medical

The Choice Was “Comfort Care” or a Trial of Life

nancyvalko culture, education, end-of-life, inspiration, medical, medical ethics

In a November 19, 2025, article by Kevin Reece titled “”Micro-preemie’ born at less than one pound thrives after state-of-the-art careMicro-preemie’ born at less than one pound thrives after state-of-the-art care”, he describes a mother’s dilemma when Annie Babcock gave birth to a daughter at just 24 weeks gestation:

“Annie Babock was in trouble. The baby she was carrying had been diagnosed with intrauterine growth restriction and Annie, her pregnancy at just 24 weeks gestation, was diagnosed with preeclampsia and placental abruption. 

Her doctors in Bedford delivered a sentence she will never forget.

“They said we can either deliver here and do comfort care and let the baby pass, or go to Texas Health in Fort Worth and do a trial of life.” (Emphasis added)

THE PARENTS CHOOSE THE TRIAL OF LIFE

“Nora Babcock was born March 10. She weighed 13.1 ounces and was just 10.5 inches long – roughly the size of a soda can. Rushed into the Neonatal Intensive Care Unit at Texas Health Harris Methodist Fort Worth, Nora would need prolonged respiratory assistance and a delicate procedure to repair a heart defect. It would be 10 days before Annie Babcock was able to hold her. 

“It was terrifying,” Annie Babcock said. 

“It was our first bonding experience, but it sure was scary,” she said of holding her tiny daughter while the infant was supported by multiple wires, monitors, and tubes.

EIGHT MONTHS LATER

“She came home July 10,” Babcock said. “So we’ve been in the NICU more days than we’ve been out of the NICU.”

Nora weighs 10 pounds now and is, according to her doctors, the picture of health.

“It was a huge shock when they said she was going to be born at 24 weeks,” Babcock said. “I had no idea a baby less than a pound could be born and also live. It was terrifying, but also like miraculous.”

“You look at her now, and it’s hard to even think about that,” Owen Babcock said of his daughter’s precarious start at life.

“When she was born so small I didn’t think she could live,” Annie Babcock said. “And the nurses are like, no, she’s going to thrive.”

A DOCTOR SPEAKS

“A case like Nora is still quite rare, mostly because of her size,” said Dr. Megan Schmidt, neonatologist at Pediatrix Neonatology of Texas and Texas Health Harris Methodist Fort Worth Hospital. 

Nora is considered a “micro-preemie” – a baby born before 26 weeks gestation or less than 2.2 pounds.

You’re really battling against nature,” Schmidt said. “And trying to get this body that is not ready to be in this world and be in the outside world, you’re trying to force it to stay in this outside world and to function. It takes highly highly specialized care to even be able to have a chance to have these babies survive.”

“These sorts of things and these innovations that have been developed over the last 10-plus years are things that are making big changes for our babies now,” Schmidt said. “We couldn’t have done these things as early as 30 years ago that we can do now. So there is hope.”

The Parents Speak

“Just the advancements that have been made over the last decade are incredible,” said Owen Babcock.

Owen and Annie Babcock will tell you they have taken a “ridiculous” amount of pictures. They were also allowed to keep Nora’s first blood pressure cuff – barely big enough to fit on an adult finger.

“I think of this little fighter who was ready to come into the world too soon, but she was ready to come fighting, and she never gave up,” Annie Babcock said while looking at the handprints and footprints the hospital gave them – the footprint barely the size of an adult thumb.

“I will tell her she’s the strongest person I’ve ever met in my whole life,” Annie Babcock said when asked what she will tell her daughter when she is older. “I really hope she’s a neonatologist someday. I’m trying to manifest it.”

There is a photo wall in the Babcock’s dining room that includes the phrase – “I still remember the days I prayed for the things I have now.” After their ordeal, they are truly thankful

“I can’t thank Dr. Schmidt enough for just believing in her and not like never giving up hope,” Annie Babcock said.

Hope that they want other parents of preemie babies to know is possible for them too.

“What they do as their work,” she added, “it’s amazing.”

CONCLUSION

This story is heartwarming but also disturbing.

The choice between “comfort care” and more aggressive care can mean life or death for any critically ill person of any age. Families deserve ALL pertinent information and options!

New Dementia Directive Developed to Avoid Late-Stage Dementia

nancyvalko advance directives, Alzheimer's, assisted suicide, Cancer, culture, dementia, end-of-life, euthanasia, food and water, law, medical, medical ethics

In the September 25, 2025, issue of the Journal of Law, Medicine and Ethics, there is a shocking article titled “New VSED Advance Directive: Improved Documentation to Avoid Late-Stage Dementia.” VSED means voluntary stopping of eating and drinking.

The authors state:

“People use advance directives to express preferences that direct their future care when they lack decision-making capacity. One form of advance directive, a “dementia directive,” records preferences about living in various stages of dementia. This is important because many Americans want to avoid living with advanced progressive dementia. Unfortunately, traditional advance directives cannot dependably achieve this goal. In contrast, some dementia directives can achieve this goal by directing cessation of manually assisted feeding and drinking. (Emphasis added)

We proceed in six stages. First, we review the prevalence of advanced dementia. Second, we identify the disadvantages of another option for accomplishing the goal of not living into advanced dementia, preemptive VSED. Third, we distinguish notable court cases where dementia directives were unsuccessful. Fourth, we review nine prominent dementia directives, noting how the Northwest Justice Project’s Advance Directive for VSED remedies those shortcomings. Fifth, we review this directive’s legal status. Sixth, we articulate its ethical justification.”

CONCLUSION

I have had a lot of experience caring for people with Alzheimer’s, both personally and professionally. I have written several blogs over the years, such as “Five Things my Mother (and Daughter) Taught Me about Caring for People with Dementia” (2016), Marketing Death and Alzheimer’s Disease (2019), and Alzheimer’s Association Ends Agreement with Compassion and Choices, Marketing Death and Alzheimer’s Disease (2023). In 1988, I wrote an op-ed published in the St. Louis Post-Dispatch titled “FEEDING IS NOT EXTRAORDINARY CARE– DECISION IN THE NANCY CRUZAN CASE ADDS TO THE LIST OF EXPENDABLE PEOPLE“

I remember when my mother was first diagnosed with Alzheimer’s and thyroid cancer. She needed a tracheostomy (a tube in her windpipe), but was able to eat by mouth.

I was shocked when one doctor asked if we wanted her fed, and I responded angrily, “She gets up and eats ice cream out of the refrigerator! Do you want me to tackle her?!”

Of course, I knew what he meant, but he got the message.

Eventually, my mother died peacefully in her sleep at a nursing home after enjoying a meal and laughter with the whole family. It was the kind of death she told me she wanted.

Unfortunately, my younger brother developed Alzheimer’s and diabetes and was critically injured in a fall down the stairs last October. I was able to calm him and carefully feed him.

The doctor recommended a feeding tube to ensure he was getting adequate nutrition, especially for his diabetes.

However, a palliative care team was called in and disagreed with the doctor, telling my sister-in-law that my brother was not going to get better anyway.

I explained to the family that a small feeding tube was available and comfortable, but the family rejected that option.

It took several long days for him to die.

No wonder assisted suicide is being considered for Alzheimer’s patients!

SUPREME COURT RULES THAT STATES MAY DEFUND PLANNED PARENTHOOD

nancyvalko abortion, culture, education, law, media, medical, nursing, Planned Parenthood, pro-life

Supreme Court clears way for states to kick Planned Parenthood out of Medicaid – POLITICO

A stunning 6-3 Supreme Court decision on June 26, 2025 has now cleared the way for states to exclude Planned Parenthood from their Medicaid programs, concluding that federal law doesn’t allow health care providers or patients to sue if a state violates a provision of federal law guaranteeing the Medicaid patients can visit their preferred provider.

According to Politico:

“The decision rejected a challenge to South Carolina’s 2018 expulsion of Planned Parenthood from its Medicaid program. It will likely allow other conservative states to similarly expel reproductive and sexual health clinics — shrinking the already narrow network of providers available in the health insurance program for low-income Americans.”

and

“Defunding” Planned Parenthood is a goal of many conservatives, who object to its abortion services. Federal law has long banned federal money from being used for abortions. But Planned Parenthood clinics provide many other health care services that are typically eligible for payment under Medicaid.

Thursday’s ruling will make it easier for states to deprive Planned Parenthood — and other clinics that provide abortions — from receiving Medicaid payments for any of their non-abortion-related care.”

BACKGROUND

As I wrote in my December 14, 2018 blog, “Why is the US Supreme Court Ducking the Issue of States Defunding Planned Parenthood?”:

“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”. (All emphasis added)

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.

FEEDING IS NOT EXTRAORDINARY CARE– DECISION IN THE NANCY CRUZAN CASE ADDS TO THE LIST OF EXPENDABLE PEOPLE

nancyvalko assisted suicide, brain injury, conscience rights, disability, education, end-of-life, euthanasia, food and water, futility, law, Living wills, medical, medical ethics, nursing, pro-life

Before the famous Terri Schiavo food and water case gained national attention 20 years ago, Dr. Harvath and I wrote this Op-Ed in the St. Louis Post-Dispatch (no longer online) about the Nancy Cruzan casw, an earlier case of withdrawing food and water from a “so-called “vegetative state”‘ My family was furious when it was pusblished and told me that I was being “mean” to the family.

Unfortunately, such removal has become common and even recently, has resulted in a brother’s death.

Not surprisingly, so-called “assisted suicide” is now allowed in many states and countries

Nancy Valko, RN

Here is our op-ed:
Friday, August 12, 1988
FEEDING IS NOT EXTRAORDINARY CARE– DECISION IN THE NANCY CRUZAN CASE ADDS TO THE LIST OF EXPENDABLE PEOPLE

By Susan Harvath and Nancy Guilfoy Valko                                                                    

Just a few years ago the Missouri Legislature passed a ”living will” law that specifically excluded food and water from the kinds of care that may be withdrawn from a patient. In 1984, the National Conference of Catholic Bishops stated that legislation should ”recognize the presumption that certain basic measures such as nursing care, hydration, nourishment and the like must be maintained out of respect for the human dignity of every patient.”

Therefore, it is hoped that the Missouri Court of Appeals will overturn the recent Circuit Court decision that would deny tube feedings for Nancy Cruzan, a severely disabled woman cared for at the Missouri Rehabilitation Center. The anguish felt by the Cruzan family, which initiated the suit, is understandable. However, directly causing the death of an innocent person – even for reasons of mercy – violates that person’s basic human rights.

The Cruzan case is perceived by many to be an issue of allowing a person to die. Cruzan has been categorized by some experts as being in a ”persistent vegetative state,” an unfortunate and imprecise term at best. However, she is not dying or brain-dead. Rather, she is severely disabled from brain damage and needs no special technology to survive. Withdrawing her feeding tube would not ”allow” her to die – it would ”force” her to die. She would not die from her injuries, but rather from starvation and dehydration.

Also, starvation and dehydration cause a protracted, agonizing death in a fully conscious person. Some experts have stated that Cruzan would feel no pain if her feedings were stopped. Yet Cruzan’s nurses have testified that she has cried, smiled and even laughed in response to stimuli.

The possibility of pain during the length of time before death occurs has led some to propose lethal injections as a more ”humane” way to cause death than starvation. The passive euthanasia of withdrawing feeding logically leads to active euthanasia by injection or other means. Both are unacceptable.

A recent trend has been to classify tube feedings as medical treatment. However, unlike other medical treatments, denial of food from any person (sick or healthy, in or out of coma) will always result in that person’s death.

Ethically, treatments may be withdrawn if they are useless or burdensome to the patient. However, tube feedings are not excessively expensive or burdensome to the patient and do maintain life and prevent the discomfort of hunger and thirst. In deciding what treatment may ethically be withdrawn one must be careful to judge the treatment itself, not the ”quality” of the patient’s life. A person’s limitations do not decrease a person’s humanity or worth.

In the past few years, we have seen many court cases similar to Cruzan’s in other states. Some have involved people less severely disabled than Cruzan. A recent case in North Dakota resulted in a judgment that even feedings by mouth may be stopped. In most cases, it is not the patient who requests that feedings be stopped but rather a third party, usually a family member. Often, as in the Nancy Cruzan case, there is no clear and convincing evidence that the patient would even want the feedings stopped.

Some courts have gone even further and have stated that third parties do not need the approval of a court before a patient’s food and water is withdrawn unless there is disagreement, for example, among family members. This trend has unfortunate implications for all people with mental impairments.

There is a vast difference between not prolonging dying and causing death. In the last two decades, we have seen killing promoted as a humane and compassionate response to unwanted unborn children, newborns with handicaps, and the terminally ill. Let us not add a new category of people (the non-dying, severely disabled) to the list of expendable human lives.

Nancy Guilfoy Valko, R.N., is co-chairperson, and Sue Harvath is program director of the St. Louis Archdiocesan Pro-Life Committee.

Vindication: The Great Barrington Declaration

nancyvalko Covid 19, culture, education, law, medical, mental health

President-elect Donald Trump has just nominated Dr. Jay Bhattacharya, a Stanford professor and an outspoken critic of Covid lockdowns as well as the co-author of The Great Barrington Declaration, to head the National Institutes of Health. I am delighted, especially since I wrote a March 2021 blog titled “Is it possible that there is a light at the end of the Covid tunnel?”

Here are some excerpts from my 2021 blog:

“My husband and I just returned from a trip to Florida where we were happily surprised to find the closest place to normal since the Covid 19 pandemic started. Everyone wore masks (except one young man we saw at a distance) and everyone was careful about social distancing. Hand sanitizers were everywhere.

Best of all, people seemed happy and we saw very few stores closed.

When we returned home, we both finally received the first of our 2 Covid 19 vaccination doses.

IS FLORIDA A HARBINGER OF GOOD NEWS?

Florida was among the last states to go into lockdown and one of the first states to ease restrictions.Florida’s Governor Ron DeSantis was vilified by many in the media for adopting something similar to Sweden’s strategy of protecting the vulnerable while keeping businesses and schools open but a year after the pandemic hit the US, that strategy seems to be working.

Despite having the second largest number of elderly people by state, Florida’s Covid death rate numbers are better than New York’s and California’s. And, unlike so many other states, Florida’s economy is thriving.

Now, Governor Abbott of Texas and Governor Reeves of Mississippi have announced that they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates.”

WHAT HAPPENED?

It has been almost a year since the U.S. went on lockdown for Covid 19 when President Trump declared Covid 19 a national emergency on March 13, 2020.

At first, the lockdown was only supposed to be for a few weeks to “flatten the curve” of infections and prevent hospitals from being overwhelmed by Covid patients.

However, as the lockdowns wore on for months, some doctors and other experts started warning about the emotional and health damage occurring.

Although it received little media notice, a May 19, 2020 letter titled “600 Physicians Say Lockdowns Are A ‘Mass Casualty Incident’” was sent to President Trump that detailed the physical and mental impact of the lockdown in the US due to Covid 19, calling it a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non-COVID patients. 

The doctors’ letter also stated that: “Keeping schools and universities closed is incalculably detrimental for children, teenager and young adults for decades to come.”

Then on October 4, 2020, the Great Barrington Declaration was written and released and eventually signed by thousands of doctors and experts from around the world. The Declaration encouraged governments to lift lockdown restrictions on young and healthy people while focusing protection measures on the elderly, stating:

“Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice. “

CONCLUSION

Now it is 4 years since the Covid pandemic started and we can see that Dr. Jay Bhattacharya and the other medical and public health scientists, medical practitioners, etc. who signed the Great Barrington Declaration were right, despite all the criticism from the media and others.

I personally hope that Dr. Jay Bhattacharya is confirmed as head of the National Institutes of Health.

“New Study: Brain-injured patients who died after life support ended may have recovered”

nancyvalko bereavement, brain injury, disability, education, end-of-life, futility, grief, medical, medical ethics, nursing, vegetative state, ventilators/life support

Over the years, I’ve written about several of my patients like “Mike”, “Jack”, Katie” and “Chris” in comas or “persistent vegetative states” who regained full or some consciousness with verbal and physical stimulation. I have also recommended Jane Hoyt’s wonderful 1994 pamphlet “A Gentle Approach-Interacting with a Person who is Semi-Conscious  or Presumed in Coma” to help families and others stimulate consciousness. Personally, I have only seen one person who did not improve much from the so-called “vegetative” state during the approximately two years I saw him weekly.

Since then, I have written several blogs on unexpected recoveries from severe brain injuries, most recently the 2018 blog “Medical Experts Now Agree that Severely Brain-injured Patients are Often Misdiagnosed and May Recover” and my 2020 blog “Surprising New Test for Predicting Recovery after Coma.

Now, there is an important new study “New Study: Brain-injured patients who died after life support ended may have recovered”

As the article states:

“Using data gathered over a 7 1/2-year period on 1,392 traumatic brain injury patients in intensive care units at 18 U.S. trauma centers, the researchers designed a mathematical model to calculate the likelihood that life-sustaining treatment would be discontinued. They based their model on demographics, socioeconomic factors and injury characteristics.

Then, they paired patients continuing on life-sustaining treatment to individuals with similar model scores, but for whom life-sustaining treatment was stopped.

Based on follow-up, the estimated six-month outcomes for a significant proportion of the withdrawn group were either death or recovery of at least some independence in daily activities. Of the survivors in the not-withdrawn group, more than 40% recovered at least some independence.” (All emphasis added)”

and

“While many people recover consciousness over a few hours or a day, others remain in the intensive care unit, relying on life support, such as a breathing tube, said Bodien, who also is an assistant professor in the department of physical medicine and rehabilitation at Spaulding Rehabilitation Hospital in Charlestown, Mass.

“Predicting who will recover following severe traumatic brain injury, and to what degree, can be challenging. Yet, families are often asked to make decisions about continuing or withdrawing life support, such as mechanical breathing, within just 72 hours of the injury,” Bodien said.

“This decision is based largely on whether the clinical team believes that recovery is possible,” she added. “It is unknown whether some people who died because life support was discontinued could have survived and recovered had life support been continued.”

Currently, no medical guidelines or precise algorithms determine which patients with severe traumatic brain injury are likely to recover. The most common reason families opt for withdrawing life support measures is physicians relaying information that suggests a poor neurologic prognosis.“

And:

“In the study, researchers found that some patients for whom life support was withdrawn may have survived and recovered some independence a few months after injury. Postponing decisions on withdrawing life support may be helpful for some patients, they noted.” (All emphasis added)

ADVOCATING FOR BRAIN-INJURED PATIENTS

I personally know how important and often difficult it is for healthcare professionals like myself as well as families when doctors recommend withdrawing treatments on a comatose patient.

For example and many years ago, I received a phone call from a distraught fellow nurse living in California. Her sister, “Rose”, was comatose from complications of diabetes and had been in an intensive care unit for three days. Now the doctors were telling the family that Rose’s organs were failing and that she had no chance to survive. The doctors recommended that the ventilator and other treatments be stopped so that she could be “allowed to die”. My nurse friend was uncomfortable with the speed of this recommendation even though the rest of the family was ready to go along with the doctors.

As I told her, back when I was a new nurse in the late 1960s, we would sometimes see patients in the intensive care unit who seemed hopeless and we would speak to families about Do Not Resuscitate (DNR) orders. However, the one thing we didn’t do was to quickly recommend withdrawal of treatment. We gave people the gift of time and only recommended withdrawing treatment that clearly was not helping the person. Some patients did indeed eventually die but we were surprised and humbled when an unexpected number of these “hopeless” patients went on to recover, sometimes completely.

About six weeks after the initial phone call, my nurse friend called back to tell me that the family decided not to withdraw treatment as the doctors recommended and that her sister not only defied the doctors’ prediction of certain death but was now back at work. I asked her what the doctors had to say about all this and she said the doctors termed Rose’s case “a miracle”.

“In other words” she noted wryly, “these docs unfortunately didn’t learn a thing.”

CONCLUSION

In 1983, I personally dealt with a withdrawal of treatment situation like this in my own family when my baby daughter with Down Syndrome and a severe heart defect developed pneumonia was placed on a ventilator. She was unresponsive and critically ill.

We hoped to get her stable enough for her planned heart surgery.

One day, a young resident came in and suggested “getting this over with” by removing her ventilator and “letting her die”. I told him that I would sue if he tried.

I went to the chairman of pediatric cardiology whom I knew well and told him what happened and the chairman said he would fire him. Instead, I suggested that he try to educate the young doctor first but, if he didn’t get the point, then he should be fired.

Karen did eventually die in the ICU on the ventilator but I was comforted by the fact that her death was not unnecessarily hastened as well as the fact that later, this wonderful chairman started the first clinic for people with Down Syndrome in the US to deal with their health issues.

This important study should be mandatory reading for all healthcare professionals and families who need to know the facts.

NATIONAL ASSOCIATION OF PRO-LIFE NURSES JOINS ASSOCIATION CHALLENGING CHEMICAL ABORTION IN LANDMARK SUPREME COURT CASE

nancyvalko abortion, law, medical, medical abortion, medical ethics, nursing

Washington, D.C. — The National Association of Pro-Life Nurses (NAPN) has proudly joined the Alliance for Hippocratic Medicine, an association of medical organizations suing the United States Food and Drug Administration (FDA) for its reckless removal of essential safeguards for the use of chemical abortion drugs.

The Alliance for Hippocratic Medicine, other medical organizations, and individual doctors argue that the FDA’s actions not only blatantly disregard established protocols for drug safety but also gravely jeopardize women’s health. This case now heads to the Supreme Court asking that the Court hold the FDA accountable for its callous disregard for women’s health and safety.

The lawsuit, brought forth by the Alliance for Hippocratic Medicine and others, highlights the following concerns:

  • Removal of safety standards: The FDA removed safeguards for mifepristone and misoprostol, even though its own label states that nearly 1 in 25 women who consume these drugs will end up going to an emergency room.
  • Increased patient risks: The removal of abortion drug safety standards could lead to a greater number of complications, including hemorrhage, life-threatening infection, and incomplete abortions.
  • Lack of informed consent: Remote prescription practices and the elimination of in-person doctor visits endanger women, particularly those at risk for ectopic pregnancies.

https://nursesforlife.org/press-releases

NAPN President Dorothy Kane issued the following statement on behalf of the organization:

“Nurses are on the front lines witnessing the serious harms to women caused by the FDA’s reckless removal of essential safeguards for the use of chemical abortion drugs. Women deserve the ongoing, in-person care of a medical professional when taking high-risk drugs. The FDA has compromised patient safety and shown a callous disregard for women’s health and safety. This case is about safeguarding women’s health, protecting the integrity of the healthcare profession, and committing to evidence-based care.”

For more information on the legal case, visit Alliance Defending Freedom, the legal organization representing the Alliance for Hippocratic Medicine: https://adflegal.org/case/us-food-and-drug-administration-v-alliance-hippocratic-medicine

                                                               ###

The National Association of Pro-Life Nurses (NAPN) is dedicated to promoting respect for every human life from conception to natural death, and to affirming that the destruction of that life, for whatever reason and by whatever means, does not constitute good nursing practice.

INSPIRATIONAL GERONTOLOGIST TRANSFORMED DEMENTIA CARE

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

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

MY STORY

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

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

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

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

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

NAOMI FEIL’S STORY

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

Here are some excerpts from the obituary:

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

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

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

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

NAOMI’S HISTORY

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

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

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

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

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

“No lies

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

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

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

CONCLUSION

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

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

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

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

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

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

The Legalization of Cannabis (Marijuana) and the Effects on Pregnant Women and Their Babies

nancyvalko culture, Drugs, law, media, medical, mental health

With 30 US states now fully legalizing marijuana/cannabis, others decriminalizing or only allowing it for medicinal use and only 4 states where it is illegal, the use of marijuana has risen exponentially.

And this is not the marijuana of the 1960s and 1970s.

According to a May 9, 2023 article in KFF Health News, legal marijuana is more potent than ever and still largely unregulated. Even worse, ” Marijuana-related medical emergencies have landed hundreds of thousands of people in the hospital and millions are dealing with psychological disorders linked to cannabis use, according to federal research.”

Now there is growing concern about the negative effects, especially on pregnant women, their babies and teenagers.

According to a May 26. 2023 article in Medscape titled “How Has Cannabis Legalization Affected Pregnant Mothers?”;

“”Severe morning sickness was a major risk factor for care in the emergency department or hospital for cannabis use,” said Myran. “Prior work has found that people who use cannabis during pregnancy often state that it was used to manage challenging symptoms of pregnancy such as morning sickness.”

“Most acute care events (72.2%) were emergency department visits. The most common reasons for acute care were harmful cannabis use (57.6%), followed by cannabis dependence or withdrawal (21.5%), and acute cannabis intoxication (12.8%).”

Compared with pregnancies without acute care, those with acute care related to cannabis had higher rates of adverse neonatal outcomes such as birth before 37 weeks’ gestational age (16.9% vs 7.2%), birth weight at or below the bottom fifth percentile after adjustment for gestational age (12.1% vs 4.4%), and neonatal intensive care unit admission in the first 28 days of life (31.5% vs 13%).”

And:

“There is no known safe level of cannabis consumption, and its use by pregnant women has been linked to later neurodevelopmental issues in their offspring. A 2022 US study suggested that cannabis exposure in the womb may leave children later in life at risk for autism, psychiatric disorders, and problematic substance abuse, particularly as they enter peak periods of vulnerability in late adolescence.”

and

“In the US, prenatal cannabis use is still included in definitions of child abuse or neglect and can lead to termination of parental rights, even in states with full legalization.”

Even worse, marijuana-as well as opioids, nicotine and other drugs-can lead to Neonatal Abstinence Syndrome (NAS). According to Stanford Medicine Children’s Health:

“Neonatal abstinence syndrome is what happens when babies are exposed to drugs in the womb before birth. Babies can then go through drug withdrawal after birth. The syndrome most often applies to opioid medicines” but also “Depressants such as barbiturates, or alcohol, or marijuana” (All emphasis added)

CONCLUSION

It is a symptom of an increasingly dysfunctional society when so many of us turn to drugs, alcohol, the internet, etc. to escape reality and/or amuse ourselves instead of coping with reality.

Marijuana and other drugs are too often portrayed as harmless and fun, especially after marijuana legalization.

Groups like teenagers and especially pregnant women and their babies are particularly vulnerable.

Everyone needs to know the facts.

Planned Parenthood’s Expansion into “Transgender Care”

nancyvalko abortion, culture, law, medical, medical ethics, mental health, nursing, Planned Parenthood, transgender care

In August 2023, my home state of Missouri ‘s  law banning gender-affirming medical care for minors  took effect after a legal challenge from civil right advocates. Missouri joined 22 other states with restrictions on “gender-affirming care”. Most, if not all, of these states have exemptions for a “medically verifiable disorder of sex development”.

Now a shocking October 4, 2023 article in the Washington Free Beacon titled “Planned Parenthood is Helping Teenagers Transition After a 30 Minute Consult. Parents and Doctors are Sounding the Alarm” says that “The abortion provider is wading into transgender care, doling out prescriptions for estrogen and testosterone, including to special needs kids.”

The article writes about a teenager diagnosed with autism whose parents were shocked “when, in December 2022, at 17 years old, he announced he was a transgender woman” after his best friend with autism announced he was a transgender woman.

“The parents were “Concerned that this was another phase, but open to the possibility that it wasn’t, Fred’s parents tried to enroll their son, whom they were now calling by a female name at home, in the Gender and Autism Program at Children’s National Hospital, the only gender clinic in the country specializing in autistic youth. Fred was determined to take hormones, they told the clinic, which is known for its lengthy assessments. Before he did, they wanted to be sure his dysphoria wasn’t transient or peer-driven.” There was a waiting list of a year.”

But according to the article “while his parents were out of town and after he had come of age, Fred went to Planned Parenthood, which prescribes hormones to any legal adult without a letter from a therapist or a formal diagnosis of gender dysphoria. The only requirement is a brief consultation, usually with a nurse practitioner, about the drugs’ effects, which range from mood swings and male pattern baldness to permanent infertility.” (Emphasis added)

After a nurse practitioner saw him for a “little over 30 minutes” , the nurse practitioner “prescribed their special-needs son a powerful drug without their knowledge or consent.”

The mother, a New Jersey pediatrician,  told the Beacon that “It’s criminal what Planned Parenthoods all over the country are doing,” “And most people have no idea this is happening.”

The article also quotes the liberal psychologist who helped bring pediatric gender medicine to the US:

“I have always been a very strong supporter of Planned Parenthood and am pro-choice,” said Laura Edwards-Leeper, who co-founded the nation’s first pediatric gender clinic, at Boston Children’s Hospital, in 2007. “But they have taken on something that they are not equipped to handle.” The lack of gatekeeping is so bad, she added, that some of her patients received hormones from Planned Parenthood before coming to her for an assessment.

Others, like Erica Anderson, a former president of the US Professional Association for Transgender Health, say patients they’ve sought to delay from transitioning have simply turned to Planned Parenthood. “I’ve had patients desperate to get hormones where I’ve been the voice of caution,” said Anderson, who is transgender herself. “In some cases, they say, ‘I’ll just go to Planned Parenthood when I’m 18.’ Usually I can dissuade them but sometimes I can’t.”

CONCLUSION

As the article points out:

“Planned Parenthood is one of the largest providers of cross-sex hormones in the United States, and one of the fastest growing. Affiliates in the greater Portland area saw a nearly 400 percent increase in “gender-affirming care visits” between 2021 and 2022, according to their annual reports, while those in Ohio saw a 544 percent increase over the same period. Hormones now appear to be in higher demand than abortion at some branches: A Planned Parenthood in Knoxville, Tenn., told NPR that nearly a fifth of its patients sought hormone therapy in 2021, whereas abortion makes up just 3 percent of Planned Parenthood’s services nationally. (Emphasis added)

This growth has come as pediatric gender clinics, which used to wait months before prescribing hormones, are becoming more laissez faire themselves. Some now prescribe hormones on the first visit, a Reuters investigation found last year, while others say ballooning caseloads have made it harder to conduct the kind of in-depth assessments once standard in the field.”

Now, even the World Professional Association of Transgender Health (WPATH), whose standards of care are among the most aggressive and controversial in the field, says “it is critical to differentiate gender incongruence” from autistic “obsessions” and “rigid thinking.” Though the group does recommend an informed consent standard for people over 18, it also states that its guidelines for minors—which call for “comprehensive” evaluations by experts on autism and other disorders—are “often relevant” to young adults. (Emphasis added

Fred’s parents have now filed a  complaint  with New Jersey’s nursing and medical boards.