conscience rights

NAPN: Ohio’s Issue 1 Abortion Vote Marks a Temporary Setback, Not a Surrender

nancyvalko abortion, adoption, conscience rights, culture, education, law, medical ethics, nursing, pro-life

FOR IMMEDIATE RELEASE

November 7, 2023

National Association of Pro-Life Nurses

Contact: media@nursesforlife.org

Columbus, Ohio – The National Association of Pro-Life Nurses (NAPN) is expressing deep disappointment over the passage of Ohio’s extreme, deceptive abortion initiative. Despite the passage of Issue 1, NAPN remains committed to upholding ethics in healthcare practice.

Issue 1 undermines common-sense health and safety protections by lowering the standard of care in Ohio. Its passage will enshrine discriminatory abortion practices into the state’s constitution, including for reasons of gender or disability. Further, the ballot initiative will expand abortion into the third trimester, when a preborn child is capable of feeling pain. Issue 1 is radically out of touch with the 7 in 10 Americans who support common-sense abortion limits after 15 weeks. NAPN firmly believes in upholding the principles of compassion, empathy, and respect for all human life, echoing the fundamental principles of the nursing profession.

Executive Director Marie Ashby, on behalf of the NAPN, stated, “While we are deeply concerned by the passage of extreme, anti-life legislation, it does not diminish our resolve to protect human life in all its stages. We must continue to support families facing unexpected pregnancies through pregnancy resource clinics and Federally Qualified Health Centers. NAPN remains steadfast in advancing a higher standard of patient care, which is fundamentally incompatible with abortion.”

NAPN will continue to push back against healthcare disinformation, as it paves the path forward for excellence in nursing practice. The National Association of Pro-Life Nurses calls upon policymakers to consider the profound ethical implications of legislation that erodes patient protections. The association stands ready to counter public health threats by educating lawmakers and healthcare providers on policies that seek to undermine patient care.

The National Association of Pro-Life Nurses is a not-for-profit organization uniting nurses who are dedicated to promoting respect for every human life from conception to natural death, and to affirming that the destruction of that life, for whatever reason and by whatever means, does not constitute good nursing practice.

###

For further inquiries or interviews, please contact:

Marie Ashby

Executive Director

National Association of Pro-Life Nurses

marie@nursesforlife.org

www.nursesforlife.org

Repost from 2018: My Book Review on “Nurses and Midwives in Nazi Germany: The ‘Euthanasia Programs’”

nancyvalko conscience rights, culture, disability, economics, euthanasia, food and water, law, medical ethics, mental health, nursing

In view of the current war in the Middle East, I am reposting this blog. I was shocked to learn that 31 US states don’t require schools to teach about the Holocaust.

When I was in school in the 1960s, we not only learned about the Holocaust but also read Anne Frank’s book “The Diary of a Young Girl”. We were both horrified and inspired by her courage.

In nursing school in 1969, we nurses were taught about the Holocaust as the lowest point in medical ethics and we took medical ethics very seriously. Tragically, now the majority of nursing and medical schools do not include Holocaust and genocide studies in the curriculum. In view of the current deterioration in healthcare ethics, these schools should require it.

“Nurses and Midwives in Nazi Germany-The ‘Euthanasia Programs’”
Edited by Susan Benedict and Linda Shields
Routledge Studies in Modern European History. London: Routledge 2014

My book review (abstract) was just published in the Linacre Quarterly journal. Here are some excerpts from my review. with all emphasis added only for this blog.

In my nursing education during the 1960s, the Nazi euthanasia program was covered during a class but mainly as a ghastly aberration that was unthinkable today with our now strong ethical principles. As students, we were shocked and horrified by the revelation that nurses were integral to Nazi killing programs. We had little knowledge of the mechanisms that existed to encourage nurses to kill those patients whose lives were deemed “not worth living.”

Unfortunately, it is difficult these days to find information about nurses during the Nazi regime, even on the American Nurses Association website. Thus, the editors of this book do nurses and the public a great service by examining the little-known but crucial role of nurses in the Nazi euthanasia programs. Knowing this history is more important than ever as efforts to legalize assisted suicide and euthanasia continue to grow.

The authors explain the history, education, propaganda, and pressures that led so many nurses to participate in the killing of hundreds of thousands of helpless men, women, and children in the 1930s and 1940s; they also propose a model for teaching nursing ethics using the Nazi euthanasia program to encourage nursing students to examine ethical principles and their own values as a nurse in today’s health-care system.

……

The authors start with the rise of the influential eugenics movement in the early twentieth century in countries like the United States where the American Eugenics Society even held conferences on eugenics, such as the 1937 one which included the topic “The Relation of Eugenics to the Field of Nursing.” Eventually, the US eugenics movement fell out of favor after the Nazi euthanasia programs were discovered in World War II.

Even prior to World War II, German professional nursing publications discussed eugenics as “providing a scientific basis for the positive eugenics promoting reproduction among the healthy (often of northern European descent) middle to upper classes and negative eugenics encouraging limited reproduction and forced sterilization of the ‘unfit’ (who were often poor, uneducated, and more recent immigrants) as reasonable”.  Eugenic language was most prevalent in public health and psychiatric nursing texts and in discussions of poverty, immigrants, cleanliness, and social problems.

The editors also point to the influence on Adolf Hitler of the 1920 book titled Approval of the Extermination of Worthless Human Lives by Germans Karl Binding, a jurist, and Alfred Hoche, a psychiatrist. Binding and Hoche noted that there were no legal arguments preventing legalizing the killing of those whose lives were considered not worth living. (Emphasis added)

There was extensive propaganda aimed at increasing the acceptance of euthanasia by the public and health-care providers. Only a few months after Hitler seized power, the first law, affecting people diagnosed with psychiatric conditions, was passed. It mandated sterilization for people with hereditary disorders including alcoholism and epilepsy. Propaganda emphasized wastefulness of providing health care to the chronically mentally ill and the hereditary nature of undesirable physical, mental, and social traits.

Hitler did not propose the systematic killing of psychiatric patients during peacetime because he anticipated the opposition of the churches and the German people. The beginning of World War II muted moral objections and distracted the populace with concerns of conserving resources for the war effort and was the start of state-sponsored euthanasia. The first documented killing occurred in 1939 when Hitler granted the euthanasia request of a father whose son was born blind, missing a leg and part of an arm and who “seemed to be an idiot” .

In 1939, the German Ministry of Justice proposed two new clauses:

1.“Whoever is suffering from an incurable or terminal illness which is a major burden to himself or others can request mercy killing by a doctor, provided it is his express wish and has the approval of a specially empowered doctor.”

2. “The life of a person who, because of incurable mental illness, requires permanent institutionalization and is not able to sustain an independent existence may be prematurely terminated by medical measures in a painless and covert manner” . (Emphasis added)

The program started targeting those in asylums and the disabled in nursing homes for death by lethal gas, starvation, drugs, and neglect. The Jewish population was especially targeted regardless of health.

………

In 1933, Adolf Bartels, the deputy leader of the Reich’s medical profession, provided a blueprint of the future of nursing under the Nazis. He emphasized that German nurses in social and medical service had to meet standards in the new Reich that were very different from before. The new Reich not only wanted to look after the sick and weak but also wanted to secure a healthy development of all Germans “if their inherited biological predisposition allows for it” (p. 38). Above all, the new state wanted to secure and promote a genetically sound, valuable race, and, in contrast to the past, “not to expend an exaggerated effort on the care of genetically or racially inferior people”. (Emphasis added)

As a Nazi politician stated, “a nurse is the one who should carry out the will of the State in the health education of the people”. It was not necessary for the majority of nurses to become ardent supporters of the Nazi regime for them to do the will of the Reich. One source noted that the majority of nurses who participated in a secret euthanasia program known as T4 tried to remain good nurses; an estimated 10 percent or fewer were enthusiastic supporters of Nazi practice. But, as in other areas of public life, the Reich absorbed professional nursing organizations, leaving the nursing profession with no means of expressing opposing or dissenting views as well as no organizational support for refusing to participate. (Emphasis added)

……

Using midwives, the Reich took various measures both to prevent those regarded as having a “hereditary disease” or who were “racially inferior” from reproducing while increasing the birth rate of those considered valuable and healthy. Thus, the traditional midwife focus on the mother and child was changed to focus on the nation as a whole.

Midwives could initiate proceedings for forced sterilization, and it was now a duty for midwives to report to public health officers “deformed” births and small children with disabilities before their third birthday. Reports received from doctors and midwives were reviewed by medical examiners, and based solely on the reports, the examiners decided whether the child was to be killed or spared.

Parents with such children were told about institutions for children who needed special care that were being established through the country. They were persuaded to admit these children and were assured that the children would receive the best possible care. Parents could refuse but had to sign forms stating their responsibility to supervise and care for their children. The identified children in these institutions were killed by starvation or lethal injection. Parents were told that their children had died from natural causes.

……..

The world was riveted by the 1945 Hadamar trial, the first mass atrocity trial after the Nazi regime was defeated in World War II. This trial came before the infamous Nuremburg trials that included doctors. Hadamar was covered extensively by American media but ignored by the American Journal of Nursing even though nurses were charged.

The trial involved one of the largest and most important killing centers, Hadamar Psychiatric Hospital, one of the six institutions in Germany designated for killing the mentally ill. In 1943, a ward (called an “educational home”) was set up for mixed-race children with Jewish heritage within Hadamar. Completely healthy children were killed with lethal injections. The actual numbers are not known because employees were required to take an oath of secrecy. It is estimated that more than 13,000 patients were killed in 1941 and 1942, even before the ward was set up.

In the first Hadamar trial, Head Nurse Irmgard Huber was tried with six others for killing over 400 men, women, and children. Nurse Huber was charged with “obtaining the lethal drugs, being present when some of the fatal injections were given, and being present when the false death certificates were made out”. Two male nurses were charged with administering the lethal injections. All pleaded not guilty. Their defense was that they were powerless and had inadequate knowledge to judge the morality of their actions. All denied accountability. (Emphasis added)

Trial testimony confirmed that the nurses prepared patients for their deaths, directed the entire nursing staff of the institution, and were present at the daily conferences where the falsified death certificates were completed. Duties to patients were limited to so-called kindnesses that consisted of bringing small gifts to pediatric patients and taking care to prevent patients from knowing that they would soon be killed. Head Nurse Huber insisted that she wished to render a last service to these patients and did not want to do them any harm and that she had a clear conscience.

…….

The second Hadamar trial in 1947 did not receive the same attention as the first. Twenty-five members of the Hadamar staff were charged. At this trial, Head Nurse Huber was charged with killing 15,000 German mental patients. All but one of the defendants were found guilty and served sentences ranging from two and a half to five years. The one nurse found not guilty claimed she had feigned pregnancy in order to achieve release from the killing center. (Emphasis added)

In the end, Head Nurse Huber was released from prison in 1952; the others by 1954.

………

The book presents a model used for two innovative teaching programs about this subject, one in Israel and one in Australia, perhaps the most important contribution of this book. The editors believe that the Nazi era should be taught to students, “highlighting the danger of failing to see each individual as a valuable member of human society. And while the heart of nursing and midwifery continues to be care and caring practices, it is fundamental for students to confront this history to develop insights into the causes and social constructs that enabled nurses and midwives to distort the goal of nursing practice and theory to harm and murder patients.”

The results of these programs and the responses by students appear encouraging. The editors hope that by raising these issues, students will be forced to confront their own values and beliefs, sometimes an intensely uncomfortable experience. They also believe students who are exposed to this “dark element of nursing and midwifery history” will be better prepared to face pressure or to report and oppose violations of the trust that is central to any relationship between nurses and patients

CONCLUSION

Decades after the Nazi atrocities, we are seeing a resurgence of the same “life unworthy of life” justification that drove Nazi eugenics. We see how this perspective increasingly approves the deliberate termination of some lives as “merciful” and “humane.” There is an emerging, shocking consensus that we can—or perhaps even should—choose to have our own lives terminated when our lives are considered not worth living either by ourselves or by others if we cannot speak for ourselves.

The authors of this book make it clear: we all need to know and understand the past in order not to repeat it. Hopefully, it is not too late to turn the tide of history back toward respect for all life.

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Catholic Hospital in Canada Under Fire for Naming Euthanasia Provider as Palliative Care Director-Why Should We Care?

nancyvalko AMA, assisted suicide, Compassion & Choices, conscience rights, dementia, disability, economics, education, end-of-life, euthanasia, food and water, futility, hospice, law, media, medical ethics, mental health, nursing, palliative care, terminal/palliative sedation, ventilators/life support, VSED

In a shocking Sep 16, 2023 article from the Catholic News Agency titled Catholic hospital under fire for naming euthanasia provider as palliative care director | Catholic News Agency, Dr. Danielle Kain, a palliative care specialist who is associate professor and division co-chair of palliative medicine at Queen’s University, was appointed to the directorship of palliative care at Providence Hospital in Kingston, Ontario in Canada despite being “is both a staunch proponent and practitioner of euthanasia.”

Providence Hospital is one of 22 health care institutions in Ontario under the sponsorship of Catholic Health Sponsors of Ontario (CHSO). Canada has one of the most expansive assisted suicide laws in the world and is now considering adding people whose sole medical condition is mental illness. (Emphasis added)

The article also states that “Kain has argued that all publicly funded institutions, including Catholic hospitals, should be compelled to offer MAiD (Medical Aid in Dying) She has also expressed support for the Effective Referral Policy: doctors who have conscientious objections to euthanasia must refer patients to MAiD-offering doctors. In a 2016 Twitter post, Kain wrote: “Making an effective referral is not an infringement of rights.” (All emphasis added)

And

“A variety of professional associations of Canadian Catholic health care providers, including the Canadian Federation of Catholic Physicians, have made appeals to both the CHSO and the local ordinary, Archbishop Michael Mulhall, to intervene….but “The archbishop’s office did not respond before publication to a request for comment.” (Emphasis added)

RECENT HISTORY

In 2019, The National Association of Pro-life Nurses joined the Euthanasia Prevention Coalition USA and other organizations in opposing the  Palliative Care and Hospice Education and Training Act (2019) H.R. 647, S.2080 (known as PCHETA) introduced in the US Congress.

We stated that:

“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.

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)

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.”

NOW A NEW PCHETA BILL HAS NOW BEEN PROPOSED

The 2019 PCHETA did not pass in Congress but now a new and almost identical version US SB2243 has just been has been introduced into the US Senate.

A new addition is included to “develop and implement a strategy to be applied across the institutes and centers of the National Institutes of Health to expand and intensify national research programs in palliative care in order to address the quality of care and quality of life for the rapidly growing population of patients in the United States with serious or life-threatening illnesses.”(Emphasis added)

A letter of support for the new 2023 PCHETA bill was signed by a multitude of groups including the Alzheimer’s Association, American College of Surgeons, American Academy of Pediatrics, American Geriatrics Society, the American Heart Association, American Psychological Association, Association of Pediatric Hematology/Oncology Nurses, American Academy of Association of Professional Chaplains, Hospice Action Network Hospice and Palliative Nurses Association, Leukemia & Lymphoma Society Motion Picture & Television Fund, etc.

Even the United States Conference of Catholic Bishops (USCCB) and the Catholic Health Association of the United States have also sent a letter of support for the 2023 PCHETA, citing that it “includes crucial clarifications which ensure that the palliative and hospice care training programs abide by the provisions found in the Assisted Suicide Funding Restriction Act of 1997 (P.L. 105-12) and are not furnished for the purpose of causing or assisting in causing a patient’s death for any reason.” Unfortunately, as we have long observed, practices such as terminal sedation, withdrawal of food and water, etc. are routinely called just “patient choice” or routine comfort care-even in Catholic institutions.

And, as lawyer Sara Buscher of the Euthanasia Prevention Coalition USA writes, the 2023 HHS Office of Inspector General’s report cites problems with hospice and she says that the PCHETA’s “safeguards are illusions”, “unenforceable and pretty much meaningless.”

CONCLUSION

In September 3, 2023 article titled ” by Jonathan Turley, a 19 year-old woman with is critically ill with a rare genetic mitochondrial disease that is progressively degenerative but conscious and communicative and on a ventilator, feeding tube and dialysis wanted to be allowed to travel to Canada for an experimental treatment but doctors opposed her plan saying that “she is not accepting the realities of her terminal illness.” She and her family appealed to a court but “Nevertheless, the judge found that she is mentally incapable of making decisions for herself because “she does not believe the information she has been given by her doctors”  and “Accordingly, the court ruled that decisions about ST’s further care should be determined by the Court of Protection based on an assessment of her best interests. Her “best interest,” according to the doctors, is to die.” (all emphasis added)

As lawyer Turley writes: “Thus, the courts have declared that ST cannot choose to continue life-extending treatment and can be forced into palliative care against her will.”

Thus the “choice” of a “right to die” can trump the choice of a right to live and even become a “duty to die”.

We need to be able to trust out healthcare system to provide ethical, life-affirming and compassionate care when we need it most.

A good first step would be to make sure the 2023 PCHETA does not become law.

Progress in the War Against Conscience Rights

nancyvalko abortion, AMA, ANA, assisted suicide, brain injury, civil rights, Compassion & Choices, conscience rights, culture, education, end-of-life, euthanasia, food and water, futility, law, medical, medical ethics, nursing, Planned Parenthood, pro-life, vegetative state

As I wrote in my 2016 blog “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 finally 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)

PROGRESS DURING THE TRUMP ADMINISTRATION

In 2018, the Trump administration announced a new Conscience and Religious Freedom Division  in the department of Health and Human Services’ Office for Civil Rights (OCR) to enforce “federal laws that protect conscience and the free exercise of religion and prohibit coercion and discrimination in health and human services”. The division specifically mentions “issues such as abortion and assisted suicide (among others) in HHS-funded or conducted programs and activities” and includes 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”.

Both Planned Parenthood (abortion) and Compassion and Choices (assisted suicide) loudly condemned this.

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.

NOW STATES ARE GETTING INVOLVED

In 2020, the Medical Conscience Rights Initiative (MCRI)  was launched by the Religious Freedom Institute, Alliance Defending Freedom and the Christ Medicus Foundation to promote legislation on the state level “to protect America’s healthcare providers from mandates to perform voluntary procedures in violation of their conscience (e.g., abortion, physician assisted suicide, gender transition surgery, etc.).”

Now five states-Arkansas, Ohio, South Carolina, Florida and now Montana– have enacted versions of this model legislation while “similar efforts are ongoing in multiple other states.”

CONCLUSION

Conscience rights are a necessity, especially since as 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.” (Emphasis added)

Disturbingly, as a 2021 paper “Teaching the Holocaust in Nursing Schools: The Perspective of the Victims and Survivors” points out: “the majority of nursing and medical schools do not include Holocaust and genocide studies in their curriculum“, unlike years ago when it was included as an essential part of medical ethics education.

The results are frightening, as I wrote in a 2019 blog “How Could This Happen? Ohio Doctor Accused of Murder in 25 Patient Overdose Deaths”. The doctor was eventually acquitted of murder after “Husel’s defense team, led by high-profile attorney Jose Baez, argued that no maximum doses of fentanyl are considered illegal under state law and that his client was trying to give comfort care to people who were dying or near death.” (Emphasis added)

 Today, both the American Medical Association and American Nurses Association champion “abortion rights” and have dropped their total opposition to medically assisted suicide.

Without conscience rights and whistleblower protections, our health care system can not only become unethical but also downright dangerous to both healthcare providers and patients.

The National Association of Pro-life Nurses Opposes “The Right to Reproductive Freedom with Protections for Health and Safety” Amendment to the Ohio Constitution

nancyvalko abortion, adoption, AMA, conscience rights, culture, education, law, medical ethics, nursing, pro-life

The National Association of Pro-Life Nurses supports Ohio Right to Life in opposing “The Right to Reproductive Freedom with Protections for Health and Safety” amendment to the Ohio Constitution. Here are some of our objections:

  1. The amendment states that: “Every individual  has a right to make and carry out one’s own reproductive decisions,” the amendment says. If approved, the state couldn’t unduly “burden” this right.   According to FindLaw . : “Minors in Ohio generally cannot provide consent to most medical procedures and must seek the consent of a parent or legal guardian instead. But the state also allows so-called “mature minors” to consent   to such procedures without the consent of a parent or guardian. “Mature minors” must be at least 15 years of age or older, and they must be able to show a doctor that they have enough understanding to make such decisions on their own.” (All emphasis added) It is vitally important that parents be informed about such abortions procedures before they occur, especially with teenagers who may be pressured to get rid of the baby before their parents find out. Not only can parents help their teens make a life-saving decision like adoption but also be there to help if any physical or emotional complications result from the abortion.
  2. The amendment states: “Abortion may be prohibited after fetal viability,” except if a physician  believes it’s necessary “to protect the pregnant patient’s life or health.” (Emphasis added)  We agree with AAPLOG (American Association of Pro-life Obstetrician and Gynecologists) that: “The amendment would legalize abortion through all nine months of pregnancy by allowing post-viability abortion for broadly defined ‘health reasons, which have been long been understood legally to include any and all factors supposedly affecting health, including socioeconomic reasons. Its broad language forbidding ‘direct or indirect’ restriction on abortion places at risk such basic safeguards as protections against coerced abortion parental consent, conscience rights for pro-life clinicians, current health and safety regulations for abortion clinics, and counseling to support a woman through her pregnancy-all of which have been demonstrated to help women” and” this proposed amendment also opens the door for the legal targeting of pregnancy resource centers, which serve thousands of Ohio women with material, medical and emotional support every year.” (Emphasis added) This makes an abortion right more extreme than what prevailed under Roe v. Wade.
  3. Conscience rights for healthcare providers are at risk. In a July 31, 2023 USA Today article “‘Conscience’ bills let medical providers opt out of providing a wide range of care” states cites a March 2020 article in the American Medical Association’s Journal of Ethics that said, “Clinicians who object to providing care on the basis of ‘conscience’ have never been more robustly protected than today. Legal remedies for patients who receive inadequate care as a result have shrunk significantly”. Many of the most sweeping bills are backed by organizations that have promote the “conscience” agenda nationwide, such as the Christian Medical Association, Catholic Medical Association, and National Association of Pro-Life Nurses. Other groups launched a joint effort in 2020 with the explicit purpose of advancing state legislation that makes it easier for health care providers to refuse to perform a wide range of procedures, including abortion and types of gender-affirming care.” And that “Opponents such as the American Civil Liberties Union, Planned Parenthood, and the Human Rights Campaign have been vocal opponents of this trend, criticizing it as a backdoor way to restrict the rights of women, LGBTQ+ community members, and other individuals. (Emphasis added)

CONCLUSION

We urge all people of good will to join us in working to protect and help vulnerable people as well as ethical healthcare providers.

The Frightening Deterioration of Professional Medical Ethics Regarding Abortion and Assisted Suicide at the AMA and ANA

nancyvalko abortion, assisted suicide, Compassion & Choices, conscience rights, culture, end-of-life, law, medical ethics, nursing, pro-life

ABORTION AND THE AMERICAN MEDICAL ASSOCIATION

When I went to nursing school in 1967, abortion was illegal in the US and so-called “back alley” abortions were universally condemned.

According to a Hopkins Bloomberg Public Health article titled “A Brief History of Abortion in the U.S.”:

“America’s first anti-abortion movement wasn’t driven primarily by moral or religious concerns like it is today. Instead, abortion’s first major foe in the U.S. was physicians on a mission to regulate medicine.” and “Most providers were midwives, many of whom made a good living selling abortifacient plants.” (Emphasis added)

The American Medical Association was established in 1847 and the “AMA was keen to be taken seriously as a gatekeeper of the medical profession, and abortion services made midwives and other irregular practitioners—so-called quacks—an easy target.”

“In 1857, the AMA took aim at unregulated abortion providers with a letter-writing campaign pushing state lawmakers to ban the practice. To make their case, they asserted that there was a medical consensus that life begins at conception, rather than at quickening.“

The campaign succeeded. At least 40 anti-abortion laws went on the books between 1860 and 1880.” (All emphasis added)

And abortion eventually became illegal throughout the US until the 1973 Roe v. Wade Supreme Court decision that legalized most abortions in the US.

FAST FORWARD TO TODAY

In a June 13, 2023 article on Medpage titled “AMA Delegates Make Short Work of Proposals on Abortion” at AMA Delegates Make Short Work of Proposals on Abortion | MedPage Today, Dr Thomas Eppes Jr, MD from Virginia introduced a resolution that asked the AMA to:

 “advocate for availability of the highest standard of neonatal care to [an] aborted fetus born alive at a gestational age of viability,” which occurs at approximately 22 weeks’ gestation. “This position is not to argue the woman’s right to choose … The decision to abort is still between the patient and the physician,” Eppes said. “It does not imply the woman’s responsibility for the fetal life, but this resolution places the burden of care on the physician, who now has to care for two patients once the fetus is viable.” (Emphasis added)

The resolution was opposed by Kavita Arora, MD, of Chapel Hill, North Carolina, a delegate from the American College of Obstetricians and Gynecologists (ACOG) who was speaking on behalf of the ACOG section council and the Specialty and Service societies who said that:

“Our policy should be based on science, it should be based on fact, and it should be based on the best available evidence that honors and upholds the value of the patient-physician relationship and the nuance and complexity of medical care,” and that “It is not a one-size-fits-all approach and should not be based on misinformation or disinformation. I strongly urge you to oppose.” (Emphasis added)

The Dr. Eppes’ resolution was voted down 476-106 and the council moved on to reimbursement matters.

ASSISTED SUICIDE AND THE AMA

A May 1, 2023, article by Dallas R. Lawry, DNP, FNP-C, AOCNP® from the University of California, San Diego in the Journal of the Advanced Practitioner in Oncology titled “Rethinking Medical Aid in Dying: What Does It Mean to ‘Do No Harm?’” at Rethinking Medical Aid in Dying: What Does It Mean to ‘Do No Harm?’ – PMC (nih.gov) reveals that:

“Until 2019, the American Medical Association (AMA) maintained that MAID (medical aid in dying aka assisted suicide) was incompatible with their code of ethics and a physician’s responsibility to heal (AMA, 2022)“.

 But now, the AMA Medical Code of Ethics now has two provisions that support both positions on MAID, including: “Physicians who participate in MAID are adhering to their professional, ethical obligations as are physicians who decline to participate” (AMA, 2019, 2022; Compassion & Choices, 2022) (Emphasis added)

ABORTION AND THE ANA (American Nurses Association)

When I graduated nursing school in 1969, abortion was still a criminal act and no one expected the 1973 Roe v. Wade decision legalizing most abortions.

In 2022, the ANA publish a position statement fully supporting “respect for a person’s reproductive choices; sex education; access to contraception; access to abortion care; ensuring equity in reproductive health, access, and care delivery; and matters of conscience for nurses in SRH (sexual and reproductive health)”.

So it was not surprising that several national nursing associations condemned the US Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision overturning the 1973 Roe v Wade decision and returning regulating abortion to the states and the ANA wrote in its  official statement that:

“the “U.S. Supreme Court’s decision to overturn Roe vs. Wade is a serious setback for reproductive health and human rights” and that “”(n)urses have an ethical obligation to safeguard the right to privacy for individuals, families, and communities, allowing for decision making that is based on full information without coercion.” (All emphasis added)

ASSISTED SUICIDE AND THE ANA

In 1995, the American Nurses Association stated:

“The American Nurses Association (ANA) believes that the nurse should not participate in assisted suicide. Such an act is in violation of the Code for Nurses with Interpretive Statements (Code for Nurses) and the ethical traditions of the profession. “ (Emphasis added)

In 2017, the ANA revised in position on VSED (voluntary stopping of eating and drinking) “with the intention of hastening death”.

In 2019, the American Nurses Association revised their position on assisted suicide titled “The Nurse’s Role When a Patient Requests Medical Aid in Dying”, stating that nurses:

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

• Have an ethical duty to be knowledgeable about this evolving issue.

• Be aware of their personal values regarding medical aid in dying and how these values might affect the patient-nurse relationship.

• Have the right to conscientiously object to being involved in the aid in dying process. (But “Conscience-based refusals to participate exclude personal preference, prejudice, bias, convenience, or arbitrariness”)

• Never “abandon or refuse to provide comfort and safety measures to the patient” who has chosen medical aid in dying (Ersek, 2004, p. 55). 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)

But while the ANA is states that “It is a strict legal and ethical prohibition that a nurse may not administer the medication that causes the patient’s death“, it is silent when some states with assisted suicide laws like Washington state’s where Governor Jay Inslee signed a new expansion to the law in April 2023 to “allow physician assistants and advanced nurse practitioners to be one of the medical providers who sign off on the procedure”, “eliminates a two-day waiting period for prescribing the drugs” and “allow the necessary drugs to be mailed to patients instead of picked up in person”. (Emphasis added) https://www.axios.com/2023/04/24/washington-death-with-dignity-law

Most recently on June 2, 2023 in Hawaii, Gov. Josh Green (D), a physician, signed a bill that “allows qualified advanced practice registered nurses (APRNs) the authority as attending and consulting healthcare providers to evaluate and confirm a patient’s eligibility and to prescribe medical aid in dying medications.“ (Emphasis added)

CONCLUSION

Because there are now many state and national medical professional organizations that support assisted suicide, , abortion and other problematic ethical issues, the discouraging effect on idealistic people considering or remaining in a health care career may be devastating to our most vulnerable people and indeed to our healthcare system itself.

But, as I will write in a future blog, there is hope, alternatives and resources that everyone needs to know to protect themselves and their loved ones as well as other vulnerable lives.

Statement of the National Association Of Pro-Life Nurses against the Potential Revision of the Uniform Determination of Death Act (UDDA)

nancyvalko brain death, conscience rights, end-of-life, law, medical ethics, nursing

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WHILE PRO-ABORTION VIOLENCE AGAINST PRO-LIFE CRISIS PREGNANCY CENTERS INCREASES, THE WORLD HEALTH ORGANIZATION SAYS CONSCIENCE RIGHTS REGARDING ABORTION MAY BECOME “INDEFENSIBLE”

nancyvalko abortion, assisted suicide, bereavement, Compassion & Choices, conscience rights, culture, law, medical ethics, Planned Parenthood, pro-life

We have been witnessing the rage and misinformation dividing Americans after the outrageous leak of Supreme Court Justice Alito’s draft decision on the Dobbs v Jackson Women’s Health Organization returning abortion laws back to the states since it was reported on May 2, 2022.

Many pro-life crisis pregnancy centers are now being attacked with paint, firebombs, etc. by pro-abortion groups like “Jane’s Revenge”. But as Nicole Ault of the Wall Street Journal points out:

“No woman is forced to go to one of these clinics, where more than 10,000 licensed medical professionals worked or volunteered as of 2019, according to the pro-life Charlotte Lozier Institute. In addition to providing ultrasounds and pregnancy tests, the centers help women get supplies and counseling.”

But then, on June 8, 2022 and during the night, U.S. Marshals protecting the home of Supreme Court Justice Brett Kavanaugh from illegally picketing protesters apprehended an individual with a gun and a knife who readily admitted that “he was there to kill Justice Kavanaugh in response to the leaked draft opinion that indicated the Court might be preparing to overturn Roe v. Wade.”

Now, Jane’s Revenge has issued a call to ‘riot’ against the Supreme Court if it does overturn Roe v. Wade.

Their flyer “DC CALL TO ACTION NIGHT OF RAGE” declares “THE NIGHT SCOTUS OVERTURNS ROE V. WADE HIT THE STREETS YOU SAID YOU’D RIOT. TO OUR OPPRESSORS: IF ABORTIONS AREN’T SAFE, YOU’RE NOT EITHER.’ JANE’S REVENGE.” (Emphasis added)

THE WORLD HEALTH ORGANIZATION ON ABORTION

On March 8, 2022, the World Health Organization (WHO), the international body responsible for public health and part of the United Nations involved in many aspects of health policy and planning, issued its’ “Abortion Care Guideline“.

In the Guideline, WHO recommends “the full decriminalization of abortion” and calls conscientious objection to abortion a major obstacle to making abortion freely available.

According to the WHO recommendations:

“If it proves impossible to regulate conscientious objection in a way that respects, protects and fulfils abortion seekers’ rights, conscientious objection in abortion provision may become indefensible.” (Emphasis added)

CONCLUSION

Personally, when my daughter Karen, born with Down Syndrome and a severe heart defect, died at 5 1/2 months in 1983, my grief was substantially lessened by donating Karen’s clothes, formula, etc. to our local Birthright organization, one of the many pro-life organizations providing help to pregnant women.

Since Karen and as a nurse and mother, I have been able to help advocate for distressed mothers and their families, children and adults with disabilities and, best of all, my own daughter who found she was pregnant in her first year of college and gave birth to my first grandchild.

And I know that the WHO is absolutely wrong in calling conscientious objections to abortion “indefensible”. Conscience rights are critically important for all of us, whether or not we are healthcare providers.

As I wrote in my December 13, 2019 blog “Are We Witnessing the Coming Extinction of Conscience Rights?”:

“With the current support of a predominantly sympathetic mainstream media, well-funded and politically active groups like Planned Parenthood and Compassion&Choices are also putting pro-life health care providers and their supportive institutions in grave danger of becoming an endangered species in law, politics and health care.

If this happens, our health care system will radically change-especially for the unborn, the elderly and people with disabilities.

When dedicated and compassionate people are denied entry into the health care professions because they refuse to deliberately end lives, harassed and/or fired when they refuse to participate in a deliberate death decision and efforts to make religiously based healthcare institutions to allow lives to be ended by “choice”, will any of us ever be able to trust our healthcare system when we need it the most?” (Emphasis added)

A DISTURBING BUT IMPORTANT LOOK INTO THE TRAINING OF DOCTORS FOR MEDICALLY ASSISTED SUICIDE

nancyvalko assisted suicide, Canada, Compassion & Choices, conscience rights, disability, end-of-life, law, medical ethics, mental health

Most people seem to assume that medically assisted suicide is a simple matter of getting a doctor to prescribe a lethal overdose, taking a pill or two and then go to sleep and die. Many seem unaware that a second consulting doctor (or other healthcare provider in some states) must agree.

This view, abetted by polls, well-funded groups like Compassion and Choices as well as a mostly sympathetic mainstream media, is disastrously wrong.

A stunning February 2022 article in Medscape for healthcare providers titled  “Medical Aid in Dying: Your Clinical Guide and Practice Points” exposes some very real problems with medically assisted suicide that are largely hidden from the general public.

But while citing a Gallup poll showing that 74% of the American public support legalizing “medical aid in dying” (their preferred term for medically assisted suicide) as well as 58% of doctors, the article admits that:

“Study data, however, have revealed a discrepancy between attitudes about legalization and willingness to practice. Only 15% to 22% of physicians in favor of legal access to medical aid in dying would be willing or likely to provide such assistance” (Emphasis added)

And citing Oregon, the first state to legalize assisted suicide, the article claims that:

“Pain management and hospice use have improved in Oregon since passage of the Death with Dignity Act” but also that “Opponents of medical aid in dying express concern that in Oregon, more than 70% of patients who elect medical aid in dying are elderly and have cancer–both being commonly associated with depression–but fewer than 5% are referred for psychiatric evaluation”. (Emphasis added)

Tellingly, the article recognizes the toll assisted suicide can take on the medical professionals involved:

“A Mental Note for the Healthcare Provider: Discussion of end-of-life options represents a profound event for both the patient and the healthcare provider. Do not neglect your own self-care while guiding your patient through the emotionality that can be brought on by end-of-life decision-making.” (Emphasis added)

THE MEDICALLY ASSISTED SUICIDE PROTOCOL IS COMPLICATED

It is recommended that the patient does not eat or drink for 6 hours before ingesting the lethal dose called D-DMAPh.

Anti-nausea medication and a gastric motility medication is to be taken 1 hour before ingesting the life-ending medication.

A large dose of Digoxin to slow the heart is taken 30 minutes later and then a compound of anxiolytic, opioid and tricyclic medications are to be swallowed in less than 90 seconds.

Recommendations include:

– adding a favorite liquor may counter the bitterness of the mixture

– a small amount of sorbet can be ingested to avoid potential post-ingestion esophageal burning or distress

-Prepare for the possibility that the medication may not work if not quickly and fully ingested; it is crucial that the patient who self-administers not fall asleep before consuming the full dose-Patients should not take the medicine when alone or in a public place

-kept carefully out of the reach of children and vulnerable adults

-and must be disposed of properly. (Emphasis added)

For special circumstances:

“It is legal in all jurisdictions for physicians, other HCPs, or family members to assist in medical aid in dying but not to administer medical aid-in-dying medications.[1-9] The law requires that the patient self-administer the medication through ingestible means, which may include:

•         Drinking the medication mixture

•         Ingesting through a nasogastric tube

•         Ingesting the medication through a feeding tube, or

•         Insertion through a rectal catheter

Patients are permitted to receive help in preparing or mixing the medication for self-administration, but the patient must take a voluntary, affirmative act (i.e., swallowing or pushing a syringe) and administer the medication him- or herself. Medical aid-in-dying laws do not allow physicians, family members, or anyone else, including the dying person, to administer medical aid-in-dying medication by intravenous (IV) injection, parenteral injection, or infusion.” (Emphasis added)

The article states that decision-making capacity is the basis of informed consent and that:

“Guidance begins with assessment of the patient’s decision-making capacity and understanding of palliative measures as alternatives to or concurrent with medical aid in dying. No matter the practice specialty, HCPs (health care providers) are trained on the art of assessing a patient’s medical decision-making capacity and their ability to understand the situation, appreciate the consequences, reason rationally, and express a choice.” (Emphasis added)

If there is a concern, the patient:

 “must be referred for additional evaluation by a licensed psychiatrist, clinical psychologist, or clinical social worker. The request for aid-in-dying medication does not proceed unless the mental health professional affirms that the patient is free of mental illness, acute psychological distress, or demoralization.” (Emphasis added)

COMPLICATIONS

The article admits that complications such as regurgitation and seizures can occur but says they are infrequent.

Prolonged dying can also occur so the “families should make contingency plans for how to manage such circumstances” and “remain calm and engage with hospice or other support services as needed. Families should understand that to help avoid unnecessary deployment of police and emergency medical personnel, they should not call 911.” (Emphasis added)

The article also warns that:

“Those present at the death may witness the following changes, which frequently occur during the natural dying process: snoring; gurgling noises; changes in rate of breathing; and fluctuations in body temperature that may leave their skin cool, warm, moist, or pale. Physical movements or other external signs of distress are sometimes exhibited, but the internal peace of the person is not disturbed.” (Emphasis added)

Sadly, the article reports that 4% of patients in Oregon “chose not to inform their families of their decision” even though support groups “strongly recommend that at least 1 other person be present” but not the doctor.

LEGAL REQUIREMENTS DIFFER WIDELY BETWEEN STATES

The article illustrates how dramatic the differences are in state laws such as the eligible medical providers in New Mexico to include APRNs (advance practice registered nurses) and physician assistants and no consulting provider is required if the patient is in hospice.

and

“In Hawaii, a mental health evaluation is mandatory for all patients requesting medications under the law. In New Mexico, a mental health evaluation is also required if the patient has a recent history of a mental health condition or intellectual disability.” (Emphasis added)

Required waiting periods to make the second request varies from as little as none in Oregon and New Mexico if the patient is unlikely to survive the waiting period to at least 20 days in Hawaii.

The article also recommends that health care providers familiarize themselves with the assisted suicide group Compassion and Choice’s Doc2Doc helpline that “offers free, confidential telephone consultation with clinicians who are experienced in providing end-of-life medical care”.

Right now, 9 U.S, states (California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont,  Washington)  and the District of Columbia have medically assisted suicide laws and 12 states (Massachusetts, Delaware, Minnesota, New York, Pennsylvania, North Carolina, Indiana, Kentucky, Rhode Island, Virginian, Arizona and Utah) have bills in their legislatures.

And there are more states seeking to expand their existing assisted suicide laws such as Vermont S 74  that threatens conscience rights by defining assisted suicide as a “healthcare service” and allows assisted suicide by telemedicine and Washington state HB 1141 that expands the prescriber to PAs (physician assistants), advanced registered nurse practitioners and allows the lethal dose to be sent by mail or courier.

CONCLUSION

Our neighbor Canada is a cautionary tale about the inability to limit medically assisted suicide.

In a June, 2021 article in the Psychiatric Times titled “First, Do No Harm: New Canadian Law Allows for Assisted Suicide for Patients with Psychiatric Disorders” , Dr. Mark Komrad chronicles the expansion of the 2016 MAID (medical aid in dying) law allowing medical euthanasia (the doctor directly administers a substance that causes death, such as an injection of a drug) and physician-assisted suicide for the terminally ill to expand to those “with nonterminal chronic illnesses and permitted euthanasia for those whose psychological or physical suffering is deemed intolerable and untreatable”.

Now, those Canadians “whose only medical condition is a mental illness, and who otherwise meet all eligibility criteria, will not be eligible for MAID until March 17, 2023″. (Emphasis added).

As a nurse with over 50 years of personal and professional experience in hospice, critical care, oncology, etc., I am willing to do anything for sick people– except kill them or help them kill themselves. These people deserve better!

Medically assisted suicide is a dangerous proposition that has proven to be impossible to strictly limit. It also corrupts the essential element of trust we must have in the health care system and makes suicide more attractive to vulnerable people as a way to solve life’s problems.

Six Problems with Covid 19 Vaccination Mandates

nancyvalko civil rights, conscience rights, Covid 19, culture, law, medical ethics, vaccines

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

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

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

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

and signed

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

PROBLEM ONE

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

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

What scientific justification is there for this?

PROBLEM TWO

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

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

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

and

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

PROBLEM THREE

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

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

PROBLEM FOUR

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

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

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

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

PROBLEM FIVE

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

PROBLEM SIX

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

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

CONCLUSION

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

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

We are all Americans and we need to work together.

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

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