Nurse Vindicated After Being Forced to Participate in an Abortion

In 2018, I wrote about “The New Federal Conscience and Religious Freedom Division” established by the Trump administration as a desperately needed help for those of us health care professionals whose conscience rights have been ignored or threatened and included a link to report complaints even online.   Now in fiscal 2018 alone, the division says it has received and dealt with more than 1300 complaints.

Most recently and thanks to the Conscience and Religious Freedom Division and with help from the American Center for Law and Justice, an unnamed nurse who was forced into assisting in an elective abortion in 2017 has been vindicated.

On August 28, 2019, the US Department of Health and Human Services, Office for Civil Rights (OCR) announced that, after a thorough investigation and attempts to resolve the issue, the OCR issued a Notice of Violation to the University of Vermont Medical Center (UVMMC) for forcing that nurse to assist in an elective abortion over her conscience-based objections and even though other nurses were available.

The OCR found that the UVMMC had discriminatory policies that assign or require employees to assist abortion procedures even after they record their moral or religious objections. UVMMC now must conform its policies to the long-standing Church amendments that protect the conscience rights of individuals or entities that object to performing or assisting abortions and take corrective action or “face potential action by the HHS from which UVMMC has received federal funding”.

The notice also noted that for the last 3 years UVMMC “reported that it cumulatively expended $1.6 million of federal financial assistance.”

The unnamed nurse, who no longer works at UVMMC, told the American Center for Law and Justice that she was misled into thinking she was assisting in a miscarriage but then found out that it was an elective abortion. However, her superiors “callously refused to relieve her”.  Fearing retaliation, she went through with assisting the abortion and was traumatized.

According to the American Center for Law and Justice, at least four other nurses, have now confirmed that they had been subjected to similar violations of their conscience rights.

As the American Center for Law and Justice also noted, even though the Church amendments were enacted after the US Supreme Court legalized abortion in 1973,  they always lacked a mechanism for enforcement by private citizens. Enforcement depended on the Health and Human Services department. Unfortunately that enforcement has, for all intents and purposes, been nonexistent until recently.

Now the new division has put some teeth into enforcement.

CONCLUSION

As I have written before, groups like Compassion and Choices (the former Hemlock Society) and Planned Parenthood have vehemently criticized the Conscience and Religious Freedom Division, claiming that it would allow medical professionals “to impose their own religious beliefs on their patients and withhold vital information about treatment options” as well as “pave the way for discrimination against people for a variety of reasons.”

The fundamental right not to perform or assist in deliberate death procedures terrifies these organizations that depend on medical professionals willing to assist suicides or perform abortions.

Therefore, we must all make sure that the whims of politics never again interfere with the fundamental right of medical professionals to “Do no harm”.  This is not only for their protection but also for our own.

 

 

 

The National Association of Pro-life Nurses Statement Opposing the Palliative Care and Hospice Education and Training Act (2019)

The National Association of Pro-life Nurses joins the Euthanasia Prevention Coalition USA and the Healthcare Advocacy and Leadership Organization (HALO) and other organizations in opposing the  Palliative Care and Hospice Education and Training Act (2019) H.R. 647, S.2080.  (HALO has issued an action alert with the contact numbers for legislators on the Senate committee considering this bill.)

As nurses, we strive to care for our seriously ill, disabled and terminally ill patients with compassion and the highest ethical standards. We applaud the medical innovations and supportive care options that can help our patients attain the highest quality of life possible.

However now many of us nurses are now seeing unethical practices such as assisted suicide, terminal sedation (with withdrawal/withholding of food, water and critical medicines), voluntary stopping of eating, drinking and even spoon feeding, etc. used to cause or hasten death but often called palliative, “comfort” or routine hospice care for such patients.

We believe that the Palliative Care and Hospice Education and Training Act (2019) will allow federal funding to teach and institutionalize such unethical practices without sufficient oversight, safeguards or penalties.

For example, the Section 5 Clarifications (p. 21) against federal funding for objectionable practices “furnished for the purpose of causing, or the purpose of assisting in causing, a patient’s death, for any reason” is toothless. Such practices are already  considered acceptable by many influential hospice and palliative care doctors like Dr. Timothy Quill, a board-certified palliative care physician, 2012 president of the American Academy of Hospice and Palliative Medicine and promoter of legalizing physician-assisted suicide and terminal sedation.

It is also disturbing the Compassion and Choice, the largest and best funded organization promoting assisted suicide and other death decisions,  has a mission statement stating:

“We employ educational training programs, media outreach and online and print publications to change healthcare practice, inform policy-makers, influence public opinion and empower individuals.”

and a “Federal Policy Agenda / 2016 & Beyond”  goal to:

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

As nurses, we are also very concerned that the Act contains no conscience rights protection for those of us-doctors and nurses alike-who will do anything for our patients except deliberately end their lives or help them kill themselves.

Many of us have already faced threats of termination of employment for refusing to participate in unethical, life-ending practices without support from our nursing organizations like the American Nurses Association that recently dropped their traditional opposition to physician-assisted suicide and voluntary stopping of eating and drinking.

For the sake of protecting our patients, the integrity of our medical and nursing professions as well as our healthcare system, we urge the public and our congressional representatives to oppose this dangerous Act.

 

Press Release: The National Association of Pro-life Nurses Condemns the American Nurses Association Decision to Drop Its Long-standing Opposition to Assisted Suicide

In June 2019, the American Medical Association (AMA) House of Delegates decisively approved reaffirming the AMA’s long-standing policy opposing physician-assisted suicide despite enormous pressure from assisted suicide supporters and groups like Compassion and Choices as well as some other professional associations to change its position to “neutrality”.

But a few weeks later, the American Nurses Association (ANA) dropped its long-standing policy opposing physician-assisted suicide. Instead its’ new “The Nurse’s Role When a Patient Requests Medical Aid in Dying (aka physician-assisted suicide)” insists that it is really about “high-quality, compassionate, holistic and patient-center care, including end-of-life care”.

As the new position states, “A nurse’s ethical response to a patient’s inquiry about medical aid in dying is not based on the intention to end life. Rather, it is a response to the patient’s quality-of-life self-assessment, whether based on loss of independence, inability to enjoy meaningful activities, loss of dignity, or unmanaged pain and suffering.” (Emphasis added)

This response includes even being present when the patient takes the lethal overdose: “If present during medical aid in dying, the nurse promotes patient dignity as well as provides for symptom relief, comfort, and emotional support to the patient and family.” (Emphasis added)

For nurses who object to assisted suicide, the position states that “Conscience-based refusals to participate exclude personal preference, prejudice, bias, convenience, or arbitrariness” and that “Nurses are obliged to provide for patient safety, to avoid patient abandonment, and to withdraw only when assured that nursing care is available to the patient” (Emphasis added)

In other words, nurses would have to abandon their vital role in preventing and treating suicide for some of their patients when the issue is assisted suicide. And a conscience-based refusal to participate depends on whether or not another nurse willing to participate is available.

Although the ANA insists that their position “is intended to reflect only the opinion of ANA as an organization regarding what it believes is an ideal and ethical response based on the Code of Ethics for Nurses with Interpretive Statements”, the effect is chilling for those of us who cannot or will not help our patients kill themselves even where legal.

Already, Compassion and Choices (the former Hemlock Society) is praising the ANA for “dropping opposition to ‘medical aid in dying’”, stating that “It’s no surprise that the largest national nursing association recognized the growing public demand for medical aid in dying and updated their policy to allow nurses to better support their patients at life’s end.” (Emphasis added)

But the ANA may eventually have to again update their position on assisted suicide since we are now seeing, as in a (thankfully failed) recent bill in New Mexico,  further attempts to change the definition of terminal illness to expected death in the “forseeable future”,  non-physicians such as advance practice nurses able to prescribe assisted suicide, inclusion of people with mental health disorders, approval by “telemedicine” and no state residency requirement.

Right now, less than ten percent of the nation’s nurses are members of the ANA or other professional organizations” and that number is declining. The ANA should reconsider its new position on assisted suicide for the good of all nurses and even society itself.

In the end, who will remain or want to enter a healthcare profession that allows helping some patients kill themselves? And how many of us would be just as trusting with a nurse who is as comfortable with assisting our suicide as he or she is with caring for us?

 

Contact

Marianne Linane RN, MS, MA, National Association of Pro-Life Nurses Executive Director

📞  (202) 556-1240
✉  Director@nursesforlife.org

Nancy Valko, RN ALNC Spokesperson for the National Association of Pro-Life Nurses

📞 (314)504-5208

Website: www.nursesforlife.org

Facebook: https://www.facebook.com/Nurses4life/

 

 

American Nurses Association Damages Good Nursing with Misleading “No Stance” on Assisted Suicide

In 2017 and despite opposition by nurses and groups like the National Association of Pro-life Nurses, the American Nurses Association (ANA) approved a new position on “Nutrition and Hydration at the End of Life” supporting a form of suicide called VSED ( voluntary stopping of eating and drinking) to “hasten death”.

The ANA also stated regarding VSED that nurses who have “an informed moral objection….should communicate their objections whenever possible, to provide safe alternative nursing care for patients and avoid concerns of patient abandonment” (Emphasis added)

In March 2019, the American Nurses Association (ANA) then wrote a draft position paper “The Nurse’s Role When a Patient Requests Aid in Dying” that would have dropped the ANA’s long-standing opposition to physician-assisted suicide and even change the term “physician-assisted suicide” to “medical aid in dying”. The paper would require nurses to be “non-judgmental when discussing end of life options with patients”, and that nurses who object to assisted suicide are still “obliged to provide for patient safety, to avoid patient abandonment, and to withdraw only when assured that nursing care is available to the patient.

In other words, nurses would have to abandon their vital role in the prevention and treatment of people with suicidal ideation for some of their patients when the issue is assisted suicide. Conscience rights could only be invoked if free from “personal preference, prejudice, bias, convenience, or arbitrariness”. (Emphasis added)

Many people responded with shock and dismay, including many nursing organizations like the National Association of Pro-life Nurses and even the Canadian Catholic Nurses Association  that warned about their experience after assisted suicide was legalized there in 2015:

“we experience ongoing demands for access to lethal injections for new categories of patients, including “mature minors;” those who write advanced directives; and those whose mental illness is the sole condition underlying their request.” (Emphasis added)

THE FINAL POSITION

Now the ANA has issued its final position on “The Nurse’s Role When a Patient Requests Medical Aid in Dying” (aka physician-assisted suicide) that claims it is not “a stance for or against medical aid in dying but rather to frame the nurse’s compassionate response within the scope of practice”. (Emphasis added)

However, this new final position has the same problems as the draft when it states that a nurse should:

 “Remain objective when discussing end-of-life options with patients who are exploring medical aid in dying”

And now, a new requirement is added for the nurse who objects to participating in assisted suicide:

“Never ‘abandon or refuse to provide comfort and safety measures to the patient’ who has chosen medical aid in dying. Nurses who work in jurisdictions where medical aid in dying is legal have an obligation to inform their employers that they would predictively exercise a conscience-based objection so that appropriate assignments could be made.” (All emphasis added)

This obligation to preemptively inform employers about objections to participating in terminating life opens a nurse to potential discrimination, bullying or even termination of employment, not to mention the chilling effect on ethical men and women considering a nursing career.

CONCLUSION

In its press release on the final position, the ANA states that its new position is “a step in a new direction for ANA and provides guidance for almost 1 million registered nurses in the U.S. who practice in the nine jurisdictions where medical aid in dying (MAID) is legal.” The ANA also states that “This statement is intended to reflect only the opinion of ANA as an organization regarding what it believes is an ideal and ethical response based on the Code of Ethics for Nurses with Interpretive Statements.” (All emphasis added)

However, the ANA also claims that it ‘is the premier organization representing the interests of the nation’s 4 million registered nurses’ even while  less than ten percent of the nation’s nurses are members of the ANA or other professional organizations” and that number is declining.

The ANA along with the American Medical Association (AMA) are the best known health care professional organizations and both are very politically active.

Ironically and just last month, the AMA House of Delegates decisively reaffirmed the AMA’s long-standing opposition to assisted suicide while the ANA has now surrendered its influence to the pro-assisted suicide movement.

Just as bad, the ANA has now effectively abandoned ethical nurses’ conscience rights when it comes to deliberate death decisions.

Although we now have the Conscience and Religious Freedom Division established by the Trump administration in the Office for Civil Rights to enforce already existing “federal laws that protect conscience and the free exercise of religion and prohibit coercion and discrimination in health and human services” and has a link to file a conscience or religious freedom complaint, it’s final rule implementation has now been delayed by lawsuits.

As assisted suicide and other such deliberate death decisions continue trying to expand, it is more necessary than ever that all of us-the public as well as healthcare professionals-understand and fight the pro-death movement to regain our trust in the healthcare system.

Final Federal Conscience Protection Rule Delayed Because of Lawsuits

Last year, I wrote about the new Conscience and Religious Freedom Division established by the Trump administration in the Office for Civil Rights to enforce already existing “federal laws that protect conscience and the free exercise of religion and prohibit coercion and discrimination in health and human services”. The division specifically mentioned “issues such as abortion and assisted suicide in HHS (Health and Human Services)-funded or conducted programs and activities”. The division also included a link to file a conscience or religious freedom complaint “if you feel a health care provider or government agency coerced or discriminated against you (or someone else) unlawfully”.

The rule mandates that institutions receiving federal money be certified that they comply with more than two dozen laws protecting conscience and religious freedom rights.

Despite fierce opposition by groups like Compassion and Choices and Planned Parenthood, HHS announced  on May 2, 2019 that the Final Conscience Rule Protecting Health Care Entities and Individuals  would go into effect July 22, 2019.

However, lawsuits were quickly filed by groups like Americans United for Separation of Church and State and the Center for Reproductive Rights, delaying implementation of the Final Conscience Rule until at least late November. The first lawsuit was filed by San Francisco within hours of the announcement of the Rule.

WHAT IS THE PROBLEM WITH CONSCIENCE RIGHTS?

While Roger Severino, the head of the HHS Office for Civil Rights has said that the Final Rule did not add any new laws but rather strengthened the enforcement of rules already on the books, the San Francisco lawsuit alleged that if San Francisco does not comply with the rule “”it risks losing nearly $1 billion in federal funds that support critical health care services and other vital functions.”

In a press release, San Francisco city attorney Dennis Herrera stated the Final Conscience Rule:

“would have allowed health care professionals to refuse to provide service to patients based on the staffer’s personal beliefs, threatening medical access for women, lesbian, gay, bisexual, and transgender people, and other medically or socially vulnerable populations.”

and that

“Hospitals are no place to put personal beliefs above patient care. Refusing treatment to vulnerable patients should not leave anyone with a clear conscience.”(All emphasis added)

Of course, ethical healthcare professionals respect all patients without bias. The problem is being forced to participate in actions that violate our consciences.

ARE CONSCIENCE AND RELIGIOUS RIGHTS NECESSARY?

Dr. Donna Harrison, director of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) makes the crucial point that:

 “Those who oppose the HHS Conscience Rule demonstrate their clear intention to squeeze out of the medical profession any doctor who still abides by the Hippocratic Oath, and to squelch any opposition to forcing doctors to kill human beings at the beginning and end of life.”

Those of us who are nurses have been especially vulnerable.

As I have written before, I was threatened with termination when I refused to cause a patient’s death by increasing a morphine drip “until he stops breathing”. I know many other nurses who have had similar experiences.

And in 2013, 12 New Jersey nurses who had a long-standing, in-writing agreement exempting them from participating in abortions apart from a medical emergency were nevertheless threatened with termination when the hospital initiated a new mandatory policy to participate in all abortions. These nurses were finally vindicated in court but litigation is time-consuming and expensive.

And even the liberal NPR recently noted the rise in conscience complaints for health care workers since the Division of Conscience and Religious Freedom was established.

Obviously, there is a great need for this conscience rights protection for all healthcare workers. Now there is a way to stand up  to bullying and discrimination so that we can properly care for our patients.

CONCLUSION

A few years ago, a worried student nurse asked if there was any area of nursing where her conscience rights would not be threatened. This was an important question because over the past several decades, new threats to conscience rights have widened from refusing to participate in abortions to other deliberate death decisions like withdrawal of feedings from people with serious brain injuries, VSED (voluntary stopping of eating and drinking), terminal sedation and physician-assisted suicide.

Most recently, the American Nurses Association wrote a draft position paper potentially changing its’ opposition to assisted suicide to neutrality and requiring that nurses must be nonjudgmental in discussing assisted suicide with a patient and even participate if no other willing nurse is available.

As assisted suicide and other such death decisions continue trying to expand, it is more necessary than ever to support ethical healthcare professionals both in law and in practice.

We all need the Conscience Rights Protection rule to ensure that ethical healthcare professionals can continue in their professions and help to restore trust in our healthcare system.

Great News: American Medical Association Votes to Continue Opposition to Physician-assisted Suicide. But Will the American Nurses Association Follow?

Over the last few years the American Medical Association (AMA) has been under enormous pressure from assisted suicide supporters and groups like Compassion and Choices as well as some other professional associations to change its’ long standing opposition to physician-assisted suicide to “neutrality”.

This month, the AMA House of Delegates decisively approved a strong report from AMA’s Council on Ethical and Judicial Affairs reaffirming current AMA policy on physician-assisted suicide stating that:

“permitting physicians to engage in assisted suicide would ultimately cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.”

Dr. Shane Macaulay, MD, of Kirkland, Wash., speaking for the Washington delegation supported the report, stating that:

“Oregon legalized assisted suicide in 1997 with repeated assurances that it would stay contained and would not become euthanasia” (but) “Just last month, the Oregon state House of Representatives approved a bill to allow patient death by lethal injection, showing the inevitable progression from assisted suicide to euthanasia once physicians have accepted the idea that taking a patient’s life is permissible.”

Dr. David Grube, the national medical director of the pro-assisted suicide organization Compassion and Choices, countered that physician-assisted suicide is:

“a rarely-used request from patients, and yet it’s a response we can give to them when they’re suffering. The enemy is not death, but the enemy is terminal suffering; responding to that in ways that provide comfort is what matters the most.”

Ironically, physician-assisted suicide laws themselves do not require that pain or other suffering be present but rather death expected within six months.

In the Compassion and Choices article titled “AMA contradicts itself by passing resolution saying medical aid in dying is unethical, but ethical doctors can practice it”, Dr. Grube further criticizes the decision, saying:

“The report by the AMA Council on Ethical and Judicial Affairs (CEJA) reinterpreted the AMA’s Code of Medical Ethics (CEJA) by maintaining that ‘physician-assisted suicide’ (i.e., medical aid in dying) is ‘fundamentally incompatible with the physician’s role as healer,’ while paradoxically saying physicians can provide medical aid in dying ‘according to the dictates of their conscience without violating their professional obligations.’” (Emphasis added)

However, the report itself concluded that:

“Because Opinion E-5.7O   powerfully expresses the perspective of those who oppose physician-41 assisted suicide, and Opinion E-1.1.7   (on the exercise of conscience) articulates the thoughtful moral basis for those who support assisted suicide, the Council on Ethical and Judicial Affairs recommends that the Code of Medical Ethics not be amended, that Resolutions 15-A-16 and 14-A-17 (on neutrality) not be adopted, and that the remainder of the report be filed.”

As I wrote in my 2016 blog “Neutrality Kills”:

In 1997, Oregon became the first state to pass a physician-assisted suicide law. This came after the Oregon Medical Association changed its position from opposition to neutrality. 21 years later and after multiple failed attempts, the California state legislature approved the latest physician-assisted suicide law after the California Medical Association changed its opposition to neutrality.

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

BUT THIS IS NOT JUST ABOUT DOCTORS

Earlier this year the American Nurses Association (ANA) wrote a draft position paper  about dropping its longstanding opposition to assisted suicide. The ANA draft paper also proposed changing the term “assisted suicide” to ““aid in dying”, requiring that nurses to be “non-judgmental when discussing end of life options with patients”, and that nurses who object to assisted suicide are still  “obliged to provide for patient safety, to avoid patient abandonment, and to withdraw only when assured that nursing care is available to the patient.” (Emphasis added)

In other words, nurses must abandon their vital role in detecting and preventing suicide for some of their patients when it comes to assisted suicide. This kind of discrimination is not only lethal to the patient but also discourages dedicated, ethical people from entering or remaining in the healthcare professions.

Although most doctors and nurses are NOT members of the ANA or AMA, if such organizations capitulate to the pro-assisted suicide groups, legalized assisted suicide throughout the US may be inevitable.

Hopefully, the ANA will follow the AMA example of continued opposition to assisted suicide and begin to restore the public’s trust that we will never kill our patients or help them kill themselves.

 

How Could This Happen? Ohio Doctor Accused of Murder in 25 Patient Overdose Deaths

The shocking June 5, 2019 Associated Press headline read “Doctor accused of murder in 25 patient overdose deaths” and the details were alarming to read.

Dr. William Husel, a critical care physician, “was charged with murder Wednesday in the deaths of 25 hospital patients who, authorities say, were killed with deliberate overdoses of painkillers, many of them administered by other medical workers on his orders” at the Columbus-based Mount Carmel Health System in Ohio, a member of one of the largest Catholic health care delivery systems in the nation.

The Mount Carmel Health System found that Husel “ordered potentially fatal drug doses for 29 patients over several years, including five who may have been given that pain medication when there still was a chance to improve their conditions with treatment. The hospital system said six more patients got doses that were excessive but likely didn’t cause their deaths.”

According to the article “Many of the patients who died were on ventilators and receiving palliative care. The deaths occurred between 2015 and 2018.” Authorities decided not to prosecute the 48 nurses and pharmacists involved, although they were reported to their professional boards.

Dr. Husel pleaded not guilty and his lawyer said that Dr. Husel “was trying to provide ‘comfort care’ for dying patients. At no time did Dr. Husel ever intend to euthanize anyone — euthanize meaning speed up death.”

According to the article, none of the families of the victims who talked with investigators believed that what happened was “mercy treatment”.

In a related February Columbus Dispatch article Attorneys say former Mount Carmel doctor might have inappropriately deemed patients brain-dead”, it was also alleged by attorneys for the families that there were several instances where Dr. Husel would prescribe excessive dose of fentanyl shortly after telling family member their loved one was brain dead.

More than 2 dozen wrongful death lawsuits have now been filed against the doctor and  Mount Carmel.

Mount Carmel publicly apologized and said “it should have investigated and taken action sooner. It has acknowledged that the doctor was not removed from patient care for four weeks after the concerns were raised, and three patients died during that time.” (Emphasis added)

HOW COULD THIS HAPPEN?

When I started my career as a nurse in 1969, a situation like this was unthinkable, especially in a Catholic institution like Mount Carmel. But over the years, I saw ethics begin to change for the worse with the so-called “right to die” involving seriously brain-injured but non-dying people who needed feeding tubes. Eventually, the “right to die” became the “right to choose” legalized physician-assisted suicide by lethal overdose for people expected to die within 6 months with immunity granted to the prescribing doctor. Tragically, public and professional attitudes started to change.

Several years ago on a night shift in my intensive care unit, I was involved in a case similar to these 25 alleged murders when I was almost fired for refusing to increase a morphine drip “until he stops breathing” on a patient who continued to breathe after his ventilator was removed. The doctors presumed (mistakenly, as it turned out) that the patient had had a massive stroke and thus was irreparably brain-damaged.

I immediately reported this to the supervisor and a doctor but I was told that giving and increasing the morphine-even though the patient showed no discomfort-was merely “comfort care” that would “prevent pain”. But I knew it was euthanasia. No one supported me but I persisted trying to get a response from the patient after I stopped the morphine to hopefully give him a chance.

I was not surprised when I was later told that the doctor who gave the order wanted me fired. I defended myself and refused to be reprimanded or otherwise punished. I even threatened legal action.

I was relieved when I was not fired but other nurses heard about the incident and recognized the problem. Nurses on one unit began refusing to give what they now saw as lethal overdoses to terminally ill patients and eventually that practice stopped on that unit.

CAN SUCH CASES BE PREVENTED?

In another related March AP article ” 25 nurses over high doses for patients who died”, Attorney General Dave Yost, whose office represents the Ohio Board of Nursing in this matter, said that “Nurses who helped administer excessive and possibly fatal painkillers to dozens of Ohio hospital patients should have questioned an intensive-care doctor’s order for those high doses” and was quoted as saying:

“Nurses are professionals who have a duty to exercise their best judgment, and tens of thousands of them do, every single day. These nurses didn’t.”

But is this fair?

In Dr. Husel’s case, remember that Mount Carmel admitted it did not remove him for four weeks after concerns were raised and three more patients died.

I know how hard it is to report a problem with a doctor, especially when you realize that your own career may be at risk as a nurse. I’ve personally seen nurses fired or harassed until they quit when they reported a doctor or a serious problem. Tragically,  I have not yet seen our national or state nurses associations backing up such brave nurses. This is why I support not only strong conscience rights for all health care professionals but also whistle blower protection for the person reporting a problem so they will not lose their job.

It is said that sunlight is the best disinfectant and that is why I tell my story as well as similar stories other nurses have told me. The public has a right to know and be aware of potential problems that can occur when they or their loved ones face a life-threatening illness. They need to know the questions to ask and the actions to take if the answers are not acceptable.

Also, we need to fight against physician-assisted suicide laws and the seductive lie promoted by Compassion and Choices that killing can be “humane” in some circumstances. Terminal illness, disability, fear of being a burden, etc. are never reasons to end someone’s life, even when the person himself or herself asks for the lethal overdose.

Personally, I now always make sure the health care providers for myself or my loved ones share my values.

It’s a matter of safety and trust as well as ethics.

When Palliative Care goes Horribly Wrong

As I have written before,   I was almost fired for refusing to increase a morphine drip “until he stops breathing” on a patient who continued to breathe after his ventilator was removed. The doctors mistakenly presumed he had a massive stroke and thus was irreparably brain-damaged. I was told at that time that giving and increasing the morphine even though the patient showed no discomfort was merely “comfort care” that would “prevent pain”. I knew it was euthanasia.

I remembered this terrible incident when I read the April 1, 2019 Federalist magazine article “This Belgian Nurse Watched Euthanasia Turn Pain Management Into A Death Prescription”

Belgium has had legalized euthanasia for many years, including organ donation euthanasia and now even minors and psychiatric patients. But Sophie Druenne, a palliative care nurse, reached her breaking point when she had to call a doctor had to come back to give another lethal injection when the patient didn’t die from the first injection. Sophie caught herself laughing at the absurdity of the situation at first but then realized the horror of the situation and began to question Belgium’s so-called social experiment with euthanasia.

What changed Sophie’s opinion was working in Belgium’s integrated palliative care (IPC) system. Palliative care is “medical aid that treats symptoms of a typically serious disease rather than the disease itself, which sometimes cannot be treated or not easily.” However Belgium’s euthanasia framework now includes integrated palliative care in the framework.

As the article states, palliative care used to be defined by the anti-euthanasia beliefs of its founder, Dame Cicely Saunders, a British nurse who developed holistic care for the dying in the 1940s. Dame Saunders believed that “that a patient’s request for euthanasia represented a failure to adequately care for the patient’s spiritual, emotional, and social needs.”

Although Belgium tried to reconcile Dame Cicely Saunders’ standard with its euthanasia laws, Sophie observed that the guiding intention to relieve suffering changed from “first, do no harm” to “first, relieve suffering”. This allowed euthanasia to become an “easy” solution that could effectively nullify even patient consent.

Sophie finally left Belgium to take a position in Paris at a hospital where terminally ill patients are treated with traditional palliative care

THE SITUATION IN THE US

Recently I was giving a talk on assisted suicide/euthanasia when I noticed that a woman in the audience was visibly upset. After I finished, I went over to her to ask if I said something that upset her. She responded that she was a nurse for 30 years and, when I related the story about the morphine overdose I refused to give, she said that she suddenly realized the truth of what was happening in her hospital. She started to cry while I held her hand. She was devastated just like the Belgian nurse.

Palliative care is a wonderful holistic approach to evaluating the patient’s needs beyond just the physical but it must not include causing death.

Unfortunately, a recent Delaware assisted suicide bill  actually tried to define assisted suicide as a palliative care option.

Currently, hospice/palliative care is held up as a good way to combat assisted suicide. However,  Compassion and Choices touts  that “(a) growing number of national and state medical organizations have endorsed or adopted a neutral position regarding medical aid in dying (physician-assisted suicide) as an end-of-life option for mentally capable, terminally ill adults.”

Barbara Coombs Lee, CEO of Compassion and Choices even issued a 2017 “Call to the Palliative Care Community for a Patient-Centered Response to Medical Aid in Dying (aka physician-assisted suicide)” stating that assisted suicide actually “could improve the image and acceptance of palliative care” by taking a position of  “engaged neutrality” that “indicates that it is a professional organization’s obligation to provide its members with the clinical guidelines, information, and tools they need if they choose to support their patients’ requests” for assisted suicide.” (Emphasis added)

Not surprisingly, Compassion and Choices had supported the 2016  “The Palliative Care and Hospice Education and Training Act” (reintroduced this year as HR 647) that would provide millions of dollars in grants or contracts to “increase the number of permanent faculty in palliative care at accredited allopathic and osteopathic medical schools, nursing schools, social work schools, and other programs, including physician assistant education programs, to promote education and research in palliative care and hospice, and to support the development of faculty careers in academic palliative medicine.” (Emphasis added)

Fortunately, a provision was added to forbid federal assistance to any health care item or service causing or assisting death such as assisted suicide. Since then, the Compassion and Choices website has been silent on the Act.

CONCLUSION

Over the years, the public has been told that assisted suicide is a humane answer to emotional and physical suffering at the end of life. But if doctors, nurses and their professional organizations come to agree with this, we all will lose the protection of truly ethical healthcare that rejects causing death as a solution. We must be able to trust that our healthcare system will  give us the care we need and deserve, especially at the end of our lives.

We cannot become like Belgium.

Assisted Suicide and “Failure of Unconsciousness”

As a nurse, I have seen patients assumed to be unconscious while in a coma or sedated on a ventilator later tell me about some memories and feelings during that time. This is why I always cared for such patients as if they were awake.

Now in a stunning February, 2019 Association of Anaesthetists article titled “Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying”, a group of international doctors explore the difficulty in ensuring unconsciousness to death in lethal injection capital punishment and assisted suicide/euthanasia. (Note: Since the authors are international, some quoted terms here are spelled differently than here in the US)

Believing that “A decision by a society to sanction assisted dying in any form should logically go hand‐in‐hand with defining the acceptable method(s)”, the authors reviewed the methods commonly used and contrast these with an analysis of capital punishment in the US. They “expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used.”

They were wrong.

They found that with self-administered lethal overdoses “with death resulting slowly from asphyxia due to cardiorespiratory (heartbeat and breathing) depression”, helium self-suffocation and the Dutch lethal injection that resembles US capital punishment, “there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re‐awakening from coma (up to 4%), constituting failure of unconsciousness.” (Emphasis added)

The authors take no position on assisted suicide and state their intention to “dispassionately examine whether the methods used to induce unconsciousness at the point of death in assisted dying achieve their objective”. With many of the authors being anesthesiologists themselves, they used the most recent research into “accidental awareness” during anesthesia to try to find an “optimal means” that could better achieve unconsciousness.

ASSISTED SUICIDE AND CAPITAL PUNISHMENT

It was difficult for the authors to find discussion of actual methods to cause death but the Dutch have published guidelines for both “passive participation” where the doctor prescribes a high-dose barbiturate and “active participation where the doctor administers a high dose of IV anesthetic and a neuromuscular (paralyzing) drug.

Notably, the authors found that a lethal injection is recommended by the Dutch when self-ingestion death fails to occur within 2 hours and that this is “an explicit recognition” that self-ingestion can fail.

The Dutch lethal injection resembles (except for the use of potassium to stop the heart) the US method of capital punishment so the authors looked at the US method of lethal injection capital punishment because it is “designed to be ‘humane’ and bears technical similarities” to lethal injection assisted suicide/euthanasia. The US lethal injection protocols also includes technical aspects such as drugs, dosage and monitoring of the patient.

However, as the authors note, “prisoners have been reported to be clearly awake and in distress during some executions”. Two death row prisoners even petitioned the US Supreme Court to consider a requirement for a physician to confirm unconsciousness before the lethal drugs are given. They argued that they “might be awake but paralysed at the point of death, making the method a ‘cruel or inhumane punishment’ which violated the US constitution’s Eighth Amendment”. (Emphasis added) The authors note that this “situation has clear parallels with the problem of ‘accidental awareness during general anesthesia’, where the patient awakens unnoticed and paralysed during surgery, which is known to be a potent cause of distress.” However, the US Supreme Court rejected this argument in 2008, “concluding that the anaesthetic doses used reliably achieved unconsciousness without any need to check that this was the case.” (All emphasis added)

As the authors state, “We now know that the Court was wrong.” (Emphasis added)

DO US ASSISTED SUICIDE LAWS GUARANTEE A PEACEFUL DEATH?

The US assisted suicide laws mandate secrecy in reporting requirements and the little yearly data available about complications is self-reported by the doctors who are not required to be with the person during the process or even afterwards to pronounce death.

However, the authors were able to use data from the Dutch protocols, and other similar methods used elsewhere and state that after taking the lethal overdose:

“patients usually lose consciousness within 5 min. However, death takes considerably longer. Although cardiopulmonary collapse occurs within 90 min in two‐thirds of cases, in a third of cases death can take up to 30 h(ours) 3133. Other complications include difficulty in swallowing the prescribed dose (in up to 9%) and vomiting thereafter (in up to 10%), both of which prevent suitable dosing, and re‐emergence from coma (in up to 2%). Each of these potentially constitutes a failure to achieve unconsciousness, with its own psychological consequences, and it would seem important explicitly to acknowledge this in suitable consent processes.” (Emphasis added

The authors also note:

“that the incidence of ‘failure of unconsciousness’ is approximately 190 times higher when it is intended that the patient is unconscious at the time of death 3133, as when it is intended they later awaken and recover after surgery (when accidental awareness is approximately 1:19,000)21, 22. (Emphasis added)

CAN TECHNOLOGY ENSURE UNCONSCIOUSNESS?

The authors discuss the limitations of just using EEGs (brain wave tests) and the isolated forearm technique (IFT) where the person can move their single, non-paralysed forearm to signal their awareness.

Instead the authors state:

“Recent lessons from anaesthesia lead us to conclude that, if we wish better to ensure unconsciousness at the point of death… then this can be achieved using: (1) continuous drug infusions at very high concentrations; (2) concomitant EEG‐based brain function monitoring, targeted to the very low, burst suppression or isoelectric values; and (3) clinical confirmation of unconsciousness by lack of response to command or to painful/arousing stimuli (and this last could include an IFT). Alternative methods that do not include these elements entail a higher, possibly unacceptable, risk of remaining conscious and so, by definition, are suboptimal.” (Emphasis added)

However, the authors acknowledge practical problems with this protocol such as the technical requirements requiring the involvement of trained practitioners like anesthetists.

And the “optimum method” for ensuring unconsciousness is so medicalized that:

“Society or individuals might prefer to retain a choice for alternative methods, even if these are suboptimal and carry a greater risk of consciousness at the point of death 54. If so, then legal frameworks and consent processes should explicitly acknowledge this choice. ” (Emphasis added)

CONCLUSION

The assisted suicide legalization movement led by Compassion and Choices portrays assisted suicide as an easy and dignified death, even one that can be a cause of celebration.

Polls about assisted suicide like the latest Gallup poll find 65% say “yes” when asked “When a person has a disease that cannot be cured and is living is severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patient requests it?” even though assisted suicide laws don’t mention pain and state that the person must be terminally ill and expected to die within 6 months.

But how many people, especially legislators, would still say “yes” to legalizing assisted suicide after learning the truth in this article about the so-called “peaceful” assisted suicide?

And how many people would still pursue assisted suicide if they knew they might be conscious and in more distress during the process?

Unfortunately and right now, no assisted suicide law requires that kind of  explicit “informed consent”.

The obvious solution is to fight all assisted suicide laws and support all suicidal people.

 

Lessons from the Victory against Assisted Suicide in Maryland

In a dramatic end, the Maryland Senate was deadlocked in a 23-23 on their physician-assisted suicide bill when it came time for the last senator to vote on March 27, 2019.

Sen. Obie Patterson decided not to cast a vote which effectively killed the bill that needed a majority vote to pass.

Sen. Patterson told reporters that “I researched it, I talked with folks and my decision today was not to cast a vote. But I think I did my job. I did not relinquish my responsibility to thoroughly review all of the concerns I had about the bill. At the end of the day, I felt I could not cast a vote.”

This fourth attempt in Maryland to pass a physician-assisted suicide bill had just passed in the Maryland House of Delegates following “an intense and emotional debate that brought some lawmakers to tears”.

Although there was testimony on both sides with many personal stories, a Goucher College poll of people in Maryland showed 62% of those polled supported “allowing terminally ill adults to obtain medication to end their lives”. The Maryland State Medical Society that previously opposed assisted suicide bill had now changed its stance to “neutrality”.

Kim Callinan, CEO of the Compassion & Choices organization that promotes such legislation throughout the US had said that “with baby boomers beginning to reach retirement age, they are dealing with deaths of their parents and peers, causing them to rethink their views on death experiences allowing terminally ill adults to obtain medication to end their lives.”

Disability advocates were forced to wait to testify until all witnesses in favor of the bill testified, effectively blocking those advocates who had to leave.

LESSON ONE: DON’T GIVE UP EDUCATING  LEGISLATORS AND THE PUBLIC ON THE FACTS AND DANGERS OF ASSISTED SUICIDE

Although it seemed that the bill would pass in the Senate, all the efforts by disability advocates, pro-life people, medical professionals, concerned Maryland residents, etc. to write, speak and even march about the facts and dangers of physician-assisted suicide apparently had an effect.

When the bill was sent to a Senate committee to evaluate before being sent to the entire Senate for final passage, members of the committee now had reservations about the assisted suicide bill itself. Committee chairman Senator Bobby Zirkin said the bill as introduced to the committee was “flawed to its core”, even though he said he didn’t want to stand in the way of terminally ill people “who are truly, truly at the end of their life and out of treatment options.”

The senate committee members “spent more than 7 hours hashing out dozens of proposed amendments to the bill” before agreeing to vote it out to the full senate with these changes requiring patients:

“Be at least 21 years old, a change from 18 in the original bill.

Have their diagnosis confirmed by their attending physician and a consulting physician. Those two physicians cannot be in the same practice or have a financial relationship

Ask for the prescription three times, including once in private with a doctor and with witnesses.

Undergo a mental health evaluation.”

The senators also set a stricter definition of who could qualify for assisted suicide, and removed the prescribing doctors’ immunity “from civil lawsuits related to prescribing the fatal drugs.”

Kim Callinan, CEO of Compassion & Choices said “the new drastically revised version of this bill includes troubling amendments that we know from our experience in other states will make the bill nearly impossible for patients to access.”

But as I noted in my previous blog on the assisted suicide bill, the Maryland Against Physician Assisted Suicide coalition correctly noted that even with the revisions, the bill “does not offer sufficient protection of those in our system of health care who are most vulnerable to abuse” and should not be passed.

After the bill died in the senate, one senator said he would sponsor yet another assisted suicide bill sometime in the future.

LESSON TWO: REVIEW THE RESULTS

As the Baltimore Sun article on the defeat of the assisted suicide bill noted:

“Some senators who voted against the bill recalled the General Assembly’s action a few years ago to abolish the death penalty — in part on the grounds that life is precious, even the life of a convicted criminal.

Sen. Michael Hough, a Frederick County Republican, said that his vote in favor of keeping the death penalty has haunted him. He pledged to himself that if he ever faced a vote like that again, “I would err on the side of life.”

Others questioned the logic of allowing doctors, who they see as people who save lives, to participate in a process that leads to death.

“There are no do-overs in this type of law,” said Sen. Bryan Simonaire… “Doctors have and will continue to make mistakes and miscalculations. They are humans. Once a life is taken, it is final.” (All emphasis added)

We may not always know what resonates with a legislator charged with representing his or her district but it is an awesome responsibility to make laws involving life or death decisions. That decision should not just be based on polls or horrific fears about death.

LESSON THREE: REACH OUT TO ALL GROUPS AND PEOPLE

None of us who oppose assisted suicide has the power, money or media support that Compassion and Choices has. But when we band together and use all our personal stories as well as the moral, legal, disability and medical perspectives against assisted suicide, we can win state by state and even educate the public nationally.

Our goal should not only be about defeating assisted suicide and upholding truly ethical healthcare but also to offer hope and support to improve the lives of all people experiencing suicidal despair, whether or not they are terminally ill.