Year: 2016

Could Brittany Maynard Have Been Saved?

nancyvalko assisted suicide, end-of-life, law, suicide

This week, CBS’ “60 Minutes” TV show reported that FDA has just granted “breakthrough status” for an innovative treatment for glioblastoma brain cancer that was first reported by 60 Minutes on March 29, 2015.

Brittany Maynard had glioblastoma and died by physician-assisted suicide on November 1, 2014, just 5 months before the original TV segment aired.

Brittany Maynard was a young newly wed who, with enormous media publicity and the support of the pro physician-assisted suicide group Compassion and Choices, announced her intention to commit assisted suicide and asked for donations to the Brittany Maynard Foundation to raise money to help Compassion and Choices fight for legalization of physician-assisted suicide throughout the US.

Using Brittany’s story and foundation, Compassion and Choices was finally successful after years of failed attempts to get a physician-assisted suicide law passed in California.

Did Brittany, her doctors or Compassion and Choices know about the promising clinical trials for glioblastoma reported by “60 Minutes” before Brittany took her life with a physician ordered lethal overdose?

Although reported medical breakthroughs are frequent and often over-hyped or prove disappointing, information is available at ClinicalTrials.gov, a registry and results database of publicly and privately supported clinical studies of human participants conducted around the world. This service was developed by the National Institutes of Health and the Food and Drug Administration and made available to the public in February 2000.

The Decision to Forego Treatment

According to Brittany’s own words:

After months of research, my family and I reached a heartbreaking conclusion: There is no treatment that would save my life, and the recommended treatments would have destroyed the time I had left…

And

I probably would have suffered in hospice care for weeks or even months. And my family would have had to watch that.

No one is ethically obligated to try any experimental or unduly burdensome treatment for such conditions but many people do so not only for a possible cure but also to potentially gain more time or to advance medical research. I saw this when I was an oncology nurse and also in my personal life.

For example, a few years ago, a friend developed a usually terminal lung cancer and agreed to try  an unusual and massive combination of chemotherapy and radiation. As explained by her doctors, the side effects were very tough on her but today she is happy, active and enjoying her life and her grandchildren. Her cancer continues to be in remission. Success stories like this were unimaginable of when I first became a nurse.

But while treatment of a serious or terminal condition can be a personal choice, killing oneself-with or without medical assistance-must not be treated as just another valid treatment “option”.

Hard Cases Make Bad Law

“Hard cases make bad law” is an old legal adage that means that an extreme case is a poor basis for a general law that would cover a wider range of less extreme cases. This is particularly true when it comes to physician-assisted suicide where the slippery slope expanding the pool of potential victims has become a superhighway.

I also remember when AIDS, not glioblastoma, was the “hard case” used to justify physician-assisted suicide in the 1990s because it was also considered terminal.

But by 1998, the CDC issued the first national treatment guidelines for the use of antiretroviral therapy in adults and adolescents with HIV  Today, AIDS is no longer considered an automatic death sentence and those with AIDS can even achieve normal lifespans.

But how many despairing people in the 1990s resorted to suicide, assisted or not, when the treatment for AIDS was so close?

Conclusion

Hope can be life-enhancing as well as life-saving.

Sadly, as one brain tumor expert poignantly wrote, Brittany Maynard’s “suicide was a blow to fellow brain tumor patients who were living in hope”.

 

My Most Memorable Mother’s Day

nancyvalko adoption, culture, family

Mother’s Day has always been special to me since my children were born although I always thought I should be thanking my children for making me a mom instead of them thanking me.

However, Mother’s Day 1998 was my most memorable for another reason.

My oldest daughter Marie had just started college and dating the first boy she said she loved when she found out she was pregnant. The young man offered to marry her but she thought about some serious problems they both had and felt she had to refuse.

Over the next several months, Marie was torn between keeping her baby and choosing adoption. When she considered the most important question of what would be best for the baby, she finally decided on open adoption. It was not an easy decision and we were both heartbroken by the realization that Marie would not be raising the baby herself.

Unfortunately, due to the unwed pregnancy, there was almost no support from extended family members. In addition, most of Marie’s friends supported her rejection of abortion but not her decision for adoption. However, I was proud and awed by Marie’s heroic determination to give her baby the best life possible.

It was a difficult time but then on Mother’s Day that year, a card came in the mail from a priest friend of mine that brought a big ray of sunshine and truth to the situation. 

It was a beautiful Mother’s Day card for Marie!

Marie and I both smiled and cried because it was such a wonderful acknowledgement of Marie’s eternal motherhood as well as the gift of life. I can never thank that priest enough for his timely encouragement.

Four months later, Marie’s daughter was born and released to a wonderful couple who sent pictures every month.

Later on, when Marie’s daughter grew older, she called Marie every Mother’s Day and because of the generosity of her parents, she saw Marie often until Marie’s untimely death in 2009.

This thoughtful priest’s kindness in 1998 should remind us all that Mother’s Day should always be special whatever the circumstances and whether or not our children are in our arms or just in our hearts.

 

Sparks Fly at Conception-Literally

nancyvalko abortion, conception, law, medical ethics, prenatal testing

I remember the shock I felt when I first read these words in the 1973 Roe v. Wade abortion decision:

“We need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man’s knowledge, is not in a position to speculate as to the answer.”

I could not believe that anyone could deny the obvious: life begins at conception.

Just 5 years later, the first child conceived through in vitro fertilization was born. While I recognize the several ethical problems with this procedure, I thought that at least this obviously proved that life begins at conception since the process was monitored from the beginning. Unfortunately, not to the pro-abortion movement that then pivoted to we don’t know when human personhood begins.

Ironically, presidential candidate Hilary Clinton recently revealed the hypocrisy of this pivot when she said “The unborn person doesn’t have constitutional rights” on NBC’s Meet the Press TV show. (Emphasis added)

Flash of Light

But now researchers at Northwestern University have discovered a flash of light that occurs at the moment of conception!  To see the video of this phenomenon, go to the link at LifeNews.com.

Here is the science behind this:

“The bright flash occurs because when sperm enters and egg it triggers calcium to increase which releases zinc from the egg. As the zinc shoots out, it binds to small molecules which emit a fluorescence which can be picked up my camera microscopes.

Over the last six years this team has shown that zinc controls the decision to grow and change into a completely new genetic organism.

In the experiment, scientists use sperm enzyme rather than actual sperm to show what happens at the moment of conception.

“These fluorescence microscopy studies establish that the zinc spark occurs in human egg biology, and that can be observed outside of the cell,” said Professor Tom O’Halloran, a co-senior author.”

And

Dr. Teresa Woodruff, a professor at Northwestern said, “We discovered the zinc spark just five years ago in the mouse, and to see the zinc radiate out in a burst from each human egg was breathtaking. It was remarkable.”

An Ethical Downside

Regrettably, the scientists say that the intensity of the flash of light also appears to indicate the egg’s quality and the embryo’s future health. This could allow more in vitro fertilization embryo selection with the destruction of embryos thought to be of lesser “quality”.

Therefore, instead of celebrating this physical proof of conception, Dr. Eve Feinberg, who co-authored the study, said

 “Often we don’t know whether the egg or embryo is truly viable until we see if a pregnancy ensues… If we have the ability up front to see what is a good egg and what’s not, it will help us know which embryo to transfer, avoid a lot of heartache and achieve pregnancy much more quickly.”

However, real heartache comes with infertility, desperate medical procedures to obtain a baby by any means possible, and the termination of life both inside and outside the womb.

But in the meantime, we can still rejoice in the apparent discovery of a true “spark of the Divine”.

 

Why Are Suicide Rates Climbing after Years of Decline?

nancyvalko assisted suicide, culture, law, medical ethics, mental health

After years of declines, the US suicide rate rose 24% over 15 years according to a new report from the national Centers for Disease on suicide rates in the US from 1999-2014.  The suicide rate rose for everyone between the ages of 10-74 between 1999-2014.

National media like the Wall Street Journal  and CNN   speculated that the economic downturn, drugs and lack of mental health resources could be factors in the 24% increase.

However, one huge factor was totally ignored: the legalization and promotion of physician-assisted suicide.

The Legalization of Physician-Assisted Suicide and Suicide Contagion

It must not be dismissed as mere coincidence that the new rise in suicides correlates to the implementation of the first physician-assisted suicide law in Oregon.

A 2012 report on suicide trends and risk factors for the Oregon Health Authority found the state’s overall suicide rate had risen 41 percent higher than the national rate . This is the “regular” suicide rate. Physician-assisted suicides are not included.

Since Oregon, four more states (California, Vermont, and Washington) have legalized physician-assisted suicide via legislation with a Montana supreme court ruling in favor of assisted suicide but without a regulatory framework. But it is only now that the media is noticing a suicide rate that has been increasing for 15 years.

There is a well-known and recognized suicide contagion effect after reported suicides. Both national media guidelines   and  World Health Organization guidelines   warn against media glamorization or normalization of suicide by the media that could lead to more suicides.

Yet, since the legalization in Oregon, the media has become increasingly positive in reporting on physician-assisted suicide. This reached a peak when People magazine devoted it cover story  and some subsequent issues to Brittany Maynard , her impending assisted suicide, and her Compassion and Choices led foundation to raise money to promote the legalization of physician-assisted suicide throughout the US.

That’s not just glamorizing or normalizing physician-assisted suicide. That’s advertising.

And it is having an enormous effect. Now the media is bowing to the pro-assisted suicide movement’s propaganda by changing even the terminology. Instead of physician-assisted suicide, news reports now use more soothing terms like “death with dignity”, “aid in dying” or “physician-assisted death”.

Make no mistake. This is a calculated tactic to increase support of physician-assisted suicide by denying reality.

Why Don’t  Physician-Assisted Suicide Laws Require Psychiatric or Psychological Evaluation?

As most of you may know,  I am the mother of a physically healthy 30 year old daughter who killed herself in 2009 using a technique the medical examiner called “textbook Final Exit”, the title of a book she read by assisted suicide supporter Derek Humphry. But I am also an RN with 46 years of experience who has cared for terminally or seriously ill people considering even physician-assisted suicide who changed their minds after suicide prevention and treatment interventions.

I am appalled that no physician-assisted suicide law actually requires a psychiatric or psychological evaluation before a person is given the lethal overdose prescription. For example in Oregon, the physician-assisted suicide law only states “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 such evaluations are currently done, according to Oregon’s annual reports.

That stands in stark contrast to the standard evaluations given to other suicidal patients.

There must be no medical discrimination based on a predicted  prognosis when it comes to standard suicide prevention and treatment interventions. Suicide for any reason is always a tragedy to be prevented when possible.

The terrible despair that leads to suicide must not be ignored in favor of a cold piece of paper with a lethal prescription.

 

 

What Is-Or Should Be- the Future of Nursing?

nancyvalko conscience rights, end-of-life, medical ethics, nursing

In a recent Medscape News article “Back to the Future of Nursing: What Progress Have We Made?” , Laura A. Stokowski, RN, MS reported on the results five years after the national Institutes of Medicine (IOM) issued a 2010 report titled “The Future of Nursing: Leading Change, Advancing Health” that was designed to be:

“a wake-up call that exposed the many barriers that prevented the nursing profession from contributing fully to the healthcare system: an aging workforce, regulatory restrictions on nursing practice, fragmentation of healthcare, limited capacity of the nursing education system, and lack of workforce data. It was also a catalyst for finding solutions to these problems.”

The followup report titled “Assessing Progress on the Institute of Medicine Report The Future of Nursing” came out in December 2015 and reported only some progress in their key questions:

  -Have scope-of-practice barricades been pushed aside? Are nurses being permitted to practice to the full extent of their education and licensure?

-Are more nurses earning baccalaureate, master’s, and doctoral degrees?

-Are new graduate nurses being transitioned to the profession more safely and effectively through nurse residency programs?

-Does the ethnic composition of the nursing workforce more closely match the level of diversity in the general population?

-Have opportunities expanded for leadership and interprofessional collaboration in healthcare?

If you are a nurse and were unaware of all this, you are not alone. As a full-time ICU nurse, neither I nor my fellow nurses were aware of this study at that time. The only change we noticed was when our hospital suddenly announced  that every RN must have a BSN by 2021 or be terminated.

I wish we had been asked for our input!

WILL MORE DEGREES, DIVERSITY AND EXPANDED RESPONSIBILITIES REALLY HELP NURSING?

Instead of the IOM focus on these issues, I would propose  at least four measures to really help the majority of us who work in health care institutions to provide the quality care we want for our patients as well as to reduce the stresses of nurses that often lead to burnout and quitting the profession.

 1. Consider bringing back the head nurse

When I started nursing over 47 years ago, we had head nurses who knew the patients, doctors and staff by working with them daily to make sure care was coordinated, staffing was adequate,  and problems were addressed quickly.

Now we have managers and other administrators who often are not RNs and who are often rarely seen or available because of endless meetings. The formerly close working relationships with head nurses have now become almost adversarial relationships with managers as cost containment measures, endless new policies based on legal risk, mandated government regulations, inadequate staffing etc., grind down nurses.

 2. Try retention incentives instead of signup bonuses

Years ago when there was a nursing shortage, signup bonuses were offered to potential nurse employees. I was asked by a director of nurses if I thought the bonuses were high enough.

I told this director that it might be better to try retention bonuses since the newly employed nurses we trained often left after the required year of service to get a signup bonus at another hospital. This wasted the money and time used to assign a precepting nurse to support the temporary new nurse during the weeks-long orientation to our hospital policies and procedures.

A retention bonus would help keep our good, experienced nurses who were already familiar with the doctors, other staff, departments and hospital policies. Such nurses are also often excellent resources for the rest of the staff. This could help prevent some mistakes caused by inexperience or unfamiliarity. In addition, such bonuses could also save money  and increase staff morale by reducing a high turnover rate.

3. Don’t automatically force nurses to get a BSN (bachelor’s degree in nursing)

As I wrote in my March blog “Is it Time for a Two-Track Nursing Education System?”, there is a lack of openings in many BSN programs, not to mention the time stresses and money involved in trying to coordinate full-time 12 hour hospital shifts while  caring for a family and taking classes on a deadline.

Yet there will always a need for excellent bedside nurses who strive to improve their skills, whether or not they decide to pursue a BSN. I believe that it should be a choice, not a requirement, to seek an advanced degree only in nursing.

In the meantime, I believe we should improve basic nursing education, especially by increasing clinical experience and providing mentoring to new graduates.

4. Good nurses deserve to have both conscience and whistle blower rights respected

An April, 2016  Medscape News article “Two Nurses Who Spoke Up, Lost Their Jobs, and Sued”  chronicled the years-long battle of 2 nurses who discovered and reported patient safety problems at their hospitals and lost their jobs as a result of their patient advocacy efforts. Unfortunately, being a good nurse does not automatically provide job security or protection.

Good nurses need both conscience and whistle blower rights protected. Despite rapid changes in historic ethical  and legal principles involving life-termination and abortion issues, most nurses still don’t want to actively participate. Neither do most nurses want to be intimidated from reporting medical incompetence or serious violations of standards involving patient safety.

However, good nurses often find themselves  at risk of harassment or even termination if they refuse to participate in deliberate life-ending decisions or refuse to ignore actual or potential harms to their patients.

Unfortunately, the American Nurses Association and state boards of nursing do not offer much help to nurses in such difficult situations. As the Medscape News article states, even though one nurse cited documents from the American Nurses Association (ANA) code of ethics  which say that nurses have a professional responsibility to protect patient safety:

 “The tricky part—and this is where an experienced attorney is helpful—is understanding the ins and outs of state laws that describe the exceptions to “at will” employment. If an employee reports a patient safety problem and/or is a member of a protected class (older, or a minority), the employer will probably try to prove that the employee was fired for another reason—poor performance, for example. A court will weigh the evidence and decide whether the public policy at issue is more important than upholding the doctrine of at-will employment.”

CONCLUSION

Nurses share a special bond and I am proud to be part of a truly noble profession.  But we need to be able to speak out without fear to insist on the highest standards to improve our healthcare system for both ourselves and especially our patients’ sake.

Five Things my Mother (and Daughter) Taught Me about Caring for People with Dementia

nancyvalko end-of-life, family, mental health

My mother developed Alzheimer’s disease, the most common type of dementia, in her early 60s. Later on, she was diagnosed with an aggressive thyroid cancer that required a surgical opening in her throat called a tracheostomy so that she would not suffocate from the tumor. My father and siblings were naturally distraught and overwhelmed.

I was 38 years old at the time and a suddenly single mother with 3 young children. My youngest daughter Joy was 2 years old and in diapers. My family looked to me for help.

As a nurse, I thought I knew the challenges of caring for someone with Alzheimer’s as well as someone with cancer and I was glad to use that knowledge to care for my mother. But, especially at first, it wasn’t easy.

Mom would ask the same questions over and over, have episodes of hostility and paranoia and periodic insomnia. She also became adept at thwarting the safety measures we used to protect her.

Then, one day near the end of my mother’s life, I sat on a sofa holding hands with both Joy, now over 3 years old, and my mom watching Sesame Street on TV. I was struck by the fact that both of them had the exact same expression of happiness on their faces. It was then that I realized how far we all had come and how much I had learned.

FIVE THINGS MY MOTHER AND MY DAUGHTER TAUGHT ME ABOUT:

1. Getting things done

I soon realized that both my 2 year old daughter and my mother responded best to one direction at a time and the patience to wait until one action was completed before directing another action.

For example, instead of just saying “brush your teeth” and trying to hurry the action along, directing both of them on just one step at a time time ultimately saved both time and frustration on everyone’s part.

I also found that set routines were comforting to both my mother and daughter despite their obvious differences.

2. Answering questions

Like most people caring for a relative with dementia, I found that answering the same question from my mother over and over again was exhausting. Answering different but incessant questions from my daughter was also difficult at times. So I learned the technique of distraction. For example with my mother, I would interest her in another activity such as folding laundry with me. With my daughter, I would often ask her to “read” a book to me. Judiciously used, this kind of pivot would relieve the increasing tension and make both of them happy.

3. Attitude

I made sure to smile often and establish eye contact with both my mother and my daughter. I would work my name into the conversation when I could see my mom trying to remember who I was and I made sure to often say “I love you” and praise the efforts of both my mother and my daughter. I made sure each had my full attention at that time even when I was in a hurry myself.

4. De-escalation

I found that both people with Alzheimer’s and 2 year olds are prone to sudden meltdowns that are difficult to handle. I discovered that watching for increasing agitation, frustration or the need for a nap and taking preemptive measures could often calm the situation before tempers flared out of control.

5. Music

I always found it fascinating that people with late-stage Alzheimer’s, even those who were rarely verbal, would often start singing when they heard a song they knew. The same is true with young children who naturally delight in songs. Our sing-a-longs were great fun for both my mother and my daughter. “You Are My Sunshine” was a special favorite. My daughter Joy is now an adult and a music teacher.

Best of all, my children still have fond memories of their grandmother after almost 30 years.

A FINAL STORY

This year, some married friends of ours buried the wife’s beloved mother who had Alzheimer’s. They and the rest of the family had worked together to take wonderful care of the mother at home as long as possible and in the nursing home where she finally died.

As the mother’s Alzheimer’s progressed to a later stage, she started to have vivid hallucinations.

One day, the couple made plans to take the mother to her favorite restaurant but she refused to go without the “two little girls over there.” The wife started to tell her mother that she was having hallucinations but her husband gently stopped her. Instead, he told the mother that the little girls weren’t hungry. The mother smiled and immediately got up to go to the restaurant.

The wife later asked me if it was OK to “lie” to her mother. I told her that her mom would probably have been embarrassed and upset to hear that she was having a hallucination. She might have even argued about it.

On the other hand, her husband’s response was both kind and respectful of her mother’s dignity. And, technically, those “two little girls” could not be hungry because they were not real.

To me, that kind of loving attitude from both these friends is inspirational. I wish that it was universal.

“Everybody’s a Winner When Euthanasia Combines with Organ Donation, Say Doctors”

nancyvalko assisted suicide, euthanasia, medical ethics, organ donation

This excellent article by Michael Cook  titled “Everybody’s a Winner When Euthanasia Combines with Organ Donation, Says Doctors” is a must read for anyone concerned about ethics and healthcare.

Michael Cook, the current editor of Mercatornet, writes that

Several Dutch and Belgian doctors have proposed legal reforms to increase the popularity of combining euthanasia and organ donation in the Netherlands and Belgium.

Writing in the Journal of Medical Ethics, they report valuable unpublished information about the prevalence of the procedure. So far, it has been performed only about 40 times in the two countries. However, there is “a persisting discrepancy between the number of organ donors and the number of patients on the waiting lists for transplantation” – which euthanasia patients could help to balance. (Emphasis added)

Ominously, the authors of this British Medical Journal article  titled “Legal and ethical aspects of organ donation after euthanasia in Belgium and the Netherlands”, write that public perception of this formerly abhorrent practice is increasingly positive:

“transplant coordinators in Belgium and the Netherlands notice a contemporary trend towards an increasing willingness and motivation to undergo euthanasia and to subsequently donate organs as well, supported by the increasing number of publications in popular media on this topic.”

and

“In the context of organ donation after euthanasia, the right of self-determination is a paramount ethical and legal aspect. It is the patient’s wish and right to die in a dignified way, and likewise his wish to donate his organs is expressed. Organ donation after euthanasia enables those who do not wish to remain alive to prolong the lives of those who do, and also—compared with ‘classical’ donation after circulatory death—allows many more people to fulfil their wish to donate organs after death.” (Emphasis added)

This slippery slope actually started in 1998 when Jack Kevorkian removed the kidneys of one of his victims and offered them for transplantation. Almost everyone was stunned and horrified. Transplant surgeons refused the organs at that time but the reasons given in some news articles unfortunately had less to do with the ethics than with the concerns over the viability of the organs and the  harvesting technique of the organs themselves.

By 2003, the prestigious journal Critical Care Medicine published an article titled “Role of brain death and the dead-donor rule in the ethics of organ transplantation” by Drs. Robert D. Troug and Walter M. Robinson that went even further:

“We propose that individuals who desire to donate their organs and who are either neurologically devastated or imminently dying should be allowed to donate their organs, without first being declared dead”.  (Emphasis added)

Thus, the actual cause of death would be the organ removal which, in itself, would be euthanasia.

We should not assume that legalized organ donation euthanasia can’t happen here in the US when the public has already been softened up for years by a mostly sympathetic media publicizing sad cases like Brittany Maynard’s and the relentless Compassion and Choices campaign to legalize physician-assisted suicide in every US state.

I can even envision a time when organ donation euthanasia could be presented to the public as merely “medically assisted death-with benefits.”

 

 

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.