to determine which individuals will receive life saving care during an emergency event or disaster and which ones will not.’ With the event of the COVID-19 Public Health Emergency (PHE), it is important for palliative and hospice care providers to be familiar with Crisis Standards of Care.” (Emphasis added)

However, access to the actual crisis standards is restricted to NHPCO members only.

But transparency is not the only  problem.

Unfortunately, I have also personally and professionally seen cases of deliberate overdose sedation. I have written about this, most recently in my 2019 blog When Palliative Care goes Horribly Wrong”.

CONCLUSION

While Sweden has not yet legalized physician-assisted suicide, Sweden’s National Board of Health and Welfare did authorize passive euthanasia in 2010, whereby “patients may request the termination of their treatment knowing that this will lead to their death”. This ruling came in response to a request by a 32 year old woman who was totally paralyzed and dependent on a ventilator since the age of six. She requested it be shut off when she was asleep. Whether or not she received a “palliative cocktail” beforehand is unknown.

Now, Swedish officials seem to have forgotten the part about “patient request” when it comes to Covid 19 and the elderly.

In the US, we started down a similar path when “right to die” groups focused on “living wills” and withdrawal of even basic treatment before outrightly promoting physician-assisted suicide.

The bottom line for any country is that we must not lethally discriminate against anyone, regardless of age or condition like Covid 19 and we must hold palliative care to the high standards set by the late Dame Cicely Saunders,  founder of hospice movement (1918 – 2005) who said:

“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.” (Emphasis added)

 

 

 

Over 600 Doctors Send Powerful Letter to President Trump Calling the Covid 19 Lockdown a “Mass Casualty Incident”

Although it received little media notice, a May 19, 2020 letter to President Trump signed by over 600 doctors detailed the physical and mental impact of the lockdown in the US due to Covid 19, calling it a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non-COVID patients. 

As the highly contagious Covid 19 virus was spreading around the world, President Trump issued a proclamation on March 12, 2020 declaring a national emergency with “preventive and proactive measures to slow the spread of the virus and treat those affected”.

On March 18, the Centers for Medicare and Medicaid Services recommended that hospitals cancel all elective surgeries and nonessential medical, surgical and dental procedures to prepare for the expected deluge of patients with Covid 19 and the health system complied.

Regular healthcare became virtually suspended as states went to lockdown with rules to shelter in place except for essential errands or work. Schools and many businesses were closed. 

Ironically,  except for New York and other hotspots that received massive federal help including ventilators and emergency field hospitals, US hospitals wound up with many empty beds and even emergency room visits dramatically declined

Many hospitals are now facing a financial crisis and health care professionals are being furloughed.

THE IMPACT OF THE LOCKDOWN ON AMERICANS’ PHYSICIAL AND MENTAL HEALTH

The doctors’ letter to President Trump focused on the devastating impact on Americans’ physical and mental health of the lockdown and why the months-long lockdowns should be ending. 

Here are some excerpts:

“Suicide hotline phone calls have increased 600%,” the letter said. Other silent casualties: “150,000 Americans per month who would have had new cancer detected through routine screening.”

“Patients fearful of visiting hospitals and doctors’ offices are dying because COVID-phobia is keeping them from seeking care. One patient died at home of a heart attack rather than go to an emergency room. The number of severe heart attacks being treated in nine U.S hospitals surveyed dropped by nearly 40% since March. Cardiologists are worried “a second wave of deaths” indirectly caused by the virus is likely.

“The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

“It is impossible to overstate the short, medium, and long-term harm to people’s health with a continued shutdown,” the letter says. “Losing a job is one of life’s most stressful events, and the effect on a person’s health is not lessened because it also has happened to 30 million [now 38 million] other people. Keeping schools and universities closed is incalculably detrimental for children, teenagers, and young adults for decades to come.” (All emphasis added)

But while nearly all 50 states are starting to relax lockdown rules to some extent, some officials are threatening to keep many businesses closed and other draconian measures in place until August or even later. Many schools and universities now say they may remain closed for the remainder of 2020.

But as Dr. Marilyn Singleton, a California anesthesiologist and one of the signer of the letter said, “Ending the lockdowns are not about Wall Street or disregard for people’s lives; it’s about saving lives.” (Emphasis added)

CONCLUSION

We know a lot more about Covid 19 now. The US Center for Disease Control’s new ‘best estimate’ implies a COVID-19 Infection fatality rate below 0.3% with an estimated 35% of people with Covid 19 never having symptoms. 

States have rescinded orders that forced long term care facilities with our most vulnerable people to admit Covid 19 patients after hospital discharge resulting in lethal outbreaks.

But as more states are slowly opening, Grace-Marie Turner of the Galen Institute writes:

“Will patients come back? COVID-phobia is deathly real.

Patients still are fearful about going to hospitals for heart attacks and even for broken bones and deep lacerations. Despite heroic efforts by physicians to deeply sanitize their offices, millions have cancelled appointments and are missing infusion therapies and even chemotherapy treatments. This deferred care is expected to lead to patients who are sicker when they do come in for care and more deaths from patients not receiving care for stroke, heart attacks, etc.”

While still observing social distancing, sanitizing and other common sense measures to protect ourselves and others, it is my opinion that the more than 600 doctors writing to President Trump are right when they urge ending the Covid 19 shutdown as soon as possible for all Americans’ physical and mental health.

 

 

 

 

 

 

 

Covid 19 and the Culture of Death

“Ironically, the Covid 19 pandemic has pulled back the curtain on how far our healthcare ethics has fallen from the ideal of  respecting every life to the dangerous notion that some lives are expendable-even our own.”

I have written about how the Covid 19 pandemic has resulted in dangerous and unethical responses like ventilator rationing,  unilateral DNRs, and some states ordering nursing homes and other long-term care facilities to accept coronavirus patients discharged from hospitals.

But now,  the Covid 19 crisis has also spawned new ideas such as the American Clinicians Academy On Medical Aid in Dying’s policy recommendations on medically assisted suicide requests by telemedicine in the context of Covid 19  and Covid 19 advance directives aimed at refusing potentially life-saving treatment.

Compassion and Choices, the former Hemlock Society that promotes assisted suicide, voluntary stopping of eating and drinking (VSED) and terminal sedation, now has a Covid 19 toolkit with a special Covid 19 addendum  to add to an existing advance directive to refuse care if a person gets Covid 19. The addendum even contains the question:

“Do you want your healthcare proxy to have the ability to override any of these orders if he or she believes you have a reasonable chance of living a life consistent with your values and priorities based on the information provided by the doctor? Or, do you want these orders followed no matter what?” (Emphasis added)

Another organization “Save Other Souls”, headed by an MD and an ethicist, has an “altruistic” advance directive for Covid 19 that states:

“In the event of shortages during the period of a declared emergency related to COVID-19, and in order to direct resources to others, I am willing to receive palliative care instead of: Critical medical equipment (ventilator, ECMO, etc.), Medication (other than palliative), Placement in a hospital care unit that provides critical care.” (Emphasis added)

Even more disturbing, the National Hospice and Palliative Care Organization (NHPCO) has a new resource for Crisis Standards of Care for the “ethical allocation of scarce medical resources during a disaster” that:

“provides a framework for healthcare professionals to utilize a predetermined framework to determine which individuals will receive life saving care during an emergency event or disaster and which ones will not. With the event of the COVID-19 Public Health Emergency (PHE), it is important for palliative and hospice care providers to be familiar with Crisis Standards of Care.” (Emphasis added)

The National Hospice and Palliative Care Organization (NHPCO), founded in 1978, is the nation’s largest membership organization for providers and professionals who care for people affected by serious and life-limiting illness”. NHPCO states that it “represents the interests of its members and the general public with legislative advocacy that helps to enhance and expand access to care that addresses holistic health and the well-being of communities.” (Emphasis added)

Not surprisingly, the NHPCO has supported  the problematic Palliative Care and Hospice Education and Training Act, currently still in the US Congress awaiting passage.

CONCLUSION

The Covid 19 pandemic is especially terrifying to many people but we must realize that just like any other serious or terminal illness, we must act responsibly and ethically in caring for people with Covid 19.

While medical treatment that is medically futile or unduly burdensome to the person can be ethically refused or withdrawn, refusing or removing ordinary medical treatment or deliberately oversedating a person in order to cause or hasten death is unethical. Even when we think it may help another person get care.

We need to know the difference, especially when it comes to making out living wills” or other advance directives.

Ironically, the Covid 19 pandemic has pulled back the curtain on how far our healthcare ethics has fallen from the ideal of  respecting every life to the dangerous notion that some lives are expendable-including our own.

 

 

Covid 19 and Nursing Homes

Recently, two good friends of mine with physical limitations who had been waiting for over a year to enter a carefully chosen assisted living/long term healthcare facility changed their minds about going. They found out that the facility had at least one resident with Covid 19. They are now staying at home with help from their sons, friends and a paid caregiver.

And my 97 year old friend Melissa with heart and mobility problems is adamant about staying at home to be cared for, primarily by her wonderful family. Recently, she developed a disturbing symptom but instead of going to her doctor as usual, her doctor was able to come to her via a telehealth visit by computer. Melissa is happy at home and knows that other options like home hospice are available if necessary.

Are these three people overreacting about nursing homes?

In my opinion, the answer is probably no at this time.

Unfortunately, long-term health facilities for the elderly have become hotbeds for Covid 19 despite those residents being the most at risk during the pandemic. A number of  staff at those facilities have also caught Covid 19 and some have also died.

Even worse, as NBC News reported April 25, 2020:

“Three states hit hard by the pandemic — New York, New Jersey and California — have ordered nursing homes and other long-term care facilities to accept coronavirus patients discharged from hospitals.” (Emphasis added)

On May 6, 2020, the Wall Street Journal reported that New York nursing homes may have nearly 5,000 Covid-19 related deaths and the next day, the California Mercury News  reported that  “at least 41 percent of all known coronavirus deaths in California have occurred among residents and staff of nursing homes and assisted living facilities.” (Emphasis added)

And, unfortunately, these same people are usually dying alone due to restrictions for even family members in hospitals and nursing homes. Sadly, even funerals are changing with new restrictions for ceremonies and mourners.

According to an April 21, 2020 article “Nursing Homes Balk at COVID Patient Transfers From Hospitals” by the American Association for Retired Persons (AARP):

“The American Health Care Association says discharged hospital patients should return only to nursing homes with separate COVID-19 units. Ideally, those units are staffed with employees with access to personal protective equipment. The federal Centers for Medicare & Medicaid Services (CMS), which regulates nursing homes, endorsed the idea of separate COVID units this month.” (Emphasis added)

CONCLUSION

I was personally shocked to discover that  only  23 states publicly reported data for cases and deaths due to COVID-19 in long-term care facilities  as of April 23, 2020.

However, the Trump administration has recently announced upcoming new regulatory requirements that:

“will require nursing homes to inform residents, their families and representatives of COVID-19 cases in their facilities. In addition, as part of President Trump’s Opening Up America, CMS will now require nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC).” (Emphasis added)

When my mother with Alzheimer’s disease was dying from cancer in 1988, there was no pandemic and we cared for her at home as long as possible before placing her in a nursing home nearby for safety reasons. So I do know that nursing homes and other long-term care facilities can be wonderful and even necessary options.

But until this pandemic dissipates, we need all the essential information  necessary to protect and advocate for the most vulnerable among us.