What Will It Take?

I recently wrote a blog titled “The War Against Crisis Pregnancy Centers Escalates” about the attacks on crisis pregnancy centers after the Dobbs v. Jackson Women’s Health Organization decision returning abortion law to the individual states was outrageously leaked.

 Now that the final Dobbs v. Jackson Women’s Health Organization decision  is public, the violence against crisis pregnancy centers and churches has continued with few if any arrests.

However, now even pro-life individuals have been targeted.

For example, an 84-year-old pro-life volunteer was shot on Sept. 20 while going door-to-door in her community to talk about a ballot measure concerning abortion in Michigan. Thankfully, she is expected to recover.

Even more disturbing and over the last weekend, was the news that the FBI raided the home of a pro-life advocate Mark Houck and arrested him in front of his 7 crying children for the alleged crime of “Assaulting a Reproductive Health Care Provider”.

According to the National Review, Mrs. Houck “described an incident in which her husband ‘shoved’ a pro-abortion man away from his 12-year-old son after the man entered ‘the son’s personal space’ and refused to stop hurling ‘crude… inappropriate and disgusting’ comments at the Houcks.” The man did not sustain any injuries but did try to sue Houck. The charges were later dismissed.

WHAT WILL IT TAKE TO RESOLVE THE NATIONAL TURMOIL SURROUNDING ABORTION?

I was a young intensive care unit nurse when the Supreme Court’s Roe v. Wade decision came down in 1973. Like most people I knew, I was surprised and shocked when abortion was legalized. However, I quickly found that my medical colleagues were split on the issue, and I was vehemently attacked for being against abortion. I was even asked what I would do if I was raped and pregnant. When I replied that I would not have an abortion and would probably release the baby for adoption, I was ridiculed. Our formerly cohesive unit began to fray.

But I was professionally offended by the pro-life argument that legalizing abortion would lead to the legalization of infanticide and euthanasia.  

It was one thing to deny the truth with an early and unobserved unborn baby, but it was quite another to imagine any doctor or nurse looking at a born human being and killing him or her.

But I was wrong.

As I wrote in my 2019 blog “Roe v. Wade’s Disastrous Impact on Medical Ethics”, personal and professional experiences opened my eyes to the truth.

I have seen the push for “choice” to expand to abortion for any reason up to birth, infanticide and medical discrimination against people with disabilities, including my own daughter who had Down Syndrome.

I wasn’t long until “choice” also became the heart of the “right to die” movement to include to include legalized assisted suicide and euthanasia, withdrawal of feedings from people with serious brain injuries whose “choice” was exercised by family members or doctors and even the voluntary stopping of eating and drinking (called VSED by the pro-death-choice group Compassion and Choices).

With VSED, Compassion & Choices maintains that:

“Many people struggle with the unrelieved suffering of a chronic or incurable and progressive disorder. Others may decide that they are simply “done” after eight or nine decades of a fully lived life. Free will and the ability to choose are cornerstones of maintaining one’s quality of life and dignity in their final days”.  (All emphasis added)

CONCLUSION

I have long preferred the term “respect life” to “anti-abortion” because obviously we should respect the lives of all people at any age or stage of development.

But this doesn’t mean anger or vilification of others.

Over the years I have written, spoken, debated, etc. people who do not agree with the respect life philosophy, but I never became angry.

I also found that listening to and not judging others-especially people in crisis-was crucially important.

For example and many years ago, I ran into an acquaintance I will call Diane and I congratulated her on her obvious pregnancy.

I was stunned when she replied, “Don’t congratulate me yet. I might not be pregnant.”

Diane, the mother of a 5-year-old boy, went on to explain that she was awaiting the results of an amniocentesis and said, “I know what you went through with your daughter but I can’t give up my life like that. If this (the baby) is Downs, it’s gone.”

I reassured her that the test would almost surely show that her baby was ok, but I added that if the results were not what she expected I would like her to call me. I promised that I would give her any help she needed throughout the pregnancy and that my husband and I or even another couple would be willing to adopt her baby. She was surprised, as I later found out, both by my reaction and the information about adoption.

Diane gave birth to a healthy baby girl a few months later and ran up to me to apologize for her comments, saying that she probably would not have had an abortion anyway. But I understood her terrible anxiety. Society itself seems to have a rather schizophrenic attitude towards children with disabilities. Special Olympics is considered inspirational but Down’s Syndrome is too often seen as a tragedy.

Whether it is abortion or legalized assisted suicide, we must be prepared to help desperate people either personally and/or referring them to a crisis pregnancy center or suicide hotline.

Every life deserves to be respected.

Pain, Choice, and Canada’s now “most permissive euthanasia legislation in the world”

In his excellent July 10, 2022 blog, Alex Schadenberg, chair of the International Euthanasia Prevention Coalition, reveals that now “Canada’s medical assistance in dying (Maid) law is the most permissive euthanasia legislation in the world”.

He says “Canada’s MAiD law currently allows suicide facilitation for persons with disabilities and is on track to expand in March 2023 to those living with mental illness. “ (Emphasis added)

How did assisted suicide/euthanasia laws get so far and so fast down the proverbial “slippery slope”?

In my December, 2016 blog “Pain and ‘Choice’”,  I wrote about how I saw the warning signs when I was a new nurse in 1969.

Here is my blog:

PAIN AND “CHOICE”

December 15, 2016 nancyvalko 

It was 1969 and I was fresh out of nursing school when I was assigned to a patient I will call “Jenny” who was thirty-two years old and imminently dying of cancer. She was curled up in her bed, sobbing in pain and even moaned “just kill me.” The small dose of Demerol I injected into her almost non-existent buttocks every four hours “as needed” was not helping. I reassured Jenny that I was immediately calling the doctor and we would get her more comfortable.

However, I was shocked when the doctor said no to increasing or changing her medication. He said that he didn’t want her to get addicted! I told him exactly what Jenny said and also that she was obviously very close to death so addiction would not be a problem. The doctor repeated his no and hung up on me.

I went to my head nurse and told her what happened, but she told me I had to follow the doctor’s order. Eventually, I went up the chain of command to the assistant director of nursing and finally the Chief of the Medical Staff. The verdict came down and I was threatened with immediate termination if I gave the next dose of Demerol even a few minutes early.

I refused to abandon Jenny so for the next two days before she died, I spent my time after my shift sitting with her for hours until she fell asleep. I gave her whatever food or drink she wanted. I stroked her back, held her hand and told stories and jokes. I asked her about her life. I did everything I could think of to distract her from her pain and make her feel better. It seemed to help, although not enough for me. I cried for Jenny all the way home.

And I was angry. I resolved that I would never watch a patient needlessly suffer like that again.

So, I educated myself by reading everything I could about pain medicine and side effects. I also pestered doctors who were great at pain control to teach me about the management, precautions, and rationale of effective pain management. I used that knowledge to advocate and help manage my patients’ pain as well as educating others.

I was delighted to see pain management become a major priority in healthcare and even called “the fifth vital sign” to be evaluated on every patient. I saw new developments like nerve blocks, new drugs, and regimens to control pain and other techniques evolve as well as other measures to control symptoms like nausea, breathlessness, and anxiety. Now we also have nutritional, psychological, and other support for people with terminal illnesses and their families.

Best of all was that I never again saw another patient suffer like Jenny despite my working in areas such as ICU, oncology (cancer) and hospice.

TWENTY-FOUR YEARS LATER

When my oldest daughter was 14, she attended a public high school where the science teacher unexpectedly started praising the infamous Dr. Jack Kevorkian and his public campaign for legalized assisted suicide and euthanasia.  Kevorkian’s first reported victim was Janet Adkins, a 54 year old woman with Alzheimer’s in no reported physical pain who was hooked up to a  “death machine” in the back of a rusty van. Mrs. Adkins was just the first of as many as 130 Kevorkian victims, many if not most of whom were later found to have no terminal illness. Kevorkian escaped prosecution-even after he harvested a victim’s organs and offered them for transplant-until the TV show 60 Minutes aired Kevorkian’s videotape showing him giving a lethal injection to a man with ALS (Lou Gehrig’s disease). Shockingly, Kevorkian served only 8 years in prison before he was paroled and eventually became a media celebrity peddling assisted suicide and euthanasia.

My daughter, who never before showed any interest in my speaking and writing on the topic of assisted suicide, now stood up and peppered her teacher with facts about Kevorkian. The teacher asked her where she learned her information and she answered, “From my mom who is a cancer nurse”.

Sarcastically, he responded “So your mother wants to watch people suffer?” My daughter responded “No, my mother just refuses to kill her patients!” End of discussion.

CONCLUSION

But not the end of the story. Tragically, we now have legalized assisted suicide in several states and serious efforts  to expand it to include people without physical pain but with conditions like Alzheimer’smental illness or other psychological distress as well as even children.

As Wesley Smith recently and astutely observed:

 “Moreover, the statistics from Oregon and elsewhere show that very few people commit assisted suicide due to physical suffering. Rather, the issues are predominately existential, such as fears of being a burden or losing dignity

The public is being duped by groups like Compassion and Choices that campaign for legalized assisted suicide on the alleged basis of strict criteria for mentally competent, terminally ill adults in unbearable physical pain to freely choose physician-assisted suicide with (unenforceable) “safeguards”.

The emerging situation throughout the world is more like Kevorkian’s dream of unfettered and universal access to medical termination of the lives of “expendable” people. How much easier is that when people with expensive mental health problems, serious illnesses or disabilities can be encouraged to “choose” to be killed?

THE TRAGIC DIVIDE ON THE ROE V. WADE ABORTION DECISION

It has been almost physically painful to watch the tidal wave of 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.

But this is not the first time I saw such division about abortion.

I was a young intensive care unit nurse when the Roe v. Wade decision came down in 1973. Like most people I knew, I was surprised and shocked when abortion was legalized.

However, I quickly found that my medical colleagues were split on the issue, and I was vehemently attacked for being against abortion. I was even asked what I would do if I was raped and pregnant. When I replied that I would not have an abortion and would probably release the baby for adoption, I was ridiculed. Our formerly cohesive unit began to fray.

But I was professionally offended by the pro-life argument that legalizing abortion would lead to the legalization of infanticide and euthanasia.  

It was one thing to deny the truth with an early and unobserved unborn baby, but it was quite another to imagine any doctor or nurse looking at a born human being and killing him or her.

How wrong I was!

As I wrote in my 2019 blog “Roe v. Wade’s Disastrous Impact on Medical Ethics” , it wasn’t until the 1982 Baby Doe case and my daughter Karen’s birth and death opened my eyes and changed my life.

HARD TRUTHS ABOUT ABORTION

Because I am a nurse and mother, I have personally learned some hard truths about abortion and the abortion industry. Here are some of my experiences.

A young relative came to me after visiting a Planned Parenthood clinic for a suspected sexually transmitted disease. She said the clinic told her that she didn’t have an infection but the girl continued to get worse-and scared.

I arranged for her to see my own pro-life ob-gyn who discovered that the infection had damaged her cervix so much that part of it had to be removed and, even worse, she would probably have to have her cervix sewn shut until delivery if she became pregnant in the future.

Learning that Planned Parenthood had apparently missed the diagnosis, my doctor never charged for his services.

KNOWLEDGE IS ESSENTIAL

I will never forget the Christmas day my 18-year-old daughter told me she was pregnant.

We talked for hours, and I told her that I would support any decision she would make-except abortion.

She laughed and told me that abortion was not an option because she “knew too much”, especially from the prenatal pamphlets I showed my children with each pregnancy. They all were excited about how their brother or sister was developing and asked almost daily what their unborn sibling was now able to do.

My first grandchild is now 23 years old and has a loving family who allows us to be part of her life.

And we know even more now about pregnancy, as I wrote in my 2019 blog “An Amazing Video of a Living, First Trimester Unborn Baby” . The video shows an approximately 8 week old unborn baby moving its’ tiny head and limbs remarkably like a newborn baby. Unfortunately, the video was both heartbreaking and beautiful since this little one was developing outside the mother’s womb (ectopic pregnancy) and had to be removed surgically. He or she could not survive for long but this recognizable baby was obviously not a “clump of cells”!

POST-ABORTION TRAUMA IS REAL

Many years ago when I worked in home health and hospice, I cared for a very cranky, elderly woman I will call “Rose” who had rejected all the other nurses in our agency. Even her own doctor had problems with her and told me that he could not understand why she was even still alive because her end stage congestive heart failure was so severe. Part of my assignment was to measure her abdomen and legs to adjust her diuretics (water pills).

As I got to know Rose over a few visits, she softened towards me and began telling me about her life. But one day, while I was measuring her abdomen, she burst into tears and told me she hated looking 9 months pregnant because of the fluid retention in her abdomen. Rose said she knew it was God punishing her for the abortion she had 60 years before!

Rose had never told anyone, not even her late husband, about the abortion she had before marrying him. She felt that baby was the boy she never had but she didn’t feel worthy to even name him. She also told me that she knew she had committed the “unforgivable sin” and was afraid to die because she would be sent to hell. My heart went out to this woman who was suffering so much, more emotionally than even physically.

We talked for a long time and in a later visit about forgiveness and God’s love. I told her about Project Rachel, a healing ministry for women (and even men) wounded by abortion. I gave her the phone number and offered to be with her to meet a counselor or priest but she insisted that my talking with her was enough to help. I felt it wasn’t but she seemed to achieve a level of peace and she even started smiling.

I wasn’t surprised when Rose died quietly and comfortably in her sleep about a week later.

OFFERING HELPFUL INFORMATION IS CRUCIAL

In 1989, I had just started working as an RN on an oncology (cancer) unit when we discovered that one of our patients had CMV (Cytomegalovirus).

One of our nurses was pregnant and tested positive for the virus. Her doctor told her how her baby could die or have terrible birth defects from the virus and he recommended an abortion.

“Sue” (not her real name) was frantic. She had two little girls and worked full time. She said she didn’t know how she could manage a child with serious birth defects.

I told her that it was usually impossible to know if or how much a baby might be impaired before birth. I also told her about my Karen who was born with Down Syndrome and a critical heart defect and died at 5 months. I told her that I treasured the time I had with her and later babysat children with a range of physical and mental disabilities.

Most importantly, I also told her that I would be there to help her and her baby.

“Sue” decided against abortion and told the other nurses what I said.

The other nurses were furious with me and said if the baby was born with so much as an extra toe, they would never talk to me again.

But slowly, the other nurses came around and also offered to help Sue and her baby.

In the end, we all celebrated when Sue had her first son who was perfectly healthy!

CONCLUSION

Many people don’t understand is that being pro-life isn’t just being against abortion, infanticide and euthanasia. What being pro-life really means is truly caring about all lives, born or unborn.

What I have found most helpful is a  sincere interest and willingness to help when encountering people struggling with an abortion decision for themselves or someone close to them.

Why talk about abortion? Because we never know who may need to hear the truth and we need to help heal the tragic divide in our nation by our example.

Rethinking Brain Death and Organ Donation

I have been writing for many years about the implications of brain death, the lesser known “donation after cardiac/circulatory death”, diagnosed brain death cases like the supposedly “impossible” prolonged survival and maturation of Jahi McMath, the unexpected recoveries like Zack Dunlap’s and even that some mothers declared “brain dead” were able to gestate their babies for weeks or months to a successful delivery before their ventilators were removed.

Last August, I wrote about the World Brain Death Project and the effort to establish a worldwide consensus on brain death criteria and testing to develop the “minimum clinical standards for determination of brain death”. (Emphasis added)

I also wrote about the current effort “to revise the (US) Uniform Determination of Death Act (UDDA) to assure a consistent nationwide approach to consent for brain death testing” that could otherwise lead to a situation where ”a patient might be legally dead in Nevada, New York, or Virginia (where consent is not required). But that same patient might not be legally dead in California, Kansas, or Montana (where consent is required and might be refused)”. (All emphasis added)

The Uniform Declaration of Death Act (UDDA) was drafted in 1981 by a President’s Commission study to brain death and approved by both the American Medical Association (AMA) and the American Bar Association (ABA). It was intended to provide a model for states to emulate.

It offered 2 definitions of when a person could be declared legally dead to align the legal definition of death with the criteria largely accepted by the medical community:

“Irreversible cessation of circulatory and respiratory functions (the traditional definition of death); or

Irreversible cessation of all functions of the entire brain, including the brain stem (brain death)” (Emphasis added)

The UDDA in some form has since been adopted by all US states and the District of Columbia.

THE PUSHBACK TO REVISE THE US UNIFORM DETERMINATION OF DEATH ACT (UDDA)

But now, 107 experts in medicine, bioethics, philosophy, and law, are challenging the proposed revisions to the UDDA. While they admit that they “do not necessarily agree with each other on all aspects of the brain-death debate or on fundamental ethical principles”, they do object to three aspects of the revision to:

“(1) specify the Guidelines (the adult and pediatric diagnostic guidelines) as the legally recognized “medical standard,” (2) to exclude hypothalamic function from the category of “brain function,” and (3) to authorize physicians to conduct an apnea test without consent and even over a proxy’s objection.” (All emphasis added)

These experts’ objections to those proposed revisions are that:

” (1) the Guidelines have a non-negligible risk of false-positive error, (2) hypothalamic function (a small but essential part of the brain helps control the pituitary gland and regulates many body functions) is more relevant to the organism as a whole than any brainstem reflex, and (3) the apnea test carries a risk of precipitating BD (brain death) in a non-BD patient….provides no benefit to the patient, does not reliably accomplish its intended purpose”… and “should at the very least require informed consent, as do many procedures that are much more beneficial and less risky.” (All emphasis added)

And these experts further state that:

“People have a right to not have a concept of death that experts vigorously debate imposed upon them against their judgment and conscience; any revision of the UDDA should therefore contain an opt-out clause for those who accept only a circulatory-respiratory criterion.”

CONCLUSION

Many years ago, I served on a hospital ethics committee when a doctor complained that he could not arrange an organ transplantation from an elderly woman in a coma caused by a stroke because she “failed” one of the hospital’s mandated tests for brain death. He said he felt like he was “burying two good kidneys”.

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.

Unfortunately, now some countries’ healthcare ethics have degenerated to the point where euthanasia by organ donation is legally allowed.

Personally, I am all for the ethical donation of organs and tissues. Years ago, I volunteered to donate a kidney to a friend and one of our grandsons was saved in 2013 by an adult stem cell transplant.

But I do not have an organ donor card nor encourage others to sign one because I believe that standard organ donor cards give too little information for truly informed consent. Instead, my family knows that I am willing to donate tissues like corneas, skin and bones that can be ethically donated after natural death and will only agree to that donation.

The bottom line is that what we don’t know-or allowed to know-can indeed hurt us, especially when it comes to organ donation. We need to demand transparency and accurate information because good medical ethics are the foundation of a trustworthy healthcare system.

The Assisted Suicide Juggernaut Continues in the U.S.

Since Oregon passed the first physician-assisted suicide law in 1997, 8 more states and the District of Washington, D.C. passed assisted suicide laws by 2020. They are:

  • California (End of Life Option Act; approved in 2015, in effect from 2016)
  • Colorado (End of Life Options Act; 2016)
  • District of Columbia (D.C. Death with Dignity Act; 2016/2017)
  • Hawaii (Our Care, Our Choice Act; 2018/2019)
  • Maine (Death with Dignity Act; 2019)
  • New Jersey (Aid in Dying for the Terminally Ill Act; 2019)
  • Oregon (Death with Dignity Act; 1994/1997)
  • Vermont (Patient Choice and Control at the End of Life Act; 2013)
  • Washington (Death with Dignity Act; 2008)

So far in 2021, 13 more states have new proposed assisted suicide bills and 4 states with assisted suicide laws are facing bills to expand their assisted suicide laws.

These 13 states are  Arizona , Connecticut, Indiana, Iowa, Kansas, Kentucky, Massachusetts, Minnesota, Nevada, New Mexico, New York, North Dakota and Rhode Island. Most of these states have been repeatedly hounded for years to pass an assisted suicide law.  

The 4 states with bills expanding their assisted suicide laws are California , Hawaii , Vermont, and the state of Washington.

The expansions range from expanding “qualified medical providers” from doctors to a range of non-doctors including nurses to eliminating so-called “safeguards” such as 15 day waiting periods, in person requests and even to allow electronic prescribing and shipping of lethal overdoses. Compassion and Choices (the former Hemlock Society) and other assisted suicide supporters have long portrayed assisted suicide “safeguards” as “burdensome obstacles”.

CONSCIENCE RIGHTS AND CENSORSHIP

Conscience rights for health care providers has been a very real problem since the 1974 Roe V. Wade U.S. Supreme Court decision legalized abortion in the U.S. The legalization of assisted suicide in several states has made this even worse for nurses, doctors, pharmacists and other healthcare workers. Even healthcare institutions have faced discrimination problems.

The Christian Medical and Dental Association even compiled a long list in 2019 of “Real-life examples of discrimination in healthcare” .

Now, we are seeing censorship. A March 28, 2021 Wall Street Journal op-ed titled “Big Tech Censors Religion, Too stated that:

“In January, Bishop Kevin Doran, an Irish Catholic, tweeted: “There is dignity in dying. As a priest, I am privileged to witness it often. Assisted suicide, where it is practiced, is not an expression of freedom or dignity.” Twitter removed this message and banned Bishop Doran from posting further. While the company reversed its decision after public opposition, others haven’t been so lucky.” (Emphasis added)

CONCLUSION

Back in 2014, I wrote a blog “Should a Pro-Life person Become a Nurse” about a worried pro-life student nurse who wrote me asking “what area of nursing can I move into that does not demand that I do things that I absolutely will not do?”

I wrote her back and told her that I had that challenge in several areas I worked in over 45 years but was able to live up to my ethics despite some difficult situations and that I never regretted becoming a nurse.

However, conscience rights are a not a luxury but rather a necessity.

That is why some of us nurses in Missouri worked so hard to get a conscience rights law passed in 1992 after the Nancy Cruzan starvation and dehydration death that, although not as strong as we wanted, is still in effect today. And I was thrilled when the Trump administration announced a new Conscience and Religious Freedom Division  in 2018 to enforce “federal laws that protect conscience and the free exercise of religion and prohibit coercion and discrimination in health and human services”.

Society has long insisted that health care professionals adhere to the highest standards of ethics as a form of 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 that bright line to separate killing from caring now be erased by legislators or judges?

Without a strong resistance movement, the assisted suicide movement will only keep expanding. So far, much of the public has been shielded from the real truth by euphemisms and false reassurances from assisted suicide supporters, a mostly sympathetic mainstream media and often spineless professional and health care organizations.

We all must educate ourselves to speak out before it is too late.

Think the Political and Cultural Divisions in Our Country are Bad? The Divisions in Medical Ethics Could Cost Your or a Loved One’s Life!

I wanted to be a nurse since I was 5. I was drawn to nursing not only because I wanted to help people but also because medical ethics standards were so high, especially in contrast to some of the corrupt business practices that I saw.

I graduated from a Catholic nursing school in 1969 and spent the next 50 years working mostly in intensive care but also in home health and hospice, oncology (cancer), kidney dialysis, volunteer work and on ethics committees.

I first noticed the change in medical ethics when the US Supreme Court’s Roe v. Wade decision in 1973 legalized abortion for the first three months of pregnancy. I was working in intensive care at the time and found that my fellow medical professionals who supported the abortion decision angrily rebuked those of us who were shocked that the first rule of medical ethics we were taught-First, Do No Harm-was eroding.

Then in 1982, my doctor husband and I were shocked by the Baby Doe case where the parents received a judge’s approval to let their newborn son with Down Syndrome die instead of repairing an easily correctable hole between the tube that leads from the throat to the stomach and the  tube that leads from the throat to the windpipe and lungs.  While lawyers were appealing his case and many parents (including my husband and me) wanted to adopt Baby Doe, the newborn starved and dehydrated to death without the desperately needed surgical repair.

My husband asked “What has happened to medical ethics??” but we both knew the answer: babies with Down Syndrome are often unwanted and aborted.

Five months after Baby Doe died, our third child Karen was born with Down Syndrome and a reparable heart defect but the heart doctor gave us a choice to “let” our baby die without surgery. We refused but my former trust in the medical system was shattered.

After I suddenly became a single parent in 1988, I had to return to a paid nursing job to support my three children but found a drastically different medical ethics system.

I found that during the 1970s, medical ethics began to evolve into the newer “bioethics”, even in Catholic hospitals.

This new bioethics has essentially four principles:

1. Respect for autonomy (the patient’s right to choose or refuse treatment)

2. Beneficence (the intent of doing good for the patient)

3. Non-maleficence (not causing harm)

4. Justice (“fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation”) Emphasis added.

Unfortunately, those principles are malleable and then used to justify actions and laws that would have been unthinkable when I graduated from nursing school. That bioethics mindset changed not only medical and nursing education but also the principles that informed our work.

Even the Hippocratic Oath, the oldest and most widely known treatise on medical ethics that forbade actions such as abortion and euthanasia that medical students routinely took upon graduation, has now been revised or dropped at many medical schools.

SOME MEDICAL ETHICS DIVISIONS THAT CAN COST YOU OR A LOVED ONE’S LIFE

Abortion

The American Medical Association, the American Congress of Obstetricians and Gynecologists and the American Nurses Association and other healthcare organization that used to condemn abortion are now supporting “abortion rights”.

Abortion on demand and taxpayer-funded has now been deemed a “civil right” by Planned Parenthood and many Democratic politicians throughout pregnancy to birth and even beyond. Alternatives to abortion such as free pregnancy tests, counseling, ultrasounds, maternity and baby clothes, diapers, car seats, bassinets, etc. are not options at Planned Parenthood but rather at non-profit crisis pregnancy centers.

As a parent of an unwed teenage daughter, I support these services and give thanks for my now 22 year old granddaughter.

Assisted suicide/euthanasia

In the early 1970s when I was a young ICU nurse, none of us medical professionals had even heard of a “living will”. There was a universal presumption for life and “quality of life” was something to be improved, not judged.

Nevertheless, sick people could and did refuse treatment and even check themselves out of the hospital against medical advice. When patients appeared to be dying, they or their families could agree to a “do not resuscitate” (DNR) order. Treatments could be ethically refused when such measures were considered medically futile or excessively burdensome for the patient. But one thing we didn’t do was offer to withhold or withdraw medical care like tube or even spoon feedings to cause or hasten a patient’s death. And it was unthinkable that medical professionals could assist even a dying patient’s suicide.

Unknown to us, all this began to change after Louis Kutner, a Chicago lawyer, wrote a 1969 article in the Indiana Law Journal titled Due Process of Euthanasia: The Living Will, A Proposal” in 1969. (emphasis added).

By 1970, The Euthanasia Society of America (later renamed the Society for the Right to Die) distributed 60,000 living wills. In 1976, California passed the nation’s first “living will” law and in 1990, The US Congress passed the Patient Self-Determination Act that requires information to be given to patients about their rights under state laws governing advance directives (commonly called “living wills), including the right to accept or refuse medical or surgical treatments.

Now, 8 states and the District of Columbia have assisted suicide laws and Compassion and Choices, the largest advocacy group for medically assisted suicide, is using the Covid 19 pandemic to push for telehealth (the provision of healthcare remotely by means of telecommunications) for medically assisted suicide.

Infanticide

In my nursing school 50 years ago, we were taught medical ethics and one example used was the case of a newborn with Down Syndrome who needed life-saving surgery but whose parents refused, choosing to let him die. We were told that the law would protect such children from medical discrimination-even by the parents.

Now we have cases like Charlie Gard and Simon Crosier and others whose parents chose life for their babies with disabilities but were thwarted by doctors and courts.

Organ donation

When I started working in an ICU in 1971, I had questions about the brain death diagnosis for organ harvesting but was told not to worry because there were strict rules.

However and over subsequent years, I discovered that the rules for organ donation have been changing from brain death to other criteria including severe brain injury. There have even been proposals for “presumed consent” state laws where people would have to register an “opt-out” or be automatically presumed to consent to organ donation.

I do not have an organ donor card nor encourage others to sign one. Instead, I once offered to give a friend one of my kidneys as a living donor. Although I was not able to donate then, my family knows that I am willing to donate tissues like corneas, bone, etc. that can be ethically donated after natural death and will only agree to that donation

Conscience rights

Doctors and nurses used to be protected when asserting their conscience rights when refusing to deliberately hastening or causing a patient’s death.

Now, even that protection-which protects both patients and medical professionals-is under attack.

I discovered this personally several years ago when I was almost fired for refusing to increase a morphine drip “until he stops breathing” on a patient who didn’t stop breathing after his ventilator was removed.

CONCLUSION

The bottom line is that everyone must remain vigilant when they or a loved one becomes seriously ill, regardless of the hospital or institution. It is also important not to be afraid to ask questions.

There are also non-denominational, non-profit groups like the National Association of Pro-life Nurses, the Healthcare Advocacy and Leadership Organization and state and national pro-life organizations that have much useful information and resources for patients, families and the public.

The bottom line is that what we don’t know-or allowed to know-can indeed hurt us. We need to demand transparency and the highest ethical standards from our doctors and healthcare system before they can earn our trust.

And without a change in laws, policies and attitudes promoting deliberate death as an answer to human suffering, those of us medical professionals who believe we should never cause or hasten anyone’s death may become an endangered species-as well as our medically vulnerable patients.

Health Care Rationing, Covid 19 and the Medical Ethics Response

While the key medical model in the US for Covid 19 deaths has just again been revised from 240,000 to 100,000 to now just 60,000 by August along with concerns about the possible overuse of ventilators in Covid 19, there is still a push for medical health care rationing guidelines.

As the April 8, 2020 Wall Street Journal article As Coronavirus Peaks, New York City’s Hospitals Prepare ‘Live or Die’ Guidance” notes, some hospitals and health care systems are coming up with guidelines and scoring systems to allocate ventilators. At the same time, New York lawmakers have recently passed a measure to protect hospitals and clinicians from certain medical malpractice lawsuits while the Covid 19 virus strains the health system.

Disability groups are complaining about discrimination in health care rationing plans that would “illegally deprive people based on age, mental cognition or disability”. In addition, a recent Center for Public Integrity analysis shows that policies in 25 states would ration care in ways disability advocates have denounced.

While such rationing plans are usually said to be based on determining which patients have little if any chance of a good outcome, i.e.  medical futility, even the American Medical Association has admitted in its Code of Ethics that “However, physicians must remember that it is not possible to offer a single, universal definition of futility. The meaning of the term “futile” depends on the values and goals of a particular patient in specific clinical circumstances.” (Emphasis added)

THE CATHOLIC MEDICAL ETHICS PERSPECTIVE

Medical ethics in Catholic health care institutions are often considered the most stringent in terms of protecting human life from conception to natural death. So what do Catholic ethics authorities say about rationing?

On April 3, 2020, the US Catholic Conference of Bishops (USCCB) issued a powerful statement “Bishop Chairmen Issue Statement on Rationing Protocols by Health Care Professionals in Response to Covid-19” that stated:

“Every crisis produces fear, and the COVID-19 pandemic is no exception. However, this is not a time to sideline our ethical and moral principles. It is a time to uphold them ever more strongly, for they will critically assist us in steering through these trying times.”

and

“Good and just stewardship of resources cannot include ignoring those on the periphery of society, but must serve the common good of all, without categorically excluding people based on ability, financial resources, age, immigration status, or race.” (Emphasis added)

The statement cited other Catholic health care groups like Catholic Medical Association, the National Association of Catholic Nurses and the National Catholic Bioethics Center that all issued helpful statements.

However another Catholic group mentioned, the Catholic Health Association, has also issued a problematic statement on the rationing issue titled “Code Status and COVID-19 Patients “ stating that:

“CPR may be medically inappropriate in a significant portion of elderly, critically ill patients with COVID-19 and underlying comorbidities. As per Parts 3 and 5 of the Ethical and Religious Directives for Catholic Health Care Services, if it is shown that the burdens exceed the benefits, it is morally acceptable to withhold such procedure.” (Emphasis added)

And even worse:

“If treating clinicians, including more than one physician, determine that CPR is not medically appropriate, a Do Not Attempt Resuscitation Order (DNR) may be written without explicit patient or family consent.” (All emphasis added)

In a separate April 7, 2020 statement from the  National Catholic Partnership on Disability titled “Rights of Persons with Disabilities to Medical Treatment During the COVID-19 Pandemic , the NCPD states “As The Office of Civil Rights of the U.S. Department of Health and Human Services has recently reminded us, America’s basic civil rights laws, including the Americans with Disabilities Act, prohibit discrimination:

“[P]ersons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative ‘worth’ based on the presence or absence of disabilities. ”  (Emphasis added)

CONCLUSION

Over my many decades as a nurse, I have seen the question of “quality of life” deteriorate from what can we do to improve the quality of life for every patient to judging whether or not a patient has sufficient quality of life to justify treatment or care like a feeding tube.

During that time, Alzheimer’s and major CVAs (strokes) in advanced age have come to be seen as fates worse than death that should not be a burden on people and their families or a waste of health care resources.

Before my own mother developed Alzheimer’s and a terminal cancer, she often told me that she never wanted to be a “burden to her family”. I never considered her a “burden” when I cared for her and she was comfortable and fed to her last day. I will never tell my children what my mother told me.

And especially with assisted suicide polls showing much public support, we cannot afford to play into the idea that some people are “better off dead” regardless of whether or not they “choose” a premature death or someone else “chooses” it for them.

We should also remember the lethal legacy of the 2005 Hurricane Katrina disaster. Flooding caused the New Orleans mayor to issue an unprecedented mandatory evacuation of the city with the exception of major hospitals. But when conditions worsened at the large Memorial Medical Center and evacuation efforts were slow, some medical staff allegedly euthanized some of the patients.

However and despite strong evidence, a massive PR campaign portraying those patient deaths as “compassionate” resulted in the 2007 grand jury refusing to indict the doctor and 2 nurses charged.

As we see this debate over medical ethics in crisis situations continue today, we must continue to insist that every person deserves a natural lifespan without discrimination.

Euthanasia: Canada, Conscience and Coercion

A January 22, 2020 CNA article titled Perform Euthanasia or Lose Government Funding”, Canadian Hospice Told” revealed that a secular Canadian hospice was at risk of losing its government funding over its refusal to euthanize patients who request an “assisted death.”

How could this happen?

First of all, Canadian health care (known to Canadians as “medicare”) is 69% publicly funded for “medically necessary” care administered by the 13 provinces and territories with different rules. 31% of Canadian health care costs are paid by the private sector for services not covered or only partially covered by medicare, such as prescription drugs, dentistry and optometry.

The problems started when the Canadian Supreme Court legalized MAiD (Medical Assitance in Dying” in 2015.

Soon after, the province of Quebec drew up guidelines for MAiD and made “euthanasia kits” for lethal injections available to every doctor in Quebec. Now most MAiD deaths in Canada are done by lethal injection.

In September 2016, about three months after euthanasia became legal in Canada, British Columbia’s Fraser Health Authority ( the publicly-funded organization responsible for administering healthcare in British Columbia) introduced a new policy which required all hospices receiving more than 50% of provincial funding for their beds to offer euthanasia to their residents. However, the hospice was operated by the non-profit organization the Delta Hospice Society, which is opposed to Canada’s MAiD

One doctor said that there are “‘strong lobbies’ backing this new effort to expand MAiD into additional institutions which receive provincial funding, including faith-based hospitals or hospices.(Emphasis added)

HOW ONE CATHOLIC HEALTH CARE FACILITY RESPONDED TO MAiD

Unfortunately and in 2018, the Catholic Covenant Health system in the province of Alberta, Canada released a revised MAID policy:

“after consultations with more than 100 individuals and groups including doctors, Catholic bishops, Alberta Health Services, the Alberta government, patient advisers, families, ethicists and community members.
Under the policy, witnessing and signing of legal documents and assessments of eligibility can take place on Covenant Health sites. Patients deemed eligible for MAID would still be transferred to other facilities.” (Emphasis added)

A current check of the Covenant website on MAiD shows no change in policy.

THE CANADIAN “SLIPPERY SLOPE” ALSO CONTINUES

In January, 2020 the Halifax Group, published “MAiD Legislation at a Crossroads: Persons with Mental Disorders as Their Sole Underlying Medical Condition” that supported MAiD not only for non-dying persons ” experiencing enduring, intolerable and irremediable suffering from physical conditions” but also for persons who have “a mental illness as their sole underlying medical condition.” (Emphasis added)

This month, The Expert Advisory Group responded to the Halifax group, warning that the Canadian medical suicide law is the “most permissive in the world”.

THE EFFECT OF MAiD ON DOCTORS AND NURSES

Last year, The Canadian Catholic Nurses joined the National Association of Catholic Nurses in opposing the American Nurses Association’s draft position for neutrality on physician-assisted suicide (unfortunately later approved) and gave a chilling look at what may be our future if legalized assisted suicide is not opposed:

“Our association formed in 2018 primarily in response to Canadian nurses’ moral distress regarding the nation-wide legalization of medically induced death.

Professional associations and licensing bodies across Canada endorsed the legal changes, requiring conscientious objectors to participate in “Medical Assistance in Dying” by “effective referral” to facilitate access at the patient’s request. Faith-based health care facilities are pressured to participate. Nurse practitioners are trained and qualified to prescribe and administer lethal doses of medication to patients that they or others deem eligible for euthanasia.”

and

The Canadian experience with assisted suicide and euthanasia provides evidence for your continued resistance to the practice.

Unlike Oregon, Canada has not experienced a growth in palliative care along with the rapid expansion of induced death. Instead, we experience ongoing demands for access to lethal injections for new categories of patients, including “mature minors;” those who write advanced directives; and those whose mental illness is the sole condition underlying their request.”

A 2018 study “Medical assistance in dying (MAiD): Canadian nurses’ experiences” stated that:

“It is vital to understand how MAiD is influencing nurses in the Canadian context to ensure a smooth transition of this end‐of‐life care option across settings and communities. ” (Emphasis added)

The study acknowledges some nurses’ “moral distress” but describes “how participating in, or declining to participate in MAiD is shaping the participants’ perceptions of nursing as a profession“. The authors suggest promoting concepts like “Providing holistic care without judgment, Advocating choice, Supporting a good death” to positively reinforce  that MAiD was “not a significant departure from their professional goals”. (Emphasis added)

(Ironically, 77% doctors in Laval, Canada refused to provide MAiD 18 months after legalization with the most common reason that MAiD was “too much of an emotional burden to bear”.)

CONCLUSION

Last year it was reported that More than one in every 100 deaths in Canada is administered by a doctor but that even this number is likely higher because parts of Canada currently do not report such deaths.

The numbers are also likely to get higher as the Canadian euthanasia laws expand the eligibility criteria and health care professionals worry about losing their jobs if they refuse to participate.

Unfortunately, most of the US mainstream media ignores the Canadian euthanasia experience while approvingly reporting on the increasing number of US states legalizing physician-assisted suicide.

What all of us need to understand is that the legalized killing of any patient ultimately leads to the destruction not only of the patient but also of a trustworthy health care system and a truly safe and civilized society.

Accidental Oversight or Deliberate Omission in new Palliative Care and Hospice Education and Training Act?

With the enthusiastic support of Compassion and Choices (which promotes legalizing assisted suicide throughout the US), the first Palliative Care and Hospice Education and Training Act (PCHETA) was introduced in Congress in 2016  to allow millions of dollars in federal grants to, in the bill’s words, “increase the number of permanent faculty in palliative care at accredited allopathic and osteopathic medical schools, nursing schools, social work schools, and other programs, including physician assistant education programs, to promote education and research in palliative care and hospice, and to support the development of faculty careers in academic palliative medicine.”

While palliative care has been traditionally defined as “compassionate comfort care that provides relief from the symptoms and physical and mental stress of a serious or life-limiting illness” and hospice care as “compassionate comfort care (as opposed to curative care) for people facing a terminal illness with a prognosis of six months or less, based on their physician’s estimate”, the PCHETA bill may radically change such care.

I started writing  about the potential dangers with the PCHETA bill in Congress in 2018 when it was passed by the US House of Representatives and sent to a Senate Committee for approval. The PCHETA stalled there, thought to be at least partially due to concerns by some U.S. senators about the bill’s potential problems with hastening of death and legalized assisted suicide  despite a “clarification” in the bill that that “None of the funds made available under this Act (or an amendment made by this Act) may be used to provide, promote, or provide training with regard to any item or service for which Federal funding is unavailable under section 3 of Public Law 105–12 (42 U.S.C. 14402)” such as assisted suicide, euthanasia or mercy killing.

So after the bill stalled, a second “clarification” was added to the Senate bill (now S. 2080) in July, 2019 that states “Sec. 5(b) ADDITIONAL CLARIFICATION.—As used in this Act (or an amendment made by this Act), palliative care and hospice shall not be furnished for the purpose of causing, or the purpose of assisting in causing, a patient’s death, for any reason.” (Emphasis added)

This second clarification is critical because, as the US Conference of Catholic Bishops representative Greg Schleppenbach, has written:

“This provision is important because for the first time anywhere in federal law or regulations it explicitly states that palliative and hospice care cannot be furnished for the purpose of causing or assisting in causing death.  These protective provisions were added as a condition of our support for this bill.” (Emphasis added)

But on October 28, 2019, the House PCHETA (HR 647) bill that does NOT contain the second clarification was reintroduced and quickly passed by the US House of Representatives on a voice vote  and sent to the Senate for approval. That bill is now in the Senate Committee on Health, Education, Labor, and Pensions. (Senators can now be contacted by even email.)

OPPOSITION TO THE PCHETA BILL CONTINUES

Even with the second clarification, many groups continue to voice concern about the PCHETA bill because many of us nurses and doctors are seeing unethical practices such as assisted suicide, terminal sedation, voluntary stopping of eating, drinking (VSED) and even spoon feeding, etc. being used to cause or hasten death but often called palliative or “comfort care” for such patients.

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

Julie Grimstad of the Healthcare Advocacy and Leadership Organization (HALO) also voices concerns about funding new palliative care and hospice programs, citing the 2019 Department of Health and Human Services Office of Inspector General report titled Vulnerabilities in Hospice” that documented serious problems.

She also cites Dr. Farr A. Curlin, a palliative medicine specialist at Duke University, who warns that:

“When the goal of HPM (Hospice and Palliative Medicine) shifts from helping patients who are dying to helping patients die, practices that render patients unconscious or hasten their death no longer seem to be last-resort options,” [emphasis added]

HALO is joined by other groups who officially oppose PCHETA S.2080 such as the National Association of Pro-life Nurses  and the Euthanasia Prevention Coalition USA

CONCLUSION

Whether or not the omission of the second clarification in the bill sent to the Senate was intentional, the omission validates the genuine concern many of us have that the traditional end of life care ethic to neither hasten nor postpone dying is rapidly being replaced by “quality of life” judgments, economic concerns and patient “choice” to die.

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

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

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

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

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

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

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

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

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

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

HOW COULD THIS HAPPEN?

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

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

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

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

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

CAN SUCH CASES BE PREVENTED?

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

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

But is this fair?

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

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

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

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

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

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