Month: March 2016

Why New Indiana Law Bans Abortions Based on Race, Sex or Disabilities like Down Syndrome

nancyvalko abortion, disability, education, medical ethics, Planned Parenthood, prenatal testing

Just three days after World Down Syndrome Day, Governor Mike Pence of Indiana signed a law that, among other provisions, bans abortion doctors from knowingly aborting an unborn baby solely because of an unborn baby’s race, sex, or genetic disability such as Down Syndrome.

Predictably, there was an immediate backlash from groups like Planned Parenthood, the mainstream media and others.

A Bit of History

In 2008, the  Prenatally and Postnatally Diagnosed Conditions Awareness Act was signed into law by President George W. Bush. This law, co-sponsored by Senators Edward Kennedy (D-MA) and Sam Brownback (R-KS), was meant to provide parents receiving a pre- or post-natal diagnosis of Down syndrome or other disabilities – like cystic fibrosis and spina bifida – more information and support than had been available in the past. It was inspired by the words and actions of Brian Skotko , who has a sister with Down Syndrome and who is now a board-certified medical geneticist and Co-Director of the Down Syndrome Program at Massachusetts General Hospital.
Among other provisions, the law was written to:

coordinate the provision of, and access to, new or existing supportive services for patients receiving a positive diagnosis for Down syndrome or other prenatally or postnatally diagnosed conditions, including—

the establishment of a resource telephone hotline accessible to patients receiving a positive test result or to the parents of newly diagnosed infants with Down syndrome and other diagnosed conditions

the establishment of a national registry, or network of local registries, of families willing to adopt newborns with Down syndrome or other prenatally or postnatally diagnosed conditions, and links to adoption agencies willing to place babies with Down syndrome or other prenatally or postnatally diagnosed conditions, with families willing to adopt

the establishment of awareness and education programs for health care providers who provide, interpret, or inform parents of the results of prenatal tests for Down syndrome or other prenatally or postnatally diagnosed conditions, to patients. (Emphasis added)

However, the law was never funded due to disputes among members of Congress “over how the topic of abortion would be handled in the materials accepted for distribution.”

But while such positive initiatives went unfunded, funding has been no problem for companies developing prenatal screening tests that can be done ever more easily and earlier in pregnancy. Currently, there is a “cell-free DNA” blood test for expectant mothers that can be done as early as 10 weeks into a pregnancy that claims near perfect accuracy in detecting Down Syndrome and other conditions.

However, a three month examination of these unregulated tests by the non-profit New England Center for Investigative Reporting reported

“companies are overselling the accuracy of their tests and doing little to educate expecting parents or their doctors about the significant risks of false alarms.”

And the Center also noted that “prenatal screening tests prompt abortions”.

Even the abortion-supporting American Congress of Obstetrician and Gynecologists’ (ACOG) current position expresses concerns and states that :

“Given the potential for inaccurate results and to understand the type of trisomy  for recurrence-risk counseling, a diagnostic test should be recommended for a patient who has a positive cell-free DNA test result.”

and

“Management decisions, including termination of the pregnancy, should not be based on the results of the cell-free DNA screening alone.” (Emphasis added)

Nevertheless, a recent study showed that abortion after prenatal diagnosis of Down Syndrome reduced the Down Syndrome community by 30%.

“Disclosing Down Syndrome to Pregnant Patients: Must You Give an Upside?”

In this rather offensively titled opinion article by Arthur Caplan, PhD. who heads the Division of Medical Ethics at NYU’s Langone Medical Center, he criticizes laws like Indiana’s:

One reason that women seek abortions is because they don’t want to have a child with Down syndrome. Recently there has been a movement among people who have had children with Down syndrome to say, “That rate of abortion indicates bias. It’s not really choice. It’s fear of Down syndrome. It’s prejudice against Down syndrome.” Some families who have had children with Down syndrome say that they mean a lot to their family; that it has been a great experience to have a child even though the child has Down syndrome; they accomplish a lot, they’re happy, and people have the wrong view about it.

Some have gone further and started to change state laws to say that when you get a positive test for Down syndrome, you are required to get in touch with the Down syndrome associations in your state and get the message that balances the bias that no one wants a kid with Down syndrome.

The problem is that far too many medical professionals themselves seem to have a negative bias when it comes to conditions like Down Syndrome and see no “upside” to Down Syndrome versus abortion. New or expectant parents deserve better, especially when that professional is giving them their baby’s diagnosis.

I found that out personally not only when I had my daughter Karen but also when I talked to other parents who encountered negative attitudes from some medical professionals.

Eventually, we developed an educational program for hospital maternity divisions about how to help new parents of children born with disabilities. I always brought a child with Down Syndrome and his or her parent to these programs and the reaction was amazing. Doctors and nurses who only saw upset parents before now heard from these same parents about the challenges and very real joys of life with their child. Even better, these professionals were charmed by meeting the children themselves.

We found that changes in attitudes and information can change future outcomes for the better for children and their parents.

Conclusion

It is natural to feel shocked and overwhelmed when you are told either before or after birth that your baby has a condition. Panic and fear is not uncommon.

But it is at this vulnerable time that parents especially need the accurate information, resources and support that the Kennedy-Brownback law was designed to provide.

Unfortunately, we have groups like Planned Parenthood that demand legalized abortion at any time during pregnancy for any or no reason at all as a civil right. However, that must not stop us from continuing to strive for a compassionate society that protects every human life, promotes accurate information and fights discrimination at the same time.

Canada’s Assisted Suicide Law to Cover Mental illness, Dementia and Minors

nancyvalko assisted suicide, Canada, disability, euthanasia, law

In a Canadian CBC News article titled “Mature minors, mentally ill should have right to doctor-assisted death, report advises”, a special committee of MPs (members of Parliament)  and senators issued a 70 page report “Medical Assistance in Dying: A Patient-Centred Approach”  stating that mature minors and mentally ill people should not be excluded from the right to “doctor-assisted death” (physician-assisted suicide).  It also states that Canadians should have the right to make an “advance request” for physician assisted suicide, termed “medical aid in dying”,  after being diagnosed with certain debilitating, but not necessarily terminal, conditions.

There is not even a requirement that the lethal overdose be oral or self-administered and the Canadian province of Quebec has already started lethal injections.

Ironically, capital punishment existed in various forms in Canada until 1998, when the federal government completely abolished the death penalty.

How can lethal injections be “cruel and inhumane” for convicted murderers but a civil right when it is chosen by an ill person?

And while physician-assisted suicide laws in the US routinely provide immunity for physicians, the Canadian recommendations also exempt nurses, pharmacists and other health care practitioners from key criminal code provisions.

Age of Consent

Although the Canadian Pediatric Society pushed to exclude minors regardless of competence, the report states that

“Given existing practices with respect to mature minors in health care and the obvious fact that minors can suffer as much as any adult, the committee feels that it is difficult to justify an outright ban on access to medical assistance in death for minors.”(Emphasis added)

Mental Illness

The report states that the right to assisted death should not be limited to physical conditions, and that Canadians with psychiatric conditions should not be excluded from “doctor assistance to end suffering” (physician-assisted suicide).

However

“As reported by Medscape Medical News, the inclusion of psychiatric suffering in assisted death laws in European countries such as Belgium has sparked significant debate, particularly with research showing that many individuals who have a history of suicide attempts later regret taking such action.

“Most people who consider or attempt suicide never die by suicide [and] the conviction that there is no alternative but to end their lives often passes with the resolution of an acute crisis,” medical ethicist Paul S. Applebaum, MD, told Medscape Medical News.

“By making the option of suicide easier, ie, a painless, certain death with medical assistance, the Dutch, Belgian, and similar laws may encourage many people, especially women, who would not have ended their lives to do so,” said Dr Applebaum, Dollard Professor of psychiatry, medicine, and law and director of the Division of Law, Ethics, and Psychiatry at Columbia University College of Physicians and Surgeons, in New York City.” (Emphasis added)

“Advance Consent” for Assisted Suicide for People with Dementia

The advocacy group Dying With Dignity Canada applauded the report’s recommendations, especially the one to allow advance consent.

“Patients deserve real choice,” said CEO Shanaaz Gokool in a release.

“Without the option to consent in advance to assisted dying, Canadians with dementia who want to die in peace with the help of a physician face a dire choice: access assisted dying prematurely, while they are still competent; or risk losing competence before their wishes can be carried out, only to be condemned to the exact fate they sought to avoid.” (Emphasis added)

Actually, that result was already on the agenda when “living wills” were first proposed by Chicago lawyer Louis Kutner in his 1969 article “Due Process of Euthanasia: The Living Will, A Proposal” .

Some people say that Holland, Switzerland and Belgium are not like the US so that their virtually unregulated euthanasia policies should not affect us. But no one can deny the potential lethal impact on our own society from this terrible “right to be killed” propagated by our neighbor to the north.

CBS’s “60 Minutes” and the Selling of Physician-assisted Suicide

nancyvalko assisted suicide, education, end-of-life, euthanasia

In the March 13, 2016 TV “60 Minutes” segment titled “Aid in Dying” (retitled “Should the terminally ill control how they die?” in the online transcript, the vaunted investigative news show crossed the line from presenting facts to enthusiastic advocacy.

The stage was set when medical correspondent Dr. John LaPook, an internist and son-in-law of liberal activist Norman Lear, opened the segment by stating:

This is not euthanasia, when a doctor gives a patient a lethal injection. That’s illegal in all 50 states. Aid-in-dying, or what opponents call “assisted suicide” and supporters call “death with dignity,” relies on people taking the medication themselves. Oregon became the first state to legalize it 18 years ago, but because a nurse or doctor is rarely present, it’s remained mostly a private affair, practiced behind closed doors. We wanted to hear from patients and family members who’ve experienced it and are fighting to make it legal nationwide. (Emphasis added.)

If you go to the link for the transcript, you will also see “related videos” with segment extras not included on the TV show.

One titled “ethical concerns” is an interview with Dr. Katrina Hedberg, state epidemiologist of the Oregon Public Health Division, to discuss “ethical concerns raised by her state sanctioning aid-in-dying”. Not surprisingly, Dr. Hedberg strenuously denies that assisted suicide is a danger for the “disenfranchised” or for medical economic or family burden reasons. Instead, she says “the opposite has happened” despite cases like Barbara Wagner’s.

In the segment extra “How does the medicine work?”, the assisted suicide doctor explains that the medicine simply just “shuts off the brain” starting “at the top” where consciousness is and then goes to “the bottom” of the brain where heartbeat and breathing occur. Not a very accurate or scientific explanation but designed to reassure the public.

In the televised segment, there was only a very short interview with Dr. William Toffler, National Director of Physicians for Compassionate Care  but only identified by Dr. LaPook as a doctor “who’s taken care of terminally ill patients for 40 years” and whose wife died of cancer in comfort and without physician-assisted suicide. Dr. Toffler’s practical and ethical concerns were ignored or dismissed by Dr. LaPook.

The rest of the segment involved interviews with people fighting for physician-assisted suicide for themselves or a relative and an assisted suicide doctor. The usual lethal overdose drug and the method for using it for suicide were described in detail.

A major portion of the segment were interviews with Brittany Maynard’s husband and Dr. Eric Walsh, the Oregon physician who prescribed the overdose for the 29 year old woman with a gliobastoma brain tumor whose countdown to assisted suicide became a media sensation in October, 2014.  Brittany’s suicide was described by her husband as Brittany just going to sleep and slowly stopping to breathe.  Not surprisingly, it was after Brittany’s suicide that most mainstream media then changed the usual term “physician-assisted suicide” to softer terms like “aid in dying” or “physician-assisted death”.

Ironically, 60 Minutes aired a segment on March 29, 2015-just 5 months after Brittany Maynard took her lethal overdose-titled “Killing Cancer“  The segment followed patients in a year long clinical trial who had gliobastoma brain cancers like Brittany’s. Many of these patients saw their cancers disappear after being treated with a reengineered polio virus. This was touted as a great breakthrough by “60 Minutes” but went unmentioned in this segment.

Another interview was with a man in hospice who was being seen by Dr. Walsh but, as the segment stated:

Though usually extremely effective at keeping people comfortable, in rare instances, standard hospice care doesn’t work well enough. In those cases, Dr. Walsh says, one option is something called palliative sedation.

Dr. Eric Walsh: When the physician decides that suffering is intolerable, the physician prescribes a medication which puts the patient in a coma…The nurse administers it. It’s given until the person is asleep. The person sleeps for three days, five days. I’ve had someone live 10 days, still excreting, still breathing, with the family at the bedside wondering, “When is this going to end?”

When an assisted suicide doctor himself “decides that suffering is intolerable”, prescribes a intravenous continuous medication to be administered by a nurse to speed a patient’s death, how is that NOT euthanasia?

Sadly, the last interview with a woman dying of colon cancer illustrates the dangers of assisted suicide for so-called “altruistic” reasons that would also appeal to many non-terminally ill but debilitated or suicidal people:

Dr. Jon LaPook: And it sounds like from what you’re saying your decision to
perhaps take the medication will be a final act—
Elizabeth Wallner: Absolutely.
Dr. Jon LaPook: –of protecting your son.
Elizabeth Wallner: Absolutely. I just want him to remember me laughing and, you know, giving him a hard time, and telling him to brush his teeth, and knowing that I would– I would, you know, walk across the sun for him. (Emphasis added)

The public deserves a better and more comprehensive discussion about physician-assisted suicide. Such discussions have been occurring in state legislatures where physician-assisted suicide groups like Compassion and Choices relentlessly push for legalization and medical, disability, pro-life and other groups testify to the real facts and dangers.

There must be something to this opposition since so far this year 8 states have rejected physician-assisted suicide bills.

 

Is it Time for a Two-Track Nursing Education System?

nancyvalko education, nursing

In what may be news to most people, a March 6, 2016 Wall Street article “Colleges Lock Horns Over Nursing Programs-Four-year institutions try to prevent community colleges from offering advanced programs” states:

The Institute of Medicine, now part of the nonprofit National Academy of Sciences, in 2010 recommended that 80% of nurses hold bachelor’s degrees by 2020, up from about 50% at the time.

Spurred by the report, as well as incentives in the Affordable Care Act to use more highly credentialed nurses, hospitals are scrambling to bring on new staff with bachelor of science degrees in nursing, or push nurses with associate degrees to upgrade to a BSN. That means additional coursework emphasizing community health, critical thinking and evaluating research, in addition to liberal-arts or general-education classes….

That means nurses like Kristina Spaete, who landed a job as a surgical nurse at Scripps Mercy Hospital in San Diego after completing her associate degree in nursing at a community college last May, could soon find herself back in school.

“I feel selfish if I were to go back and pay a ton of money for school,” said the 35-year-old mother of three, who is hoping she can get a BSN at a community college.
For now, getting into any program is tough. U.S. schools turned away 68,938 qualified applicants from bachelor’s and graduate nursing programs in 2014, according to the American Association of Colleges of Nursing, citing a dearth of faculty, clinical sites and classroom space.

Leaders at community colleges, which now train nurses to the associate-degree level, argue they can help fill a hole in the nursing labor market at a low price. Administrators at four-year colleges counter that community colleges aren’t equipped to teach upper-level nursing courses and say there aren’t enough qualified faculty to go around.

“We have to be responsible in terms of how many students realistically can complete these programs, and how many can get jobs,” said Christine Mallon, assistant vice chancellor of academic programs and faculty development at the California State University System.

Here is the letter to the editor I sent to the Wall Street Journal about the crisis in nursing education.

In 1969, I graduated from one of the first associate degree nursing programs due to limited funds and an intense desire to start my nursing career. Some of my high school classmates chose a 4 year BSN degree but the vast majority of nurses then were three year hospital diploma nurses. Now there are almost no diploma programs which were then considered the “gold standard” for nursing education.

At the time, I felt I received a great nursing education but I also felt I needed more clinical experience so I went to the only hospital in my area to offer a nursing internship. I spent the next year in different divisions: 3 months each on medical and surgical divisions including ICUs, 3 months in operating rooms and 3 months as an elective in the cardiac ICU.

By the end of that year, not only did I gain an enormous amount of knowledge and confidence but I also was able to make the decision that I wanted to be an ICU nurse able to work in any type of ICU. I did achieve my dream and more.

A few years after working, I decided I wanted to learn more and I signed up for a BSN completion course at my own expense since scholarships were few and far between. However, I was disappointed that the program seemed geared to producing administrative nurses rather than clinical nurses. I wanted to be a great bedside nurse so instead, I took courses in music and considered pursuing an economics degree to give me more options.

But now, only a BSN will protect many fine nurses from termination or even finding employment at the beginning of their careers. In addition, the shortage of good, reasonably priced BSN completion programs will probably deter many people from even considering a nursing career.

I propose a 2 track nursing education system.

Those who want to be a great bedside nurse could obtain an associate degree and complete a year of internship as a kind of apprenticeship. This plan would not only give new nurses the support to take on the challenges of a bedside nursing career but also help them discover what kind of nursing fit their capabilities best. Such nurses could advance by becoming certified in their chosen specialties. A BSN completion course would always be available if wanted but not required as it is in many health care institutions today.

Some students would choose a BSN program from the beginning but might also want access to the support of an internship when they begin their nursing careers.
I believe this would produce the dedicated nurses we need both at the bedside and in administrative roles.

And after almost 47 years in nursing after following this plan, I would still choose this career again.

I would like to hear what you think or what ideas you have, especially if you are a nurse yourself!