Why is the US Supreme Court Ducking the Issue of States Defunding Planned Parenthood?

As a nurse, I have always known that medical ethics and the law are very much entwined. But when the US Supreme Court unexpectedly legalized abortion in the 1973 Roe v Wade decision, I started really studying the legal system and how it impacts medical practice beyond just the medical malpractice cases that I knew about.

When I studied the actual Roe v Wade decision itself, the dissenting opinions, commentaries, amicus briefs, etc., I was appalled to find that the decision was basically political and not based on established science and facts.

That sad knowledge has insulated me from hopelessness with many subsequent US Supreme Court decisions involving abortion and other life issues. I have always felt that the truth about human lives-born and unborn-will eventually win.

But I have to admit that I was surprised that the majority of the current Supreme Court justices ruled against even hearing the Gee v Planned Parenthood of Gulf Coast case involving conflicting federal court cases decisions about states defunding Planned Parenthood in their Medicaid programs.

The Gee v Planned Parenthood case involved the issue of whether patients may sue states in federal court for restricting or removing providers from their Medicaid programs. The case does not directly involve abortion since the federal Hyde amendment prohibits Medicaid funding for abortion, a prohibition that Planned Parenthood itself insists “hurts women on Medicaid” and wants eliminated. Planned Parenthood also admits that:

Most of Planned Parenthood’s federal funding is from Medicaid reimbursements for preventive care, and some is from Title X. At least 60% of Planned Parenthood patients rely on public health programs like Medicaid and Title X for preventive and primary care.” (Emphasis added)

According to a Lozier Institute Report, in its latest report 2016-2017, Planned Parenthood received “$543.7 million in funds from all levels of government in that fiscal year…primarily from the Medicaid program”.

Several state laws have already excluded Planned Parenthood as Medicaid providers, especially after the reports of illegal harvesting of organs from aborted unborn babies and fraudulent billing. Federal law does give states substantial leeway to administer their Medicaid programs but does not define the term “qualified” for providers and states can exclude providers “for any reason…authorized by state law”. The law does allow for an appeal and judicial review for excluded providers.

According to the Wall Street Journal:

“But Planned Parenthood has leapfrogged state adjudication by recruiting plaintiffs to sue in federal court to vindicate their putative right to their preferred provider. Five appellate courts including the Fifth, Sixth, Seventh, Ninth and Tenth Circuits have recognized a private right of action while the Eighth has not.” (Emphasis added)

This split in court decisions needed to be resolved by the Supreme Court because it involves basic questions about the state-federal relationship.

Only four Supreme Court judges were necessary to vote to hear the case but 6 judges voted not to hear the case, surprisingly two of whom were considered conservative.

Justice Thomas who voted to hear the case was scathing in his rebuke of the 6 judges who voted not to even hear the case saying:

“So what explains the Court’s refusal to do its job here? I suspect it has something to do with the fact that some respondents in these cases are named ‘Planned Parenthood.’ That makes the Court’s decision particularly troubling, as the question presented has nothing to do with abortion.

Some tenuous connection to a politically fraught issue does not justify abdicating our judicial duty. If anything, neutrally applying the law is all the more important when political issues are in the background…The Framers gave us lifetime tenure to promote ‘that independent spirit in the judges which must be essential to the faithful performance’ of the courts’ role as ‘bulwarks of a limited Constitution,’ unaffected by fleeting ‘mischiefs.’” (Emphasis added)

The Supreme Court’s refusal to even hear the case is more than disappointing. Continuing the legal confusion about states’ rights will almost certainly lead to more litigation against states that pass laws excluding Planned Parenthood from Medicaid programs. As the Wall Street editorial states, “If the Justices duck every case remotely implicating gender politics, substantive constitutional issues will go unresolved and individual rights may be impaired.”

CONCLUSION

Ironically, although the brief by Planned Parenthood of Gulf Coast  to the Supreme Court insisted that their clinics “..provide essential medical care to thousands of low-income Louisiana residents through Medicaid” and “offer a range of services, including annual physical exams, screenings for breast cancer and cervical cancer, contraception, pregnancy testing and counseling, and other preventative health services”, the reality is that there are many more places, such as federally qualified community health centers (which do not provide abortions) that provide more comprehensive health care services than those offered by Planned Parenthood.

On a personal note, several years ago my late daughter Marie secretly went to a Planned Parenthood clinic for a possible sexually transmitted disease. She finally admitted this to me when her symptoms grew worse. I immediately took her to my own gynecologist who had to perform surgery to remove part of her cervix to deal with the damage.

Planned Parenthood had missed the diagnosis.

Support the Fighting Irish Doctors and Nurses

I have always been proud of my Irish heritage so I was especially shocked when a voter referendum in Ireland in May, 2018 overwhelmingly approved removing Ireland’s long-standing, constitutional protections for unborn babies and left the details up to the Irish government.

Before this, Ireland’s Eighth Amendment protected both unborn babies and their mothers equally as deserving a right to life. This made Ireland one of the safest places in the world for pregnant mothers and their unborn babies and with one of the lowest maternal mortality rates in the world.

However, much of the campaign to legalize abortion focused on the “high numbers of women ordering abortion pills online or forced to travel to Britain for a termination.” As one supporter said, that “showed that abortion was already here, we are just trying to make it safe and regulated.”

Now the lower house of the Irish parliament has just passed a bill that, if subsequently passed by the upper house, would legalize abortion for any reason for the first 12 weeks of pregnancy and up to six months for a wide variety of circumstances. The bill would also force taxpayers to pay for abortion and force even Catholic hospitals to provide them. It also strictly limits conscience protections for medical professionals and forces them to refer for abortion. The lower house also rejected amendments to ban sex-selection abortions, require parental consent for girls under 16 and require basic medical care for infants born alive after abortion.

Note that these radical developments occurred after the national vote in May. A poll by Amárach taken in October found that 60% of Irish residents oppose taxpayer-funded abortions, 80% say health care workers should not be forced to carry out abortions against their conscience and 69% of those surveyed believe doctors should be obliged to give babies that survive the abortion procedure proper medical care rather than leaving the babies to die alone.

Perhaps critically, Facebook also banned outside ads as Ireland was voting on abortion, saying that “We feel the spirit of this approach is also consistent with the Irish electoral law that prohibits campaigns from accepting foreign donations,”

DOCTORS AND NURSES PUSH BACK.

Although Irish government leaders want medical professionals ready to begin aborting unborn babies by January 1, 2019, the medical community is balking.

Doctors against abortion petitioned the government stating that “forcing a doctor to make a referral for an abortion against their conscience is simply wrong” and dozens of Irish doctors stormed out of an emergency meeting about abortion because they said their conscience rights protections were being ignored.

And almost 500 Irish nurses and midwives signed a petition to Health Minister Simon Harris urging him to protect freedom of conscience and support the amendments concerning conscience rights protections.

So far, the minister has ignored their requests.

However, the pro-abortion National Women’s Council of Ireland is urging the passage of the new abortion law as soon as possible “despite fears the existing bill does not go far enough to decriminalize abortion or prevent protests at abortion facilities”.

CONCLUSION

As a fellow pro-life nurse, I applaud Nurses and Midwives4Life Ireland who stated that:

“We are dedicated, hardworking nurses and midwives who care for patients from conception to natural death. We have a conscientious commitment to life which accords with the values inherent in Our Code of Professional Conduct and Ethics. We respect and defend the dignity of every stage of human life and we have a responsibility to make every valid or reasonable effort to protect the life and health of pregnant women and their unborn babies.”

I also sent a message of support to the Facebook page of Nurses and Midwives4Life Ireland .

I also support Irish Doctors for Life and its Facebook page that states its “aim is to educate and support doctors, health care professionals and others who are concerned about the ethical questions relating to patient care and practitioner responsibility at all stages of life.”

I personally have seen the terrible destruction of some of our most basic medical ethics principles after abortion was legalized here in the US in 1973. This issue not only divided doctors and nurses but also eventually led to the increasing acceptance of assisted suicide and euthanasia.

We need to support all medical professionals throughout the world who work to care for and protect all human life.

Physician-Assisted Suicide and the Fight for the Soul of Healthcare

Despite the US Supreme Court’s unanimous rejection of a constitutional right to physician-assisted suicide in the 1997 Vacco v. Quill decision , the well-funded   pro-assisted suicide organizations like the Hemlock Society (now called Compassion and Choices) remained undeterred in their efforts to legalize assisted suicide throughout the US.

Along with its efforts to pass physician-assisted suicide laws, Compassion and Choices also focused on changing the health care system itself by influencing health care professionals and especially their organizations.

Thus, Oregon became the first state to pass a physician-assisted suicide law (by voter referendum), but only after the Oregon Medical Association changed its position from opposition to neutrality and despite the American Medical Association’s long-standing opposition to physician-assisted suicide.

However, only a few other states eventually did legalize assisted suicide over the next 20 years either by legislation or voter referendum while most states rejected physician-assisted suicide, even after almost yearly efforts in legislatures and overwhelmingly supportive mainstream media coverage.

But now Compassion and Choices is touting  that “(a) growing number of national and state medical organizations have endorsed or adopted a neutral position regarding medical aid in dying (physician-assisted suicide) as an end-of-life option for mentally capable, terminally ill adults.” (Emphasis added)

For now at least, the American Medical Association (AMA) itself continues to oppose physician-assisted suicide  despite strong pressure from groups like American Association of Family Physicians to take a neutral stance. If the AMA does change its stance to neutrality, it won’t take long until groups like Compassion and Choices finally realize their goal of “integrating and normalizing medical aid in dying (aka physician-assisted suicide) suicide as an additional end-of-life option“.

Nurses are also not immune to the efforts to convince health care professionals to accept or be neutral on physician-assisted suicide. For example, a “policy dialogue” at the American Academy of Nursing’s annual conference in Washington, DC. was covered in a May 2018  article in the American Journal of Nursing titled “Assisted Suicide/Aid in Dying: What is the Nurse’s Role?” (reprinted in full by Death with Dignity). The article included this disturbing news

“In 2018, the American Nurses Association (ANA) will be updating its current position statement “Euthanasia, Assisted Suicide, and Aid in Dying”. (Emphasis added)

Ominously and just last year the ANA approved VSED (voluntary stopping of eating and drinking) stating that “people with decision making capacity have the right to stop eating and drinking as a means of hastening death.” (Emphasis added)

Not surprisingly, our government is also not immune to the aspirations of Compassion and Choices. In its “Federal Policy Agenda / 2016 & Beyond” , Compassion and Choices set the following priority:

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….”

Compassion and Choices lists as one of its accomplishments that it:

Pioneered the medical model of aid in dying that helps ensure that doctors can ethically practice aid in dying in an open, legitimate and accessible way, and integrates the option into patients’ end-of-life care. The culmination of that work was the publication of clinical criteria in the Journal of Palliative Medicine in December 2015. (Emphasis added)

Now, a Compassion & Choices’ website even has a video presentation based on this article  titled  “Understand the Clinical Practice of Aid in Dying”  for doctors and other clinicians. The presentation even offers continuing medical education credits.

We may now be seeing the potential results of this agenda in the current  “The Palliative Care and Hospice Education and Training Act” that is endorsed by Compassion and Choices . The bill was passed in the US House of Representative and is currently in the Senate health committee as SB693. If passed, the bill would authorize grants and contracts to promote education, research and the development of faculty careers in hospice and palliative care. (I have already contacted my home state senator about the potential problems with this legislation.)

CONCLUSION

Several years after Oregon voted to legalize physician-assisted suicide, I began to notice a stark difference between my fellow health care colleagues who supported legalizing physician-assisted suicide and those who didn’t. Doctors and nurses who supported such laws often spoke about patients who “needed to die” even though those patients never even mentioned wanting to die. They often tried to get out of caring for or even talking to difficult patients. In contrast, those doctors and nurses who were appalled by physician-assisted suicide were the ones who patiently listened to patients and addressed their fears and hopes, treated relatives as part of the care team and actively advocated for the best care for their patients.

But with Compassion and Choices’ leaders like Barbara Coombs Lee, one of the architects of Oregon’s assisted suicide law, even arguing against strong conscience rights protections for those of us who refuse to participate, it may become impossible in the future to even find a health care professional committed to protecting the life of every patient.

All of us, both medical and lay people, must speak out against physician-assisted suicide before our health care system becomes irreparably corrupted.

Now Even Family Assisted Suicide?

Her obituary  stated that Tessa was 55 years old and the divorced mother of two adult children when she died on May 14, 2002 in San Francisco, California after a nearly four year fight with breast cancer . She had been a real estate agent and later worked as controller in her son’s company.

Her son was Gavin Newsom, who just won the race for California governor November 6, 2018.

However and just the day before, a November 5, 2018 article in The New Yorker titled “Gavin Newsom, the Next Head of the California Resistance gave a different version of Tessa’s death:

“Newsom’s sister, Hilary, said that when their mother had breast cancer, in her fifties, he was difficult to reach. ‘Gavin had trouble explaining to me how hard for him it was to be with her when she was dying, and I had trouble explaining to him how much I needed him,’ she said. ‘Back then, he seemed like the kind of guy who would never change a diaper.’

In May, 2002, his mother decided to end her life through assisted suicide. Newsom recalled, “’She left me a message, because I was too busy: ‘Hope you’re well. Next Wednesday will be the last day for me. Hope you can make it.’ I saved the cassette with the message on it, that’s how sick I am.’ He crossed his arms and jammed his hands into his armpits. ‘I have P.T.S.D., and this is bringing it all back,’ he said. ‘The night before we gave her the drugs, I cooked her dinner, hard-boiled eggs, and she told me, ‘Get out of politics.’ She was worried about the stress on me.’” (Emphasis added)

Sadly, a previous 2016 San Francisco Chronicle article entitled How Gavin Newsom’s family tragedy led to ammo-control initiative” quoted Gavin Newsom on an earlier suicide tragedy in his mother’s life:

“My grandfather committed suicide, but not before putting his daughter — my mother — and her twin against the fireplace and saying he was going to blow their brains out,” Newsom said.”(Emphasis added)

THE CRAZY HISTORY OF CALIFORNIA’S PHYSICIAN ASSISTED SUICIDE LAW

I admit I was puzzled when California governor Jerry Brown signed a new law in September, 2018   titled  “AB-282 Aiding, advising, or encouraging suicide: exemption from prosecution”. This amended the 2016 physician-assisted suicide law that “Every person who deliberately aids or advises, or encourages another to commit suicide is guilty of a felony” to “A person whose actions are compliant with the provision of the End of Life Option Act (physician-assisted suicide) shall not be prosecuted under this section.” (Emphasis added)

For many years, California was especially targeted by assisted suicide groups like Compassion and Choices, the former Hemlock Society, for the legalization of physician-assisted suicide because of its size and influence. By 2015, there had been 8 failed attempts for legalization of physician-assisted suicide.

However, the Brittany Maynard tragedy started a media frenzy around the 30-year-old newlywed with an aggressive brain tumor when she announced that  she and her family left California for Oregon to commit assisted suicide where it was legal and picked November 1, 2014 for her assisted suicide. Brittany Maynard also became a spokesperson to raise funds for Compassion and Choice’s campaign to legalize assisted suicide throughout the US. Her family continued to vigorously fight for a physician-assisted suicide law in California after her assisted suicide in Oregon.

Significantly and because of the Brittany Maynard tragedy, most mainstream media outlets have now dropped the term “physician-assisted suicide” in favor of more palatable terms like “death with dignity” and “physician aid in dying.”

Surprisingly though, another attempt to pass  the “End of Life Options Act” in California failed in the 2015 legislature-until a sudden extra and controversial legislative session was called to pass it. This new law was signed into law by Gov. Brown and took effect in June 2016.

However in May 2018 and after at least 111 assisted suicide deaths, a Superior Court judge overturned the law, ruling it unconstitutional because of  how it was improperly passed in the special legislative session.

Physician-assisted suicide was again illegal until a month later when California’s 4th District Court of Appeals granted the state’s request to reinstate physician assisted suicide while it considers the case.

Then, as I mentioned before, Gov. Brown signed the law to prevent prosecution of anyone involved in an assisted suicide, including family members.

CONCLUSION

According to Findlaw:

“If you’re not a licensed physician, then assisting someone with suicide is most definitely a crime. But in states that have enacted “right to die” or “death with dignity” laws, eligible patients may request lethal drugs and administer them on their own.” (Emphasis added)

But the reality is that very few cases of a friend or family member assisting a suicide are prosecuted and even then, the penalty is light or nonexistent.  So-called “safeguards” are useless.

There is no chance that Governor Newsom will be prosecuted or even investigated for allegedly assisting his mother’s death in 2002 (long before California legalized physician-assisted suicide). But the new California law that forbids prosecuting anyone involved in a physician-assisted suicide who “aids or advises, or encourages suicide” further reinforces the dangerous myth that assisting  suicide is a victimless and even loving act.

Should a Mental Health Exam be required before Physician-assisted Suicide?

When I read the October 27, 2018 MedPage news article titled “Assessing Competency in Aid-in-Dying Patients (aka physician-assisted Suicide)-Should a Competency Exam by an Outside Doctor be Required?”, I was struck by one case cited by psychiatrist Richard Martinez, MD, professor of psychiatry and law at the University of Colorado Denver who opposes mandatory mental health exams as “an invasion of privacy ” …”(t)o mandate an interaction with a stranger”. Dr. Martinez also contends that “Depression should not be an exclusionary decision.” (Emphasis added)

Dr. Martinez cited the case of a young man who had a severe spinal cord injury after a fall and was on a ventilator to breathe. Doctors took him off sedation and asked if he wanted to live. He said no so the ventilator was removed and he died.

Although Dr. Martinez acknowledged that “people who work with people with spinal cord injuries have argued for a waiting period” and that this was a very difficult case in bioethics, he still maintained that, in the end, the issue is really about choice. (Emphasis added)

When I read this, I remembered when “Aaron” (not his real name) was admitted to our intensive care unit with a severe spinal cord injury after a car accident. This was in the early 1970s, long before the “right to die”/physician-assisted suicide movement became known to the public.

I was there when the doctors told Aaron that his legs were permanently paralyzed and he would never walk again. Naturally, this 18 year old young man was devastated. It didn’t take long before he told us he wanted to die. We were not surprised by this  normal reaction and the doctors wanted to stabilize him medically before ordering a psychiatric consult if he persisted in wanting to die.

One day while I was bathing Aaron, I asked him if many people complimented him on his legs. Aaron was puzzled but answered “No”. Then I asked him if his legs were the most important part of him. After a pause, he smiled a little and said probably not.

Then I talked with him about what he would still be able to do once he was medically stable and what he might be able to do in the future with rehabilitation and medical advances. Aaron looked a little less forlorn. I reassured him that we doctors, nurses and his wonderful family would be there every step of the way and I predicted how much better he could feel with time and more information.

But what really made a difference was when Aaron’s parents told me how much he enjoyed poker. So one quiet night, I started a midnight poker game in Aaron’s ICU room with the nurses taking turns between caring for the patients and playing. It was great to see Aaron finally laughing and making fun of how badly we played.

Even though we were caught by an unexpected visit from administrators and I had to promise never to do this again, it was worth it. When I last visited Aaron after he left our unit, he was laughing and talking to his friends. And making plans.

Supporters of physician-assisted suicide claim that one of their strongest safeguards is, as the Oregon physician-assisted suicide law states, that “If, in the opinion of the attending physician or the consulting physician, a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patient for counseling.” (Emphasis added) But only the evaluation of a patient’s competence to make such a decision- not the diagnosable mental disorders that afflict more than 90 percent of people who die by suicide- is required .

However, now that supposed “safeguard” is being questioned by some psychiatrists in this new MedPage article reporting on a panel discussion during the 49th annual American Academy of Psychiatry and the Law (AAPL) meeting.

In the article, psychiatrists like Anna Glezer, MD, an associate professor of psychiatry and of ob/gyn at the University of California San Francisco (UCSF) who supports requiring a mental health exam stated:

“A psychiatrist can help identify potentially treatable psychiatric symptoms that may relieve elements of patient suffering, and detect family agreement versus family conflict that may require further intervention and counseling,”

and

‘”I’ve done a case where I didn’t say ‘This person meets the criteria or doesn’t,’ but [instead said] ‘These are my concerns,'” she said. In this case, the patient had lost her husband within the past year “and I thought grief might be compounding her decision-making capacity.” (Emphasis added)

Dr. Ariana Nesbit, a psychiatrist at the San Diego Central Jail says PAD (physician-assisted death aka physician-assisted suicide) is a complicated issue, stating that:

Our goal is often thought to be to prevent suicide, and we still conceptualize suicidal ideation as a symptom and pathological. As someone who just recently finished training in three very liberal states, I can tell you that at no point during my training was I ever taught how to figure out whether someone’s suicidal ideation, or their suicide attempt, was rational, so we don’t have any widely accepted method for determining this.” (Emphasis added)

Dr. Nesbit also cited a study titled “Prevalence of depression and anxiety in patients requesting physician’s aid in dying: cross sectional survey” that found 26% of patients requesting physician-assisted suicide did meet depressive disorder criteria but three of them were approved for physician-assisted suicide anyway. The authors concluded that “Although most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.” (Emphasis added)

During a question and answer session, Annette Hanson, MD, adjunct assistant professor of psychiatry at the University of Maryland in Baltimore, questioned whether PAD itself was a good idea. “We’re not just consulting psychiatrists — we’re members of a profession,” she said. “We’re shapers of healthcare policy that will affect everyone in the country … including people who are institutionalized, including people who don’t have physical illnesses.” (Emphasis added)

Dr. Hanson told how she was contacted by a colleague who asked her how to do such an mental health exam on a patient seeking assisted suicide in Switzerland. because of an “irreversible neurological condition”.  Dr. Hanson said, “It turned out the ‘irreversible neurologic condition’ was schizophrenia”. Dr. Hanson concluded that “So the publicity surrounding the right-to-die movement is hurting our psychiatric patients.” (Emphasis added) She also added that “the American Psychiatric Association also considers [PAD] to be unethical, and re-emphasized that in [amicus] briefs to the Supreme Court.”

Another MD talked about self-care for doctors after making mental health exams for physician-assisted suicide, saying that she deliberately tried “not to find out what happened to the patient” but still often found out what happened to the patients she evaluated when she would see an announcement about a memorial service

CONCLUSION

I am glad that I became a nurse decades before state legalized physician-assisted suicide. Back then, I saw what happened with patients like Aaron when we didn’t have the assisted suicide “option”: Patients received a chance for the best life possible and we received a chance to show how much we cared.

 

 

 

 

My Review of “Gosnell: The Trial of America’s Biggest Serial Killer”

I just saw the movie “Gosnell: The Trial of America’s Biggest Serial Killer” and was moved to tears even though I already knew much of the story about the notorious Philadelphia abortionist who ran an outrageously filthy clinic where he executed late-term babies who survived abortion by callously cutting their spinal cords. I also knew that some of the women died, suffered serious complications or contracted diseases from dirty instruments during the 30 years Dr. Kermit Gosnell ran his politically protected clinic.

This PG 13 movie scrupulously avoids sensationalism but through great acting, writing and accurate depictions of the clinic and Gosnell himself (actual pictures were shown at the end of the movie), the enormity of the evil cannot be ignored.

The movie starts much like an episode of “Law and Order” portraying a drug bust but then expands as police raid Gosnell’s abortion clinic for evidence of illegal prescription drug sales and find even greater problems. After the initial reluctance to prosecute by the District Attorney because the case involves abortion, a courageous assistant district attorney puts her job on the line to prosecute Gosnell.

The trial of Gosnell is riveting, especially when an expert witness abortionist describes how to correctly perform a late-term abortion that is unnervingly similar in callousness to Gosnell’s. The testimony of girls as young as 15 when they were trained by Dr. Gosnell to be his unlicensed assistants is also devastating as they describe an aborted baby swimming in a toilet or another struggling to keep breathing. The trial is very contentious but a stunning development late in the trial determines the result.

I highly recommend seeing this movie that even opened the eyes of people like Ann McElhinney who was neutral on abortion until she worked on this film.

CONCLUSION

Although one of the most shocking aspects of the Gosnell trial was his cutting the spinal cords of babies who survived abortion, Kermit Gosnell was not the first known abortionist to deliberately end the lives of babies who survived abortions.

In 1999, nurse Jill Stanek was shocked to discover a live baby boy left to die after an induced-labor abortion  and found this was a common practice in her hospital. Her courageous testimony led to the 2002 “Born-Alive Infants Protection Act” which extended legal protection to infants born alive after an abortion.

However, the lack of legal enforcement power in this Act led to the current “Born-Alive Abortion Survivors Protection Act that not only requires physicians and abortion facilities to afford “the same degree” of care to a baby born alive during an abortion that would apply “to any other child born alive at the same gestational age,” including transportation to a hospital, but also mandates fines and the possibility of imprisonment for medical professionals found to be noncompliant.

This bill was passed in the US House of Representatives this year and sent to the Senate where (because of procedural hurdles), it might need 60 votes to pass and be signed into law by President Trump.

Although it might be difficult to pass the Act now because of the political entrenchment of abortion supporters in the Senate, passing this law would provide at least one fitting endnote to the horrors of Dr. Kermit Gosnell’s clinic.

Beware the New “Palliative Care and Hospice Education and Training Act”

Right now, there is a Senate Bill 693 titled “The Palliative Care and Hospice Education and Training Act” to authorize more and better training in palliative and hospice care. Although a provision (SEC. 6. Clarification) was recently added to explicitly forbid federal funding for any health care furnished for the purpose of causing or assisting the death of any individual by assisted suicide, euthanasia or mercy killing, many of us have serious concerns. (The similar House Bill 1676 has already passed and sent to the Senate.)

As an RN with decades of nursing experience in hospice, oncology (cancer) and critical care, I have been involved with many end-of-life situations. I am an enthusiastic supporter of ethical palliative and hospice care which is indeed wonderful for patients of any age and their families.

Unfortunately, there is a growing trend towards calling unethical practices “palliative” or “hospice” care.

For example and just a few years ago in a Catholic hospital, I saw a nurse/friend’s life deliberately ended due to so-called palliative and hospice care labeled “comfort care.” She had recently suffered a serious brain injury and was declared hopeless after a couple of weeks. The family was strongly pushed to switch to “comfort care”.  She was taken off a ventilator, had her feeding tube removed (against her adult son’s wishes), and continued to receive the sedation medications used when she was on the ventilator, even receiving an increase in those medications when she continued to breathe on her own. Despite my friend’s son insisting that he wanted the feeding tube replaced and that he wanted to eventually care for his mother at home whatever her level of functioning was, he was told to wait until a doctor could order the feeding tube replaced. The hospital waited until he went home to sleep, transferred her to the hospice unit without his permission and she was dead by morning.

Unfortunately, similar stories have become increasingly more common since the 1970s when the Euthanasia Society of America changed its name to the Society for the Right to Die and promoted the new “living wills”. Now we have well-funded groups like Compassion and Choices (the former Hemlock Society) not only promoting physician-assisted suicide but also trying to change medical ethics from never deliberately causing or hastening death to merely a “choice” about when and how to die.

Two years ago in my blog “Is Compassion and Choices aiming to become the “Planned Parenthood” of Euthanasia?, I warned about the current and future involvement of Compassion and Choices in “end of life” education.

Here are some excerpts:

With over $22 million in 2015 net assets,  a 4 star rating from Charity Navigator, enthusiastic media coverage and a new  Federal Policy Agenda for 2016 and Beyond” , Compassion and Choices increasingly appears to be following in the 4 star, politically and media supported, $1.3 billion dollar revenue ($528 million in government taxpayer funding) steps of the Planned Parenthood Federation of America.

While Compassion and Choices claims that it just “works to improve care and expand choice at the end of life”, it also admits that “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.” (Emphasis added)

……….

THE PALLIATIVE AND HOSPICE CONNECTION

Compassion and Choices has worked for decades not only to legalize physician-assisted suicide in every state but also to normalize and integrate physician-assisted suicide into medical practice and reaches out to established medical groups like the American Academy of Palliative and Hospice Medicine (AAPHM.

………..

Now, Compassion & Choices’ website has a video presentation based on this article  titled  “Understand the Clinical Practice of Aid in Dying” for doctors and other clinicians. The presentation even offers continuing medical education credits.

This would not be possible if the AAPHM had not changed its position on assisted suicide from opposition to “studied neutrality”, a position that the American Medical Association itself is now considering.

………….

Compassion and Choices also supports two other “legal” options for assisted suicide in states that haven’t passed physician-assisted suicide laws. One is “voluntary stopping of eating and drinking (VSED)” and the other is “palliative sedation-Sometimes called terminal sedation”. Significantly, the recommendations include the admission that “VSED includes pain and symptom management” and “Palliative sedation must be medically managed by a healthcare provider”. Thus the need to influence and train hospice and palliative care providers.

………..

WHERE THE MONEY AND POWER IS

Compassion and Choices now has its “Federal Policy Agenda / 2016 & Beyond”.

The priorities on its agenda include:

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….”  (Emphasis added)

Also included are

Professional Education and Development” training programs for doctors and other providers “in discussing terminal prognoses and death” and  “Policies and Payment Systems” to change medical policies and payments to a “a value-based healthcare payment system” that will “(e)ncourage Congress to direct CMS (the Centers for Medicare and Medicaid Services) and other federal agencies” to withhold   “appropriations or other funds”  for treatment that was “provided but (deemed) unwanted”.

This last provision reinforces the fear many healthcare providers already have that, if in doubt, it is safer not to treat a person rather than treat him or her in hope of a good result because of potential lawsuits or reimbursement problems.

………

In the meantime, if the Compassion and Choices federal policy agenda is successful, they stand to benefit from a potential windfall of government taxpayer funding to provide their currently  “free consultation, planning resources, referrals and guidance”.

CONCLUSION

I have already contacted my state senator to express my concerns and urged him to vote “no” on SB 693.

As Nancy Elliot, chair of the Euthanasia Prevention Council USA, ended in a great letter to Senators opposing the Palliative Care and Hospice Education and Training  Act :

“instead of creating a rival form of palliative care…Wouldn’t it be better to educate/update all physicians and nurses about pain and symptom management?”

Journal of the American Medical Association Article Calls Crisis Pregnancy Centers “Legal but Unethical”

When I first started nursing school, abortion was illegal in all 50 states and the American Medical Association (AMA) was influential and widely admired.

But, as cited and influential in the Roe v Wade decision in 1973, the AMA dropped its’ opposition to abortion in 1970  after a few states legalized abortion with resolutions  that stated:

“abortion is a medical procedure that should be performed by a licensed physician in an accredited hospital only after consultation with two other physicians and in conformity with state law, and that no party to the procedure should be required to violate personally held moral principles”.

I remember how upset many doctors were with the AMA after Roe v Wade and many dropped out of the AMA.

Now, there are over one million MDs in the US  but less than 25% of practicing doctors are members of the AMA, down from 75% in the 1950s. (This is not just because of abortion but also the politics of the AMA.)

The AMA today now stands firmly for abortion rights and even against common sense conscience rights protection.

“AT ‘CRISIS PREGNANCY CENTERS’, CRITICS SAY, IDEOLOGY TRUMPS EVIDENCE”

This is the title of a July 18, 2018 article in the Journal of the American Medical Association by Rita Rubin, MA excoriating crisis pregnancy centers (CPCs) as “legal but unethical”.

Among the allegedly “unethical” practices the article cites are that CPCs “don’t prescribe or provide birth control” and “dispense misleading information-sometimes mandated by the state-about disproved or exaggerated harms associated with abortion, including increased risk of breast cancer, depression and infertility”. The article also criticizes the free ultrasounds as “medically unnecessary” and “emotional manipulation”.

But, according to the article, the biggest ethical problem seems to be “withholding information” about obtaining abortions.

The article cites California as the first state to pass a crisis pregnancy mandatory disclosure law that mandates CPCs to “post or distribute a notice about California’s public programs that provide free or low-cost contraception, prenatal care, and abortion“.(Emphasis added)

The article criticizes the June 26, 2018, the US Supreme Court’s National Institute of Family and Life Advocates v. Becerra decision that struck down the California law as likely unconstitutional.

The JAMA article also decries a recent Health and Human Services’ announcement that Title X family planning services grants includes “natural family planning methods” and that faith-based organizations are eligible to apply for such grants.

THE REAL FACTS ABOUT CRISIS PREGNANCY CENTERS

As even the JAMA article admits, there are more than 3500 CPCs in the US, more than twice the number of US institutions that performed at least 1 abortion in 2014 according to the pro-abortion Guttmacher Institute. That is a decline of 3% between 2011 and 2014.

Obviously, crisis pregnancy centers are seen as threatening to the pro-abortion movement.

As CPC volunteer Patty Knap observed in her blog The Real Reason Crisis Pregnancy Centers Must Always be Free”,  “The difference between an abortion center and a pro-life pregnancy center is like day and night. Or life and death.”

Ms. Knap observes that, unlike an abortion clinic that charges for everything, CPCs don’t charge for anything-including pregnancy tests. Instead, Ms. Knap says, “Every pregnancy center in the country is constantly fundraising”.

Ms. Knap says offering their services without charge is necessary because the trust factor is so important. When their clients understand the motivation of someone who isn’t profiting from the decision they are making, they are more likely to accept the truth and real help.

CONCLUSION

Just as outrageous as California’s attempt to compel crisis pregnancy centers to advertise abortion is that so many mainstream media outlets continue to ignore or disparage the ongoing efforts of the pro-life movement to offer desperate women a loving opportunity for them and their unborn babies.

We may sometimes wonder if attending fundraising baby showers in our churches, picketing abortion clinics with telephone numbers for help, donating to Birthright, etc.  is really accomplishing much. But, as the successes of CPCs show, even the smallest effort by a great number of people can produce the awesome result of helping distressed mothers and saving their babies’ lives.

An “Acceptable” Prejudice

This week, Fox News had a story  about John Cronin, a young man with Down Syndrome who, with his father, founded and runs what is now a $4 million dollar company called Crazy Socks.

This story follows the February announcement that the new Gerber Spokesbaby is Lucas Warren who had Down Syndrome. The famous baby food company stated that Lucas “exemplifies Gerber’s longstanding heritage of recognizing that every baby is a Gerber baby.” (Emphasis added)

However, this past week, the influential ethicist Arthur L. Caplan, PhD wrote a commentary titled “Should It Be Harder to Get Abortions for Down Syndrome Babies?”
for Medscape, a password protected medical news website for health professionals.

In his commentary, ethicist Caplan recognizes the worries that “Down Syndrome is becoming increasingly rare in Europe and the United States” because of prenatal testing and abortion.

But he contends that because:

“In recent years, we have even seen kids with Down syndrome appearing on cheerleading squads, or being put into beauty pageants. It’s clear that there has been movement to not exile or isolate children in the United States with Down syndrome and to try and get them more mainstream.” (Emphasis added)

Nevertheless, ethicist Caplan accepts the ultimate “exile” of Down Syndrome by abortion because “After all, legally, you don’t have to have any reason to decide to end the pregnancy.” (Emphasis added) He additionally cites polls showing high public support for abortion for “genetic  or hereditary diseases”.

Therefore he also criticizes the few states that have passed laws to protect unborn babies testing positive for Down Syndrome from abortion. (Emphasis added)

Dr. Caplan says he is not against “offering information to parents” about Down Syndrome but he is against “mandating” that such information be given.

Perhaps Dr. Caplan has forgotten that in 2008, the Kennedy Brownback law “Prenatally and Postnatally Diagnosed Conditions Awareness Act” was overwhelmingly passed by both houses of Congress and signed into law “(t)o amend the Public Health Service Act to increase the provision of scientifically sound information and support services to patients receiving a positive test diagnosis for Down syndrome or other prenatally and postnatally diagnosed conditions.”

DOWN SYNDROME AND PREJUDICE

Unfortunately, prenatal discrimination naturally leads to postnatal discrimination as I personally discovered when my husband and I had our daughter Karen who had Down Syndrome and a heart defect. We were shocked when the cardiologist gave us the option of refusing cardiac surgery and letting her die despite the excellent chance for survival with surgery.

Although we chose life for our daughter, we later found that Karen was secretly made a “Do not Resuscitate” (DNR) during one hospitalization by our trusted pediatrician who said I was “too emotionally involved with that retarded baby”. Unfortunately, we eventually lost our Karen to complications from pneumonia before her planned surgery.

I’m sure Dr. Caplan would not be in favor of terminating anyone because of race, sex, etc. but he apparently has a “politically correct” blind spot when it comes to abortion.

Ironically, one of the state laws that ethicist Caplan objects to states:

“That Indiana does not allow a fetus to be aborted solely because of the fetus’s race, color, national origin, ancestry, sex or diagnosis or potential diagnosis of the fetus having Downs syndrome or any other disability.”  (Emphasis added)

Sadly, that Indiana law was ruled unconstitutional in 2018 because of the legal “right to abortion” for any or no reason at all.

CONCLUSION

There is no test that will prove that an unborn baby is “perfect”, either before or after birth. For example, many of us have had our so-called “normal” children unexpectedly die or become addicted to illegal drugs years after birth. It is a sad conceit to assume that we can ensure the happiness of ourselves and our families by testing and then controlling which of our unborn babies are allowed to live.

In reality, a 2016 study “Positive attitudes prevail within families of people with Down syndrome” showed that almost 90% of families with members having Down Syndrome reported pride, love and even feelings of enrichment.

And a 2011 study in the American Journal of Medical Genetics titled “Self-perceptions from People with Down Syndrome “ found that “99% of people with Down syndrome indicated that they were happy with their lives”.

Nevertheless, as those of us who have had children with Down Syndrome know, the negative stereotypes of people with Down Syndrome persist despite these studies and often affect the medical professionals and ethicists charged with giving women and families information and options (including adoption) for conditions like Down Syndrome. Incomplete or biased information can be deadly and result in the now up to 90% of mothers who abort their unborn babies after a diagnosis of Down Syndrome.

The world is so much poorer without people like my late daughter Karen who was greatly loved. Prejudice against Down Syndrome justified as the legal “right to abortion” is lethal, not “acceptable”.

Women and their families surely deserve both comprehensive information and support when a prenatal diagnosis like Down Syndrome is made.

And every child, born or unborn, deserves a chance for life.

Alfie Evans and the Shocking UK Gosport Independent Panel Report

The Baby Alfie Evans’s case this year shocked the world but now we learn his forced death against his parents’ wishes follows a legal and healthcare nightmare in the UK.

Some of us expressed concerns years ago about the UK’s “Liverpool Care Pathway” developed in the 1990s to improve care of the dying by applying “the high standard of palliative care prevalent in hospices to other clinical settings”.  But the “Liverpool Care Pathway” went horribly wrong and in 2009, the UK Daily Mail published an article “Euthanasia by the back door: Hospitals ‘death pathway’ is open to error” with cases of non-dying patients considered “not worth saving” who died from the “combination of dehydration and powerful painkillers”, explaining that:

“Under the Liverpool Care Pathway, doctors can withdraw fluids and drugs from patients if they are deemed close to death. Many are then put on continuous sedation so they die free of pain.

But sedation can often mask signs of improvement, meaning doctors may be closing the door on people who would otherwise live for months.”

In 2013, the British Journal of General Practice published “The Liverpool Care Pathway for the dying: what went wrong?” . The authors acknowledged the problems that led an independent review to call for an end to the Liverpool Care Pathway but concluded that:

“(a)vacuum left by the abolition of the LCP makes a return to the ‘bad old days’ of poor or non-existent communication about dying a real possibility: we would argue that the response to poor use should be right use, not non-use” and  called for “increased funding and training in palliative care and suggest that skills in end-of-life care should become a required competency for all health care professionals.” (Emphasis added)

THE GOSPORT INDEPENDENT PANEL REPORT

More details of this scandal have just now surfaced in a report on the Gosport War Memorial Hospital  where patients were often admitted for rehabilitation or respite care. The report concludes that at least 450 patients had their lives “shortened” by denial of food and water along with powerful painkillers between 1989 and 2000. It details cases and concerns and ultimately acknowledges the families’ years-long pleas for the truth. Here is one excerpt:

“Those (nurses) who raise concerns about the conduct and practice of colleagues are now widely known as ‘whistle-blowers’. To put it into context, it is generally agreed that the NHS (National Health Service) has not been good at protecting people who take such a difficult step; as the documents make clear, the events of 1991 were no exception. Nor should the consequences for whistle-blowers be underestimated: these commonly included disciplinary action and undermining of professional credibility.

“The documents show that, following a complaint to the Trust in 1998 and the police investigation, it should have become clear to local NHS organisations that there was a serious problem with services at the hospital. Although the successive police investigations undoubtedly complicated the NHS response, it is nevertheless remarkable that at no stage was there a public admission of failure or any public apology. Nor was there a proportionate clinical investigation into what had happened. On the contrary, the documents show numerous instances of defensiveness and denial – to families, to the public and the media, and to health service and other organisations.” (Emphasis added)

CONCLUSION

Will charges now be brought against those involved in the Gosport War Memorial Hospital euthanasia deaths? Who knows? The Independent Panel only concluded that:

“With this Report and an online archive of documentation, the Panel has completed its Terms of Reference. The Panel now calls upon the Secretary of State for Health and Social Care and the relevant investigative authorities to recognise the significance of what is revealed by the documentation in this Report and to act accordingly.

But just as important is the question “Has health care now improved?”

Unfortunately, the answer may be no.

As the UK Telegraph reported in 2015 in the article “New NHS (National Health Service) death guidelines ‘worse than Liverpool Care Pathway’”, the Liverpool Care Pathway was supposedly phased out in 2014 in favor of the National Institute of Health and Care Excellence (NICE) guidelines. but families were still reporting poor end of life care, including denial of food and water.

And now, unlike that Liverpool Care Pathway horrors that were hidden for so long, we had the very public case of Baby Alfie Evans this year where courts enforced the doctors’ decision to shorten his life by removing his ventilator, refused his family’s requests to transfer him or take him home and even take away his feedings when he continued to breathe for days after the ventilator was removed.

Apparently, the death culture is apparently very hard to kill in the UK and, as we are finding, also in the US.