conscience rights

CALIFORNIA GOVERNOR SIGNS ASSISTED SUICIDE BILL AND MY 1996 ARTICLE “NO BLANK BULLETS”

nancyvalko assisted suicide, conscience rights, euthanasia, medical ethics

USA Today article: Calif. governor signs assisted suicide bill

Comment: Note the quote about why Governor Brown signed this bill after it was defeated 4 times in committee with weeks of deliberation: “In the end, I was left to reflect on what I would want in the face of my own death,” the governor wrote. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

Unfortunately, it seems too many people base their judgements about physician-assisted suicide based on possible future self-interest rather than what the bill allows-medicalized killing by suicide-instead of the terrible consequences on people at risk, medical ethics and society.

Almost 20 years ago and before Oregon implemented its physician-assisted suicide law, I wrote the following commentary for the January-March 1996 edition of the Patients Rights Council newsletter. I believe it is just as valid today.

No Blank Bullets

Ready… aim… fire!

All the B-movie scenes I watched as a child flashed through my mind when I heard that a convicted murderer had been recently executed by firing squad. My visceral reaction was to cringe, instantly imagining the terror of being blindfolded and waiting for the bullets to hit. What I couldn’t imagine, though, were the feelings of being one of the men called to pick up and aim a piece of cold, hard steel at another human being. Would the man cope by pretending it was just another round of target practice? Would he try to remember the details of the murders and the tears of the victims’ families to muster the outrage that such crimes call for? What did he feel after the execution — sadness or satisfaction?

I was not surprised to later learn that one of the firing squad guns contained only blank bullets. In such circumstances, it is sensible to protect each executioner from the certain knowledge that he personally ended another’s life. In the more common lethal injection executions, the process is said to include at least two people and two buttons to start the process. Again, the procedure for legally terminating another life tries to protect those whom society asks to perform the awful task.

It is ironic, therefore, that society is considering the addition of yet another kind of execution to the legal list — assisted suicide — but this time without the blank bullets.

Few people would seriously consider legalizing relative– or family-assisted suicide. The inherent dangers of this type of private killing are much too obvious. Thus, the goal must be physician-assisted suicide or, more accurately, health care professional-assisted suicide, since nurses also must necessarily be involved when the assisted suicide occurs in a health facility or home health situation. We doctors and nurses are the ones society is now considering asking to perform the act of terminating lives, but unlike the firing squad or the lethal injection team, we will know and have to live with the certain knowledge that we caused death.

It is doubly ironic that when a convicted murderer tries to discourage efforts by lawyers to stop his or her execution, this is considered as a sign of stress or mental disorder, while a sick person’s willingness to die is considered an understandable and even courageous decision! How do we reconcile the two views that killing is the ultimate punishment for a convicted murderer and, at the same time, the ultimate blessing for an innocent dying or disabled person?

Both the American Medical Association and the American Nurses Association have recently issued strong statements against assisted suicide and euthanasia. While acknowledging the very real deficiencies too often found in care at the end of life, these organizations call for more education and access to help instead of the simple but dangerous option of killing terminally-ill or severely-disabled people or helping such people kill themselves. It is eminently logical that our concern for life should not be limited to just the curable.

And, although some polls show that a significant number of doctors and nurses, like the general public, say they could support assisted suicide in a hypothetical case, when faced with the realities and ramifications of legalizing the practice, most express deep concerns and fears regarding its implementation.

Society has long insisted that health care professionals adhere to the highest standards of ethics as a form of protection for society. The vulnerability of a sick person and the inability of society to monitor every health care decision or action are powerful motivators to enforce such standards. For thousands of years doctors (and nurses) have embraced the Hippocratic standard that “I will give no deadly medicine to any one, nor suggest any such counsel.” Should the bright line doctors and nurses themselves have drawn to separate killing from caring now be erased by legislators or judges?

As a nurse, I am willing to do anything for my patients — except kill them. In my work with the terminally ill, I have been struck by how rarely these people say something like, “I want to end my life.” And the few who do express such thoughts are visibly relieved when their concerns and fears are addressed and dealt with instead of finding support for the suicide option. I have yet to see such a patient go on to commit suicide.

This should not be surprising. Think about it. All of us have had at least fleeting thoughts of suicide in a time of crisis. Imagine how we would feel if we confided this to a close friend or relative who replied, “You’re right. I can’t see any other way out either.” Would we consider this reply as compassionate or, instead, desperately discouraging? The terminally-ill or disabled person is no different from the rest of us in this respect.

I often wonder if right-to-die supporters really expect us doctors and nurses to be able to assist the suicide of one patient and then go on to care for a similar patient who wants to live without this having an effect on our ethics or our empathy. Do they really want to risk more Jack Kevorkians setting their own standards of who should live and who should die?

The excuse that the only real issue is the patient’s choice would be cold comfort to us doctors and nurses when we have to go home and face the fact that we helped kill another human being or had to remain silently powerless while some of us legally participated. There will be no blank bullets then for us — or for society.

DEATH REFERRALS AND CONSCIENCE RIGHTS

nancyvalko assisted suicide, conscience rights, medical ethics

In his September 23, 2015 article “Ontario doctors squeezed on conscientious objection to assisted suicide” ,  Michael Cook states that

“The legalisation of physician-assisted suicide in Canada after February’s decision by the Supreme Court is starting to affect doctors. The College of Physicians and Surgeons of Ontario has quietly issued a directive that conscientious objectors must help them find someone willing to do so.”

Mr. Cook also writes that such a directive requires unwilling doctors to make

“an effective referral to another health-care provider” defined as ‘a referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency’.”

and

“It was approved by College Council in March despite overwhelming opposition to the demand for ‘effective referral’.”

Personally and as a nurse, I could not refer for either abortion or physician-assisted suicide. Not only do I oppose these actions but I also don’t know any ethical or scandal-free organizations or practitioners that perform death procedures.

And does “mandated referral” also mean that I am forbidden to give any accurate but negative information about these procedures? Probably.

Here is what happened to nurses in Oregon after the physician-assisted suicide law took effect and even though the Oregon Nurses Association (ONA) is part of the American Nurses Association which opposes against assisted suicide.

The ONA’s 1997 guidelines on the “Role of the Registered Nurse in Assisted Suicide” states that

“ONA supports the patient’s right to self-determination and believes that nurses will and must play a primary role in end-of-life decisions.”

And here are some excerpts from that paper concerning those “Nurses Who Choose Not To Be Involved”:

According to the ONA, such nurses may:

“Conscientiously object to being involved in delivering care. You are obliged to provide for the patient’s safety, to avoid abandonment and withdraw only when assured that alternative sources of care are available to the patient.” (Emphasis added)

I faced such a situation myself years ago when I was told that there was no other nurse available when I refused to comply with a death decision. I was almost fired.

Furthermore, according to the position paper, such objecting Oregon nurses may not:

“Subject your patients or their families to unwarranted, judgmental comments or actions because of the patient’s choice to explore or select the option of assisted suicide.” (Emphasis added)
Or
“Subject your peers or other health care team members 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.” (Emphasis added)

My point is that mandated referral must be opposed. It is just another kind of required participation and denial of conscience rights that is intended to silence the objections of doctors and nurses and even threaten their careers.

But above all, conscience rights protect patients and their right to safe health care.

DISASTER IN CANADA-THE BIGGEST UNDERREPORTED STORY IN US MEDIA

nancyvalko assisted suicide, conscience rights

This February, The Supreme Court of Canada ruled unanimously that  the Canadian law that makes it illegal for anyone to help people end their own lives should be amended to allow doctors to help in specific situations. The court gave federal and provincial governments 12 months to craft legislation to respond to the ruling. Until then; the ban on doctor-assisted suicide stands. If the government doesn’t write a new law, the court’s exemption for physicians will stand.

Against this ghastly situation, however, there are welcome voices of opposition.

In a September article in the Canadian press titled “Quebec’s split over euthanasia a warning for Canada”, reporter Allan Woods writes:

But with time running out before Dec. 10 — the date that patients can begin requesting the procedure — hospitals and health-care providers are scrambling to draw up policies and find the staff who will carry out those patients’ wishes.
If that wasn’t tough enough, some of those who might be expected to lead the change — palliative care physicians and hospice administrators — have let it be known that they are instead digging trenches for the battle.

“The vocation of a palliative care hospice is to provide care, and that doesn’t include medical aid in dying,” said Élise Rheault, director of Maison Albatros Trois-Rivières.

Mr. Woods goes on to write that:

Quebec Health Minister Gaétan Barrette, a doctor himself, says the refusal by the province’s hospices to provide the procedure amounts to “administrative fundamentalism” and he accused palliative care doctors — who have a right under the law to conscientious objection — of acting like hospital owners rather than service providers.
“The law was very much framed as being in a continuum, along the lines of (euthanasia) being the end part of palliative care, so it is a logistical problem if the significant majority of palliative-care professionals are saying we will invoke conscientious objection,” said Dr. Eugene Bereza, director of the Centre for Applied Ethics at the McGill University Health Centre.

This horrific development in our neighbor Canada is a warning to those in the US, especially with a California law rammed though the legislature and now sitting on Governor Jerry Brown’s desk awaiting either his signature or veto.