Six Problems with Covid 19 Vaccination Mandates

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

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

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

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

and signed

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

PROBLEM ONE

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

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

What scientific justification is there for this?

PROBLEM TWO

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

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

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

and

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

PROBLEM THREE

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

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

PROBLEM FOUR

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

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

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

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

PROBLEM FIVE

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

PROBLEM SIX

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

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

CONCLUSION

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

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

We are all Americans and we need to work together.

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

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

Why “Living Wills” Are Not Working Well

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

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

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

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

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

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

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

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

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

WHAT DOES WORK?

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

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

However, pitfalls still remain.

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

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

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

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

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

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

CONCLUSION

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

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

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

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

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

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

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

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

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

Who Wants a “Defective” Baby?

by Nancy Valko, R.N.

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

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

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

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

The student refused to believe that this could be true.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Especially mine.

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

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

Karen taught me:

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

That I needed to worry less and celebrate more.


Sources:

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

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

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

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

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


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

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

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

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

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

and signed

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

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

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

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

MORE POTENTIAL PROBLEMS WITH THE COVID 19 VACCINE MANDATE

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

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

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

WHY VACCINE HESITATION OR REFUSAL?

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

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

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

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

CONCLUSION

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

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

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

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

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

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

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

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

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

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

MY EXPERIENCE WITH ROE V. WADE

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

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

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

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

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

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

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

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

CONCLUSION

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

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

An Unexpected Recovery and What We Can Learn from It

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

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

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

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

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

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

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

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

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

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

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

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

WHAT WE CAN LEARN FROM JACOB’S STORY

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

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

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

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

CONCLUSION

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

In Jacob’s own words:

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

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

Covid 19 Vaccine Refusal?

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

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

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

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

VACCINE REFUSAL NOW

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

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

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

However, according to CNN:

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

and

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

with

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

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

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

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

LEGAL CONSIDERATIONS

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

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

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

The article also discusses religious and medical exemptions.

CONCLUSION

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

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

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

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

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

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

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

However, as Mr. Mann wrote:

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

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

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

THE HARSH REALITY TODAY

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

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

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

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

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

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

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

HUNGARY FIGHTS BACK

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

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

As Minister Novak states:

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

THE SITUATION IN THE UNITED STATES

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

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

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

CONCLUSION

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

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

As the US Census Bureau states:

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

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

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

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

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

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

Rethinking Brain Death and Organ Donation

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

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

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

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

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

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

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

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

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

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

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

These experts’ objections to those proposed revisions are that:

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

And these experts further state that:

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

CONCLUSION

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

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

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

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

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

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

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

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

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

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

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

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

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

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

THE MEDICAL ETHICS AND DIVERSITY ACT

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

As the statute eloquently states:

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

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

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

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

In response to this criticism, Governor Hutchinson stated:

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

CONCLUSION

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

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

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

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

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