Roe v. Wade’s Disastrous Impact on Medical Ethics

This was published in the National Right to Life News January 2019 issue “The Consequences of Roe v Wade” on page 8.

Most people volunteer for the pro-life movement. I consider myself a draftee.

I was a young intensive care unit nurse when the Roe v. Wade decision came down in 1973. Like most people I knew, I was shocked when abortion was legalized. As a medical professional, I couldn’t imagine good doctors and nurses condoning — much less participating in — such a brutal act. However, my medical colleagues were split on the issue with those supporting what was then said to be “only” early abortions the most vocal and insistent. Our formerly cohesive unit began to fray.

However, I was professionally offended by the pro-life argument that legalizing abortion would lead to the legalization of infanticide and euthanasia. It was one thing to deny the truth with an early and unobserved unborn baby but it was quite another to imagine any doctor or nurse looking a born human being in the eye and killing him or her.

How wrong I was!

INFANTICIDE AND MEDICAL DISCRIMINATION AGAINST PEOPLE WITH DISABILITIES

My eyes were opened with the 1982 Baby Doe case in Indiana. Baby Doe was a newborn baby boy with an easily correctable hole between his esophagus (food pipe) and trachea (windpipe) who was denied this lifesaving surgery by his parents and a judge because he also had Down Syndrome. Six days later, Baby Doe starved and dehydrated to death while his case was being appealed to the Supreme Court.

My husband and I wanted to adopt Baby Doe when we read the story but all offers of adoption were refused. I did not know at the time that my expected third child also had Down Syndrome and a life-threatening problem.

When Karen was born a few months after Baby Doe, we were stunned that she had both Down Syndrome and a severe heart defect but I was determined that she would not become another Baby Doe.

But even when the cardiologist told us that Karen had an 80-90% chance of survival with one open-heart surgery by age 6 months, he also gave us the “choice” to let Karen die. I was outraged that he could even consider not treating my daughter like any other baby with the same heart defect.

Even worse, when my daughter was hospitalized with pneumonia at 4 months, I was tipped off that my trusted pediatrician had made her a “do not resuscitate” without my knowledge or consent because “Nancy is too emotionally involved with that retarded baby”. I then realized that “choice” was just an empty slogan that had infected medical ethics.

Although Karen survived that incident, she unfortunately died at age 51/2 months just before her scheduled surgery.  I finally joined the disability rights and the pro-life movements.

THE “RIGHT TO DIE” MOVEMENT

A few years after Karen, I was shocked by the so-called “right to die” movement that pushed “living wills” to refuse even food and water by tube if or when a person became incapacitated. I became involved in both the Nancy Cruzan and Terri Schiavo cases involving seriously brain-injured, non-dying young women declared “vegetative”, a term invented in 1972. I wrote an op-ed for my local paper predicting that the potential pool of victims would expand if death by starvation and dehydration was allowed. I was thinking about my own mother who had Alzheimer’s and cancer and indeed I was asked at one point if our family was going to feed her. I replied that my mother would die naturally from her condition, not starvation and dehydration.

How far we have descended!

Now,  prominent doctors and the American Nurses Association are promoting what Compassion and Choices calls voluntary stopping of eating and drinking by mouth (VSED) as a legal option to  “speed up dying” for competent people with serious illnesses. “Living wills” to prevent even spoon feeding for people with dementia are also being developed.

PHYSICIAN-ASSISTED SUICIDE

The “right to die” movement ultimately did expand into the Compassion and Choices organization, the well-funded former Hemlock Society that promotes physician-assisted suicide by lethal overdose. In the late 1990s, Oregon became the first state to legalize assisted suicide. Now a handful of states and the District of Columbia have followed Oregon but the relentless effort to legalize physician-assisted suicide continues in the other US states.

Over the years, I had cared for many suicidal people and I saw the seductive effect of people like Jack Kevorkian, the infamous “Dr. Death”on them. As a nurse, I knew how dangerous it was to portray suicide as a “solution” to many at-risk people.

But it became personal when my 30 year old daughter Marie killed herself using an assisted suicide technique that she learned reading the pro-assisted suicide book “Final Exit”. My Marie had struggled with drug addiction for 16 years and despite our best efforts and those of her therapists, she finally succumbed to despair. She was the only suicidal person I ever lost.

I was not surprised when two people close to Marie became suicidal after her death. Fortunately, they were saved.

Suicide contagion is a real phenomenon  and it doesn’t appear to be a coincidence that the US suicide rate has skyrocketed since Oregon first legalized physician-assisted suicide.

EUTHANASIA

I also discovered that it’s only a short step from “I wouldn’t want to live like that” for assisted suicide to “No one should have to live like that” for euthanasia.

In 2003, Dr. Lloyd Thompson, then head of the Vermont Medical Society, escaped prosecution for intentionally giving a paralyzing, “life ending drug” to an elderly woman with terminal cancer whose breathing machine had been removed. The family had opposed prosecuting the doctor.

 Ironically and around the same time, I was threatened with termination after I refused to increase a morphine drip “until he stops breathing” on an older man who did not stop breathing as expected after his ventilator was removed. The patient was presumed to have had a stroke when he did not wake up from sedation after 24 hours. I reported the situation up the chain of command at my hospital but no one supported me. I escaped termination that time but I refused to back down.

An autopsy later showed that the man had no lethal condition or brain injury.

CONCLUSION

As the late Fr. Richard John Neuhaus wisely said  ” I believe in the slippery slope the same way I believe in the Hudson River. It’s there.”

But until and unless we are ready to recognize what we unlock when we legalize “just a little bit” of medical killing, we may find that the slippery slope has no bottom and that no one is safe.

And I saw it all start with the Roe v Wade decision legalizing abortion.

The Trouble with Planned Parenthood

In a stunning December 20, 2018 New York Times article  titled “Planned Parenthood Is Accused of Mistreating Pregnant Employees”, former employees of the $1.5 billion dollar ($543.7 million in government grants and reimbursements) organization assert that they were discriminated against because of their pregnancies.

The New York Times has long been one of the staunchest supports of Planned Parenthood as a great champion of “reproductive choice” through abortion, so it is ironic that their article paints a terrible picture of how the organization treats its own employees when they make the reproductive choice to have a child.

The New York Times interviewed several current and former employees of Planned Parenthood who described discrimination that violated state or federal laws against pregnancy discrimination by declining to hire pregnant job candidates, refusing requests by expecting mothers to take breaks and in some cases pushing women out of their jobs after they gave birth.

Perhaps the most heartbreaking story was that of  Ta’Lisa Hairston, an employee who became pregnant but later started battling high blood pressure that threatened her pregnancy. However, her multiple medical orders stating she needed frequent breaks  were ignored by management. Her hands swelled so much that she couldn’t wear the required plastic gloves and her doctor ordered bedrest. When she returned with orders not to work over 6 hours, she worked a much longer shift and few days later had to have an emergency C-section at 34 weeks. She resigned after repeated calls urging her to return to work before her guaranteed 3 months under the Family and Medical Leave Act was up.

Dr. Leana Wen, the new head of Planned Parenthood, says that the organization is looking into the allegations and will be “conducting a review to determine the cost of providing paid maternity leave to nearly 12,000 employees nationwide.”

While the New York Times article admits that “most Planned Parenthood offices do not provide paid maternity leave”, it counters that “(d)iscrimination against pregnant women and new mothers remains widespread in the American workplace.” The Times also blames “conservative lawmakers (who) routinely threaten to kill” Planned Parenthood’s taxpayer funding, making the organization’s financing “precarious”.

THE REAL TROUBLE WITH PLANNED PARENTHOOD

Planned Parenthood tries to downplay its’ role as the largest provider of abortion in the US by touting  services like breast cancer screening (without mammograms), birth control pills and devices, pregnancy tests, etc. to low-income women even though 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.

But the larger problem is that it is hard to reconcile two completely opposite philosophies: an unborn child is nothing more than tissue that can be removed by abortion if a woman so chooses vs an unborn child is a living human being deserving of protection. Planned Parenthood is firmly on the side of the first philosophy.

Thus, as Live Action found when it contacted 97 facilities at 41 Planned Parenthood affiliates, it is almost impossible to find a Planned Parenthood clinic that offers prenatal care as well as abortion, not to mention Planned Parenthood’s current campaign to encourage women to “Shout Out Your Abortion”.

So it perhaps it should not be a surprise that a pregnant employee who wants her unborn baby might pose a challenge in a Planned Parenthood abortion clinic.

 

 

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.

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.

American Academy of Family Physicians Urges the American Medical Association to Drop Opposition to Physician-assisted Suicide

Compassion and Choices, the former Hemlock Society and now well-funded promoter of assisted suicide and other death “choices”, is celebrating the new resolution by the American Academy of Family Physicians (AAFP) to oppose the American Medical Association’s (AMA) long-standing opposition to assisted suicide.

The AFFP, the second largest component society of the AMA with over 131,000 members, just approved a new resolution adopting a position of  “engaged neutrality toward medical-aid-in-dying (aka physician-assisted suicide) as a personal end-of-life decision in the context of the physician-patient relationship.” (Emphasis added)

But as Dr. Rebecca Thoman, campaign manager for Doctors for Dignity for Compassion and Choices explained when the Massachusetts Medical Society adopted the same policy in 2017:

A “‘neutral engagement’ position is even better than a simply neutral position. It means if Massachusetts enacts a medical aid-in-dying law, the medical society will offer education and guidance to physicians who want to incorporate medical aid in dying into their practices.” (Emphasis added)

Now, yet another physician-assisted suicide bill is expected to be introduced next year in the Massachusetts legislature.

The AAFP resolution also stated that:

“By supporting the AMA’s opposition to medical aid in dying, some members feel the AAFP is telling them that they are unethical

and that

“the American Academy of Family Physicians reject(s) the use of the phrase ‘assisted suicide’ or ‘physician-assisted suicide’ in formal statements or documents and direct(s) the AAFP’s American Medical Association (AMA) delegation to promote the same in the AMA House of Delegates.” (Emphasis added)

CONCLUSION

In 1994, Oregon became the first state to pass a physician-assisted suicide law. This came after the Oregon Medical Association changed its position from opposition to neutrality. 21 years later and after multiple failed attempts, the California state legislature approved a physician-assisted suicide law after the California Medical Association changed its opposition to neutrality.

The unfortunate message sent-and received- was that if doctors themselves don’t strongly oppose physician-assisted suicide laws, why should the public?

Still, it was a surprise that in June 2018, the American Medical Association House of Delegates rejected the AMA’s Council on Ethical and Judicial Affairs (CEJA) strong report recommending that the AMA continue its long standing policy opposing physician assisted suicide. Instead the delegates “voted 314-243 to refer the matter back to the trustees for further deliberation”.

With the crucial help of a supportive media, Compassion and Choices started this momentum towards acceptance of physician-assisted suicide and other death choices like VSED (voluntary stopping of eating and drinking), terminal sedation and withdrawal of even spoon-feeding, affecting not just doctors but also nurses and other health care professionals and institutions.

In addition, Compassion and Choices also opposes conscience rights, even stating that  the new Federal Conscience and Religious Freedom Division:

“is not about freedom; it’s about denying patient autonomy. Under their proposed rules, providers are encouraged to impose their own religious beliefs on their patients and withhold vital information about treatment options from their patients — up to, and including, the option of medical aid in dying. And your federal tax dollars will be used to protect physicians who make the unconscionable decision to willfully withhold crucial information regarding their care from a patient and abandon them when they are most vulnerable.” (Emphasis added)

However, here are a few ways any of us can help turn around this dire situation:

When the most basic medical ethic of not killing patients or helping them to kill themselves can be discarded in favor of “choice” or “quality of life”,  none of us of us can afford to be neutral- or silent-on this life or death issue.

No Suicide Discrimination!

When I was asked by my late daughter Marie’s best friend to join her on a family and friends fundraising walk for suicide prevention last Sunday, I hesitated.

I was in the process of reading yet another disturbing article about assisted suicide, this time a Journal of Clinical Psychiatry article titled “Working with Decisionally Capable Patients Who Are Determined to End Their Own Lives”  and I found it outrageous that the suicide prevention groups I know exclude potential physician-assisted suicide victims.

As a nurse, I have personally and professionally cared for many suicidal people over decades including some who were terminally ill. To my knowledge, none of these people went on to die by suicide except one-my own daughter.

Almost nine years ago, my 30 year old daughter Marie died by suicide using an assisted suicide technique she found after searching suicide and assisted suicide websites and reading assisted suicide supporter Derek Humphry’s book “Final Exit”.

Marie was a wonderful woman who achieved a degree in engineering despite struggling off and on with substance abuse and thoughts of suicide for 16 years. She was in an outpatient behavioral health program at the time of her suicide. Her suicide was my worst fear and it devastated all of us in the family as well as her friends. Two people close to Marie also became suicidal after her death but were fortunately saved.

For years before and after Marie’s death, I have written and spoken to groups around the country about the legal and ethical problems with assisted suicide as well as suicide contagion  and media reporting guidelines for suicide.

So it was with mixed feelings that I participated in the suicide prevention walk but now I am glad I did.

“WORKING WITH DECISIONALLY CAPABLE PATIENTS WHO ARE DETERMINED TO END THEIR OWN LIVES”

I finally finished reading this article after the walk and found that while the authors of this Journal of Clinical Psychiatry article insist that they are only discussing “decisionally capable” people with “advanced medical illness”, they write:

The 24% increase in US suicide rates from 1999 to 2014 has led to greater efforts to identify, prevent, and intervene in situations associated with suicidality. While the desire to kill oneself is not synonymous with a mental illness, 80%–90% of completed suicides are associated with a mental disorder, most commonly depression. Understandably, psychiatrists and other clinicians face strong moral, cultural, and professional pressures to do everything possible to avert suicide. Hidden within these statistics are unknown numbers of individuals determined to end their lives, often in the context of a life-limiting physical illness, who have no mental disorder or who, despite having a mental disorder, were nevertheless seemingly rational and decisionally capable and in whom the mental disorder did not seem to influence the desire to hasten death.”

Tragically, the authors also state:

“In reviewing the either sparse or dated literature in this field, surveys from the United States and Canada support that most psychiatrists believe that PAD (physician aid in dying, a euphemism for assisted suicide) should be legal and is ethical in some cases and that they might want the option for themselves.”

And

“Although we see ‘assisted death’ as an option of last resort, we instead ask whether on certain occasions psychiatrists might appropriately not seek to prevent selected decisionally capable individuals from ending their own lives.” (All emphasis added)

This flies in the face of long-standing professional suicide prevention and treatment principles.

Notably, the article ends with an addendum, the 2017 Statement of the American Association of Suicidology (AAS): “Suicide is not the same as ‘Physician Aid in Dying’

That concludes:

“In general, suicide and physician aid in dying are conceptually, medically, and legally different phenomena, with an undetermined amount of overlap between these two categories” but “Such deaths should not be considered to be cases of suicide and are therefore a matter outside the central focus of the AAS.” (Emphasis added)

WHY I AM GLAD I WENT ON THE SUICIDE PREVENTION WALK

The Sunday walk was sponsored by the American Foundation for Suicide Prevention (AFSP), a group that I discovered states it is trying to “Develop an updated AFSP policy position on assisted death (other common terms include physician assisted suicide or Death with Dignity Laws)

The next day, I was able to contact a policy person at their Washington, DC office and, unlike other suicide prevention group representatives I have contacted in the past, I found this woman surprisingly interested and receptive to the idea that we should not discriminate against certain people when it comes to suicide prevention and treatment. She even asked for my contact information.

Of course, the AFSP may decide to exclude potential assisted suicide victims like other organizations have done but at least I tried and that’s the best tribute I can give to my daughter now.

 

How the New “Palliative Care and Hospice Education and Training Act” Could Threaten Conscience Rights.

Two weeks ago, I wrote about the new Senate Bill 693 titled the “Palliative Care and Hospice Education and Training Act” (now referred to the Committee on Health, Education, Labor, and Pensions) and warned about the current and future involvement of Compassion and Choices (the former Hemlock Society now pushing for legalizing physician-assisted suicide throughout the US) in “end of life” education for healthcare professionals. But Compassion and Choices is not the only organization supporting practices that, until the last few decades, were universally condemned.  For example, last year the American Nurses Association took a position approving VSED (voluntary stopping of eating and drinking) to hasten death  and that those decisions “will be honored” by nurses.

In addition, this year the American Medical Association House of Delegates rejected the AMA’s Council on Ethical and Judicial Affairs (CEJA) report recommending that the AMA continue its long standing policy opposing physician assisted suicide. Instead the delegates “voted 314-243 to refer the matter back to the trustees for further deliberation”.

Unfortunately, Senate Bill 693 does not contain any requirement of conscience rights protection in allocating grants to groups proposing to expand hospice and palliative care education programs for healthcare professionals.

BIOETHICS AND CONSCIENCE RIGHTS

According to Dr. Edmund Pellegrino, writing on the origin and evolution of ethics in 1999 for the Kennedy Institute of Ethics :

“In the 1960s and 1970s, building upon liberal theory and procedural justice, much of the discourse of medical ethics went through a dramatic shift and largely reconfigured itself into bioethics.”

Instead of the old Hippocratic Oath principles requiring high ethical and moral standards for doctors including prohibitions against actions such as assisting a suicide, bioethics has evolved into essentially four principles: Respect for autonomy (the patient’s right to choose or refuse treatment), Beneficence (acting in the best interest of the patient), Non-maleficence (not causing harm) and Justice (fairness, equality and distributive justice “so that the needs of the entire population are taken into account.” ) which often compete in actual medical situations.

Unfortunately, the principles of the new bioethics do not address the issue of conscience, which has now become a contentious issue in bioethics.

For example at the 2018 AMA meeting where the House of Delegates voted not to accept the Committee on Ethical and Judicial Affairs report’s recommendation to continue the AMA’s opposition to physician-assisted suicide, one doctor responded:

“We feel the AMA abandoned all physicians who, through conscience beliefs, want to support patients with this in states where it’s legal,” said Lynn Parry, MD, a Colorado delegate, on behalf of the PacWest group, which includes AMA delegates from six Western states that have legalized physician aid-in-dying. “I personally think we need to protect physicians in those states and would ask for referral back.” (Emphasis added)

Dr. Ezekiel J Emanuel, MD, PhD, an influential physician who was one of the architects of Obama care and a formerly strong opponent of assisted suicide, wrote in a 2017 New England Journal of Medicine article “Physicians, Not Conscripts — Conscientious Objection in Health Care” that:

“ Conscientious  objection  still  requires  conveying  accurate  information  and  providing  timely  referrals to ensure patients receive care.

……

“Health care professionals who are unwilling to accept these limits (on conscience rights) have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession.

……

“Laws may allow physicians, nurses, pharmacists, and other health care workers to deny patients treatment or to refuse to care for particular populations, but professional medical associations should insist that doing so is unethical.” (All emphasis added)

CONCLUSION

When it comes to issues like withdrawing feeding tubes from so-called “vegetative”  patients, terminal sedation to hasten death and physician-assisted suicide, this last point from Dr. Emanuel leaves those of us physicians and nurses who refuse to kill our patients or help them kill themselves with few options to continue in our professions.

Years ago when I was threatened with firing for refusing to increase a morphine drip on a comatose man who was removed from a ventilator but still continued breathing, I was told that this was acceptable “end of life” care to “prevent pain”.  I know one nurse who was fired for refusing to give morphine every hour to a dying patient in no distress and barely breathing because the family demanded it. I’ve heard from families who were automatically offered hospice instead of rehab when their loved one was elderly and injured.

When such outrages occur even outside of formal hospice or palliative care programs and considered “normal” end of life care, ethical healthcare professionals find no recourse through their professional organizations or the law to protect their patients from premature death.

Thus when healthcare legislation like SB 693 promotes giving grants to organizations who support or might support VSED, assisted suicide, etc. to train healthcare professionals in hospice and palliative care without clear conscience rights protection, both healthcare professionals and the public are at risk of a normalized culture of premature death.