end-of-life

Important Position Paper on Criteria for Brain Death and Organ Donation: A Call to Action

nancyvalko assisted suicide, brain death, brain injury, Canada, conscience rights, culture, education, end-of-life, euthanasia, medical ethics, ventilators/life support

I am a signatory on this statement and it deserves to be read and shared. Although the statement touches on Catholic teaching, it is primarily is about science and ethics. Please read the statement and press release.

The statement, “Catholics United on Brain Death and Organ Donation: A Call to Action”, was published on February 27, 2024. It was prepared by Joseph Eble, a physician and President of the Tulsa Guild of the Catholic Medical Association; John Di Camillo, an ethicist of The National Catholic Bioethics Center; and Peter Colosi, a philosophy professor at Salve Regina University.

As a nurse, I have been writing about this topic for years, most recently in my May, 2021 blog “Rethinking Brain Death and Organ Donation” and my experience serving on an ethics committee at a hospital where a patient “failed” one of the hospital’s brain death tests and thus could not have her organs removed.

Although I already knew that the medical criteria used to determine brain death vary — often widely — from one hospital to another, one young doctor checked our area hospitals and came back elated after he found a hospital that did not include the test the elderly woman “failed”. He suggested that our hospital adopt the other hospital’s criteria to allow more organ donations.

When I pointed out that the public could lose trust in the ethics of organ donations if they knew we would change our rules just to get more organ transplants, I was told that I being hard-hearted to people who desperately needed such organs.

I was also alarmed when a 2011 Illinois almost passed a “presumed consent for organ donation” law in 2011 that would allow presumed consent unless a person ” opt(s) of the presumed donation by executing an anatomical gift as otherwise provided in the Act or by filing with the Secretary of State an organ donor opt out document. ” (Emphasis added) Thankfully, it was defeated especially with the help of the disability group Not Dead Yet.

FINDINGS OF THE POSITION PAPER

“At least half of donors declared brain-dead are actually alive when their organs are removed, according to the position paper endorsed by 151 Catholic health care professionals, theologians, philosophers, ethicists, lawyers, apologists, pro-life advocates, and others, including a brain death survivor and a professional organization.” (There is now a webpage of some of the people diagnosed as brain dead who “lived to tell the tale”.)

“Catholic United explains that the criteria for brain death establish only partial loss of brain function. This is now abundantly clear based on scientific studies, a recent effort to lower the legal standard for death, and updated brain death guidelines issued in October 2023.” (All emphasis added)

The statement calls for an effort “to unite against the utilization of the current brain death criteria” because they do not ensure that patients are dead. They recommend concrete action steps to protect vulnerable patients, enable informed decisions, identify better criteria for determining actual death, and protect the conscience rights of healthcare professionals and organizations”.

Also “Catholics United bridges a divide among faithful Catholics about whether the concept of brain death aligns with Church teaching. Some Catholics hold that brain death represents true death when there is complete and irreversible cessation of all brain activity, often called whole brain death. Others hold that brain death does not represent true death. Since the existing criteria establish only partial loss of brain function, all the endorsers—whether they accept or reject whole brain death as true death—agree that “the current brain death criteria in widespread use do not provide moral (prudential) certainty of death.” (Emphasis added)

RECOMMENDATIONS

The statement “calls on health care professionals and institutions to cease organ harvesting that relies on the inadequate criteria, noting that 70% of all donors are declared dead using brain death criteria. “ (Emphasis added)

Given the lack of moral certainty of death whenever the current brain death criteria are used, the statement affirms that “a clear majority of vital organ donors can be presumed alive at the time of organ harvesting.” Since the Catholic Church forbids removing vital organs when this would kill the patient, “it is therefore wrong to remove organs from patients declared dead using these inadequate criteria.”

Catholics United makes a number of other strong recommendations, including:

  • Declining to be an organ donor at the Department of Motor Vehicles.
  • Refusing to be an organ donor after death in advance directives.
  • Improving education on end-of-life care and organ donation at the pastoral level.
  • Identifying criteria that will establish certainty of death.
  • Advocating for conscience protection rights for health care professionals and institutions.

The statement also cites:

“Current president and co-founder of the pro-life advocacy group American Life League, Judie Brown, has decided to update its Loving Will Comfort and Care Directive in accord with the new recommendations. “I think that any organization that has a pro-life document addressing wishes at the end of life needs to be updated in view of this article,” said Ms. Brown.”

CONCLUSION

Unfortunately, now some countries’ healthcare ethics have even degenerated to the point where eight countries including Canada, the Netherlands, Spain, and Belgium allow organ donation after euthanasia by “combining medical assistance in dying (MAiD) with donations after circulatory determination of death (DCDD) is known as organ donation after euthanasia (ODE)”. (Emphasis added)

Personally, I am all for the ethical donation of tissues like bone, skin, corneas, etc. after natural death. And I am also a strong supporter of living donation. For example, I volunteered to donate one of my kidneys to a friend years ago and one of our grandsons was saved in 2013 by an adult stem cell transplant donated by a living person.

Hopefully, this statement can help all of us to better protect ourselves and vulnerable patients at the end of life- especially when it comes to organ donation-as well as promoting a dignified, humane and peaceful end of life.

Victory: “After Initial Hope, Medically Assisted Suicide Bill Won’t Move Forward in Maryland”

nancyvalko ANA, assisted suicide, conscience rights, culture, education, end-of-life, euthanasia, food and water, law, medical ethics, nursing, VSED

In 2019, I testified in Maryland against another “medically assisted suicide” bill that was expected to pass and wrote a blog about it titled “Lessons from the Victory against Assisted Suicide in Maryland”. It failed to pass by one vote.

Now, yet another attempt to pass an assisted suicide bill in Maryland failed by “one or two votes”, according to a Baltimore Sun article titled “After initial hope, medically assisted suicide bill won’t move forward in Maryland”, thanks to efforts like that of Mary Bogdan BSN, MA-C, DNP-S, ALNC who wrote an excellent expert witness testimony stating in part:

“The physician assisted suicide bill has been called many things: medical aid in dying, euthanasia, withholding of food and water, etc., etc., etc. The bottom line is this: I did not become a nurse to kill people. The American Nurses Association (ANA) says that nurses should support patient autonomy, the desire to have control over one’s life. I submit this; if we allow patients to end their lives as desired by them, we subject ourselves to unfathomable consequences.” (Emphasis added)

Note this sentence from the article in the Baltimore Sun “I think that as we slowly got closer to the vote and had more in depth discussions with their constituents, folks just expressed unreadiness to move on it at this time,” Smith said. “I’m obviously very disappointed, but you have to respect the decisions of the individual senators who were listening to their constituents and listening to their conscience.” (Sen. Will Smith is chair of the Judicial Proceedings Committee and a previous sponsor of the bill)

CONCLUSION

Nurse Bogdan’s testimony ends with a powerful quote from Dr.  Harvey Max Chochinov, MD, PhD in his December 2023 recent Medpage article ” Intensive Caring: Reminding Patients They Matter— How to care for those who no longer care about themselves”:

“There is abundant evidence that patients approaching death are susceptible to feeling that they no longer matter. When patients feel life is no longer worth living, healthcare professionals must affirm their intrinsic worth to patients for all that they are, all that they were, and all that they will become in the collective memories of those they will eventually leave behind.” (Emphasis added)

Virginia is now facing SB 280, an assisted suicide bill.

Unfortunately, the assisted suicide proponents never seem to give up and we must continue to be vigilant in every state and continue to educate legislators, healthcare providers, and the general population about these dangerous assisted suicide laws.

INSPIRATIONAL GERONTOLOGIST TRANSFORMED DEMENTIA CARE

nancyvalko Alzheimer's, assisted suicide, Compassion & Choices, dementia, end-of-life, family, food and water, inspiration, medical, medical ethics, mental health, nursing, palliative care, VSED

I don’t normally read obituaries but this obituary I recently read in the January 11, 2024 Wall Street Journal titled “Naomi Feil, Who Transformed Dementia Care, Dies at 91” was inspiring and, most of all, educational!

MY STORY

When I was 13, I became a volunteer in our local nursing home to help feed the elderly patients, some of whom had dementia. I loved it but was told I should be feeding the patients faster instead of listening to their stories.

When I said that these stories were great and really enjoyed by all the patients at the table, the nurses told me that most of the stories were probably not true anyway!

When I began my nursing career in 1969, patients with dementia were often considered just “difficult” or even “crazy”. Some were put in restraints for safety but that just seemed to agitate them more. I found that sitting and listening to them helped a lot.

So I have long had an interest in people with dementia-most often Alzheimer’s disease, not only because of the patients I cared for as a nurse, but also because of my late mother and brother who also have had the condition.

That’s why I have written blogs about the condition such as ““Repairing Our View of Dementia” and “Five Things my Mother (and Daughter) Taught Me about Caring for People with Dementia”, hoping these blogs would help other caregivers, patients and their families.

NAOMI FEIL’S STORY

Naomi’s obituary is subtitled “Instead of forcing people to remember facts, she helped them express their anger and sorrow. She found it made all the difference.”

Here are some excerpts from the obituary:

“Caregivers, struggling to help people with dementia, often see their role as offering scraps of reality—reminding them what year it is, for instance, or who is in the White House.

Naomi Feil had a different strategy. As a social worker in nursing homes, she resisted the impulse to yank disoriented people back to her reality. Instead, she sought to enter their realities and affirm their emotions. Rather than offering a cup of tea or chirping that everything would be fine, she helped her charges express their anger and sorrow—and found they often were more at ease afterward.”

In the 1960s and 1970s, Feil devised what she called the validation method for dementia care. She wrote books, led workshops and established 24 validation-training centers in 14 countries.

Feil’s ideas have become fundamental to what is now called person-centered dementia care, which focuses on discovering individual needs and preserving dignity rather than following standard routines, said Sam Fazio, a senior director of the Alzheimer’s Association. In such care, he said, “You’re meeting them in their reality versus expecting them to meet us in our reality when they are no longer able to do that.” (Emphasis added)

NAOMI’S HISTORY

“When she was 4 years old, her Jewish family fled Nazi Germany. They eventually settled in Cleveland, where her father was the administrator of a nursing home, which doubled as living quarters for her family. Some of her earliest friends were very old people.”

“Her work was with the troublemakers other staff members avoided. These were the blamers, the martyrs, the moaners, the wanderers, the yellers, the pacers, the pounders whom nobody wanted,” she wrote in one of her books, “The Validation Breakthrough.”

“Sometimes nursing assistants tied people to their chairs so they wouldn’t wander off and make trouble. When she tried to engage with these misfits, a nursing assistant scolded her: “You’re getting them all worked up…. You can’t help them. I’ve been working here for five years, and I ought to know.” 

“Feil persisted and gradually learned from her encounters. ‘I learned not to contradict, patronize, argue, or try to use logic or give insight,” she wrote. Instead, she made clear she was listening. If an old person imagined the nurses were stealing her jewelry, Feil might say, ‘You loved that necklace, didn’t you. Who gave it to you?’ She could share the emotion and then explore deeper.” (Emphasis added)”

As a social worker in the 1960s and 1970s, she developed her methods through trial and error. “

“No lies

“She opposed the idea of telling comforting lies. Lies could be detected, even by those who seemed most deluded, and that would destroy trust. When an old woman said she needed to see her mother right away, Feil wouldn’t point out that her mother was dead. Nor would she promise that the mother would visit soon. Instead, she would make it a conversation: ‘You really need to see your mother! What would you like to tell her?’”

“You don’t argue, you don’t lie,” she said in a TEDx talk. “You listen with empathy and you rephrase.”

When old people were weepy, it was a bad idea to tell them things weren’t so bad, she found. It was better to let the tears flow and talk about what made them sad.”

CONCLUSION

While so much more is known now about dementia and developing treatments, many people still consider it a fate worse than death and a burden on their family. Some have even chosen assisted suicide or voluntary stopping or eating and drinking (called VSED) through “right to die” organizations such as Compassion and Choices.

But, as I wrote last February in my blog “Alzheimer’s Association Ends Agreement with Compassion and Choices”, the Alzheimer’s Association has now ended it’s agreement with Compassion and Choices (the pro-assisted suicide organization) stating:

“In an effort to provide information and resources about Alzheimer’s disease, the Alzheimer’s Association entered into an agreement to provide education and awareness information to Compassion & Choices, but failed to do appropriate due diligence. Their values are inconsistent with those of the Association.

We deeply regret our mistake, have begun the termination of the relationship, and apologize to all of the families we support who were hurt or disappointed. Additionally, we are reviewing our process for all agreements including those that are focused on the sharing of educational information.

As a patient advocacy group and evidence-based organization, the Alzheimer’s Association stands behind people living with Alzheimer’s, their care partners and their health care providers as they navigate treatment and care choices throughout the continuum of the disease. Research supports a palliative care approach as the highest quality of end-of-life care for individuals with advanced dementia.” (All emphasis added)

Good for the Alzheimer’s Association and as I can personally and professionally attest, caring for people with dementia can be a wonderful- if sometimes challenging- experience, for healthcare providers and especially the person with dementia and their families!

Intensive Caring: Reminding Patients They Matter

nancyvalko assisted suicide, Cancer, culture, dementia, disability, end-of-life, medical ethics, nursing

Last month, there was a beautiful article on Medpage titled “Intensive Caring: Reminding Patients They Matter-How to care for those who no longer care about themselves” by Harvey Max Chochinov, MD, PhD.

Dr. Chochinov quotes Dame Cicely Saunders, the founder of the modern hospice movement, for her famous statement “”You matter because you are you, and you matter to the last moment of your life”.

That statement became an integral part of medical and nursing education in the past and a powerful argument against the current push for legalizing medically assisted suicide.

As Dr. Cochinov states in his article;

“There is abundant evidence that patients approaching death are susceptible to feeling that they no longer matter. When patients feel life is no longer worth living, healthcare professionals must affirm their intrinsic worth to patients for all that they are, all that they were, and all that they will become in the collective memories of those they will eventually leave behind.” (Emphasis added)

and

” A foundational element of this approach is nonabandonment, which demands committed, ongoing care and caring, even when patients no longer care about themselves. Absent someone who cares, suffering, like cancer, can grow, spread, and even kill.” (Emphasis added)

and in contrast:

“Intensive caring sees healthcare professionals hold or contain hope when patients can no longer do so themselves. This means expanding one’s therapeutic imagination to include the possibility that patients may find psychological, spiritual, and physical comfort, tolerable suffering, and for those near the end, a peaceful death. Toward the end of life, hope tends to conflate with meaning and purpose and may be nurtured through connections to those who, or things that, matter.” (Emphasis added)

MY EXPERIENCE

As a new nurse, I was nervous when I was assigned to terminally ill patients.I asked the senior nurses how to approach these patients and if I should be solemn or cheerful. The senior nurses said they didn’t know.

So I came up with a plan. After I clocked out after my shift, I started just visiting with them and listening to whatever they had to say.

I found that there were two basic questions that needed to be answered: “What do you want?” and “What are you afraid of?”

These patients opened up about wanting to die at home without burdening their families and not being in terrible pain at the end. I was able to tell them about good home healthcare options, pain management and being open with their doctors and families. This opened the door to great conversations and often even a lot of laughter!

(I was later chastised by some nurses who criticized the laughter coming from these rooms. I responded by asking them who needed to laugh more than patients in these situations?)

I also started spending time with the relatives who had questions of their own. They were relieved to talk about their fears and sadness and wanted to know how to help their loved ones.

Once, on an on an oncology (cancer) floor, an elderly woman with terminal cancer told me that she wished she could have just one more overnight sleepover with her granddaughter before she died. I told the other nurses and they all enthusiastically joined in with snacks and sodas to make it happen during one night shift, remembering their own special times with their grandmothers.

It was a great success, even though I was caught by an administrator who said I should not make this a habit.

In another case, an elderly woman with advanced cancer was considering another chemo treat but confided that she feared becoming more of a “burden” on her daughter’s family with whom she lived.

I told her that I had just spoken to her daughter the day before and the daughter told me how grateful she was for her mother’s presence and help. For example, the daughter said that since she and her husband both worked, they were relieved to have the mother there for their school-age children when classes ended. The daughter told me how the children loved climbing into bed with grandma and telling her about their day.

My elderly patient was almost reduced to tears by this revelation but then she laughed and admitted that sometimes she fell asleep when the children were talking to her.

I told my patient that whatever else she needed to consider before agreeing to the chemo, fear about being a “burden” should be eliminated.

CONCLUSION

Sadly, Dr. Chochinov cites studies that have shown when patients feel abandoned and bereft of care, they are more likely to contemplate or die by suicide. In addition, he cites studies on the desire for death in the terminally ill “report lower family support relative to those who don’t.”

According to an October 4, 2023 Medical Net news article “Review of Oregon’s assisted dying law finds significant data gaps”:

“Since 2017, fear of being a burden has been cited by around half of those opting for assisted death“. (Emphasis added)

It’s important to remember that no one has to be a medical professional to ask a friend, neighbor, church member, etc. in difficult circumstances to ask “What can I do to help?”.

Just visiting with the person, watching tv with them or bringing a favorite food can be a real day brightener and give family members a much needed boost.

Personally, I know how lonely it can be taking care of a loved one with a terminal illness or a disabling condition without the support of friends or family. Family caregivers also need support and encouragement.

But I also know the wonderful benefits of helping others, both personally and professionally, even just by being there.

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: We Care About All Lives

nancyvalko abortion, Alzheimer's, AMA, ANA, assisted suicide, Cancer, culture, dementia, disability, drug addiction, education, end-of-life, grief, law, media, medical ethics, nursing, pro-life

Recently, I was contacted by a college political science professor who is writing a paper about “pro-choice and pro-life viewpoints” and she wanted to know more about the National Association of Pro-Life Nurses.

I was delighted and we had a long conversation about what motivates pro-life people-and especially nurses.

I told her about our National Association of Pro-life Nurses and the why and how we do what we do. Our motto since the organization began in the 1970s is “Take my hand, not my life”.

The professor seemed surprised that the pro-life movement is founded on caring rather than the common misperception of politics and political power.

Instead, as I told her, the pro-life movement is about helping people in crisis situations from conception to death and educating people about upholding the excellent, life-giving ethics and laws that protect all lives from conception to natural death.

It is also not about being judgmental but rather about truly caring and offering help to desperate people in crisis situations and the people around them before-or even after- a person has chosen abortion or is considering medically assisted suicide. (see “Pro-Life and Other Resources for Help and Information to Protect Human Life”)

And this works!

Many people are surprised when they find out that even NBC News admits that:

“More than 2,500 crisis pregnancy centers operate in the country, outnumbering abortion clinics nearly 3 to 1 by some estimates. Critics, as well as supporters, have said the number of women seeking support at them has grown quickly in the 11 months since federal abortion rights were overturned, which resulted in the closing of abortion clinics in dozens of states. ” (Emphasis added)

And as pro-life nurses who care for everyone-not just in hospitals and crisis pregnancy centers, but also in prisons, at home in poor and sometimes dangerous areas, in homeless situations, etc., we are truly interested in helping instead of judging people.

Our message is “We Care” and I have yet to meet a pro-life nurse who isn’t also involved in some sort of volunteer work.

CONCLUSION

In my 50+ years as a nurse, I have worked in burn units, medical and surgical units, burn units, dialysis, intensive care, oncology (cancer), hospice and home health. I have also cared for relatives and friends with terminal illnesses, dementia, critical heart defects, cancer, disabilities, severe psychosis, suicide, drug addiction, teen pregnancy, etc. but never once was I tempted to end a life.

Just as doctors used to take the Hippocratic Oath that said ” I will not give a lethal drug to anyone if I am asked, nor
will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.”, new nurses used to take the Nightingale Pledge that said ” I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug.”

Unfortunately, today these oaths are little used or changed to allow for formerly illegal practices and this has harmed both professions and to the detriment of healthcare and public trust.

I have also been a newspaper reporter and writer for several publications but  in 2015, I started my blog “A Nurse’s Perspective on Life, Healthcare and Ethics” to report on the many healthcare ethics controversies and I often use my personal and professional stories to show resources and how to help people in difficult circumstances.

Most of all, I have seen the power of “I Care/We Care” to help people and their families at some of the most desperate times of their lives and I am proud to be a member of the National Association of Pro-life Nurses.

Please join us and/or follow NAPN on Facebook.

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.