My Oral Submission to the New Zealand Health Committee Regarding Physician-assisted Suicide on March 5, 2017

As a nurse and legal consultant in the USA with 47 years of experience in the most challenging areas of medicine such as critical care, oncology, burn unit and hospice, I have seen many of the most challenging cases in medicine. I also have professional and personal experience with suicidal people, including my own 30 year old daughter Marie who died using an assisted suicide technique that she found searching the internet and after a 16 year struggle with drug addiction. I have worked with many suicidal people, including some with terminal illness. To my knowledge, my daughter was the only one lost to suicide.

I have previously submitted written testimony about physician-assisted suicide and I would like to follow up with two crucial issues that I feel must be addressed.

First I will discuss how physician-assisted suicide empowers doctors, not patients. Second, I’ll share a nurse’s perspective.

1. Physician-assisted suicide empowers doctors, not patients.

Society has long insisted that health care professionals adhere to the highest standards of ethics as a form of protection for society. The vulnerability of a sick person and the inability of society to monitor every health care decision or action are powerful motivators to enforce such standards.

However in physician-assisted suicide, unlike any other medical intervention, any licensed doctor of any experience or specialty is granted immunity from “civil or criminal liability or professional disciplinary action for participating in good faith compliance “with an assisted suicide law[1].  The doctor or doctors involved are the ones to decide whether or not the patient is eligible, not the patient.

All the doctor is required to do is fill out a prescription and state forms. The usual standards for caring for a suicidal person including  intensive management[2]  are changed in physician-assisted suicide to “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.”[3] (Emphasis added). Not surprisingly, only 3.8% of people using physician-assisted suicide in Oregon were referred for psychiatric evaluation in 2016[4].

This is dangerous medical discrimination in treatment standards for suicidal people.

In addition, since the doctor is not required to be present or examine the patient after death, any complications or other problems must be self-reported by the doctor to the state. Even the death certificate must be falsified to report the death as from natural causes rather than the lethal overdose.[5]  This violates the standards set by the Centers for Disease Control which require accuracy because, among other issues, “The death certificate is the source for State and national mortality and is used to determine which medical conditions receive research and development funding, to set public health goals, and to measure health status at local, State, national, and international levels.”[6]

The  immunity protections and the secrecy of even the minimal self-reporting standards in US assisted suicide laws eliminates the possibility of future potential lawsuits or prosecutions and keeps the myth of “no problems, no abuses” alive.

2. A Nurse’s Perspective

The dangers of the legalization of physician-assisted suicide are especially acute for us nurses. Unlike doctors, we nurses cannot refuse to care for a patient in a situation like assisted suicide unless another willing nurse can be found which can be impossible. If we do refuse, that is considered abandonment and cause for discipline and even termination. And we are necessarily involved when the assisted suicide act occurs in home health, hospice or health care facility even though the prescribing doctor is not required to be there.

And these deaths are not guaranteed quick, painless or even possible in some circumstances. As a new December 21, 2016 Kaiser Health News article revealed, doctors are trying new drugs because the old drugs are becoming too expensive and taking too long to work. Unfortunately, some new alternative drugs have “turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain”.[7]

Like most nurses, I have worked over the years with a variety of doctors who are at various points on the spectrum on competency and integrity.

Years ago, I was threatened with termination after I refused to increase a morphine drip “until he stops breathing” on a man who would not stop breathing after his ventilator was removed and no other nurse was available to take over the patient. The patient was presumed to have had a stroke when he did not wake up from sedation after 24 hours. I reported the situation up the chain of command at my hospital but no one supported me. I loved my profession and at that time, I was the sole support of three young children but I knew that nothing was worth betraying the trust of my patients.

I escaped termination that time but I refused to back down. Soon after, every nurse on a medical division of nurses refused to give an overdose to a patient and told the doctor that he would have to give it himself. The doctor cancelled the order.

Legalizing physician-assisted suicide can force nurses like us to leave healthcare, leaving no reliable safe haven for people who don’t want to end their lives.

Does anyone really want to entrust our healthcare system just to people who are comfortable with ending lives? I don’t.

FOOTNOTES

[1] “Oregon Revised Statute. 127.885s.01. Online at: https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx

2 “Evaluation and Treatment of the Suicidal Patient” . American Family Physician. Online at http://www.aafp.org/afp/2012/0315/p602.html

3 “Evaluation and Treatment of the Suicidal Patient” .American Family Physician. Online at http://www.aafp.org/afp/2012/0315/p602.html

4 “Oregon Death with Dignity Act Date Summary” .Online at https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year19.pdf

5 : “Washington state “Death with Dignity Act”. Online at http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct/DeathCertificateInstructions

6 CDC Medical Examiners’ and Coroners’ Handbook on Death Registration and Fetal Death Reporting”. CDC. Online at https://www.cdc.gov/nchs/data/misc/hb_me.pdf

7 “Docs  In Northwest Tweak Aid-In-Dying Drugs To Prevent Prolonged Deaths” by JoNel Aleccia. Kaiser Health News. February 21, 2017. Online at http://khn.org/news/docs-in-northwest-tweak-aid-in-dying-drugs-to-prevent-prolonged-deaths/

Reports of My Death are Greatly Exaggerated-Again

In 2009, I began to get emails and calls from people who had read reports about the death of Nancy Valko from physician-assisted suicide in Oregon. Even our ages were almost the same.

After assuring people that I was not only very much alive but just as committed to opposing assisted suicide, I did a google search and found the obituary and information about another Nancy Valko who had planned and publicized a kind of party around her suicide.

Now almost 8 years later, I received an email from a friend who just read an article about the assisted suicide of Nancy Valko. I thought she had just run across an old article but she sent me the article “I will be dancing once again-Nancy Valko’s controversial final act brought her life, but not her legacy, to an end” from the current April 2017 issue of Woman’s Day, a well-known and long-running women’s magazine often displayed at grocery store checkout lines.

The article painted quite a  picture that was”carefully planned” by this Nancy : sunlight streaming through fir trees, bouquets of spring flowers, a manicured backyard and a friend playing classical music on a harp.

She was surrounded by her children and her former husband when she swallowed the lethal mixture. According to the article, her family continued to talk to her for the last two hours of her life telling her they loved her and praising her as an amazing mom.

The article notes that this Nancy was following a healthy lifestyle before she started have mobility problems and was eventually diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. In November 2008, she decided to move to Oregon to use its physician-assisted suicide law. The article states that she wanted to be around for her kids but she “knew that dying from ALS could be brutal-in late stages, sufferers typically remain mentally alert but lose the ability to move, swallow or breathe on their own.” She would eventually have to rely on family, friends or others.

By March when this Nancy started having more trouble talking and thus might not be able to swallow the drugs, she saw a doctor who determined that she was within 6 months of dying and able to swallow the lethal dose by herself. The article notes that “nearly everyone” in Nancy’s circle stood behind her decision to die and friends and family in other states “sent bubbles toward the sky” on April 19, 2009.

After Nancy’s assisted suicide, her older sister Marnie “was inspired” to fight for an assisted suicide law in Vermont that was signed into law in 2013.

The article ends with:

“Nancy wanted her life to matter,” says Marnie. “Because this legislation passed, it still does.”

A short section “The Case Against ‘Death with Dignity'” cites the American Medical Association’s opposition against assisted suicide but says that “it will revisit the issue”. The section also mentions that “some religions” like Catholicism and disability groups like Not Dead Yet also oppose assisted suicide but cite a recent Gallup poll showing that only around 40% of Americans now feel assisted suicide is “morally wrong”.

CONCLUSION

Why did Woman’s Day tell this story again after 8 years? It seems like a desperate attempt to show an assisted suicide as a happy party with friends and family celebrating while a loved one takes her life before, as the article states, there is a “loss of autonomy and dignity”.

I see this Nancy’s death as a sad tragedy of despair.

As a former hospice nurse myself, I felt privileged to be able to help people with life-threatening illnesses and their families achieve a peaceful and comfortable natural death. The traditional hospice philosophy of neither hastening nor prolonging dying allows a natural and truly dignified death that benefits both the patient and his or her family. Personally, these patients and their families inspired me with their devotion and love for each other. People should never feel that they are a burden to themselves, their families or to society.

Physician-assisted suicide is never the answer and I would never inflict it on my family and friends.

What You Need to Know Now That the District of Columbia Has Become the Seventh Jurisdiction in US to Legalize Assisted Suicide

Despite emails and other efforts to encourage the US Congress to exercise its legal authority to stop the Washington D.C. assisted suicide law, the expected congressional action was not completed within the 30 legislative days required.

However, there may be hope on the horizon according to a  February 18, 2017 Washington Times article that said “Congress can still neutralize the Death with Dignity Act by cutting off its funding through the appropriations process.”

What went wrong with the process of nullifying the assisted suicide law in time?  No one seems to know.

But one thing we do know is that Compassion and Choices, the well-funded assisted suicide activist organization, will continue its relentless fight over and over again in every state without an assisted suicide law and in the courts to make assisted suicide legal throughout the US. But even that is not the final goal.

Ominously, we are now seeing assisted suicide leaders like influential lawyer Kathryn Tucker even criticizing the so-called “safeguards” in assisted suicide laws  as “burdens and restrictions”. She now argues that  assisted suicide should be “normalized within the practice of medicine”.

WHAT WE NEED TO KNOW AND DO NOW

We cannot just depend on lobbying our politicians and legislatures to fight assisted suicide only when such bills are introduced in states legislatures or as public initiative votes. We must constantly reinforce our message that every life is worthy of respect and care, not medical termination.

But we must also understand that the assisted suicide/euthanasia movement has had decades of experience in shaping and publicizing its lethal message through carefully crafted steps to convince the public that physician-assisted suicide must be legalized to prevent or end suffering.

As I wrote in my 2013 article “Then and Now: The Descent of Ethics”, the assisted suicide/euthanasia movement has been very busy in the last several decades. I included a short history of the movement that people should know:

The 1970s brought the invention of “living wills” and the Euthanasia Society of America changed its name to the Society for the Right to Die. The so-called “right to die” movement received a real boost when the parents of Karen Quinlan, a 21-year-old woman considered “vegetative” after a probable drug overdose, “won” the right to remove her ventilator with the support of many prominent Catholic theologians. Karen continued to live 10 more years with a feeding tube, much to the surprise and dismay of some ethicists. Shortly after the Quinlan case, California passed the first “living will” law.

Originally, “living wills” only covered refusal of life-sustaining treatment for imminently dying people. There was some suspicion about this allegedly innocuous document and, here in Missouri, “living will” legislation only passed when “right to die” advocates agreed to a provision exempting food and water from the kinds of treatment to be refused.

But, it wasn’t long before the parents of Missouri’s Nancy Cruzan, who was also said to be in a “vegetative” state, “won” the right to withdraw her feeding tube despite her not being terminally ill or even having a “living will.” The case was appealed to the US Supreme Court, which upheld Missouri law requiring “clear and convincing evidence” that Nancy Cruzan would want her feeding tube removed, but, in the end, a local judge allowed the feeding tube to be removed. Shortly after Nancy’s slow death from dehydration, Senators John Danforth and Patrick Moynihan proposed the Patient Self-Determination Act (never voted upon but became law under budget reconciliation), which required all institutions to offer all patients information on “living wills” and other advance directives. Since then, such directives evolved to include not only the so-called “vegetative” state and feeding tubes but virtually any other condition a person specifies as worse than death and any medical care considered life-sustaining when that person is deemed unable to communicate.

But this “choice” is becoming an illusion. In 1999, Texas became the first state to pass a medical futility law to allow doctors and/or medical committees to  override advance directives and patient or family decisions to continue life-sustaining treatment on the basis that doctors and/or medical committees know best when to stop treatment.

In the 1990s, Jack Kevorkian went public with his self-built “suicide machines”  and the “right to die” debate took yet another direction. By the end of the decade, Oregon became the first state to allow physician-assisted suicide. At first, the law was portrayed as necessary for terminally ill people to die with allegedly unrelievable pain. Within a short time, though, it was reported that “according to their physicians, the patients requested assistance with suicide because of concern about loss of autonomy and control of bodily functions, not because of concern about inadequate control of pain or financial loss.”

Other states eventually followed Oregon but efforts to pass assisted suicide laws often failed in other states so Compassion and Choices (the former Hemlock Society) promoted palliative/terminal sedation and VSED (voluntary stopping of eating and drinking) as a legal alternative to assisted suicide in states without such laws.

Compassion and Choices has found much success in working with sympathetic news outlets and pollsters to encourage the public and even medical professionals to support assisted suicide.

Even TV’s popular Dr. Phil McGraw hosted a 2012 segment featuring a Canadian woman who wanted her adult disabled children to die by lethal injection. Ironically, the mother, along with former Kevorkian lawyer Geoffrey Feiger, argued that removing their feeding tubes was an “inhumane” way to end the lives of the adult children. Tragically, when the studio audience was polled, 90% were in favor of lethal injections for the disabled adults. Disability organizations protested after the show, writing that “By conveying social acceptance and approval of active euthanasia of individuals with disabilities by their family members, the segment threatens their very lives”.

Exploiting the natural fear of suffering most people have has also led to a growing acceptance of the premise that it can even be noble to choose death instead of becoming a burden on family members or a drain on society. It is up to us to combat this attitude of despair by  not only educating ourselves and others about the facts and dangers of assisted suicide but also by offering hope and support to those of us most at risk.

My Trip to Georgetown University: The Inspiration of a New Generation

I was honored to be asked to give a talk at the annual Cardinal O’Connor Conference On Life at Georgetown University in Washington D.C. on January 28, 2017, the day after the annual March for Life. To be honest, I believe that I received more from the conference and students than I could ever contribute!

The title of my talk was “Killing or Caring? A Nurse’s Professional and Personal Journey”. I spoke about the progression of the Culture of Death through 4 professional and personal stories from abortion through assisted suicide. My stories included my 1982 fight to save the life of my newborn daughter with Down Syndrome and a severe heart defect against some lethal medical discrimination based on her disability. The second story was about how a young man in a car accident in the early 1970s “miraculously” recovered when we nurses refused to give up after the doctor initially predicted that the young man would at best be a so-called “vegetable” if he lived. The third story was about my daughter who died by suicide in 2009 at the age of 30 using an assisted suicide technique she read about and the tragedy of suicide contagion when assisted suicide is normalized and even glamorized. My last story was how I was almost fired from my ICU unit when I refused to participate in a withdrawal of treatment/terminal sedation euthanasia.

I was so moved by the enthusiastic response of the students to the message that the Culture of Death cannot be ignored or tolerated because evil will always expand until we stop it by demanding the recognition that every life is valuable and worthy of protection. I also loved getting a chance to talk to so many of the students after the talk. They inspired me!

Even on my trips to and from Georgetown University, I met two other inspiring young people. One was a lovely young African-American woman seated next to me on the flight to Washington, D.C. She told me about her career as a police officer patrolling the toughest area in Oakland, California. She also spoke about her passion to help the community and how she embraced the challenges of her choice. Who could not be inspired by that?

The Uber driver who drove me to the airport after my talk was similarly inspiring. It turned out that he was a young nurse who emigrated here from Ethiopia last year and was now studying for his national nursing exam to practice in the U.S. His story was fascinating and when he learned I was a veteran nurse, we had a wonderful discussion about nursing as a great career.

CONCLUSION

We sometimes hear the pessimistic opinion that our next generation is self-absorbed and only interested in money and the next cultural fad.

Based on my experiences in Georgetown, I think that our next generation may prove to be one of the best!

Emergency re-post: Write to Your Legislators in Congress Now!

On January 21, I wrote the following post (see below) to encourage all assisted suicide opponents to contact their own state’s legislators with instructions on how to find your state’s legislators and how to contact them.

There are only 30 legislative days (not calendar days but rather official working days for Congress which are impossible to predict) to contact your own state’s legislators to support a house and senate resolution bill disapproving the D.C. assisted suicide law before it automatically takes effect. The bills are S.J.Res. 4 for the Senate and H.J.Res.27 for the House and both are titled “Nullify District of Columbia Assisted Suicide Law”. You can also find and contact your legislators at those links.

It does not matter if your state has already approved assisted suicide or not. This is a way to let your legislator know you oppose it and this can educate him or her on what a constituent actually wants.

If you can, tell your story about why you oppose legalizing assisted suicide. Speak from your heart. It could be as simple as “I am a senior citizen and I fear giving doctors the right to kill”. Shorter messages are actually more likely to be read.

Thank you.

Nancy Valko RN ALNC

Urgent: Will Congress Stop the Washington D.C. Assisted Suicide Law in Time? Write Now!

January 21, 2017 nancyvalko assisted suicide, Compassion & Choices, law, medical ethics,

Washington D.C. Mayor Muriel Bowser  quietly signed an assisted suicide bill into law on December 19, 2016 after a majority of the city council voted for it.

Under the U.S. Constitution, the Congress has exclusive legislative authority over the District of Columbia. Congress has just 30 legislative days to review a law of the District of Columbia once it is passed by the city government. Resolutions of disapproval must be passed by both houses and be signed by the president to block a D.C. law.

In a race against time, the first step  to block the assisted suicide law was taken January 12, 2017 by Sen. James Lankford (R-Okla.) who introduced introducing a resolution in the Senate that opposes D.C.’s  “Death With Dignity Act”.

A companion resolution was introduced in the House by Rep. Brad Wenstrup (R-Ohio) and Rep. Jason Chaffetz (R-Utah) also said that he would push to block the law.

COMPASSION AND CHOICES HAS ALREADY STARTED A LETTER WRITING CAMPAIGN TO LEGALIZE ASSISTED SUICIDE IN WASHINGTON, D.C.

In a message to assisted suicide supporters, Compassion and Choices claims that “more than 2400 supporters” have “sent more than 7,000 messages to members of Congress”.  The organization also emphasizes “the importance of including your personal testimony” as “often the most effective way to change the minds of lawmakers”.

HOW TO CONTACT YOUR CONGRESSMAN OR CONGRESSWOMAN TO OPPOSE  ASSISTED SUICIDE IN WASHINGTON, D.C.

The National Right to Life Committee has a website link   to “Nullify District of Columbia Assisted Suicide Law” to contact your Senators and a separate link to contact your House representative(s). Enter your zip code in the box provided and you will be taken to a list of your congresspersons and a form you fill out to send an email to those representatives or senators with your comments.

HOW TO WRITE COMMENTS

Keep your comments respectful  and address the points that most move you. If you have a personal story about why you are against assisted suicide, write it as clearly and concisely as possible.

PROBLEMS WITH THE ASSISTED SUICIDE BILL

While many legislators (as well as the public) are persuaded by the “safeguards” to support assisted suicide laws, the Washington D.C. bill has many of the same problems with “safeguards” that other assisted suicide bills have. (For example, see my blogs “The slippery Slope-Tactics in the Assisted Suicide Movement” and “Pain and ‘Choice’“.)

In the D.C. assisted suicide law, such problems include:

1.The extraordinary immunity protections against civil, criminal liability or professional  disciplinary actions for doctors who participate in “good faith compliance” with the law.

  1. Protection from life or annuity insurance problems due to suicide (“Neither may a qualified patient’s at of ingesting a covered medication have an effect upon a life, health, accident, insurance, or annuity policy”)
  2. Minimal reporting requirements and secrecy in public records (“The Department will generate and make available to the public an annual statistical record of information collected”) Emphasis added.
  3. Require mental health evaluation only for the purpose of determining if the person is mentally capable to make the decision to end his or her life. (“‘Counseling’ means one or more consultations as necessary between a state licensed psychiatrist or psychologist  and a patient for the purpose of determining that the patient is capable and not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.”)

CONCLUSION

There are many reasons to oppose legalizing assisted suicide including risk for elder abuse, discrimination against people with disabilities and/or terminal or chronic conditions, the destruction of the most basic rule of medical ethics to not kill patients or help them kill themselves, suicide contagion, etc.

Assisted suicide, legalized and approved by society, is a manifestation of despair and abandonment-not empowerment. We cannot afford to be bystanders while others like Compassion and Choices continue to demand that we all accept legalized assisted suicide as a constitutional and civil right.

 

 

Dr. Anne Bannon, Hero For Life

anne-reading

Dr. Anne Bannon “reading” her old pro-life insert. June 2016.

My friend and hero, Dr. Anne Bannon, died at the age of 89 on January 30, 2017.

Dr. Anne Bannon became a pediatrician decades ago at a time when women were usually discouraged from entering the almost exclusively men’s profession of medicine. But feisty and stubborn, Dr. Anne persevered to become a great doctor and the Chief of Pediatrics at City Hospital in St. Louis.

When the 1973 Roe v. Wade Supreme Court decision to legalize abortion came down, Dr. Anne was surprised and horrified. She went on to found Doctors for Life here in St. Louis.

One of her biggest projects was yearly producing and paying for a multi-page insert into the St. Louis Post-Dispatch (see picture), a newspaper that strongly supports legalized abortion and now assisted suicide.

Dr. Anne’s insert was full of facts but perhaps most importantly, it also listed the names of doctors against abortion. Every year, she would personally call every doctor she could and ask them if they opposed abortion and would agree to be listed in the insert. Despite the effort involved, Anne refused any help in contacting these doctors.

Every year, the list of doctors was long and it took courage for these doctors to agree to be listed. My own obstetrician-gynecologist told me that he received calls from other doctors who told him that they would never refer another patient to him if he continued to be listed in the insert. My doctor refused to be intimidated and he told me that publicly standing up for life was more important than possibly hurting his practice. In the end, his practice wound up even stronger.

DR. ANNE AND I

I was introduced to Dr. Anne in 1982 when my daughter Karen was born with Down Syndrome and a severe heart defect. I told her about several doctors who tried to undermine our decision to have our daughter medically treated exactly the same as any other child with a heart condition.

Of course, Dr. Anne was supportive and in 1983, even introduced me to Dr. C. Everett Koop, then Surgeon General under President Ronald Reagan, so that I could tell him my story and advocate for a national hotline that parents of newborns with any disability  could call to find resources to help their children.

Dr. Anne recognized that legalized abortion was leading to increasing acceptance of deliberate death decisions for born people, especially the disabled. Never married with no family nearby, she asked me to be her durable power of attorney for health care because she wanted truly ethical health care in case she became unable to speak for herself.

Several years ago, Dr. Anne developed dementia, probably Alzheimer’s, and was in a nursing home on Medicaid. By the time she died, she was in the late stages and unable to walk or even speak clearly  most of the time. But she was excited and delighted when we, her friends, visited her in the nursing home even when she could not remember our names. We were her St. Louis family and we loved her.

Dr. Anne fractured her hip last Saturday night and needed surgery. She did well in surgery but suddenly became critically ill at the end of the surgery . But, to the doctors’ surprise and just when they were ready to give up, Anne suddenly got better. She was taken to intensive care on a ventilator and unconscious but stable. Anne’s famous fighting Irish spirit came out one last time and we were proud of her.

Dr. Anne was in critical but stable condition and apparently in a coma when we called a wonderful local priest to give her the Catholic Sacrament of the Anointing of the Sick, previously known as Last Rites or Extreme Unction. According to one friend and the doctor attending, her face seemed to soften during the sacrament and she even blinked and put her tongue out. That in itself was amazing.

After the sacrament, her vital signs immediately started to drop and despite an increase in her medications, Dr. Anne died peacefully and in no distress a few hours later. We knew she wanted the sacrament and I believe that she hung on until she received it.

As a former hospice nurse, I have often seen this kind of hanging on by dying patients until an important matter was resolved.

So, to the end, Dr. Anne was still teaching about the value of all life.

Rest in peace, Dr. Anne Bannon!

Urgent: Will Congress Stop the Washington D.C. Assisted Suicide Law in Time? Write Now!

Washington D.C. Mayor Muriel Bowser  quietly signed an assisted suicide bill into law on December 19, 2016 after a majority of the city council voted for it.

Under the U.S. Constitution, the Congress has exclusive legislative authority over the District of Columbia. Congress has just 30 legislative days to review a law of the District of Columbia once it is passed by the city government. Resolutions of disapproval must be passed by both houses and be signed by the president to block a D.C. law.

In a race against time, the first step  to block the assisted suicide law was taken January 12, 2017 by Sen. James Lankford (R-Okla.) who introduced introducing a resolution in the Senate that opposes D.C.’s  “Death With Dignity Act”.

A companion resolution was introduced in the House by Rep. Brad Wenstrup (R-Ohio) and Rep. Jason Chaffetz (R-Utah) also said that he would push to block the law.

COMPASSION AND CHOICES HAS ALREADY STARTED A LETTER WRITING CAMPAIGN TO LEGALIZE ASSISTED SUICIDE IN WASHINGTON, D.C.

In a message to assisted suicide supporters, Compassion and Choices claims that “more than 2400 supporters” have “sent more than 7,000 messages to members of Congress”.  The organization also emphasizes “the importance of including your personal testimony” as “often the most effective way to change the minds of lawmakers”.

HOW TO CONTACT YOUR CONGRESSMAN OR CONGRESSWOMAN TO OPPOSE  ASSISTED SUICIDE IN WASHINGTON, D.C.

The National Right to Life Committee has a website link   to “Nullify District of Columbia Assisted Suicide Law” to contact your Senators and a separate link to contact your House representative(s). Enter your zip code in the box provided and you will be taken to a list of your congresspersons and a form you fill out to send an email to those representatives or senators with your comments.

HOW TO WRITE COMMENTS

Keep your comments respectful  and address the points that most move you. If you have a personal story about why you are against assisted suicide, write it as clearly and concisely as possible.

PROBLEMS WITH THE ASSISTED SUICIDE BILL

While many legislators (as well as the public) are persuaded by the “safeguards” to support assisted suicide laws, the Washington D.C. bill has many of the same problems with “safeguards” that other assisted suicide bills have. (For example, see my blogs “The slippery Slope-Tactics in the Assisted Suicide Movement” and “Pain and ‘Choice’“.)

In the D.C. assisted suicide law, such problems include:

1.The extraordinary immunity protections against civil, criminal liability or professional  disciplinary actions for doctors who participate in “good faith compliance” with the law.

2. Protection from life or annuity insurance problems due to suicide (“Neither may a qualified patient’s at of ingesting a covered medication have an effect upon a life, health, accident, insurance, or annuity policy”)

3. Minimal reporting requirements and secrecy in public records (“The Department will generate and make available to the public an annual statistical record of information collected”) Emphasis added.

4. Require mental health evaluation only for the purpose of determining if the person is mentally capable to make the decision to end his or her life. (“‘Counseling’ means one or more consultations as necessary between a state licensed psychiatrist or psychologist  and a patient for the purpose of determining that the patient is capable and not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.”)

CONCLUSION

There are many reasons to oppose legalizing assisted suicide including risk for elder abuse, discrimination against people with disabilities and/or terminal or chronic conditions, the destruction of the most basic rule of medical ethics to not kill patients or help them kill themselves, suicide contagion, etc.

Assisted suicide, legalized and approved by society, is a manifestation of despair and abandonment-not empowerment. We cannot afford to be bystanders while others like Compassion and Choices continue to demand that we all accept legalized assisted suicide as a constitutional and civil right.

The Slippery Slope-Tactics in the Assisted Suicide Movement

I first saw this tactic  in the mid-1980s when Missouri was considering a “living will” law to allow a person to refuse “death prolonging procedures” if a person became terminally ill and unable to speak for himself or herself.  Some of us warned about a broader agenda, citing court cases involving feeding tubes and seriously brain-injured but non-terminally ill patients like Paul Brophy and Claire Conroy in New Jersey and Massachusetts . In  response, “right to die” activists (as they were known then) added the ”safeguard” of not allowing the withholding of food and water to the Missouri law  and the bill was passed.

Not surprisingly, Missouri soon faced the Nancy Cruzan case  involving the withdrawal of a feeding tube from a non-terminally ill young woman in a so-called “persistent vegetative state”.  Soon after that,  a Missouri Designated Health Care Decision Maker Act was passed that would allow a person to designate someone to make health care decisions (or a relative if there is no document) including withholding or withdrawing of feeding tubes when the person was incapacitated whether or not they were terminally ill or even in a so-called “vegetative state”.

Now, over 30 years later, we have legalized physician-assisted suicide in several states and the District of Columbia and the former “right to die” groups are now known as Compassion and Choices.

TODAY’S SLIPPERY SLOPE TACTICS

In a December 2016 commentary article titled “End of Life Liberty in DC” for a publication supported by the University of Pittsburgh School of Law, lawyer and long-time assisted suicide activist Kathryn L. Tucker surprisingly criticizes the new assisted suicide law quietly signed into law by the mayor of Washington, DC. this month.

While most people might believe that passage of yet another assisted suicide law would be cause for celebration for assisted suicide activists, Ms. Tucker is unhappy with the so-called “safeguards” in the DC law-just as “right to die” activists were with Missouri’s “living will” law.

Ms. Tucker now complains about the “many burdens and restrictions imposed” by these “safeguards” which, ironically, are added by assisted suicide activists themselves when they  “routinely face arguments of insufficient ‘safeguards’”.  Ms. Tucker lists some of these so-called “burdens and restrictions”:

  • Patients electing AID (aid in dying, the activists preferred term for physician-assisted suicide) must make at least three requests, two oral and one written.
  • The requests must be witnessed.
  • A second opinion confirming diagnosis and prognosis is required.
  • A mental health specialist must be consulted if the attending or consulting physician has concerns regarding the patient’s ability to make an informed decision.
  • A minimum fifteen-day waiting period must elapse between the two oral requests.
  • Physicians must collect and report a vast amount of demographic data on who chooses AID and why.

Ms. Tucker claims these so-called burdens and restrictions “impose heavy governmental intrusion into the practice of medicine, which is concerning because it creates barriers to patient access and to physician participation.” (Emphasis added)

Instead, Ms. Tucker proposes another, more expansive statute without the usual so-called “safeguards” that would provide:

a clear safe harbor (i.e. immunity) for physicians to practice aid in dying in conformity with standard of care. This reflected a positive step in the direction of normalizing AID within the practice of medicine. Medicine is not routinely governed by statute but, rather, by the type of care that a competent health care professional would render in similar circumstances —referred to as standard of care or best practice. (Emphasis added)

In other words, Ms. Tucker is proposing a policy that makes assisted suicide simply normal medical care with special protections against criminal, civil or disciplinary actions for doctors who participate even though such immunity is not given for other medical practices.

CONCLUSION

Ms. Tucker and other are deadly serious about this. When Vermont passed its assisted suicide law in 2013, the law contained a “sunset” provision that would end “nearly all regulation” after the first three years. Fortunately, this was repealed in 2015.

However, assisted suicide activists will not give up on this as Compassion and Choices makes clear:

We firmly believe — and experience demonstrates — that working within healthcare systems to normalize medical aid in dying will ensure fewer people suffer at the end of their life. (Emphasis added)

As Ms. Tucker demonstrates, assisted suicide advocates will promise anything to get assisted suicide laws passed but it appears that they will never be satisfied until assisted suicide becomes a private and unfettered practice using well-funded groups like Compassion and Choices as the potentially taxpayer-funded “experts” in charge of policies, referrals, training and education.

Pain and “Choice”

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

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

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

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

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

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

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

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

TWENTY-FOUR YEARS LATER

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

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

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

CONCLUSION

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

As Wesley Smith recently and astutely observed :

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

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

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

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

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

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

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

THE MISSOURI EXPERIENCE

Missouri’s law against assisted suicide states:

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

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

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

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

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

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

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

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

FALLOUT AND CONSEQUENCES

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

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

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

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

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

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

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