Another Threat to Conscience Rights for Medical Professionals

2012 New York Times:  “Instead of attempting to legalize physician-assisted suicide, we should focus our energies on what really matters: improving care for the dying — ensuring that all patients can openly talk with their physicians and families about their wishes and have access to high-quality palliative or hospice care before they suffer needless medical procedures. The appeal of physician-assisted suicide is based on a fantasy. The real goal should be a good death for all dying patients.” (Emphasis added)

2016, Journal of the American Medical Association: “CONCLUSIONS AND RELEVANCE Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices. (Emphasis added)

The writer of these conflicting views on assisted suicide is Ezekiel J. Emanuel, M.D., PhD., a very influential doctor who is Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and one of the architects of Obamacare. He is considered an expert on medical ethics who speaks and writes prolifically for both medical journals and general media outlets.

NO CONSCIENCE RIGHTS?

Unfortunately, Dr. Emmanuel is now opposing conscience rights for those of us who object to participating in deliberate death decisions like abortion and assisted suicide.

In his April, 2017 New England Journal of Medicine article “Physicians, Not Conscripts — Conscientious Objection in Health Care” , Dr. Emanuel writes:

“Health care professionals who conscientiously object to professionally  contested  interventions  may  avoid  participating  in them directly, but, as with military conscientious objectors, who are required to perform alternative service, they cannot completely absent themselves from providing  these  servicesConscientious  objection  still  requires  conveying  accurate  information  and  providing  timely  referrals to ensure patients receive care.

….

“Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession. “

……

Although the political process may continue unabated, and courts may deem conscience clauses to be legal, it is incumbent on professional societies to affirm professional role morality and authoritatively articulate the professional ethical standards to which all licensed health care professionals must adhere. Laws may allow physicians, nurses, pharmacists, and other health care workers to deny patients treatment or to refuse to care for particular populations, but professional medical associations should insist that doing so is unethical.”

(All emphasis added)

 

CONCLUSION

Please reread that last sentence “Laws may allow physicians, nurses, pharmacists, and other health care workers to deny patients treatment or to refuse to care for particular populations, but professional medical associations should insist that doing so is unethical.

Some may think this cannot happen in the U.S. or that actions like assisted suicide only occur privately in a patient’s home but, as I wrote in my last blog “Outrage: The American Nurses Association Approves Physician Assisted Starvation Suicide”, the American Nurses Association recently published a position statement “Nutrition and Hydration at the End of Life” that states:

” Decisions about accepting or forgoing nutrition and hydration will be honored, including those decisions about artificially delivered nutrition as well as VSED.”

and

“People with decision-making capacity have the right to stop eating and drinking as a means of hastening death.”

(All emphasis added)

In reality, nurses face an even greater risk than doctors who refuse to participate or refer patients making death decisions.

After assisted suicide was legalized in Oregon, the Oregon Nurses Association quickly issued guidelines for nurses that included these two points for “Nurses Who Choose Not to Be Involved”: “You may not:”

  • Subject your patients or their families to unwarranted, judgmental comments or actions because of their decision to continue to provide care to a patient who has chosen assisted suicide.

  • Abandon or refuse to provide comfort and safety measures to the patient.”  (All emphasis added)

Abandonment is a very big deal in nursing. To be accused of abandoning a patient can result in termination, loss of license or even a lawsuit.

But even if you are not a health care professional, you should be concerned about ethical health care professionals being forced out of health care by taking Dr. Emmanuel’s advice that there are only “two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession. ”

Can any of us really trust a health care system that only accepts medical professionals who are just as willing to help end our lives as they are to  care for us?

Outrage: The American Nurses Association Approves Physician Assisted Starvation Suicide

“People with decision-making capacity have the right to stop eating and drinking as a means of hastening death.”

and

“There is an extensive knowledge base to help manage the burden of most physical symptoms (of voluntary stopping of eating and drinking). Symptom control is imperative.”

With these quotes from its’ recent position statement “Nutrition and Hydration at the End of Life”, the American Nurses Association (ANA) effectively gives up the principle of opposing physician assisted suicide.

Last November, I wrote a blog when I was alerted off that the ANA  was drafting a new position statement on food and water. The nurse who alerted me included a site for public comment and I urged others to participate as I did.

Now I am saddened but not really surprised to find that final result was the endorsement of decisions withdrawing food and water, even by mouth, and even if the patient is not imminently dying. The statement also explicitly included people with “severe neurological conditions” and dementia.

As the ANA statement makes clear “Decisions about accepting or forgoing nutrition and hydration will be honored, including those decisions about artificially delivered nutrition as well as VSED.” (Emphasis added) VSED stands for voluntary stopping of eating and drinking and is promoted by Compassion and Choices, the former Hemlock Society, as a legal alternative in states without assisted suicide laws.

Here are the ANA’s recommendations on food and water in its’ entirety from the document:

“ANA Recommends that:

  • Nurses recognize those situations when nutrition and hydration can no longer benefit a patient, and adhere to clinical standards that include providing nutrition and hydration only to patients for whom it is indicated.

  • Patients with decision-making capacity—or their surrogates, who are relying on the patients’ preference or have knowledge of the person’s values and beliefs—will be supported in decision-making about accepting or refusing clinically appropriate nutrition and hydration at the end of life.

  • Nurses will have adequate and accurate information to understand patients’ cultural, ethnic, and religious beliefs and values regarding nutrition and hydration at the end of life. Patients’ views and beliefs should be respected.

  • Nurses will support patients and surrogates in the decision-making process by providing accurate, precise and understandable information about risks, benefits and alternatives.

  • Decisions about accepting or forgoing nutrition and hydration will be honored, including those decisions about artificially delivered nutrition as well as VSED.

  • People with decision-making capacity have the right to stop eating and drinking as a means of hastening death.” (All emphasis added)

The ANA position statement admits “There is some consensus (though not universal agreement) that VSED can be an ethical and legal decision”, but in regard to conscience rights, the document only states that  “Nurses who have an informed moral objection to either the initiation or withdrawal of nutrition or hydration should communicate their objections whenever possible, to provide safe alternative nursing care for patients and avoid concerns of patient abandonment.” (Emphasis added)

DOES THE ANA SPEAK FOR ALL NURSES?

The American Nurses Association claims it is the “voice of nursing” and “the nation’s only full-service professional organization that represents the interests of the nation’s 3.6 million registered nurses.”

However, the ANA does not give out its actual membership numbers and the vast majority of the nurses I have encountered over many decades do not belong to the ANA.

I used to belong to the ANA many years ago and was even active in my state’s chapter, hoping to get support for conscience rights after the Nancy Cruzan feeding tube case. But I  became disillusioned when the organization became more politically active and took controversial positions without notifying members. I eventually joined and became active in the National Association of Pro-Life Nurses.

Medical ethics and law has radically changed in just a few decades and now we are confronting physician assisted suicide and other deliberate death decisions.

At the very least, we health care professionals need our conscience rights honored and protected so that we can truly and ethically care for our patients. Unfortunately, the ANA is hurting rather than helping that objective when it comes to nurses refusing to participate in deliberate death decisions.

 

 

 

Why is Baby Charlie Gard’s Government-appointed Guardian a Euthanasia Activist? Does It Matter?

So now we learn that Baby Charlie Gard’s guardian is a euthanasia activist who is Chairman of Compassion in Dying, an “end-of-life” advocacy group with a sister organization that supports assisted suicide.

This should not be a surprise.

In a July 19, 2017 New York Times op-ed “Charlie Gard and Our Moral Confusion”, Kenan Malik, who wrote a book on morality and ethics on moral issues, argues:

“In Charlie’s case, the judges decided that it is in his interest to die even with a possibility of treatment. Mr. Conway, in contrast, wants to be allowed to die in dignity, but the law will not permit it. His motor neuron disease is incurable, and he is not expected to live beyond 12 months. His condition is painful, and will become more so. He wants doctors to be able to give him a lethal injection when he decides that it is time to end his life. Under British law, it would be a criminal offense for a doctor to do so.”

“Death with dignity” is the catchphrase and death is considered the ideal end in both of these cases when viewed through the prism of so-called “dignity”.

Unfortunately, this “death with dignity” must be enforced through laws and courts and even down to the medical personnel involved.

“DEATH WITH DIGNITY” AND ITS’ OTHER VICTIMS

In June, a Canadian home health nurse was faced with the option of participating in assisted suicide with her patients or resigning. She resigned and yet another dedicated nurse was lost to the principle of a right to “death with dignity”.

However, Mary Jean Martin was afforded no dignity or rights herself. She was at the mercy of a new health care law that now mandates participation in medical lethal overdoses, an act considered medical murder before.

Ms. Martin called being forced to choose between her conscience and her job a “violation of my human rights.” She wrote:

“Why has my right to peacefully follow my own beliefs within a free and inclusive society been suddenly taken away from me?” she said.

“After 30 years as a nurse these laws make me feel no longer proud of being either a health care professional in this country or Canadian citizen,” she added.

The forced normalization of assisted suicide/euthanasia radically changes medicine for the healthy as well as the ill when only medical professionals willing to participate in assisted suicide/euthanasia are allowed to practice their professions.

CONCLUSION

Whether the issue is denial of food and water to brain-injured people, futility determinations overriding patients’ and families’ decisions, denying potentially beneficial experimental treatment or forcing medical personnel to participate in lethal overdoses, etc., the word “choice” in these cases is a misnomer when only the choice for death is considered “dignified”.

 

Health Care Bullying Over Conscience Rights

Years ago, some of my fellow nurses were talking about assisted suicide and two of them supported physician-assisted suicide. I asked if they were comfortable with participating in an assisted suicide. Both were shocked and said no.

They believed the myth that doctors just write lethal prescriptions that patients then go home and take privately. It never occurred to them that they could be involved if the assisted suicide occurred in a healthcare institution, home health situation, etc. where they-unlike the doctor-could not just walk away.

These nurses were unaware that there were already nursing journal articles like “Assisted Suicide: What Role for Nurses?”  (2000) that quoted one Oregon hospice administrator:

“Initially, when the law was designed, the assumption was that physicians would be the first ones to explore PAS with patients…but in reality, nurses are usually the ones in the line of fire.

While Compassion and Choices leaders now talk about “integrating” and “normalizing” assisted suicide in end of life care , this 17 year old article already stated that “Much of nurses’ roles lies behind the scenes long before the drama of PAS unfolds. Home care and hospice nurses actively help patients understand their rights, acting as advocates for those who are considering PAS.” (Emphasis added)

Now, two recent articles expose the lengths that assisted suicide activists will go to  legally bully health care professionals to participate in medically assisted suicide.

VERMONT

In an April 5, 2017 article titled “This State is Trying for Force Doctors and Health Care Workers to Give Patients Info on Assisted Suicide”, the Alliance Defending Freedom organization  filed a lawsuit against Vermont’s Act 39, arguing that

“Vermont’s Act 39 makes the State the first and only one to mandate that all licensed healthcare professionals counsel terminal patients about the availability and procedures for physician-assisted suicide, and refer them to willing prescribers to dispense the death-dealing drug. Act 39 coerces professionals to counsel patients about the ‘benefits’ of assisted suicide—benefits that Plaintiffs’ members do not believe exist—and in addition stands in opposition to a federal law protecting healthcare professionals who cannot participate in assisted suicide for conscientious reasons.” (Emphasis added)

CANADA

In a stunning March 28, 2017 Canadian Catholic Register article titled “Doctors being ’bullied’ over assisted suicide, legislators told at Bill 84 hearings” , doctors in Ontario, Canada spoke out about “being bullied, silenced and coerced in a pro-euthanasia environment which is forcing those who object to medically assisted suicide to provide an “effective referral” for patients who wish to die”. (Emphasis added)

Dr. Jane Dobson testified about the pressure she has faced: “If I don’t comply, I face fines and the possible suspension of my license.”

University of Toronto School of Medicine professor Dr. Maria Wolfs added that medical schools are facing pressure to “weed out students who might object to assisted suicide”. (Emphasis added)

Psychiatrist Dr. Janice Halpern testified that the policy is also “at odds with the subtleties of a psychiatric doctor-patient relationship and asked how long can a psychiatrist work with a patient “on finding their will to live again” before referring the patient for assisted suicide.

The Canadian Supreme Court legalized physician-assisted suicide in 2015 and as of the end of 2016, at least 744 people have died from physician assisted suicide with Ontario having the highest number.

One doctor who assisted the suicide of at least 40 patients in 2016 said that those numbers will increase “to the point of the Netherlands and Belgium because their laws are similar to ours, and that would mean about 5 % of all deaths.”

UNEXPECTED CONSEQUENCES

Ironically, there has been an unusual backlash in Canada.

According to a February 2017 article in Canada’s National Post newspaper , an increasing number of doctors performing assisted suicide are now saying “‘Take my name off the list, I can’t do any more”.  As the article states:

“In Ontario, one of the few provinces to track the information, 24 doctors have permanently been removed from a voluntary referral list of physicians willing to help people die. Another 30 have put their names on temporary hold.”

And

“The Canadian Medical Association says reports of doctors backing away from the act are not just anecdotal. “I can’t tell you how many, but I can tell you that it’s enough that it’s been noted at a systemic level,” said Dr. Jeff Blackmer, the CMA’s vice-president of medical professionalism.”

CONCLUSION

Groups like Compassion and Choices depend on assisted suicide being portrayed as a victimless and necessary medical intervention while, at the same time, they oppose conscience rights for ethical doctors and nurses trying to help and protect their patients and their professions.

However, it is hard to escape the reality that legally forced participation in medically assisted suicide damages the health care system, health care providers and even patients.

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!

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: immunity for doctors from “civil or criminal liability or professional disciplinary action for participating in good faith compliance” with the assisted suicide law.  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.

High Priority: Public Comments Needed on ANA’s New Draft Position Paper on Denying Food and Water

Although the American Nurses Association (ANA) claims it represents the over 3 million US nurses, only a tiny fraction of nurses actually belong. ANA does not give out the actual number of members. I used to belong both my state nursing organization as well as the ANA to try to uphold good nursing ethics and conscience rights for nurses. I finally gave up when my state organization would not address even the conscience rights of nurses in the Nancy Cruzan feeding tube case. I gave up on the ANA when I discovered that the ANA opposed a ban on partial birth abortion without notifying its membership. I only found this out when I watched a TV show on politics mentioning the ANA position. I called the ANA public relations department myself to protest both their position and not notifying members like me and resigned.

Yesterday, I received a call from a nurse in another state who sent me the website for public comments due by 5 pm ET 12/1/2016 about a proposed new ANA position on nutrition and hydration at the end of life.

The proposed position paper is 9 pages long and I sent the following comments with the referenced lines as requested. It would have taken me many pages to address all the issues:

Lines 18-24.  In the past, the hospice principle of never prolonging or hastening death at the end of life was paramount. Now, this has been subjugated to a legalized autonomy (even when exercised by a third party) to decide when to hasten death.

However, nurses are professionals whose integrity depends on proper respect for their conscience rights, especially when it comes to decisions about hastening death.  This concern is absent in this draft.

We do have such a provision in Missouri law that states:

Missouri Revised Statutes
Section 404.872.1

Refusal to honor health care decision, discrimination prohibited, when.

404.872. No physician, nurse, or other individual who is a health care provider or an employee of a health care facility shall be discharged or otherwise discriminated against in his employment or employment application for refusing to honor a health care decision withholding or withdrawing life-sustaining treatment if such refusal is based upon the individual’s religious beliefs, or sincerely held moral convictions.

(L. 1992 S.B. 573 & 634 § 7)

Line 88: There is no definition of “severe neurological conditions”.
Line 90 on “Dementia, recognized as a terminal illness associated with anorexia and cachexia”.  As a former hospice nurse and caregiver for my mother until her death as well as a volunteer for people with dementia, this is an alarming and potentially dangerous assertion. No one should have to die by dehydration and indeed many people with dementia can be spoon-fed like my mother until natural death. I have likewise seen several people begging for food or water but denied because of a decision not to place a feeding tube or spoon feed.

Lines 101-104. VSED as described is really assisted suicide and implicitly changes ANA opposition to medically assisted suicide.

Also, in a New York Times article in October titled “The VSED Exit: A Way to Speed Up Dying, Without Asking Permission”, Dr. Timothy Quill (past president of the AAPHM and the doctor arguing for the constitutionality of assisted suicide in the 1997 Vacco v Quill US Supreme Court case) was quoted as claiming that while VSED is “generally quite comfortable at the beginning”, he also states that “You want a medical partner to manage your symptoms,” because “It’s harder than you think.”

How hard?

In 2000, Quill and Dr. Ira Byock (a palliative care doctor who speaks against legalizing physician-assisted suicide while also supporting VSED and terminal sedation) wrote an article titled “Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids” . The patient was a doctor who wanted to die before his symptoms became worse. He was given a morphine drip that had to be increased to total unconsciousness on day 10 because he became “confused and agitated and began having hallucinations”.

Lines 114-115 cite “Psychological, spiritual, or existential suffering, as well as physical suffering” but only say that “Symptom control is imperative” rather than oppose participation in VSED  for people who are not even terminally ill.

Lines 149-150 state that “Decisions about accepting or forgoing nutrition and hydration will be honored including those decisions about artificially delivered nutrition as well as VSED”. This blanket statement destroys the conscience rights of nurses as well as our duty to advocate for our patients’ best interests. (Emphasis added)

Ironically, the ANA’s 2010 position paper on reproductive rights (i.e. abortion) states that:

“Also,nurses have the right to refuse to participate in a particular case on ethical grounds. However, if a client’s life is in jeopardy, nurses are obligated to provide for the client’s safety and to avoid abandonment.” (Emphasis added) Apparently, the ANA is proposing that the right to refuse to participate ends when the death of the patient is deliberately intended.

CONCLUSION

Just this week, it was reported that a union for Australian nurses is backing voluntary euthanasia. The Australian Nursing and Midwifery Federation (SA branch) is even partnering with other Compassion and Choices-style groups in Australia to pass a voluntary euthanasia bill. This could well be our future here in the US if we do not respond.

As nurses and citizens, we need to fight for truly patient-safe health care by responding to groups like the ANA through comments sections like the one above (which ends December 1) and in the media. We must also support and insist on ethical health care providers for ourselves and our loved ones as well as protecting our patients. As much as we can, we can also help state and national organizations that fight against euthanasia.

Especially if you are a nurse, consider joining the National Association of Pro-Life Nurses and following our Facebook page.

Our profession, our patients and even our nation are at stake!

 

 

Oh, Colorado!

Of course, the big news from the national voting last week was the stunning election of Donald Trump as president. But  barely mentioned by the media except for its passage was  Colorado’s Proposition 106 “End of Life Options Act initiative which won by a 65% to 35% popular vote. Now five states have formally legalized physician assisted suicide. Montana had a court ruling that state physician-assisted suicide is not “against public policy” but no law legalizing assisted suicide has been passed.

I remember going to Colorado about 20 years ago to speak against an assisted suicide bill in the state legislature. Enthusiasm was high and the assisted suicide bill was subsequently voted down in the legislature. But, as in other states including my own Missouri, the assisted suicide proponents never stopped pushing their agenda over and over again.

With their efforts often stymied in state legislatures after robust debate and testimony, well-funded groups like Compassion and Choices turn to the promotion of state initiatives. Colorado now joins Oregon and Washington State in legalizing assisted suicide by popular vote.

However, with groups like Compassion and Choices trying to normalize assisted suicide as just another valid medical decision, medical groups increasingly intimidated into neutrality and an almost entirely sympathetic mainstream media holding up Brittany Maynard as the ultimate poster child, the average person is easily persuaded to not look too closely  at the reality of assisted suicide.

For example, here is just the title of the Colorado ballot measure. There is also a much longer ballot summary and a link to the full proposed law.

“Shall there be a change to the Colorado revised statutes to permit any mentally capable adult Colorado resident who has a medical prognosis of death by terminal illness within six months to receive a prescription from a willing licensed physician for medication that can be self-administered to bring about death; and in connection therewith, requiring two licensed physicians to confirm the medical prognosis, that the terminally-ill patient has received information about other care and treatment options, and that the patient is making a voluntary and informed decision in requesting the medication; requiring evaluation by a licensed mental health professional if either physician believes the patient may not be mentally capable; granting immunity from civil and criminal liability and professional discipline to any person who in good faith assists in providing access to or is present when a patient self-administers the medication; and establishing criminal penalties for persons who knowingly violate statutes relating to the request for the medication?”

But what might have happened if this alternative language was used?

Should Colorado change the Colorado revised statues to permit a licensed doctor of any specialty in conjunction with a similar doctor to write a prescription for a lethal overdose to cause death for any adult resident that the doctors expect to die within 6 months; 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; grant immunity for the doctors and others from civil or criminal penalty as long as they claim “good faith” intentions; require that the death certificate falsely state the cause of death as a natural medical condition instead of the lethal overdose; prohibit life insurance policies from being affected by a request for a legal lethal overdose and prohibit  public information about such lethal overdoses except a yearly statistical report as reported by the doctors involved? (Emphasis added)

Of course, we will never know.

But when we allow medical/legal protections and standards to be suspended for some suicidal people considered expendable based on an estimated prognosis and personal fear of even potential pain and/or dependence,  we will inevitably see the pool of potential victims of medical termination expand and lethal injections accepted, as is already  happening in Canada, the Netherlands, Belgium and Switzerland.

Just as bad, we will also be creating a class of medical serial terminators immune from any real oversight and accountability while penalizing ethical health care providers who refuse to participate or refer.

CONSCIENCE RIGHTS, CRISIS PREGNANCY CENTERS-AND MORE

A new Illinois law was just signed by Governor Bruce Rauner with dire implications for pro-life health care providers.

As an August 9, 2016 National Catholic Register article titled  “Illinois Law Threatens Conscience Rights, Crisis-Pregnancy Centers” explains, this new law changes the former state Health Care Right of Conscience Act to require that pro-life doctors, nurses and even staff at crisis pregnancy centers  present abortion as a legal treatment option and are required to refer, transfer or give information about where to go for an abortion when a woman says she wants one.

While the terminology about other health care options is vague, the law specifically cites:

“family planning, counseling, referrals, or any other advice in connection with the use or procurement of contraceptives and sterilization or abortion procedures…”

Incredibly, this Illinois law  also defines conscience rights as merely religious:

 “Conscience” means a sincerely held set of moral convictions arising from belief in and relation to God, or which, though not so derived, arises from a place in the life of its possessor parallel to that filled by God among adherents to religious faiths

Ironically, as Kathy Bozyk, who operates the Southside Pregnancy Center in Chicago notes, while she is required by the law to discuss the alleged benefits of abortion and refer women to abortion providers, abortion businesses are not required to make referrals to crisis-pregnancy centers.

Instead, abortion groups like the National Abortion and Reproductive Rights Action League (NARAL) continue to actively fight crisis pregnancy centers, accusing them of false and misleading information as well as threatening women’s safety. They are a strong force working to get laws like this passed.

PUSHBACK

There is an unfortunate and surprising assessment of the law in the NCR article from Robert Gilligan, executive director of the Catholic Conference of Illinois:

According to the article, Mr Gilligan said that although the Conference was disappointed that the governor signed the law, the Catholic Conference was able to negotiate, with opposing parties, a revision to the original bill that the state’s 43 Catholic hospitals can live with, saying with regard to the requirement to refer, transfer or provide written information on where to find an abortion facility :

He said co-sponsors of the bill said even simply ripping out the pages of a phone book with names of all the local OB-GYNs in a certain area would be enough to comply.

If accurate, is this a helpful or even realistic response?

Fortunately, we have courageous, front-line  health care providers like Kathy Bozyk who refuse to comply, Illinois Right to Life continuing its opposition and pro-life legal groups like the Alliance Defending Freedom (ADF) who filed a lawsuit in state court against Governor Rauner on behalf of The Pregnancy Care Center of Rockford and the Chicago-based Thomas More Society that plans a lawsuit.

It’s important to note that this Illinois law comes on the heels of a December California law forcing pro-life pregnancy centers and state-licensed medical clinics to distribute information on where and how to obtain a state-funded abortion or face fines of $1000 a day.

So it is imperative that  all of us throughout our nation work to ensure that strong conscience rights be upheld, strengthened, correctly defined and even expanded to include all health care ethics issues, especially in the face of possible or actual assisted suicide laws.

Conscience rights are essential to help us protect our patients from a healthcare system that is increasingly succumbing to a “culture of death” mentality.

Conscientious Objection, Conscience Rights and Workplace Discrimination

The tragic cases of  Nancy Cruzan and Christine Busalacchi , young Missouri women who were claimed to be in a “persistent vegetative state” and starved and dehydrated to death, outraged those of us in Missouri Nurses for Life and we took action.

Besides educating people about severe brain damage, treatment, cases of recovery and the radical change in medical ethics that could lead to the legalization of euthanasia, we also fought for healthcare providers’ rights against workplace discrimination for refusing to participate in deliberate death decisions. We talked to nurses who were threatened with termination.

Although Missouri had some protections against forcing participating in abortion, there were no statutes we could find where health care providers were protected against being forced to participate in deliberate death decisions. We were also told by some legislators that our chance of success was almost nil

Nevertheless, we persisted and after years of work and enduring legislators watering down our original proposal to include lethal overdoses and strong penalties, Missouri Revised Statutes, Section 404.872.1 was signed into law in 1992. It states:

Refusal to honor health care decision, discrimination prohibited, when.

404.872. No physician, nurse, or other individual who is a health care provider or an employee of a health care facility shall be discharged or otherwise discriminated against in his employment or employment application for refusing to honor a health care decision withholding or withdrawing life-sustaining treatment if such refusal is based upon the individual’s religious beliefs, or sincerely held moral convictions.

(L. 1992 S.B. 573 & 634 § 7)

Fast Forward to Today

In 2016, we face groups like Compassion and Choices that have pushed assisted suicide legislation through in some states and hoping for an eventual sweeping Supreme Court decision making assisted suicide a constitutional right like abortion.

Some European countries like Belgium and Holland have virtual euthanasia on demand for even non-terminally ill people of any age. In Canada, their Supreme Court has forced assisted suicide on that country and now the province of Quebec has lethal injection kits available to any doctor.

Not surprisingly, conscience/workplace rights for health care providers are being vigorously fought both in those countries and here in the US.

For example, Compassion and Choices’ Barbara Coombs Lee, one of the architects of Oregon’s assisted suicide law, claims that strong conscience-right protections encourage “workers to exercise their idiosyncratic convictions at the expense of patient care” at the end of life.

Hope on the Horizon?

In May, a hospital in Poland stopped performing abortions after every single doctor signed a pledge refusing to do them.

Now, several hospitals in Santa Barbara  and Palm Springs as well as Providence medical centers are opting out of the new California assisted suicide law.

Personally, I believe that if people are given a choice when they are sick, they would naturally prefer a hospital that is committed to care rather than assisted suicide.

Thus, conscientious objection, workplace discrimination/conscience rights laws and the power of institutions dedicated to ethical health care can help turn the tide against assisted suicide laws or at least save some lives and mitigate some of the damage caused by assisted suicide laws. It may take a long time before killing sick or disabled people is again seen as abhorrent and unethical but the effort will be worth it.

As I have said before, “NO!” is a powerful and potentially lifesaving word.