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Welcome to my blog!

I hope you will find it worthwhile and enlightening. These are my own personal observations and I encourage you to share yours.

Links to sources are underlined. Just click to see the referenced citation.

I also have an archive of older articles, etc. from Voices magazine at my other blog “Nancy Valko, RN ALNC”.

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Nancy Valko, RN ALNC

How Secrecy and Immunity Destroy “Safeguards” in Assisted Suicide Laws

Finally this November, a mainstream media source, the Des Moines Register, investigated some of the problems with legalized physician-assisted suicide in other states such as complications during the process, prolonged deaths,  non-existent or incomplete data in assisted suicide and even the “disputed meaning of ‘self-administer’” of the lethal overdose. This is crucial since Iowa is considering an assisted suicide bill in the legislature.

However, the Register’s reporting ignored.one of the most dangerous legal problems in assisted suicide laws: the criminal, civil and professional immunity given to doctors and others involved as long as they claim they acted in “good faith”. In addition, the secrecy and often yearly destruction of even the minimal information self-reported by the doctors as well as  falsified death certificates listing such deaths as natural effectively destroys any pretense of an enforceable law.

This has made enforcement of so-called “safeguards” virtually impossible in states with legalized assisted suicide and affects even a state like my home state of Missouri that has a  law with penalties to prohibit assisted suicide.

THE MISSOURI EXPERIENCE

Missouri’s law against assisted suicide states:

A person commits the crime of voluntary manslaughter if he knowingly assists another in the commission of self-murder.
Mo. Rev. Stat. § 565.023.1

Yet despite years of failure, the pro-assisted suicide forces are again trying this year to get the standard assisted suicide bill passed in the Missouri legislature.

However, enforcement of the current Missouri law has been problematic. In the only case involving a health care professional, just a five years probation plea agreement was reached before a trial despite a nurse admitting she killed the patient, not assisting a suicide.

In 2001, Daillyn Pavia, RN  faced murder charges after she admitted giving a lethal dose of morphine to a new patient who had just had a stroke and was taken off life support.  According to police, Pavia admitted to co-workers that she had “without authorization and within a half-an-hour of taking charge of Julia Dawson as her patient … intentionally (given) Ms. Dawson 15 times the maximum dosage of morphine that had been prescribed” as well as Propofol, a strong sedative, that was not prescribed. The victim’s son defended the nurse’s action, saying it was done out of compassion and should not be prosecuted.

In 2003, 2 years later, nurse Pavia pleaded guilty to voluntary manslaughter and was sentenced to 5 years probation.  Nurse Pavia did not show up at a hearing before the Missouri State Board of Nursing which noted that Pavia was placed “on five years of supervised probation with the special condition that she surrender her nursing license.”

(Ironically, this decision followed on the heels of the decision not to prosecute Dr. Lloyd Thompson, then head of the Vermont Medical Society, for intentionally giving a paralyzing, “life ending drug” to an elderly woman with terminal cancer whose breathing machine had been removed. The family opposed prosecuting the doctor. Instead Thompson was reprimanded by the Vermont Medical Practice Board that required a monitoring and review of his care of all terminally ill patients.  10 years later, Vermont became the third state to legalize physician-assisted suicide.)

I could find only two other cases of people being charged with assisting a suicide in Missouri. One occurred in 1996 when Velma Howard, a woman with ALS died of suffocation in a motel with family members who admitted giving her sleeping medication, alcohol and a plastic bag. The prosecuting attorney later dropped charges against the family members.

The Jacob Runge assisted suicide case in 2010  resulted in a jury acquitting a young man who provided a gun to his emotionally disturbed friend in a self-described mutual suicide pact but said he could not go through with killing himself.

FALLOUT AND CONSEQUENCES

The fallout from these cases, like many others around the country, show that if someone-even a doctor or nurse-claims that they acted out of “mercy” it is unlikely that a person will face more than a slap on the wrist for ending or helping to end an ill or troubled person’s life.

In addition for those of us who are ethical and conscientious nurses, we feel the chilling effect discouraging us from even reporting other health care providers like nurse Pavia in such cases since we may face repercussions ourselves, including firing. There are apparently no real whistleblower protections for nurses (and thus the public) in such cases, especially since these cases routinely garner much media and public sympathy for the perpetrators and routinely result in minimal if any penalties. Conscience rights may not be enough to protect our patients and ourselves.

As a 2014 Medscape (password protected) article titled “Should Nurses Blow the Whistle or Just Keep Quiet?   by a nurse/lawyer author explains with regard to patient safety violations (which, of course, should include reporting the killing of a patient) :

Am I recommending that nurses adopt the “see nothing, hear nothing, speak nothing” attitude? No. I am saying that under current law, it is safer for a nurse not to report than to report. That surprises me, and it may be right- or wrong-minded, but it’s the way it is. (Emphasis added.)

This is exactly what pro-assisted suicide groups like Compassion and Choices could have hoped for when they fashioned the immunity protections and the secrecy of even the minimal self-reporting standards in their assisted suicide laws. Eliminating the possibility of future potential lawsuits or prosecutions is what keeps their myth of “no problems, no abuses” alive.

Unfortunately, that is also what puts all of us and our loved ones at risk, especially when we are at our most vulnerable. With legalized assisted suicide laws now quickly expanding to other states, we must step up our efforts to educate the public and fight against the well-funded and relentless Compassion and Choices machine.

And there is one significant effort that any of us can do.  Consider asking your own doctor or health care provider where he or she stands on assisted suicide and feel free to state your position. If your doctor is in favor of assisted suicide, you might want to consider asking for a referral to another doctor who refuses to provide assisted suicide. The life you save may be your own.

High Priority: Public Comments Needed on ANA’s New Draft Position Paper on Denying Food and Water

Although the American Nurses Association (ANA) claims it represents the over 3 million US nurses, only a tiny fraction of nurses actually belong. ANA does not give out the actual number of members. I used to belong both my state nursing organization as well as the ANA to try to uphold good nursing ethics and conscience rights for nurses. I finally gave up when my state organization would not address even the conscience rights of nurses in the Nancy Cruzan feeding tube case. I gave up on the ANA when I discovered that the ANA opposed a ban on partial birth abortion without notifying its membership. I only found this out when I watched a TV show on politics mentioning the ANA position. I called the ANA public relations department myself to protest both their position and not notifying members like me and resigned.

Yesterday, I received a call from a nurse in another state who sent me the website for public comments due by 5 pm ET 12/1/2016 about a proposed new ANA position on nutrition and hydration at the end of life.

The proposed position paper is 9 pages long and I sent the following comments with the referenced lines as requested. It would have taken me many pages to address all the issues:

Lines 18-24.  In the past, the hospice principle of never prolonging or hastening death at the end of life was paramount. Now, this has been subjugated to a legalized autonomy (even when exercised by a third party) to decide when to hasten death.

However, nurses are professionals whose integrity depends on proper respect for their conscience rights, especially when it comes to decisions about hastening death.  This concern is absent in this draft.

We do have such a provision in Missouri law that states:

Missouri Revised Statutes
Section 404.872.1

Refusal to honor health care decision, discrimination prohibited, when.

404.872. No physician, nurse, or other individual who is a health care provider or an employee of a health care facility shall be discharged or otherwise discriminated against in his employment or employment application for refusing to honor a health care decision withholding or withdrawing life-sustaining treatment if such refusal is based upon the individual’s religious beliefs, or sincerely held moral convictions.

(L. 1992 S.B. 573 & 634 § 7)

Line 88: There is no definition of “severe neurological conditions”.
Line 90 on “Dementia, recognized as a terminal illness associated with anorexia and cachexia”.  As a former hospice nurse and caregiver for my mother until her death as well as a volunteer for people with dementia, this is an alarming and potentially dangerous assertion. No one should have to die by dehydration and indeed many people with dementia can be spoon-fed like my mother until natural death. I have likewise seen several people begging for food or water but denied because of a decision not to place a feeding tube or spoon feed.

Lines 101-104. VSED as described is really assisted suicide and implicitly changes ANA opposition to medically assisted suicide.

Also, in a New York Times article in October titled “The VSED Exit: A Way to Speed Up Dying, Without Asking Permission”, Dr. Timothy Quill (past president of the AAPHM and the doctor arguing for the constitutionality of assisted suicide in the 1997 Vacco v Quill US Supreme Court case) was quoted as claiming that while VSED is “generally quite comfortable at the beginning”, he also states that “You want a medical partner to manage your symptoms,” because “It’s harder than you think.”

How hard?

In 2000, Quill and Dr. Ira Byock (a palliative care doctor who speaks against legalizing physician-assisted suicide while also supporting VSED and terminal sedation) wrote an article titled “Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids” . The patient was a doctor who wanted to die before his symptoms became worse. He was given a morphine drip that had to be increased to total unconsciousness on day 10 because he became “confused and agitated and began having hallucinations”.

Lines 114-115 cite “Psychological, spiritual, or existential suffering, as well as physical suffering” but only say that “Symptom control is imperative” rather than oppose participation in VSED  for people who are not even terminally ill.

Lines 149-150 state that “Decisions about accepting or forgoing nutrition and hydration will be honored including those decisions about artificially delivered nutrition as well as VSED”. This blanket statement destroys the conscience rights of nurses as well as our duty to advocate for our patients’ best interests. (Emphasis added)

Ironically, the ANA’s 2010 position paper on reproductive rights (i.e. abortion) states that:

“Also,nurses have the right to refuse to participate in a particular case on ethical grounds. However, if a client’s life is in jeopardy, nurses are obligated to provide for the client’s safety and to avoid abandonment.” (Emphasis added) Apparently, the ANA is proposing that the right to refuse to participate ends when the death of the patient is deliberately intended.

CONCLUSION

Just this week, it was reported that a union for Australian nurses is backing voluntary euthanasia. The Australian Nursing and Midwifery Federation (SA branch) is even partnering with other Compassion and Choices-style groups in Australia to pass a voluntary euthanasia bill. This could well be our future here in the US if we do not respond.

As nurses and citizens, we need to fight for truly patient-safe health care by responding to groups like the ANA through comments sections like the one above (which ends December 1) and in the media. We must also support and insist on ethical health care providers for ourselves and our loved ones as well as protecting our patients. As much as we can, we can also help state and national organizations that fight against euthanasia.

Especially if you are a nurse, consider joining the National Association of Pro-Life Nurses and following our Facebook page.

Our profession, our patients and even our nation are at stake!

 

 

Oh, Colorado!

Of course, the big news from the national voting last week was the stunning election of Donald Trump as president. But  barely mentioned by the media except for its passage was  Colorado’s Proposition 106 “End of Life Options Act initiative which won by a 65% to 35% popular vote. Now five states have formally legalized physician assisted suicide. Montana had a court ruling that state physician-assisted suicide is not “against public policy” but no law legalizing assisted suicide has been passed.

I remember going to Colorado about 20 years ago to speak against an assisted suicide bill in the state legislature. Enthusiasm was high and the assisted suicide bill was subsequently voted down in the legislature. But, as in other states including my own Missouri, the assisted suicide proponents never stopped pushing their agenda over and over again.

With their efforts often stymied in state legislatures after robust debate and testimony, well-funded groups like Compassion and Choices turn to the promotion of state initiatives. Colorado now joins Oregon and Washington State in legalizing assisted suicide by popular vote.

However, with groups like Compassion and Choices trying to normalize assisted suicide as just another valid medical decision, medical groups increasingly intimidated into neutrality and an almost entirely sympathetic mainstream media holding up Brittany Maynard as the ultimate poster child, the average person is easily persuaded to not look too closely  at the reality of assisted suicide.

For example, here is just the title of the Colorado ballot measure. There is also a much longer ballot summary and a link to the full proposed law.

“Shall there be a change to the Colorado revised statutes to permit any mentally capable adult Colorado resident who has a medical prognosis of death by terminal illness within six months to receive a prescription from a willing licensed physician for medication that can be self-administered to bring about death; and in connection therewith, requiring two licensed physicians to confirm the medical prognosis, that the terminally-ill patient has received information about other care and treatment options, and that the patient is making a voluntary and informed decision in requesting the medication; requiring evaluation by a licensed mental health professional if either physician believes the patient may not be mentally capable; granting immunity from civil and criminal liability and professional discipline to any person who in good faith assists in providing access to or is present when a patient self-administers the medication; and establishing criminal penalties for persons who knowingly violate statutes relating to the request for the medication?”

But what might have happened if this alternative language was used?

Should Colorado change the Colorado revised statues to permit a licensed doctor of any specialty in conjunction with a similar doctor to write a prescription for a lethal overdose to cause death for any adult resident that the doctors expect to die within 6 months; require mental health evaluation only for the purpose of determining if the person is mentally capable to make the decision to end his or her life; grant immunity for the doctors and others from civil or criminal penalty as long as they claim “good faith” intentions; require that the death certificate falsely state the cause of death as a natural medical condition instead of the lethal overdose; prohibit life insurance policies from being affected by a request for a legal lethal overdose and prohibit  public information about such lethal overdoses except a yearly statistical report as reported by the doctors involved? (Emphasis added)

Of course, we will never know.

But when we allow medical/legal protections and standards to be suspended for some suicidal people considered expendable based on an estimated prognosis and personal fear of even potential pain and/or dependence,  we will inevitably see the pool of potential victims of medical termination expand and lethal injections accepted, as is already  happening in Canada, the Netherlands, Belgium and Switzerland.

Just as bad, we will also be creating a class of medical serial terminators immune from any real oversight and accountability while penalizing ethical health care providers who refuse to participate or refer.

Why Talk About Abortion?

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 several 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 justly 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 God’s love, confession and forgiveness. 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.

Rose died suddenly and apparently in her sleep about a week later. I only had a few visits with her but I feel she finally felt ready to meet her Lord.

I have told this true story to priests and clergy who tell me that they are reluctant to speak about abortion in homilies for fear of causing further pain to a church member who may have had an abortion. I tell them that they may tragically miss the chance to tell a hurting woman like my Rose about Project Rachel. Also, by speaking about the many resources available through individual churches, local and national organizations like Birthright and the American Association of Pro-Life Obstetricians and Gynecologists, this may help another woman to choose life for her baby instead of abortion. And, of course, talking about pro-life resources may help church members get involved in volunteer work.

WHY NONE OF US SHOULD BE AFRAID TO TALK ABOUT ABORTION

There are great pro-life news outlets like Life News that email daily or weekly updates on news about all life issues. There are many positive and even amazing stories such as those about babies who defy the odds against them, grateful parents who choose life in difficult circumstances as well as important pro-life news, education and upcoming events.

I have shared many of those stories myself with friends, family and people on my email lists and this has led to many great discussions and crucial referrals.

But what I have found most effective is a  sincere interest and willingness to help when encountering people struggling with an abortion decision for themselves or someone close to them. For example, a new colleague of mine was considering abortion after her obstetrician recommended abortion and listed all the birth defects that could affect her child after being exposed to a virus early in pregnancy. Getting a second opinion and the support of her coworkers gave my colleague the confidence she needed to reject abortion. She ultimately gave birth to a healthy daughter.

Why talk about abortion? Because we never know who may need to hear the truth.

Should Ethics Committees be Death Panels?

I volunteered to serve on a newly started hospital ethics committees in the 1990s. While I wanted to help analyze difficult cases and serve as a resource for hospital personnel with ethical concerns, I became increasingly alarmed when I saw cost containment and judgments based on “quality of life” brought up as decisive factors by others on the committee.

I understood more when I researched the beginnings of ethics committees.

BACKGROUND

After numerous failed attempts to legalize euthanasia, the Euthanasia Society of America invented the “living will” in 1967 as a first step in gaining public acceptance of euthanasia by promoting a so-called “right to die”. The group achieved much success by publicly promoting “living wills” as a patient rights document that would give people and/or their families  choice and control at the end of life or, especially after the 1976 Karen Quinlan case, if their quality of life was considered too poor.

Karen Quinlan’s case (where despite predictions,  she continued to live for years after her ventilator was removed) effectively extended the “right to die” to non-terminally ill people said to be in a “persistent vegetative state”, a term invented in 1972 to describe brain-injured people who were awake but assumed unaware.

The later cases of Nancy Cruzan and Terri Schiavo  further extended the “right to die” to withdrawal of feeding tubes and other basic medical care.

Eventually the Euthanasia Society of American became The Society for the Right to Die and finally evolved into Compassion and Choices and the “right to die” became “death with dignity” by lethal overdose.

ETHICS COMMITTEES

Ethics committees in hospitals began to emerge after the Quinlan case as an alternative to controversial court cases and became more prevalent in the 1980s, especially after the Baby Doe case in 1982. That case involved a newborn boy with Down Syndrome and an easily correctable defect that prevented him from eating safely. The parents refused the surgery and were upheld by a judge. An appeal was started but the baby died of starvation and dehydration before his appeal could be heard. Disability, pro-life and other groups and individuals were outraged.

Concerns about lethal medical discrimination against infants with disabilities resulted in the Baby Doe Regulations mandating maximal care to any impaired infant, unless certain exceptions are met.

However, there was much medical and legal opposition to these rules and:

“By the end of 1984,  the American Academy of Pediatrics and the American Hospital Association issued statements supporting the use of interdisciplinary ethics committees as an alternative to governmental investigation in such cases.” (Emphasis added)

AN UNEXPECTED PROBLEM

But a surprising development happened on the way to privatizing life and death decisions through ethics committees.

Some people and families resisted and insisted that medical treatment be continued for themselves or their loved ones despite a “hopeless” prognosis and the recommendations of doctors and/or ethicists to stop treatment. Many doctors and ethicists were appalled that their expertise would be challenged and they theorized that such families or patients were unrealistic, “in denial” about the prognosis or were mired in guilt or dysfunctional family relationships.

However, these doctors and ethicists were shocked when in 1991, a court ruled in favor of the husband of Helga Wanglie when he insisted that treatment be continued for his wife despite a “persistent vegetative state” diagnosis.

That court decision was widely criticized in ethics circles and in 1999, Texas enacted a medical futility law.

THE TEXAS ADVANCE DIRECTIVES ACT

In 1999, Texas became the first state to expressly permit doctors to stop life sustaining treatment without consent after a review process by an ethics committee. According to the Texas Advance Directives Act, when care is deemed “futile” or “inappropriate” and the patient or family disagrees,  the patient or family is given 10 days to find another health facility for the patient and pay for “any costs incurred” in the transfer. “If a provider cannot be found willing to give the requested treatment within 10 days, life-sustaining treatment may be withdrawn unless a court of law has granted an extension. “ (Emphasis added)

Thus an ethics committee becomes the equivalent of a death panel.

This kind of ethics committee overreach has now spread far beyond Texas. For example in 2002, I was involved in a similar a case in Missouri involving a brain-injured man despite the state not having a Texas-style law.  It was difficult to find another health care facility to accept the man within the 2 week deadline given by the hospital but ultimately the man not only survived but recovered after the transfer.

The Texas law is now being challenged in the case of Evelyn Kelly, individually, and on behalf of the estate of David Christopher Dunn v Harris Methodist Hospital, a case where a terminally ill, conscious man’s mother fought the ethics committee’s decision to remove his ventilator.

Although Mr. Dunn has since died, the case continues on the question of whether the Texas law is constitutional or not.

In the summary judgement motion filed, Ms. Kelly and her lawyers state that the ethics committee’s action “is an alarming delegation of power by the state law” and “is a far cry from the due process intended to protect the first liberty mentioned in Article 1, Section 19 of the Texas Constitution and that of the Fourteenth Amendment”. (Emphasis added)

Mrs. Kelly and her lawyers make a good point. How can a life and death decision be automatically delegated by law to an unregulated, unaccountable group of individuals outside the legal system?

Even worse, how can the right to live have less legal protection than the “right” to be dead?

The answers to these questions are critically important.

New York Times Article, Dr. Timothy Quill Promote Physician-Assisted Suicide by Starvation and Dehydration

Physician-assisted suicide is not just about someone taking a lethal overdose of medicine prescribed by a doctor. For many years, Compassion and Choices, the former and more appropriately named Hemlock Society) has also promoted VSED (voluntary stopping of eating and drinking) as just other end of life option they insist is legal in all states, even those without an assisted suicide law.

Now in a disturbing new New York Times article  “The VSED Exit: A Way to Speed Up Dying, Without Asking Permission , columnist Paula Span (who admits that she was “also a speaker, and received an honorarium and some travel costs.”) writes about conference on VSED, “billed as the nation’s first, at Seattle University School of Law which drew about 220 participants — physicians and nurses, lawyers, bioethicists, academics of various stripes, theologians, hospice staff.” In her article, Ms. Span acknowledges that VSED “causes death by dehydration, usually within seven to 14 days.” (Emphasis added)

Thus, VSED death is no more “natural” than physician-assisted suicide by lethal overdose. It just takes longer.

One of the featured speakers was Dr. Timothy Quill, described as “a veteran palliative care physician at the University of Rochester Medical Center.” Unmentioned is that Dr. Quill is a long-time activist for physician-assisted suicide and 2012 president of the American Academy of Palliative and Hospice Medicine which is now “neutral” on assisted suicide. He was also the respondent in the 1997 US Supreme Court Case Vacco v Quill arguing for the constitutional right to physician-assisted suicide.

VSED AS A “REASONABLE” OPTION FOR “PEOPLE WITH SERIOUS ILLNESSES WHO WANT TO HASTEN THEIR DEATHS”

Although Dr. Quill claims that VSED is “generally quite comfortable at the beginning”, he also states that “You want a medical partner to manage your symptoms,” because “It’s harder than you think.”

How hard?

In 2000, Quill and Dr. Ira Byock (a palliative care doctor who speaks against legalizing physician-assisted suicide while also supporting VSED and terminal sedation) wrote an article titled “Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids”.

In the article, they wrote about the case of BG, a radiology doctor with an eventually fatal brain tumor, who “did not want to die but was fearful of becoming physically dependent and intellectually impaired.”

As they wrote: “BG stopped eating and drinking. The initial week was physically comfortable and personally meaningful.” However, “On day 10, BG became confused and agitated and began having hallucinations. The peace and comfort that he and his family had achieved began to unravel.”

His intravenous morphine drip to control his headaches was increased to cause terminal sedation and he died.

Byock and Quill conclude that   “Medicine cannot sanitize dying or provide perfect solutions for all clinical dilemmas. When unacceptable suffering persists despite standard palliative measures, terminal sedation and voluntary refusal of food and fluids are imperfect but useful last-resort options that can be openly pursued.” (Emphasis added).

THERE ARE NO RELIGIOUS OBJECTIONS TO VSED?

In her article, Ms. Span makes an effort to make VSED sound morally and ethically acceptable when she states:

“Moreover, major religious groups have yet to declare whether they consider VSED an acceptable act of self-determination or a suicide, anathema in most faiths.”

Actually, many people-religious and non-religious- as well as disability groups like Not Dead Yet have objected to VSED.

And for Catholics, the Vatican Charter for Health Care Workers specifically states :

“The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him: their undue suspension could be real and properly so-called euthanasia.” (Emphasis added)

In addition, the Charter also addresses the concept of terminal sedation:

Sometimes the systematic use of narcotics which reduce the consciousness of the patient is a cloak for the frequently unconscious wish of the health care worker to discontinue relating to the dying person. In this case it is not so much the alleviation of the patient’s suffering that is sought as the convenience of those in attendance. The dying person is deprived of the possibility of ‘living his own life’, by reducing him to a state of unconsciousness unworthy of a human being. This is why the administration of narcotics for the sole purpose of depriving the dying person of a conscious end is ‘a truly deplorable practice’.” (Emphasis added)

EXPANDING VSED

As Ms. Span observes there are “obstacles” still to overcome in the quest for universal acceptance of VSED including whether people with dementia can “pre-choose” VSED by request or “living will”  while still well.  Another issue includes legal cases where even non-terminal residents or their relatives sue to make nursing homes stop even spoon-feeding.

The Compassion and Choices death machine rolls on and in many different directions but the goal remains death on demand. Apathy is not an option.

Is Compassion and Choices Aiming to Become the “Planned Parenthood” of Euthanasia?

With over $22 million in 2015 net assets,  a 4 star rating from Charity Navigator, enthusiastic media coverage and a new  Federal Policy Agenda for 2016 and Beyond” , Compassion and Choices increasingly appears to be following in the 4 star, politically and media supported, $1.3 billion dollar revenue ($528 million in government taxpayer funding) steps of the Planned Parenthood Federation of America.

While Compassion and Choices claims that it just “works to improve care and expand choice at the end of life”, it also admits that “We employ  educational training programs, media outreach and online and print publications to change healthcare practice, inform policy-makers, influence public opinion and empower individuals.” (Emphasis added)

THE PALLIATIVE AND HOSPICE CONNECTION

Compassion and Choices has worked for decades not only to legalize physician-assisted suicide in every state but also to normalize and integrate physician-assisted suicide into medical practice and reaches out to established medical groups like the American Academy of Palliative and Hospice Medicine (AAPHM).

Currently, Oregon reports that 92.2% of its physician-assisted suicides were enrolled in hospice care and in Washington state,  93% of its assisted suicides “were assisted by an EOLWA (Compassion and Choices) volunteers”. 

Compassion and Choices also supports two other “legal” options for assisted suicide in states that haven’t passed physician-assisted suicide laws. One is “voluntary stopping of eating and drinking (VSED)” and the other is “palliative sedation-Sometimes called terminal sedation”. Significantly, the recommendations include the admission that “VSED includes pain and symptom management” and “Palliative sedation must be medically managed by a healthcare provider”. Thus the need to influence and train hospice and palliative care providers.

No wonder Compassion and Choices lists as one of its accomplishments that it:

Pioneered the medical model of aid in dying that helps ensure that doctors can ethically practice aid in dying in an open, legitimate and accessible way, and integrates the option into patients’ end-of-life care. The culmination of that work was the publication of clinical criteria in the Journal of Palliative Medicine in December 2015. (Emphasis added)

The first line of this article ““Clinical Criteria for Physician Aid in Dying” (their preferred name for physician-assisted suicide) is:

“More than 20 years ago, even before voters in Oregon had enacted the first aid in dying (AID) statute in the United States, Timothy Quill and colleagues proposed clinical criteria AID.”  (Emphasis added)

Timothy Quill, MD was the 2012 president and recipient of the Visionary award  of the American Academy of Palliative and Hospice Medicine. Dr. Quill also was the respondent in the 1997 US Supreme Court case Vacco v Quill arguing for physician-assisted suicide as a constitutional right. He lost unanimously then.

Now, Compassion & Choices’ website has a video presentation based on this article  titled  “Understand the Clinical Practice of Aid in Dying”  for doctors and other clinicians. The presentation even offers continuing medical education credits.

This would not be possible if the AAPHM had not changed its position on assisted suicide from opposition to “studied neutrality”, a position that the American Medical Association itself is now considering.

WHERE THE MONEY AND POWER IS

Compassion and Choices now has its “Federal Policy Agenda / 2016 & Beyond”.

The priorities on its agenda include:

Establish federal payment for palliative care consultations provided by trained palliative care professionals who will advocate for and support the values and choices of the patient….”  (Emphasis added)

Also included are “Professional Education and Development” training programs for doctors and other providers “in discussing terminal prognoses and death” and  “Policies and Payment Systems” to change medical policies and payments to a “a value-based healthcare payment system” that will “(e)ncourage Congress to direct CMS (the Centers for Medicare and Medicaid Services) and other federal agencies” to withhold   “appropriations or other funds”  for treatment that was “provided but (deemed) unwanted”.

This last provision reinforces the fear many healthcare providers already have that, if in doubt, it is safer not to treat a person rather than treat them in hope of a good result because of potential lawsuits or reimbursement problems.

Also a priority is “Public Education and Engagement”.  Compassion and Choices bemoans that one survey showed “22 percent of those aged 75 and older had neither written down nor talked to someone about their treatment preferences at the end of life.”

So naturally Compassion and Choices recommended strengthening the Centers for Medicare and Medicaid Services’ proposal to “reimburse doctors for communicating with patients about whether and how they would want to be kept alive if they become too sick to speak for themselves.”  This of course involves “living wills” and other advance directives that give people a list of some medical treatments or care to automatically refuse by a check mark. Unfortunately but tellingly, these directives include no explanation of the treatments themselves or their risks and benefits which is crucial for the informed consent or refusal required if the person was making the decision while fully conscious.

CONCLUSION

Compassion and Choices has been very involved in many legal cases about assisted suicide including the 1997 US Supreme Court’s Vacco v Quill decision finding no constitutional right to physician-assisted suicide. Undeterred, the organization continues to push for legalization of assisted suicide by fighting state by state while hoping for a possible future US Supreme Court decision that, like Canada’s in 2015, would legalize medically assisted suicide throughout the country.

In the meantime, if Compassion and Choices federal policy agenda is successful, they stand to benefit from a potential windfall of government taxpayer funding to provide their currently  “free consultation, planning resources, referrals and guidance”

As an article by Ashton Ellis has astutely observed ,

“The effort by pro-euthanasia group Compassion & Choices to use Brittany Maynard’s story to push physician-assisted suicide is part of a larger strategy. When talking about end-of-life issues, a strategically crafted frame points to only one logical conclusion: I’d rather be dead.”

Physician-assisted Suicide Laws: Real Safeguards? No. Discrimination. Yes!

Many years ago before the first physician-assisted suicide law was passed in Oregon, I was asked to see a patient I will call “Eleanor” who was on the oncology (cancer) unit where I worked.

Eleanor was larger than life even when she became ill with cancer in her 50s. Spirited and feisty with a wicked sense of humor, Eleanor regaled us doctors and nurses with her tales about her event-filled life. But over some months when her cancer treatments failed to cure her, Eleanor’s mood darkened and she told me of her plans to commit suicide either with a “doctor” like Jack Kevorkian or by her own hand. She was insistent that she die before she became mentally diminished or physically dependent on others. I notified the doctor and spent time talking with her.

With treatment and especially by addressing her fears and the ramifications of a suicide decision, I was elated when Eleanor changed not only her mind but also her attitude. Once she decided against suicide, she embraced life fully and with gusto. She eventually died comfortably and naturally.

However, after Eleanor changed her mind about suicide and mentioned me, her friends tracked me down and threatened to get me fired because I was unjustly “interfering with her right to die”. Instead of being happy or relieved for Eleanor, these friends were instead outraged that we took the usual measures we would take with anyone to prevent a suicide.

I was shocked then but I am not now, especially after physician-assisted suicide was legalized in some states and one of its’ victims,  the late Brittany Maynard, became a celebrity.

HOW ASSISTED SUICIDE LAWS DISCRIMINATE IN TREATMENT FOR SUICIDAL PATIENTS

When a patient expresses thoughts of suicide, this is considered an emergency. As health care providers, we notify the doctors and an evaluation is done.

As the American Family Physician website states in Evaluation and Treatment of the Suicidal Patient:

“Important elements of the history that permit evaluation of the seriousness of suicidal ideation include the intent, plan, and means; the availability of social support; previous suicide attempts; and the presence of comorbid psychiatric illness or substance abuse. After intent has been established, inpatient and outpatient management should include ensuring patient safety and medical stabilization; activating support networks; and initiating therapy for psychiatric diseases. Care plans for patients with chronic suicidal ideation include these same steps, as well as referral for specialty care.” (Emphasis added)

However, physician-assisted suicide laws like Washington state’s “Death with Dignity Act” only  requires doctors to

 (e) Refer the patient for counseling if appropriate under RCW 70.245.060

and

If, in the opinion of the attending physician or the consulting physician, a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patient for counseling.” (Emphasis added)

Not surprisingly, very few people are referred for counseling since assisted suicide activists and some others consider such suicides “rational”.

HOW PHYSICIAN-ASSISTED SUICIDE LAWS DISCRIMINATE EVEN IN DEATH CERTIFICATES

While it can be painful to the family (as I personally know), when suicide is determined to be the cause of death, it must be reported as such on the person’s   death certificate.

However, the Washington State assisted suicide law actually forbids doctors from listing  suicide or assisted suicide as the cause of death: “(2) The attending physician may sign the patient’s death certificate which shall list the underlying terminal disease as the cause of death.

There are even detailed “Instructions for Physicians and Other Medical Certifiers for Death Certificates: Compliance with the Death with Dignity Act”:

“If you know the decedent used the Death with Dignity Act, you must comply with the strict requirements of the law when completing the death record:

  1. The underlying terminal disease must be listed as the cause of death.
  2. The manner of death must be marked as “Natural.”
  3. The cause of death section may not contain any language that indicates that the Death with Dignity Act was used, such as:
  4. Suicide
  5. Assisted suicide
  6. Physician-assisted suicide
  7. Death with Dignity
  8. I-1000
  9. Mercy killing
  10. Euthanasia
  11. Secobarbital or Seconal
  12. Pentobarbital or Nembutal

The Washington State Registrar will reject any death certificate that does not properly adhere to the requirements of the Death with Dignity Act.1 If a death certificate contains any reference to actions that might indicate use of the act, the Local Registrar and Funeral Director will be instructed, under RCW 70.58.030, to obtain a correction from the medical certifier before a permit to proceed with disposition will be issued.”(Emphasis added)

This flies in the face of the 2003 CDC’s Medical Examiners’ and Coroners’ Handbook on Death Registration and Fetal Death Reporting that states:

“The death certificate is the source for State and national mortality statistics (figures 1–3) and is used to determine which medical conditions receive research and development funding, to set public health goals, and to measure health status at local, State, national, and international levels.” (Emphasis added)

The Handbook also gives the distinctions between manners of deaths:

Natural—‘‘due solely or nearly totally to disease and/or the aging process.’’

Suicide—‘‘results from an injury or poisoning as a result of an intentional, self-inflicted act committed to do self-harm or cause the death of one’s self.’’

Why were the activists and lawyers who wrote this law not challenged when it was written to actually require doctors to lie on a legal document and add yet another layer of secrecy?

Again, as I wrote in my previous blog “Why Should Physician-Assisted Suicide Laws Grant Special Privileges?” , legislatures and the public need to know and challenge these outrageous provisions as well as being informed about the personal and societal dangers of assisted suicide itself. We must demand truth, transparency and accountability, especially when life and death are at stake.

Why Should Physician-Assisted Suicide Laws Grant Special Privileges?

A May 2016 Gallup poll titled Euthanasia Still Acceptable to Solid Majority in US”   reports that now 69% of those surveyed agree that “doctors should be allowed by law to end a patient’s life by some painless means” if the person “has a disease that cannot be cured” and “if the patient and his or her family request it”.  (Emphasis added)

There is also reported  growing support among doctors  for medically assisted suicide.

This is alarming but should not be surprising in view of the intense and usually one-sided portrayal  of assisted suicide as “courageous” and honorable while unassisted death is routinely portrayed as agonizing to both the family and the patient.

However, there are few healthcare providers who actually want to personally participate in ending a life even when they say they support legalizing assisted suicide. This is one reason why Compassion and Choices, the former Hemlock Society, has been involved in most of the assisted suicides in Oregon and Washington.

The reluctance of most doctors and nurses to participate in assisted suicide has come about despite the unique and special protections given to healthcare providers who participate in medically assisted suicide that can actually encourage healthcare providers to participate without fear of legal consequences.

Note two of these provisions in the Oregon law :

“The Health Services shall make rules to facilitate the collection of information regarding compliance with ORS 127.800 to 127.897. Except as otherwise required by law, the information collected shall not be a public record and may not be made available for inspection by the public.” (Only an “an annual statistical report of information” is made public.) (Emphasis added.)

And

No person shall be subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with ORS 127.800 to 127.897. ” (Emphasis added.)

There is also no requirement that the doctor or anyone else witness or even be present at the lethal overdose.

But why are the activists and  lawyers who write these laws not challenged when they purposely omit  the stringent documentation and oversight required for any  other medical intervention by relying on doctors’ self-reporting the process  while also granting these doctors virtual immunity from any legal, civil or professional liability  for coercion, complications, abuse etc.?

One answer is that this allows the media and even doctors like Dr. Ezekiel Emanuel (one of the architects of Obamacare) to declare:

“Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices.”  (Emphasis added)

The second answer is that these provisions allow assisted suicide doctors  (who obviously have more in common with the infamous Dr. Jack Kevorkian than the iconic Marcus Welby, MD of the 1970s)  to privatize the death and thus prevent any real investigation, followup or even serious medical research as well as allowing the coverup of any problems.

Apparently, nothing can be allowed to interfere with the carefully manufactured image of a kindly doctor helping a patient in excruciating pain to have a quick painless demise.

No other area of medical practice-even lethal injection execution-is allowed such secrecy and immunity.

Legislatures and the public need to know and challenge these outrageous provisions as well as being informed about the personal and societal dangers of assisted suicide itself. We must demand truth, transparency and accountability, especially when life and death are at stake.

 

Neutrality Kills

In 1994, Oregon became the first state to pass a physician-assisted suicide law. This came after the Oregon Medical Association changed its position from opposition to neutrality. 21 years later and after multiple failed attempts, the California state legislature approved the latest physician-assisted suicide law after the California Medical Association changed its opposition to neutrality.

The message sent-and received- was that if doctors themselves don’t strongly oppose physician-assisted suicide laws, why should the public?

Now the American Medical Association is set to reconsider changing its traditional opposition to assisted suicide to neutrality. This would be another, even more far-reaching disaster in terms of national impact.

For years, the euthanasia/assisted suicide activists of Compassion & Choices have successfully lobbied groups like the California Medical Association, the American Public Health Association, The American College of Legal Medicine, American Medical Student Association and American Medical Women’s Association and The American Academy of Hospice and Palliative Medicine to support legalized physician-assisted suicide or at least take a “neutral” position.

As a former home health and hospice nurse, I am particularly outraged that the latest organization to crumble to Compassion & Choices is the Visiting Nurses Associations of America.

According to its website, Compassion & Choices says that the VNNA had Compassion & Choices as part of the their Public Policy Leadership Conference “where they discussed their federal agenda for 2016 and the important role that members of the VNAA play in end-of-life care.”

With millions of dollars from donors to advance its agenda, a supportive media that ignores dangerous facts, popular ethicists who change positions with the polls and a legal system that has helped to undermine protections for the medically vulnerable, it may seem that Compassion & Choices is getting closer to achieving its goal of forcing doctors and nurses to supply medically assisted death on demand.

For example, a 2014 survey of over 21,000 American and European doctors responding to an ethics survey conducted by Medscape (a password-protected website for medical professionals) showed that-for the first time-a majority of doctors polled supported assisted suicide.

However, here are a few ways any of us can help turn around this dire situation:

 

  •  Educate yourself on the facts and consider joining others to publicly oppose medically assisted suicide/euthanasia in our courts, legislatures and media outlets.
  • Demand that suicide prevention and treatment must be made available to all, not just the young and physically healthy.
  • Ask your health care professionals about their position on assisted suicide/euthanasia and support only health care providers who will not assist suicide or refer for it.
  • Discover and reach out to at risk individuals and their families who may be in your neighborhood or church. Loneliness and isolation can be debilitating.
  • Consider volunteering at a local nursing home or facility. Some churches have even started programs to encourage church members to visit one hour, once a week with one patient.

None of us can afford to be neutral- or silent-when it comes to this life or death issue.