medical ethics

“Everybody’s a Winner When Euthanasia Combines with Organ Donation, Say Doctors”

nancyvalko assisted suicide, euthanasia, medical ethics, organ donation

This excellent article by Michael Cook  titled “Everybody’s a Winner When Euthanasia Combines with Organ Donation, Says Doctors” is a must read for anyone concerned about ethics and healthcare.

Michael Cook, the current editor of Mercatornet, writes that

Several Dutch and Belgian doctors have proposed legal reforms to increase the popularity of combining euthanasia and organ donation in the Netherlands and Belgium.

Writing in the Journal of Medical Ethics, they report valuable unpublished information about the prevalence of the procedure. So far, it has been performed only about 40 times in the two countries. However, there is “a persisting discrepancy between the number of organ donors and the number of patients on the waiting lists for transplantation” – which euthanasia patients could help to balance. (Emphasis added)

Ominously, the authors of this British Medical Journal article  titled “Legal and ethical aspects of organ donation after euthanasia in Belgium and the Netherlands”, write that public perception of this formerly abhorrent practice is increasingly positive:

“transplant coordinators in Belgium and the Netherlands notice a contemporary trend towards an increasing willingness and motivation to undergo euthanasia and to subsequently donate organs as well, supported by the increasing number of publications in popular media on this topic.”

and

“In the context of organ donation after euthanasia, the right of self-determination is a paramount ethical and legal aspect. It is the patient’s wish and right to die in a dignified way, and likewise his wish to donate his organs is expressed. Organ donation after euthanasia enables those who do not wish to remain alive to prolong the lives of those who do, and also—compared with ‘classical’ donation after circulatory death—allows many more people to fulfil their wish to donate organs after death.” (Emphasis added)

This slippery slope actually started in 1998 when Jack Kevorkian removed the kidneys of one of his victims and offered them for transplantation. Almost everyone was stunned and horrified. Transplant surgeons refused the organs at that time but the reasons given in some news articles unfortunately had less to do with the ethics than with the concerns over the viability of the organs and the  harvesting technique of the organs themselves.

By 2003, the prestigious journal Critical Care Medicine published an article titled “Role of brain death and the dead-donor rule in the ethics of organ transplantation” by Drs. Robert D. Troug and Walter M. Robinson that went even further:

“We propose that individuals who desire to donate their organs and who are either neurologically devastated or imminently dying should be allowed to donate their organs, without first being declared dead”.  (Emphasis added)

Thus, the actual cause of death would be the organ removal which, in itself, would be euthanasia.

We should not assume that legalized organ donation euthanasia can’t happen here in the US when the public has already been softened up for years by a mostly sympathetic media publicizing sad cases like Brittany Maynard’s and the relentless Compassion and Choices campaign to legalize physician-assisted suicide in every US state.

I can even envision a time when organ donation euthanasia could be presented to the public as merely “medically assisted death-with benefits.”

 

 

Why New Indiana Law Bans Abortions Based on Race, Sex or Disabilities like Down Syndrome

nancyvalko abortion, disability, education, medical ethics, Planned Parenthood, prenatal testing

Just three days after World Down Syndrome Day, Governor Mike Pence of Indiana signed a law that, among other provisions, bans abortion doctors from knowingly aborting an unborn baby solely because of an unborn baby’s race, sex, or genetic disability such as Down Syndrome.

Predictably, there was an immediate backlash from groups like Planned Parenthood, the mainstream media and others.

A Bit of History

In 2008, the  Prenatally and Postnatally Diagnosed Conditions Awareness Act was signed into law by President George W. Bush. This law, co-sponsored by Senators Edward Kennedy (D-MA) and Sam Brownback (R-KS), was meant to provide parents receiving a pre- or post-natal diagnosis of Down syndrome or other disabilities – like cystic fibrosis and spina bifida – more information and support than had been available in the past. It was inspired by the words and actions of Brian Skotko , who has a sister with Down Syndrome and who is now a board-certified medical geneticist and Co-Director of the Down Syndrome Program at Massachusetts General Hospital.
Among other provisions, the law was written to:

coordinate the provision of, and access to, new or existing supportive services for patients receiving a positive diagnosis for Down syndrome or other prenatally or postnatally diagnosed conditions, including—

the establishment of a resource telephone hotline accessible to patients receiving a positive test result or to the parents of newly diagnosed infants with Down syndrome and other diagnosed conditions

the establishment of a national registry, or network of local registries, of families willing to adopt newborns with Down syndrome or other prenatally or postnatally diagnosed conditions, and links to adoption agencies willing to place babies with Down syndrome or other prenatally or postnatally diagnosed conditions, with families willing to adopt

the establishment of awareness and education programs for health care providers who provide, interpret, or inform parents of the results of prenatal tests for Down syndrome or other prenatally or postnatally diagnosed conditions, to patients. (Emphasis added)

However, the law was never funded due to disputes among members of Congress “over how the topic of abortion would be handled in the materials accepted for distribution.”

But while such positive initiatives went unfunded, funding has been no problem for companies developing prenatal screening tests that can be done ever more easily and earlier in pregnancy. Currently, there is a “cell-free DNA” blood test for expectant mothers that can be done as early as 10 weeks into a pregnancy that claims near perfect accuracy in detecting Down Syndrome and other conditions.

However, a three month examination of these unregulated tests by the non-profit New England Center for Investigative Reporting reported

“companies are overselling the accuracy of their tests and doing little to educate expecting parents or their doctors about the significant risks of false alarms.”

And the Center also noted that “prenatal screening tests prompt abortions”.

Even the abortion-supporting American Congress of Obstetrician and Gynecologists’ (ACOG) current position expresses concerns and states that :

“Given the potential for inaccurate results and to understand the type of trisomy  for recurrence-risk counseling, a diagnostic test should be recommended for a patient who has a positive cell-free DNA test result.”

and

“Management decisions, including termination of the pregnancy, should not be based on the results of the cell-free DNA screening alone.” (Emphasis added)

Nevertheless, a recent study showed that abortion after prenatal diagnosis of Down Syndrome reduced the Down Syndrome community by 30%.

“Disclosing Down Syndrome to Pregnant Patients: Must You Give an Upside?”

In this rather offensively titled opinion article by Arthur Caplan, PhD. who heads the Division of Medical Ethics at NYU’s Langone Medical Center, he criticizes laws like Indiana’s:

One reason that women seek abortions is because they don’t want to have a child with Down syndrome. Recently there has been a movement among people who have had children with Down syndrome to say, “That rate of abortion indicates bias. It’s not really choice. It’s fear of Down syndrome. It’s prejudice against Down syndrome.” Some families who have had children with Down syndrome say that they mean a lot to their family; that it has been a great experience to have a child even though the child has Down syndrome; they accomplish a lot, they’re happy, and people have the wrong view about it.

Some have gone further and started to change state laws to say that when you get a positive test for Down syndrome, you are required to get in touch with the Down syndrome associations in your state and get the message that balances the bias that no one wants a kid with Down syndrome.

The problem is that far too many medical professionals themselves seem to have a negative bias when it comes to conditions like Down Syndrome and see no “upside” to Down Syndrome versus abortion. New or expectant parents deserve better, especially when that professional is giving them their baby’s diagnosis.

I found that out personally not only when I had my daughter Karen but also when I talked to other parents who encountered negative attitudes from some medical professionals.

Eventually, we developed an educational program for hospital maternity divisions about how to help new parents of children born with disabilities. I always brought a child with Down Syndrome and his or her parent to these programs and the reaction was amazing. Doctors and nurses who only saw upset parents before now heard from these same parents about the challenges and very real joys of life with their child. Even better, these professionals were charmed by meeting the children themselves.

We found that changes in attitudes and information can change future outcomes for the better for children and their parents.

Conclusion

It is natural to feel shocked and overwhelmed when you are told either before or after birth that your baby has a condition. Panic and fear is not uncommon.

But it is at this vulnerable time that parents especially need the accurate information, resources and support that the Kennedy-Brownback law was designed to provide.

Unfortunately, we have groups like Planned Parenthood that demand legalized abortion at any time during pregnancy for any or no reason at all as a civil right. However, that must not stop us from continuing to strive for a compassionate society that protects every human life, promotes accurate information and fights discrimination at the same time.

Arguing Life, Death and Assisted Suicide

nancyvalko assisted suicide, Canada, disability, euthanasia, law, medical ethics, mental health, palliative care

In the article “Sides discuss NY proposal for aid in dying”, the exchange between Diane Coleman, a founder of Not Dead Yet, the foremost disability organization fighting physician-assisted suicide, and  Dr Timothy Quill, who fought for the constitutionality of physician-assisted suicide in the landmark 1997 US Supreme Court Vacco v Quill decision, is very enlightening.

Diane Coleman of Not Dead Yet spoke simply and eloquently:

“I don’t think I speak for all (opponents), but the disability community’s core message is that if assisted suicide is legal, some people’s lives will be lost due to mistakes, coercion and abuse, and that’s an outcome that can never be undone.

There is inherent discrimination in assisted-suicide laws. Most suicidal people receive suicide prevention. Assisted suicide laws would carve out an exception to that, and that exception would apply to people who are elderly, ill, disabled, and those are devalued groups in society. … Assisted-suicide laws would say, ‘these certain people, we not only agree with their suicide but give them the means to carry it out.’ We’re saying it comes down to social justice. Equal rights means equal suicide prevention.”

And

“It’s really not about physical pain. If you look at Oregon reports, about reasons people want to commit suicide, the reasons are things like feeling like the person has lost their autonomy, they’ve lost their dignity, they can’t do the things they used to do. They feel like a burden on their families. Those are psychosocial reasons that relate to the disability that people have when they have an advanced stage or chronic condition.”

On the other hand, Dr. Quill portrayed assisted suicide as little more than a benign discussion:

“Whether or not this practice is legalized, seriously ill patients are asking us to talk about it, they’re asking us to consider it” said Quill, founding director of the palliative care program at URMC and a board-certified palliative care consultant. (Emphasis added)

But to the question “Why do people with a terminal illness want to end their lives?”, Dr. Quill telling states:

“Some of it has to do with severe symptoms. I would say that’s not the majority. The majority is people who are tired of dying. It’s going on way too long for them. The kind of debility and weakness that accompany it, particularly for people that are used to being in charge of their lives, is very, very, very hard. Some of those people want to talk about what options they have to accelerate the process.” (Emphasis added)

This is very different from the way physician-assisted suicide has been sold to the public as a necessary last resort for terminally ill people in “unbearable pain”. However, as a 2014 article  “Dignity, Death, and Dilemmas: A Study of Washington Hospices and Physician-Assisted Death” admits, pain is not even a requirement for receiving physician-assisted suicide  in Oregon and Washington state:

The authorizing legal statutes in both states make no reference to the experience of severe pain or intolerable suffering as an indication for a patient to make a request for physician-assisted death but rely entirely on the entitlement due a patient in respect of their personal dignity. A patient rights framework provides the primary moral structure… (Emphasis added)

Thus, physician-assisted suicide is really about power and control over death, not the  suffering of the individual. And it is this power and control that has led European countries like the Netherlands to expand physician-assisted suicide even to non-terminally ill people who cannot or have not made the death decision themselves such as babies with deformities and people with dementia, mental illness or other impairments.

Closer to the US, the Canadian Supreme Court  has legalized physician-assisted suicide but still  without formalized rules, even on conscience rights.  In the province of Quebec, legal injection euthanasia kits  can be distributed to any doctor who wants them.

The Assisted Suicide Agenda in the US

It is alarming that the influential American Academy of Hospice and Palliative Medicine that had this same Dr. Timothy Quill in the article as a recent past president and honoree of their Visionary award. But it should not be surprising that the AAHPM has changed its former position of opposition to physician-assisted suicide to a position of “studied neutrality” towards what it now calls “physician-assisted death”.  Neutrality is progress to physician-assisted suicide activists like Dr. Quill and organizations like Compassion and Choices that need to neutralize medical opposition as much as possible while quietly setting up relentless campaigns to legalize assisted suicide in every state. If enough states give in, a new Supreme Court decision may even overturn the Vacco v Quill decision and legalize physician-assisted suicide throughout the US.

But in the meantime, trying to sell “neutrality” to doctors and convincing the media to change the term “physician-assisted suicide” to  “physician-assisted death” cannot mask the inevitable and lethal damage done not only to individuals but also to our medical and legal institutions that can no longer ensure ethical protection for our lives.

My testimony for Simon’s Law

nancyvalko disability, futility, law, medical ethics, Simon's Law

On February 16,  a hearing was held by the Health committee of the Missouri Legislature on Simon’s Law.

Here is my submitted testimony to Dr. Frederick and all the committee members:

I am a past member of the Down Syndrome Association in St. Louis, an RN and legal nurse consultant and most importantly, the mother of a daughter who had special needs.
I cannot be at the hearing tomorrow but please accept my testimony in favor of Simon’s Law:

In September 1982, I gave birth to a beautiful baby girl we named Karen. Karen was born with both Down Syndrome and a severe heart defect called a complete endocardial cushion defect. A pediatric cardiologist was called in and even before I left the recovery room, he gave me the bad news about our Karen’s heart defect and even said that it was inoperable. He said to take Karen home where she would die in 2 weeks to 2 months.

This doctor turned out to be wrong. Further testing revealed that Karen’s heart defect could be fixed with one open heart operation and she had a 90% chance of survival.

My husband (a doctor) and I (an ICU nurse) were determined that our daughter receive the best medical care possible for her heart condition and without bias because she had Down Syndrome. We knew about the recent Baby Doe case where the parents of baby boy with Down Syndrome and an easily correctable tracheoesophageal fistula refused surgery so that their baby would die. The case went to court and a judge ruled that the parents could make that lethal choice. As medical professionals, we were appalled by this case but at least we could make sure that our daughter would have her chance at life. Or so I thought.

The bias against children like Karen soon became apparent when the cardiologist said he would support us “100%” if we chose to let our Karen die without surgery. I had to insist that Karen be treated for her heart defect the same way any other child would be treated for the same heart defect. To do otherwise was medical discrimination and illegal.

Then, the surgeon recommended for Karen’s pre-op heart catheterization was overheard questioning the wisdom of even treating “all these little mongoloids”! Another doctor sympathetically told us that “people like you shouldn’t be saddled with a child like this.” We were stunned by this negative view of children with Down Syndrome.

Later on when Karen developed a pneumonia that was being successfully treated in the hospital, I found out that my trusted pediatrician had even made Karen a “Do Not Resuscitate” behind my back because I “was too emotionally involved with that retarded baby”. The DNR was rescinded and we took Karen home but I found it hard to trust any doctor after that.

Unfortunately, Karen developed another bout of pneumonia and died of complications just before her scheduled open-heart surgery. But even at the very end, when Karen was apparently dying, a young resident physician “offered” to pull all her tubes so that she would die as soon as possible. I reported this young man to the chief of pediatric cardiology who was furious with the resident. (This chief of cardiology later started a clinic for children with Down Syndrome to meet their special health needs.)

Although we lost Karen when she was just 5 ½ months old, I still treasure my time with her and because of her, I became an advocate and volunteer for people with disabilities.
I wish I could say that my story is unique but I have seen many similar situations over the last three decades involving people of all ages with disabilities.

Therefore, I beg you to approve Simon’s Law. It will potentially save lives as well as send a strong message that medical discrimination against the disabled based on subjective judgements of “medical futility” and/or predicted “poor quality of life” is wrong.

Sincerely,

Nancy Valko, RN ALNC

“Good” News about Dying in America?

nancyvalko assisted suicide, conscience rights, euthanasia, medical ethics

This month Medscape, a subscription news service for medical professionals, published the article “Good News about Dying in America” by Dr. George Lundberg. Dr. Lundberg is the former editor of the Journal of the American Medical Association (JAMA)  and editor-at-large of Medscape itself as well as a member of the Institute of Medicine of the National Academies.

But the title “Good News about Dying in America” is ironic because this article is really a homage to the pro-death movement. In the article, Dr. Lundberg approvingly chronicles a recent history of the “right to die” movement in the US including the rise of legalized physician-assisted suicide and his part in it.

Although he writes that he is not looking forward to his own death, he maintains that

To accomplish medical and cultural change, one needs to work at the levels of moral beliefs and ethical standards with professional and individual leadership.Subsequent changes in state and federal laws and regulations may be needed. Economic drivers can move it along. But first, you have to get their attention.” (Emphasis added)

Dr. Lundberg congratulates himself for getting this attention started by publishing the anonymous 1988 JAMA article “It’s Over Debbie”  which Lundberg claims is a “factual tale of a caring physician using intravenous morphine to end the horrid pain-wracked life of a young woman with terminal ovarian cancer.”

However, when you read this short article, you read about a doctor in training who, under the cloak of anonymity, writes about being on call at a hospital and awakened in the middle of the night to see a patient he had never met before. He describes “a 20-year-old girl named Debbie was dying of ovarian cancer. She was having unrelenting vomiting apparently as the result of an alcohol drip administered for sedation.” He writes that her condition was“a cruel mockery of her youth and unfulfilled potential” but that Debbie’s only words to him were “Let’s get this over with”. An older, dark-haired woman staying with Debbie was assumed by the young doctor to be her mother.

Then, in the anonymous doctor’s own words, he writes :

The patient was tired and needed rest. I could not give her health, but I could give her rest. I asked the nurse to draw 20 mg of morphine sulfate into a syringe. Enough, I thought, to do the job. I took the syringe into the room and told the two women I was going to give Debbie something that would let her rest and to say good-bye. (Emphasis added)

After giving Debbie the the lethal overdose, the doctor writes:

I waited for the inevitable next effect of depressing the respiratory drive. With clocklike certainty, within four minutes the breathing rate slowed even more, then became irregular, then ceased. The dark-haired woman stood erect and seemed relieved.

Quite a different story from what Dr. Lundberg  proudly portrays as a caring act. Is the deliberate killing of a newly met patient without request, explanation or actual consent by a doctor in training really part of Dr. Lundberg’s  vision of “(t)he cultural change we need now is to allow death to occur when its time has come and to do so with dignity and without undue pain and suffering for the patient to the greatest extent possible?”

Dr. Lundberg writes further on other “breakthrough” moments in medicalized killing after the “It’s Over Debbie” article:

Next was Dr Timothy Quill and his disclosure in the New England Journal of Medicine in 1991 that he prescribed barbiturates at the request of a leukemia patient to allow her to end her life. Then, beginning in 1990, Dr Jack Kevorkian and his suicide machine assisted in the deaths of more than 100 patients; the right message writ large but by a deeply flawed messenger. (emphasis added)

As a medical professional myself, it is horrifying that such influential medical people not only have embraced the concept that it is acceptable and even compassionate to medically kill people, but now promote it.

And there is a jarring apparent lack of empathy and understanding of the challenges serious illness poses to patients and their families at the end of Dr. Lundberg’s article:

hospitals interested in their patient safety statistics might do well to note that much of what is chalked up as deaths related to medical error is actually occurring with the frail elderly, often in critical care units (CCUs). Many of these patients probably should not be in the CCU anyway. Maybe not even in hospitals. …. Help your safety statistics; let the dying die at home. (Emphasis added)

While Dr. Lundberg’s article is appalling to those of us who refuse to kill our patients or help them kill themselves, it is important for all of us to understand that many of our alleged “experts” are leading us into a cultural as well as medical and legal war over human extermination.

Some Canadian Veterinarians Offer to Teach Doctors about Euthanasia

nancyvalko assisted suicide, euthanasia, medical ethics

In February 2015, the Canadian Supreme Court unanimously voted to legalize physician-assisted suicide.  In September 2015, it was revealed that Canada’s Quebec province was preparing euthanasia kits with lethal injections for distribution to doctors for assisted suicide.

In December, Canada’s National Post published an article titled “‘We can definitely help’: What vets can teach doctors about assisted dying“ that reports:

Before every euthanasia, Dr. Amy Wilson prays things will go smoothly — that her patient will sedate well, that she’ll hit the vein with the catheter on the first try, that there will be no sudden, involuntary spasms or grunts for breath that can be agonizing for owners.
Wilson, like all veterinarians, is trained to put suffering animals to death as humanely as possible. She does it more often than she wishes she had to, but she does it well. Now, as Canada continues to debate the way forward on assisted dying, she and other vets say there is much they can teach doctors about a different kind of animal — humans

One argument long promulgated by assisted suicide/euthanasia proponents is that we should put people out of their misery just as we do for our pets.

However, pets become at risk for many reasons:

According to the American Humane Association, the most common reasons why people relinquish or give away their dogs is because their place of residence does not allow pets (29%), not enough time, divorce/death and behavior issues (10% each). The most common reasons for cats are that they were not allowed in the residence (21%) and allergies (11%).

Many are then taken to animal shelters. About twice as many animals enter shelters as strays compared to the number that are relinquished by their owners but nevertheless about 1/3 each year, approximately 2.7 million animals, are euthanized.

According to the website Petful, pets in animal shelters in the United States are euthanized every year for three major reasons: illness, aggression and overpopulation.

Regarding illness, the website states:

Because most shelters operate on tight budgets, the cost of treating every animal’s illness is impossibly high.Many shelters have veterinarians to prescribe medications and perform exams for sick animals, but the decision to euthanize must still be made sometimes after considering several factors:
•The severity of the illness
•The chance of recovery
•How infectious the disease is
•The cost of treatment
•The length of treatment
•The adoptability of the pet

Do we really want to adopt a veterinary standard that makes it acceptable to euthanize people as well as pets when illnesses are too expensive or  personalities are too difficult or simply when there are too many of them around?

Effects of Euthanasia on Veterinarians

Although the National Post article is generally supportive of veterinarians teaching doctors to perform euthanasia, it does document the emotional distress that can affect even veterinarians who perform euthanasia:

Studies suggest people whose jobs require them to kill animals are at risk of a phenomenon known as PITS – perpetration-induced traumatic stress. Euthanasia was one of the reasons Rothenburger (a veterinarian) chose to leave practice; she now specializes in pathology. When she used to perform euthanasia, “I put this filter on: This was ending suffering. That was the role I had to play. But it often wasn’t easy, and it’s hard to keep your professional persona on when you’re trying not to shake while you’re injecting the medication, or not cry with the owners until you’ve done your job.”

Studies have documented a higher suicide risk among vets than the general population. A 2010 survey by the Canadian Veterinary Medical Association found 19 per cent of those who responded had seriously thought about suicide, half reported experiencing burnout and 27 per cent were taking anti-depressants. Rothenburger belongs to a closed Facebook page called Not One More Vet. “It’s a safe place for vets to talk about things they need to get off their chest,” she says, “like compassion fatigue, and maybe that tough euthanasia.” (Emphasis added)

Many years ago, my adult children and I had to have our beloved cat Callie euthanized because of an inoperable cancer. We decided to stay with Callie throughout the procedure because we wanted to surround her with love until the end. However, the procedure had some unexpected difficulties and we all found the process stressful and incredibly sad.

When we left, I told my children that if anyone ever tried to euthanize me for any reason, they had better stop them.

People are not animals and they must not be treated like animals.

Do We Know Enough About Brain Death?

nancyvalko brain death, medical ethics, organ donation

Just last month, there were two major developments reported on the controversial issue of brain death. One was an article about a lawsuit to revoke the death certificate of Jahi McMath, a California teenager who was declared brain dead 2 years ago but is still alive and apparently showing some signs of improvement.

The other was a December 30, 2015 article in Medscape, a website for medical professionals that requires subscription, titled “Not All Hospital Brain Death Policies Comply With Guidelines” . The article reports on a medical journal study titled “Variability of Brain Death Policies in the United States.”

Jahi McMath

Jahi McMath, a 13-year-old girl, underwent a routine surgery for sleep apnea in December 2013 at a California children’s hospital. That night she started bleeding and eventually her heart stopped. Her heart was restarted and she was placed on a ventilator to stabilize her condition, but soon the doctors declared her brain dead and prepared to remove the ventilator. However, the family insisted that the ventilator be continued, hoping that Jahi might eventually get better.

The doctors disagreed, insisting that Jahi was legally dead by brain death criteria. The parents went to court to keep the doctors from removing her ventilator but after a series of legal battles lasting weeks, a judge eventually gave Jahi’s family permission to transfer her to another facility that would continue the ventilator.

Virtually all the ethicists and other experts contacted by most media outlets condemned the family’s actions as denying the reality of brain death. In a January 10, 2014 USA Today article, ethicist Arthur Caplan, head of the bioethics division at New York University’s Langone Medical Center, criticized the judge’s decision for Jahi’s family, declaring that Jahi’s new doctors are “trying to ventilate and otherwise treat a corpse,” Caplan said. “She is going to start to decompose.”

Now, 2 years after Jahi was declared brain dead, her family is in federal court suing to revoke her death certificate because as their experts contend

“At this time, Jahi does not fulfill California’s statutory definition of death, which requires the irreversible absence of all brain function, because she exhibits hypothalamic function and intermittent responsiveness to verbal commands.”

A future ruling revoking Ms. McMath’s death certificate would be groundbreaking.

“Variability of Brain Death Policies in the United States.”

In this December 28, 2013 Journal of the American Medical Association Neurology article, a study was done of 508 US hospital policies on brain death determination.

Alarmingly, the article states that hospital brain death criteria requirements “are not 100% compliant” even with updated 2010 guidelines by the American Academy of Neurology which require only one examination to determine brain death.

And of the total 508 hospitals, the article states that only

“about a third of policies (33.1%) required specialist expertise in neurology or neurosurgery, but 150 policies had no mention of who could perform the determination. Many policies still allow for more junior physicians to determine brain death, the authors noted.” (Emphasis added)

Also disturbing, the article noted that some policies didn’t require testing of lower brainstem function (required for a finding of irreversible loss of all brain functions) with less than 80% of the policies requiring the absence of a cough reflex. Only 57.2% of hospital brain death policies required that oxygen be given to maintain oxygenation during the critical apnea test to determine if a patient can take breaths off a ventilator, even though low a low oxygen level can lead to more brain damage.

In an effort to reassure, Gene Sung, MD, past-president, Neurocritical Care Society, and director, Division of Neurocritical Care and Stroke at UCLA claims that he

agreed that there have there have been no documented reports of regaining function after a declaration of brain death. “But still, we don’t know for sure; maybe mistakes happened and they weren’t reported,” he said. (Emphasis added)

Actually, there have been multiple reported cases of people regaining at least some function after a brain death declaration such as Zach Dunlap (who fully recovered) as well as Jahi McMath.

If as Dr Greer, the lead author of the study, states “This is one of those diagnoses where we need to be correct 100% of the time”, must we not rigorously examine such cases to determine if or why there was a misdiagnosis to ensure that current brain death guidelines really hold up to scrutiny?

Besides the potential premature loss of lives, our medical integrity is at stake and we medical professionals must prove worthy of the trust society gives us.

“What Kind of Mother is 8 Months Pregnant and Wants an Abortion?”

nancyvalko abortion, disability, euthanasia, family, grief, medical ethics, prenatal testing

Just after Christmas, the popular fast news website Yahoo News published the article “What Kind of Mother Is 8 Months Pregnant and Wants an Abortion?”  “as an example of one of our best of 2015.” (emphasis added)

In this story, an anonymous woman called “Kate”, a married mother of one daughter, found out at almost 8 months that her unborn second daughter had Dandy-Walker Syndrome, a genetic disorder that can result in mental and physical disabilities. A subsequent test was said to show severe brain abnormalities.

Kate, now an administrator of the website “Ending a Wanted Pregnancy” which includes a Poor Prenatal Diagnosis Index, decided to have an abortion-for her unborn daughter’s sake. Adoption and keeping the baby were mentioned as options but were rejected by Kate without explanation.

As Kate relates her story:

The doctor said, “We expect your baby to have moderate to severe mental retardation; she’s going to have moderate to severe physical disability; she is probably never going to walk or talk; she will possibly never be able to lift her head; she is going to have seizures all of the time… (and) Babies like this one are not generally comfortable enough to sleep.”

In that moment, I had to shift my thinking. I was hoping for special ed, and had been focusing on questions like: How much should you save to know your special-needs daughter will be OK after you die? I was thinking about long-term care and mild to moderate disability. Instead, I had to think about a baby who was probably not going to live very long, and the longer she lived, the more pain she would be in. That realization – that I was more scared of her living than of her dying — is what made the choice for me.

Kate then tells how difficult and expensive ($25,000) it was to find an abortionist to perform such a late abortion. Kate’s doctor eventually found one in Colorado, far from Kate’s home in Boston and Kate endured a four day abortion procedure.

Kate relates the procedure:

The whole first day was counseling and testing to make sure it was safe to do the procedure. They want to make sure you completely understand what is going to happen and that no one is pressuring you into the decision. At the end of the day, I signed all the paperwork, and the doctor injected the baby with a drug that, over a few hours, slowed her heart to still. It was a very, very difficult day. Euthanizing the baby is, obviously, a very hard thing to do. (emphasis added)

On the fourth day, labor was induced and Kate delivered her dead daughter.

Kate’s 2 year old daughter cried when Kate told her that her expected sister was “gone”. Three years after the abortion, Kate says

Now, every six months or so, we talk about it again — her understanding of it evolves as she grows. At this point, she knows the baby died because she was sick in a way the doctors couldn’t fix, because she had holes in her brain, and you need your whole brain to be healthy.

Kate’s story was obviously meant to generate sympathy for a distraught mother and thus show why abortion should continue to be legal. However, the shocking description of the third trimester abortion and the continued effect on the mother and sister undermine the narrative that abortion is the best option in such a difficult situation.

ANOTHER SIDE TO THE LATE-TERM ABORTION DECISION

Personally, I know what it is like to be told that your baby has severe problems and might die. I was told just a short time after my daughter Karen was born that she had an inoperable heart defect and would live just “2 weeks to 2 months.” I know the panic and fear that mothers like Kate must feel but in my case, as in many others, the doctor turned out to be  wrong about her terminal diagnosis.

Although my Karen later died of complications from pneumonia before her open heart surgery, I treasure the almost 6 months we had together and I have no regrets.

Today, I also have a wonderful stepdaughter who has Turner’s Syndrome, one of the conditions listed in the Poor Prenatal Diagnosis Index on the  “Ending a Wanted Pregnancy” website, and she is now a kind, generous woman who has no mental or physical disabilities.

In both these cases, abortion would have “solved” nothing.

Unfortunately, stories like Kate’s are desperately discouraging to women and families facing a difficult prenatal diagnosis. Tragically, the article also ignores the help and resources available to help such children and their families.

For example, the article does not mention groups like local Birthright centers and the website Prenatal Partners for Life which is “dedicated to providing families, either expecting, or those who have had, a child with special needs or a life limiting condition, the support, information, and encouragement they need to make informed decisions involving their preborn or newborn child’s care.” There are also support and information websites for specific conditions like the Dandy-Walker Alliance , the condition that Kate’s baby had.

And anyone who reads pro-life news sites such as Life News  and NRL News Today  has read many inspiring stories of hope and even unexpected happiness when a woman chooses life for her baby despite a difficult or even terminal diagnosis.

These and other other websites also contain information about Project Rachel, an organization that helps women, men and even families to heal after abortion.

CONCLUSION

I am not writing this blog to condemn Kate or other women who have had abortions. My heart goes out to them and I wish I could have had a chance to personally offer help, options, encouragement and information. I consider these women as additional victims of the abortion mentality that has so infected our society.

However, I do have a problem with abortion supporters who use such tragic stories to garner sympathy and support for their political agenda of legal abortion at any time for any reason and paid for by taxpayers as “reproductive health”.

Women and their babies deserve better.

Miracle Baby Comes Home for Christmas

nancyvalko brain injury, end-of-life, medical ethics, Uncategorized

Francesca and Lee Moore-Williams held their beautiful 18 month old daughter Bella’s hand as her ventilator was turned off and they waited for her death. But just 30 minutes later, Bella awoke  “kicking and screaming” according to the UK’s Mirror newspaper article “Miracle baby whose life support was turned off home for Christmas”. Five months later, she is scheduled to come home this Christmas.

Bella’s health became a concern in April when clumps of her hair fell out. Three months later, she took a turn for the worse and was admitted to a hospital in critical condition. Doctors told the parents that a MRI scan showed abnormalities on both sides of her brain and at some point, the decision was made to turn off the ventilator supporting her breathing.

According to the Mirror article:

She was later diagnosed with the genetic disorder Biotinidase deficiency, which is so rare it affects just one in every 60,000 births.

Sufferers of the condition do not produce enough biotin – a vitamin which is essential for healthy cell growth.

The deficiency can be fatal if left untreated but will now be managed safely with tablets.

And today:

Bella, of Clacton-on-Sea, Essex, who turns two in January, is now learning to walk and talk and her hair is growing back.

Experts say she is around eight months behind other children her age but she is expected to catch up.

Francesca said: “She’s at nursery and to look at her you wouldn’t think she’s been through what she has.

Perhaps this Christmas “miracle” also holds a message about the need for hope and humility for those of us in the medical professions.

Merry Christmas and Happy Holidays to all!

 

 

Contraception and Informed Consent

nancyvalko family planning, medical ethics

My late grandmother always told me “Never discuss religion, politics or sex”. Contraception can touch on all three of these topics and birth control itself can usually be counted on to arouse strong and conflicting opinions in any group.

However, contraception is crucially also a medical issue. With a range of contraceptive options and so many contrary claims about benefits and risks, it is essential for everyone, especially women and girls, to know the facts when they have to make a decision.

As Dr. David J. Hilger writes in his December 2015 article titled “Contraception and Informed Consent-Women Need a Full Account of the Risks”, the first oral contraceptive was marketed in 1960 and

“Despite early indications of severe and sometimes life-threatening risks, oral contraceptives were quickly approved and widely accepted. It was not until after oral contraception was widely utilized that many of the medical risks were published. Information regarding risk continues to be discovered and is reported in the medical literature, but it is not widely publicized.”

What I appreciated about this article was that it contained not only the latest information on some of the medical risks of oral contraceptives but also the latest research in Natural Family Planning, a routinely overlooked topic even in a doctor’s office or clinic. It is essential for women to know all the options, risks and benefits when making a birth control decision to have truly informed consent.

MY JOURNEY

As a nurse, I thought I was well-informed about contraception when I started using the Pill in 1974. At that time, all I knew about side effects was the risk of weight gain which I experienced myself when I almost could not fit into my wedding dress! I stopped 18 months later when my husband, a doctor, read medical journal articles about the increased risks of blood clots with the Pill

I never used hormonal birth control again and I eventually learned and practiced Natural Family Planning which worked great for me in both conceiving and postponing pregnancy.

It was many years later when I discovered more information about contraceptives in medical journal articles about the possible post-fertilization (abortifacient) effects , increased risk of depression or, most ironically, increased risk of sexual dysfunction. For me, the knowledge of the possible abortifacient effect alone would have kept me from ever using hormonal contraception.

In recent years but rarely mentioned in the media, there has also been many  birth control lawsuits filed against a number of different kinds of birth control pills and devices.

CONCLUSION

My children and especially my daughters, gave me even more incentive to research the facts when their public schools gave sex education classes and I discovered glaring lapses and inaccuracies. For example, condoms were promoted as safe sex even though a Centers for Disease Control fact sheet admits that

“However, condom use cannot provide absolute protection against any STD.”

Another example is that Natural Family Planning was ignored in favor of a negative depiction of the old “rhythm method”.

In the end, I believe that birth control is not a decision to be taken lightly and that women of all ages have the right to know the potential risks and options. I only wish I had known more myself in 1974.