medical ethics

This is Down Syndrome Awareness Month

nancyvalko abortion, disability, medical ethics, prenatal testing

In 1982, I was appalled when I read about the Baby Doe controversy  in which the parents of a newborn boy with Down Syndrome refused a common but life-saving surgery,  leaving him to die of starvation and dehydration while lawyers were appealing his case to the US Supreme Court. Four months later,  I gave birth my third child, a beautiful little girl named Karen Ann who had Down Syndrome and a major heart defect. Picture of Karen’s homecoming.

.In 2000, I wrote an article about Karen.  I reprint it here in honor of my Karen and Down Syndrome Awareness month:

“Who Wants a “Defective” Baby?”

“Of course, no one wants to adopt a defective baby. ” This was said with much emotion (and not much charm) by an older gentleman in a class at a local university where I was speaking this past April. I had been invited to discuss the legalities and effects of Roe v. Wade from a pro-life point of view to a class of senior citizens studying the Constitution and the Supreme Court.

While several of these senior citizen students defended abortion as a matter of complete privacy for the mother, their arguments centered around the “need” for legalized abortion as a solution for social problems.

Since I had told the story of my daughter Karen, born in 1982 with Down Syndrome and a severe heart defect, the pro-abortion students were extremely vocal about the personal and societal justifications for aborting a baby like Karen. Hence the statement about no one wanting to adopt a “defective” baby.

“Happily, sir,” I told the senior student, “You are wrong. Even back when I had Karen, I found out from the National Down Syndrome Association that there was a list of people waiting to adopt a baby with Down Syndrome. Just the night before, I added, I had found a new website for matching prospective parents with children who had chromosomal and physical defects.

The student refused to believe that this could be true.

The effects of Roe v. Wade
Life of the mother, incest, rape and fetal defect are the four hard cases usually cited to justify what has now become abortion on demand. All of these are uncommon reasons given in the estimated 1.3 million abortions every year; but the possibility of having a child with a birth defect is a common fear nearly all expectant mothers experience and, not surprisingly, polls show that the majority of the public support abortion in this circumstance.

Although I have always been pro-life, I could understand the fear underlying these poll results. Then my own daughter was born.

Just two weeks before the birth of my daughter Karen, I saw a mother trying to pry her young son with Down Syndrome away from a display case at the supermarket. She looked exhausted.

“Please, Lord,” I silently prayed, “Let this baby be ok. I can handle anything but Down’s.”

When Karen was born with Down Syndrome, I was stunned. But I was quickly put in touch with mothers from the Down Syndrome Association who replaced my fears with information and realistic hope.

Then a doctor told me the truly bad news. Karen had a heart defect, one so severe that it seemed inoperable and she was not expected to live more than 2 months. That certainly put things in the proper perspective.

What “pro-choice” really means
It turned out later that Karen’s heart defect was not quite as bad as originally thought and could be corrected with one open-heart surgery, but I was shocked when the cardiologist told me he would support me 100% if I decided not to agree to the surgery and allow her to die. This was especially hard to hear because, as a nurse, I knew that the doctor would have been otherwise enthusiastic about an operation offering a 90% chance of success — if my child didn’t also have Down Syndrome. Apparently, even though Karen was now a legal person according to Roe v. Wade by the fact of her birth, this non-treatment “option” could act as a kind of 4th trimester abortion.

It was then that I realized what pro-choice really meant: Choice says it doesn’t really matter if a particular child lives or dies. Choice says the only thing that really matters is how I feel about this child and my circumstances. I may be “Woman Hear Me Roar” in other areas according to the militant feminists, but I was not necessarily strong enough for a child like this.

I also finally figured out that Roe v. Wade’s effects went far beyond the proverbial desperate woman determined to end her pregnancy either legally or illegally. The abortion mentality had so corrupted society that it even endangered children like my Karen after birth. Too many people, like the student in Supreme Court class, unfortunately viewed Karen as a tragedy to be prevented.

Medical progress or search and destroy?
In the late 1950s, a picture of the unborn baby using sound waves became the first technique developed to provide a window to the womb. Ultrasound in recent years has been used to save countless lives by showing women that they were carrying a living human being rather than the clump of cells often referred to in abortion clinics.

But while expectant parents now routinely and proudly show ultrasound pictures of their developing baby, there is a darker side to prenatal testing. Besides ultrasound, which can show some birth defects, blood tests like AFP testing and the Triple Screen to test for neural tube defects or Down Syndrome are now becoming a routine part of prenatal care. Amniocentesis and chorionic villus sampling are also widely available tests to detect problems in the developing baby. It seems that every year, new testing techniques are tried and older ones refined in the quest to find birth defects prenatally.

97% of the time, women receive the good news that their baby seems fine; but the tests are not foolproof, and they can only test for hundreds of the thousands of known birth defects. Relatively few such birth defects can be treated in the womb at the present time. Some women want testing so that they can prepare for a child who has a birth defect, but when the tests do show a possible problem like Down Syndrome, up to 90% of women will abort.

While some hail prenatal testing as a way to prevent birth defects, the effects of such testing has led to what author Barbara Katz Rothman calls the “tentative pregnancy” in her 1993 book of the same name. Although Rothman calls herself pro-choice, her studies of women considering amniocentesis led to her conclusion that such testing has changed the normal maternal-child bonding in pregnancy and the experience of motherhood, usually for the worse.

“I might not be pregnant”
I observed this firsthand several years ago when I ran into an acquaintance and congratulated her on her obvious pregnancy. I was stunned when she replied, “Don’t congratulate me yet. I might not be pregnant.”

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

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

Diane gave birth to a healthy baby girl a few months later and apologized for her comments, saying that she probably would not have had an abortion anyway. But I understood her terrible anxiety. Society itself seems to have a rather schizophrenic attitude towards children with disabilities.

On one hand, people are inspired by the stories of people who have disabilities and support organizations like the Special Olympics; but, on the other hand, many people consider it almost irresponsible to bring a child with disabilities into the world to suffer when prenatal testing and abortion are so available.

But as the vast majority of parents who are either natural or adoptive parents of children with disabilities will attest, all children are born with both special gifts and special limitations. No child should be denied birth because of a disability or even a limited life expectancy.

Women who do abort after a diagnosis of a birth defect are also hurt. Besides depriving themselves of the special joys — which occur along with the difficulties — of loving and caring for such a child, these women often experience unresolved grief, guilt and second-guessing instead of the relief and peace they expect.

A few years ago, a local hospital which performs late-term abortions for birth defects asked a miscarriage and stillbirth counseling group to help with their distressed patients. The group declined, citing the fact that the most reassuring message they give grieving mothers is that there is nothing they did or didn’t do that caused the death of their babies. Obviously, that was not a statement they could make to mothers who abort. There is a very real difference between losing and terminating a child.

How many of these mothers knew before their abortions that, in practical terms, there has never been a better array of services and support for children with disabilities and their parents? Or that their children were dearly wanted by prospective adoptive parents? Such information might have been just the support they needed to choose life for their children.

Final thoughts
Despite the best medical care, my Karen died at the age of 5 and 1/2 months, but the impact of her life has lived on. At her funeral Mass, the priest talked about how this child who never walked or talked had transformed the lives of those who met her.

Especially mine.

After Karen died, I sat down and tried to put into words what Karen and all children with disabilities have to teach the rest of us. The following reflection was published in the National Down Syndrome Association newsletter in May, 1984.

THINGS NO TEACHER EVER TAUGHT
In 1982 my daughter, Karen, was born with Down Syndrome and a severe heart defect. Less than six months later she died of complications of pneumonia. Karen may have been retarded but she taught me things no teacher ever did.

Karen taught me:

That life isn’t fair — to anyone. That self-pity can be an incapacitating disease. That God is better at directing my life than I am. That there are more caring people in the world than I knew. That Down Syndrome is an inadequate description of a person. That I am not “perfect” either, just human. That asking for help and support is not a sign of weakness. That every child is truly a gift from God. That joy and pain can be equally deep. That you can never lose when you love. That every crisis contains opportunity for growth. That sometimes the victory is in trying rather than succeeding. That every person has a special purpose in life.

That I needed to worry less and celebrate more.

Why California’s Governor Brown is Wrong About Physician-assisted Suicide For “Excruciating Pain”

nancyvalko assisted suicide, medical ethics, palliative care

When California Governor Jerry Brown signed the physician-assisted suicide law, he wrote

“In the end, I was left to reflect on what I would want in the face of my own death,” the governor wrote. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

Gov. Brown apparently believes the two myths promulgated by pro-assisted suicide organizations and most mainstream media about physician-assisted suicide: 1. Unbearable pain is routine in terminal illnesses and often cannot be relieved. 2. Unbearable pain is the reason people choose physician-assisted suicide.

As a former hospice, oncology, trauma, and critical care nurse, I made sure my patients had the best pain control possible after one unforgettable incident that happened shortly after I graduated from nursing school.

In 1969, I cared for a 32-year old woman I will call “Joan” who was dying from cancer. Joan looked emaciated with her skin  stretching over her bones and she was in terrible pain. Joan’s pain was so intense at times that she even talked about wanting us to kill her. At the time she was on a relatively small dose of Demerol given by an intramuscular shot every 4 hours as needed for pain.

I gave her the shot, wincing as I injected it into her shrunken buttock but the shot did nothing for her pain. I went to my head nurse who said to repeat the injection in four hours but  “Joan” continued to have intense pain.

I reported this to my head nurse and Joan’s doctor, suggesting that the dose be increased and/or given more often. The doctor told me no because he said he did not want her to “become addicted” to pain meds. I couldn’t believe my ears. I told him that she was imminently dying, even asking us about killing her to relieve the pain. Joan didn’t have to worry about addiction. I knew that from nursing school. The doctor still refused.

I went over his head to the chief of staff and the assistant director of nursing to plead for Joan. Instead, I was told that if I gave Joan her shot even 15 minutes earlier than the 4 hours, I would be fired.

I was frustrated to the point of tears but I knew there was one thing I could do.

I spent the last two days of Joan’s life with her as much as possible while working my shifts. After my shifts, I would sit with her for hours telling her stories, stroking her back, and doing whatever I could to distract her from the pain until she finally fell asleep. I would not abandon her.

After Joan died, I decided to learn everything I could about pain relief so that I could rebut a future ignorant doctor and help my patients. And I did. I studied every article on pain relief that I could find and talked to experts in the field as well as experienced colleagues. I’m still doing this 46 years later.

I never again had a patient die with severe pain.

For example and 20 years later, I started working on an oncology (cancer) floor in honor of my mother who I cared for until she died  from cancer and Alzheimer’s disease. As I promised my father, I made sure she was comfortable and Mom was even alert and in good spirits at the end.

I loved my new job in oncology but one day I came in hearing a woman down the hall screaming. That was unusual on our floor. It turned out that this woman I’ll call “Kim” was also a 32-year old woman with terminal cancer.

Kim’s pain had been under good control at home with long-acting morphine pills supplemented with fast acting morphine pills to relieve breakthrough pain. However, her family mistakenly thought that since her pain was relieved, she did not need to take her long-acting pills. Kim agreed but the result over a short time was terrible pain unrelieved by slowly increasing a morphine drip.

Working with the doctor, I came up with an overnight game plan to aggressively and quickly treat her extreme pain. The doctor agreed after I promised to monitor Kim closely so that her breathing would not be compromised.

By the next morning, Kim’s pain was finally under control and shortly afterward, she was able to be discharged home on her usual medication regimen.

Governor Brown, using pain as a reason to enlist doctors and nurses to help patients kill themselves is perverse not only because pain can be controlled, especially with the medical advances we have today but also because Oregon’s own report shows that physician-assisted suicide victims in Oregon cited “Losing autonomy”, “Less able to engage in activities making life enjoyable”, “Loss of dignity”,“ Losing control of bodily functions” and “Burden on family, friends/caregivers” before “Inadequate pain control or concern about it” as the top end of life concerns.

Personally, I will continue to fight for good pain and symptom control for all patients as passionately as I oppose physician-assisted suicide.

CALIFORNIA GOVERNOR SIGNS ASSISTED SUICIDE BILL AND MY 1996 ARTICLE “NO BLANK BULLETS”

nancyvalko assisted suicide, conscience rights, euthanasia, medical ethics

USA Today article: Calif. governor signs assisted suicide bill

Comment: Note the quote about why Governor Brown signed this bill after it was defeated 4 times in committee with weeks of deliberation: “In the end, I was left to reflect on what I would want in the face of my own death,” the governor wrote. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

Unfortunately, it seems too many people base their judgements about physician-assisted suicide based on possible future self-interest rather than what the bill allows-medicalized killing by suicide-instead of the terrible consequences on people at risk, medical ethics and society.

Almost 20 years ago and before Oregon implemented its physician-assisted suicide law, I wrote the following commentary for the January-March 1996 edition of the Patients Rights Council newsletter. I believe it is just as valid today.

No Blank Bullets

Ready… aim… fire!

All the B-movie scenes I watched as a child flashed through my mind when I heard that a convicted murderer had been recently executed by firing squad. My visceral reaction was to cringe, instantly imagining the terror of being blindfolded and waiting for the bullets to hit. What I couldn’t imagine, though, were the feelings of being one of the men called to pick up and aim a piece of cold, hard steel at another human being. Would the man cope by pretending it was just another round of target practice? Would he try to remember the details of the murders and the tears of the victims’ families to muster the outrage that such crimes call for? What did he feel after the execution — sadness or satisfaction?

I was not surprised to later learn that one of the firing squad guns contained only blank bullets. In such circumstances, it is sensible to protect each executioner from the certain knowledge that he personally ended another’s life. In the more common lethal injection executions, the process is said to include at least two people and two buttons to start the process. Again, the procedure for legally terminating another life tries to protect those whom society asks to perform the awful task.

It is ironic, therefore, that society is considering the addition of yet another kind of execution to the legal list — assisted suicide — but this time without the blank bullets.

Few people would seriously consider legalizing relative– or family-assisted suicide. The inherent dangers of this type of private killing are much too obvious. Thus, the goal must be physician-assisted suicide or, more accurately, health care professional-assisted suicide, since nurses also must necessarily be involved when the assisted suicide occurs in a health facility or home health situation. We doctors and nurses are the ones society is now considering asking to perform the act of terminating lives, but unlike the firing squad or the lethal injection team, we will know and have to live with the certain knowledge that we caused death.

It is doubly ironic that when a convicted murderer tries to discourage efforts by lawyers to stop his or her execution, this is considered as a sign of stress or mental disorder, while a sick person’s willingness to die is considered an understandable and even courageous decision! How do we reconcile the two views that killing is the ultimate punishment for a convicted murderer and, at the same time, the ultimate blessing for an innocent dying or disabled person?

Both the American Medical Association and the American Nurses Association have recently issued strong statements against assisted suicide and euthanasia. While acknowledging the very real deficiencies too often found in care at the end of life, these organizations call for more education and access to help instead of the simple but dangerous option of killing terminally-ill or severely-disabled people or helping such people kill themselves. It is eminently logical that our concern for life should not be limited to just the curable.

And, although some polls show that a significant number of doctors and nurses, like the general public, say they could support assisted suicide in a hypothetical case, when faced with the realities and ramifications of legalizing the practice, most express deep concerns and fears regarding its implementation.

Society has long insisted that health care professionals adhere to the highest standards of ethics as a form of protection for society. The vulnerability of a sick person and the inability of society to monitor every health care decision or action are powerful motivators to enforce such standards. For thousands of years doctors (and nurses) have embraced the Hippocratic standard that “I will give no deadly medicine to any one, nor suggest any such counsel.” Should the bright line doctors and nurses themselves have drawn to separate killing from caring now be erased by legislators or judges?

As a nurse, I am willing to do anything for my patients — except kill them. In my work with the terminally ill, I have been struck by how rarely these people say something like, “I want to end my life.” And the few who do express such thoughts are visibly relieved when their concerns and fears are addressed and dealt with instead of finding support for the suicide option. I have yet to see such a patient go on to commit suicide.

This should not be surprising. Think about it. All of us have had at least fleeting thoughts of suicide in a time of crisis. Imagine how we would feel if we confided this to a close friend or relative who replied, “You’re right. I can’t see any other way out either.” Would we consider this reply as compassionate or, instead, desperately discouraging? The terminally-ill or disabled person is no different from the rest of us in this respect.

I often wonder if right-to-die supporters really expect us doctors and nurses to be able to assist the suicide of one patient and then go on to care for a similar patient who wants to live without this having an effect on our ethics or our empathy. Do they really want to risk more Jack Kevorkians setting their own standards of who should live and who should die?

The excuse that the only real issue is the patient’s choice would be cold comfort to us doctors and nurses when we have to go home and face the fact that we helped kill another human being or had to remain silently powerless while some of us legally participated. There will be no blank bullets then for us — or for society.

MERCATORNET: GOVERNOR BROWN, DO NOT SIGN THE DEATH WARRANT OF UNHAPPY PEOPLE

nancyvalko assisted suicide, bereavement, medical ethics

FRIDAY, 25 SEPTEMBER 2015
Governor Brown, do not sign the death warrant of unhappy people
BY NANCY VALKO

My daughter was the victim of assisted suicide, but she is not the only one.

Right now, a law hurriedly pushed through the California legislature after multiple defeats sits on the desk of Governor Jerry Brown and awaits his signature. As both a mother and a nurse I beg Governor Brown to veto it.

In 2009, I lost a beautiful, physically well 30-year-old daughter, Marie, to suicide after a 16-year battle with substance abuse and other issues. Her suicide was like an atom bomb dropped on our family, friends and even her therapists.
Despite all of our efforts to save her, my Marie told me that she learned how to kill herself from visiting suicide/assisted suicide websites and reading Derek Humphry’s book Final Exit. Derek Humphry is the founder of The Hemlock Society, now included with other assisted suicide groups and known as Compassion and Choices. The medical examiner called Marie’s suicide technique “textbook final exit” but her death was neither dignified nor peaceful.

Marie was not mere collateral damage in the controversy over physician-assisted suicide. She was a victim of the physician-assisted suicide movement, seduced by the rhetoric of a painless exit from what she believed was a hopeless life of suffering.

Adding to our family’s pain, at least two people close to Marie became suicidal not long after her suicide. Luckily, these two young people received help and were saved, but suicide contagion, better known as “copycat suicide”, is a well-documented phenomenon. Often media coverage or publicity around one death encourages other vulnerable people to commit suicide in the same way.

Think of Brittany Maynard, the young woman with a brain tumour who moved to Oregon to kill herself last November with a doctor prescribed overdose. Weeks before she killed herself, Ms. Maynard partnered with the well-funded Compassion and Choices organization to raise even more money to promote the legalization of physician-assisted suicide throughout the US.
There was an immediate and unprecedented media frenzy surrounding Ms. Maynard’s tragic story that routinely portrayed her pending suicide as “heroic” and even counting down the days to her suicide. Personally, I thought this looked like a crowd on the street shouting for a suicidal person on a window ledge to jump, but the narrative worked with much of the public.

One problem with the media frenzy is that it violated well-established public health standards for how we talk about suicide. The National Institute for Mental Health has warnings about reporting on suicide that include “Risk of additional suicides increases when the story explicitly describes the suicide method, uses dramatic/graphic headlines or images, and repeated/extensive coverage sensationalizes or glamorizes a death.” (emphasis added) Instead, the NIHM recommends including “up-to-date local/national resources where reader/viewers can find treatment, information and advice that promote help-seeking”.

However, Compassion and Choices even denies that physician-assisted suicide is suicide, insisting instead that the media use euphemisms like “aid-in-dying” and “death with dignity” in cases like Ms. Maynard’s. However, this defies common sense and even the definition of suicide as “the intentional taking of one’s own life.” Apparently, there are reasons for this:
A 2013 Pew Research Center poll showed that public opinion on physician-assisted suicide law is closely divided, with 47 percent of US adults approving and 49 percent disapproving. A Gallup poll article showed eliminating the term “suicide” in public polls on assisted suicide laws can increase support by as much as 20 percent. Changing the terminology of assisted suicide also allows immunity for assisting medical professionals and gets around standard life insurance policies that deny payouts for suicides occurring in the first two years of a policy.

I have been a registered nurse for 46 years, working in intensive care, oncology, hospice and home health among other specialties. Personally and professionally, I have cared for many people who attempt or consider killing themselves.
Some of these people were old, chronically ill or had disabilities. Some were young and physically healthy. A few were terminally ill. I cared for all of them to the best of my ability without discrimination as to their condition, age, socioeconomic status, race or gender. I will do anything to help my patients — except kill them or help them kill themselves.

It is outrageous that physician assisted suicide laws support privatized lethal overdoses for some suicidal people without even the oversight and protections we insist upon for a convicted murderer on death row. Suicide prevention and treatment works, and the standards must not be changed just because some people insist their desire for physician-assisted suicide is rational and even a civil right.

My Marie was one of the almost 37,000 reported suicides in 2009. In contrast, only about 800 assisted-suicide deaths have been reported in the past 16 years in Oregon. According to the Centers for Disease Control (CDC) suicide was the 10th leading cause of death for Americans in 2012, with “More than 1 million people reported making a suicide attempt in the past year” and “More than 2 million adults reported thinking about suicide in the past year.”. The CDC estimates that suicide “costs society approximately $34.6 billion a year in combined medical and work loss costs”, not to mention the emotional toll on families.

Obviously our real health-care crisis here is a staggering and increasing rate of suicides, not the lack of enough assisted suicides.

Yet, the assisted-suicide movement relentlessly continues to demand the participation of medical professionals like me and the approval of society for at least some suicides — for now. Those demands must be denied.

My daughter Marie was a victim of these demands to control life by embracing death. How many more people must we lose before we truly understand that evil never limits itself because evil always seeks to expand unless it is stopped. In the case of physician-assisted suicide, “No” can be a life-saving word.

Nancy Valko is a registered nurse living in St Louis, Missouri, and spokesperson for the National Association of Prolife Nurses. Recently retired from bedside nursing, she is now an advance legal nurse consultant. She writes and speaks on ethics issues around the US, and blogs at A Nurse’s Perspective on Life, Healthcare and Ethics.

This article is published by Nancy Valko and MercatorNet.com under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees.

Addendum: Mercatornet is a fascinating website about “navigating modern complexities” and encompasses a range of issues. I am pleased to have had a number of articles published there over the years including  “Organ donation: crossing the line- Linking the “right to die” with organ donation has opened a terrible Pandora’s Box”, “ Have death panels already arrived?” and “The campaign against conscience rights”

DEATH REFERRALS AND CONSCIENCE RIGHTS

nancyvalko assisted suicide, conscience rights, medical ethics

In his September 23, 2015 article “Ontario doctors squeezed on conscientious objection to assisted suicide” ,  Michael Cook states that

“The legalisation of physician-assisted suicide in Canada after February’s decision by the Supreme Court is starting to affect doctors. The College of Physicians and Surgeons of Ontario has quietly issued a directive that conscientious objectors must help them find someone willing to do so.”

Mr. Cook also writes that such a directive requires unwilling doctors to make

“an effective referral to another health-care provider” defined as ‘a referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency’.”

and

“It was approved by College Council in March despite overwhelming opposition to the demand for ‘effective referral’.”

Personally and as a nurse, I could not refer for either abortion or physician-assisted suicide. Not only do I oppose these actions but I also don’t know any ethical or scandal-free organizations or practitioners that perform death procedures.

And does “mandated referral” also mean that I am forbidden to give any accurate but negative information about these procedures? Probably.

Here is what happened to nurses in Oregon after the physician-assisted suicide law took effect and even though the Oregon Nurses Association (ONA) is part of the American Nurses Association which opposes against assisted suicide.

The ONA’s 1997 guidelines on the “Role of the Registered Nurse in Assisted Suicide” states that

“ONA supports the patient’s right to self-determination and believes that nurses will and must play a primary role in end-of-life decisions.”

And here are some excerpts from that paper concerning those “Nurses Who Choose Not To Be Involved”:

According to the ONA, such nurses may:

“Conscientiously object to being involved in delivering care. You are obliged to provide for the patient’s safety, to avoid abandonment and withdraw only when assured that alternative sources of care are available to the patient.” (Emphasis added)

I faced such a situation myself years ago when I was told that there was no other nurse available when I refused to comply with a death decision. I was almost fired.

Furthermore, according to the position paper, such objecting Oregon nurses may not:

“Subject your patients or their families to unwarranted, judgmental comments or actions because of the patient’s choice to explore or select the option of assisted suicide.” (Emphasis added)
Or
“Subject your peers or other health care team members to unwarranted, judgmental comments or actions because of their decision to continue to provide care to a patient who has chosen assisted suicide.
Abandon or refuse to provide comfort and safety measures to the patient.” (Emphasis added)

My point is that mandated referral must be opposed. It is just another kind of required participation and denial of conscience rights that is intended to silence the objections of doctors and nurses and even threaten their careers.

But above all, conscience rights protect patients and their right to safe health care.

IF I KNEW MY DAUGHTER HAD DOWN SYNDROME…

nancyvalko abortion, disability, grief, medical ethics

IF I KNEW MY DAUGHTER HAD DOWN SYNDROME….
September 6, 2015
Recently I read a Yahoo news article titled  “If I Knew My Daughter Had Down Syndrome, I Would Have Aborted Her – All Women Should Have That Right”  that broke my heart.
Beautiful pictures of this mom and her daughter accompanied her harsh words:

“Ohio is poised to become the second state in this country to ban abortion because of a fetal diagnosis of Down syndrome this fall. As a pro-choice woman who has a 7-year-old daughter with Down syndrome, I find this absolutely appalling.”
“This is an issue that hits close to home for me: If I had had a prenatal diagnosis, I would have obtained an abortion. Today, I am beyond grateful that I didn’t. But I cannot ever in any circumstances imagine insisting others not have that right.”

Here is what I wrote back in the comments section of this article:

I am an RN whose third child Karen was born in 1982 with both Down Syndrome and a heart defect. I was given a “choice” of whether or not to allow a surgery even though there was an up to 90% chance of success. I was outraged because that “choice” would not have been offered if my daughter did not have Down Syndrome. I knew then that I had to fight this medical discrimination not only for my daughter but for other children with disabilities.
Years later, a nice woman asked that, if I knew my daughter had Down Syndrome before birth, would I have chosen abortion. Instead of talking about how people with Down Syndrome were defying old, pessimistic predictions or how there was actually a waiting list of prospective adoptive parents for children with Down Syndrome, I asked the woman if she knew how abortions were done.
She said no so I asked her if she wanted to know. When she consented, I simply and clinically described how first, second and third trimester abortions were done. The woman responded with horror and said “You couldn’t do that to your child!”
That is exactly the point. It is not about what challenges a child may have but rather about deliberately killing an innocent child at any stage of life.
I would like to reassure the mom in this article that, while her feelings are understandable, she has apparently been a great mother to her daughter and should be proud of herself.
I would also like to encourage her to let go of any guilt over what she might have done, celebrate her beautiful daughter and please don’t discourage other mothers from choosing life for their child. Nancy V.

THE TRAGEDY OF SO-CALLED “THERAPUETIC ABORTION FOR FETAL DEFECT”

A friend of mine I will call “Mary” (not her real name) had an ultrasound of her unborn baby at 5 months that appeared to show anencephaly.  Anencephaly is a serious birth defect in which a baby is born without parts of the brain and skull. Most babies born with this condition die soon after birth.

However, Mary was also told that this pregnancy would kill her and, in a panic, she quickly endured 28 hours of hard labor with a prostaglandin-induced abortion before her baby was delivered. She never saw her baby.

Mary tried hard to put the tragedy behind her and decided to tell most of her friends that she had a miscarriage rather than an abortion. However, as she confided later, she half-expected to be somehow punished when she later had a son and it took several months after his birth before she could truly believe that her new son was healthy. But every Christmas she also secretly hung an ornament for her dead first child.

What Mary didn’t know was that her obstetrician apparently lied to her. First of all, she was not in any special physical danger from her pregnancy.

I later ran into an old friend who happened to be the doctor (not Mary’s obstetrician) who read her ultrasound. Since he also knew I was a friend of Mary’s, he asked how she was doing. He turned white and had to sit down when I told him about the abortion. It turns out that not only was Mary healthy but the ultrasound suggested only  the possibility of anencephaly. Such initial testing is too often wrong and should not be used as a definitive diagnosis.

I felt Mary had a right to know all this but she rebuffed my offer to tell her what I learned. However, five years later, she called and  said that although she didn’t want a lecture, she had a question that continued to haunt her: What did the hospital do with her baby’s body?

Abortion claims many victims because there is an enormous difference between dying and being killed no matter what the reason.

A Modest Proposal on Assisted Suicide

nancyvalko assisted suicide, bereavement, medical ethics

On August 26, 2015, the Wall Street Journal published letters to the editor responding to Dr. William Toffler’s great August 18 opinion article titled “A Doctor-Assisted Disaster for Medicine-As a physician in Oregon, I have seen the dire effect of assisted-suicide laws on patients and my profession”.

The letters to the editor were overwhelmingly critical of Dr. Toffler’s position. Here are some excerpts:

“On May 5, my mother, at age 73, chose to take her life using the medicine provided by her doctor to end her life. She couldn’t breathe, could barely walk and was skin and bones when she finally died. She had been a vocal advocate of the Death with Dignity Act and had spoken with all her physicians years before this ever became a real issue for her. ”  Portland, Oregon. (emphasis added)

“As a patient, I am not worried about “death doctors.” I am worried about doctors who use any treatment available to prolong life without having a matter-of-fact discussion with the patient about what the quality of that prolonged life will be.” Beaverton, Oregon (emphasis added)

“My personal experience in medical practice during the last 63 years is that those physicians who are against physician-assisted suicide have never spent month after month nor year after year with a dying patient who is suffering intolerable pain.” (emphasis added)

In response, here is the letter to the editor I sent to the Wall Street Journal today:

A MODEST PROPOSAL ON ASSISTED SUICIDE

With all the rancor about physician-assisted suicide, I would like to make a modest proposal.

First of all, take the medical professionals out of assisted suicide.

Capital punishment opponents have successfully challenged lethal injection executions on the basis that even that direct termination of life is “cruel and inhumane” and sometimes fails to render an inmate unconscious, causing much suffering. How can we then justify an oral overdose that cannot guarantee rapid unconsciousness, a quick termination of breathing and heartbeat or a lack of complications?

Secondly, if the suicide is then assisted by a family member or friend, eliminate any profit incentive by barring the person assisting from receiving any proceeds from an insurance policy or provision in a will. Families and friends who say no can instead concentrate on obtaining adequate symptom relief and support for their loved ones.

Unfortunately, the assisted suicide message of a victimless choice is seductive not only to people with life-threatening medical conditions but also to physically healthy people of all ages dealing with despair, disability, mental illness and the frailty of old age.

Almost 6 years ago, my physically healthy but addicted daughter killed herself using a technique the medical examiner called “textbook final exit”. My daughter read Final Exit, a book written by Derek Humphry, the founder of the Hemlock Society now known as Compassion and Choices.

My daughter’s suicide was neither quick nor peaceful and it devastated her family and friends. However, none of us regret the years of efforts to save her and none of us would have sat at her deathbed supporting her alleged choice while she struggled to breathe.

Sincerely,

Nancy Valko, RN ALNC

New Doctor-Assisted Suicide Bill Introduced in California After Prior Bill and 2 Court Challenges Fail

nancyvalko assisted suicide, euthanasia, medical ethics

Last October when Compassion and Choices (the former Hemlock Society) rolled out Brittany Maynard’s tragic assisted suicide story along with the establishment of a Brittany Maynard Fund to raise money to legalize doctor-assisted suicide throughout the US, the group was confident that this would be the tipping point in a movement that had stalled in other states.

The state of California was considered a sure thing for doctor-assisted suicide especially because Brittany Maynard and her family left California which had repeatedly rejected doctor-assisted suicide for Oregon, the first state to legalize such suicides. Nevertheless, People magazine and other mainstream media praised Ms. Maynard “heroism” in supporting doctor-assisted suicide and touted the “success” of such laws in the few states that had legalized it.

However, efforts to pass Senate Bill 128 failed in the California legislature this summer after efforts by disability, pro-life and other organizations to educate both legislators and the public about the dangers of doctor-assisted suicide.

Undaunted, Compassion and Choices then supported efforts to reverse the ban against assisted suicide with lawsuits filed by several terminally ill patients in two courts. However both courts, one in San Francisco and one in San Diego,  refused to overturn California’s ban on assisted suicide.

The well-funded pro-assisted suicide groups are nothing if not tenacious so it should not be a surprise that they have now unveiled a “new” and “improved”  doctor-assisted suicide bill called AB 15 End of Life Option Act with more so-called “safeguards”.

The reassurance of safeguards are critical to the selling of doctor-assisted suicide to a public understandably squeamish about allowing doctors to help some people to kill themselves.

 WHAT SAFEGUARDS?

There have been many articles about the problems with these alleged safeguards but they are rarely covered in mainstream media articles. The latest and one of the best is then August 15, 2015 US Conference of Catholic Bishops’ paper titled  “Assisted Suicide Laws in Oregon and Washington: What Safeguards?”,

For example, here is a portion of the paper that gives the real facts behind the alleged psychological counseling safeguard:

Despite medical literature on the frequent role of depression and other psychological problemsin choices for suicide, the prescribing doctor (and the doctor he selects to give a second opinion)are free to decide whether or not to refer suicidal patients for any psychological counseling.Even if such counseling is provided, its goal is to determine that the patient is not suffering from“a psychiatric or psychological disorder or depression causing impaired judgment.” Ore. Rev.Stat. 127.825; Rev. Code Wash. 70.245.060. The doctors or counselor can decide that, since depression is “a completely normal response” to terminal illness, the depressed patient’s judgment is not impaired…..
From 1998 to 2012, on average only 6.2% of patients who died under the Act in Oregon were referred for counseling to check for “impaired judgment.” Of 108 patients who died under the (Oregon) Act in 2007 and 2009, none was referred for psychological evaluation. In Washington, only 4% of patients are known to have been referred for such counseling in 2014 (six of the 167 who died from any cause after receiving the prescription); the state does not report whether any of those who actually ingested the lethal drugs had been referred for counseling.
 In another section, the paper relates what happened with an Oregon physician despite the alleged safeguard that an assisted suicide request must come from a competent, terminally ill person:
An Oregon emergency room physician was asked by a woman to end the life of her mother who was unconscious from a stroke. He tried to stop her breathing or heartbeat in several ways,finally giving a lethal dose of a paralyzing drug to the older woman who died minutes later. The state board of medical examiners reprimanded the doctor but he faced no criminal charges for this direct killing–which news reports called a case of “assisted suicide”–and he later resumed medical practice.

WHY SHOULD WE CARE?

Unfortunately, even my home state of Missouri which has laws against assisted suicide had a case similar to the one referenced here about the Oregon physician who gave a lethal overdose. This 2001 Missouri case involved a nurse. The nurse gave a lethal overdose without a doctor’s order to a patient who had a stroke the day before but wouldn’t stop breathing when taken off a ventilator. After the patient’s son voiced support for the nurse, she was only sentenced to 5 years’ probation.

The point is that when so-called “safeguards” are accepted (and routinely ignored) in states that do have legalized doctor-assisted suicide amid an aggressive national campaign to legalize doctor-assisted suicide as a civil right, there has been a chilling effect on prosecutors and juries even in other states that have rejected assisted suicide as long as “compassion” is given as the reason for ending life.

Ominously, in other countries like Belgium and Holland, the practice of doctor-assisted suicide for the terminally ill adult has  evolved over the years to now include children, people with mental illness and even people who are only “tired of life.”

Are we willing to risk a similar fate here?

Medical Professionals, Planned Parenthood and Fetal Tissue from Aborted Babies

nancyvalko abortion, family planning, fetal tissue, medical ethics, organ donation, Planned Parenthood

On August 6, 2015, the Medscape website for medical professionals had an article: “Reader Poll: “Should Medical Societies Support Federal Funding for Planned Parenthood?” with 3 questions:

1. Do you agree that Planned Parenthood should continue to receive federal funds for non-abortion-related care?
2. Do you believe that these 18 medical societies were justified in stating their support for Planned Parenthood?
3. Do you believe that it is ethical for Planned Parenthood to donate aborted fetal tissue for use in medical research?

Not surprisingly, given how these questions are worded, a large majority voted yes.

The Medscape article referenced a letter to Congress dated 8/3/2015 by 18 medical societies supporting continued funding for Planned Parenthood.
However, when I accessed the letter, it surprisingly says nothing about fetal tissue research.

I am including the actual letter and its signers below.

I wonder if these groups’ members feel the same way. I checked on two groups and couldn’t find the letter on the American Congress of Obstetricians and Gynecologists or Society’s for Adolescent Health and Medicine’s websites.

I would encourage members of these groups as well as other ethical doctors and nurses to contact to contact these organizations to encourage them to protest this position (and the use of aborted babies for fetal tissue research), especially since it appears that many medical professionals are unaware of the issues involved.

I have seen this before.

Even though the American Nurses Association did not sign this letter and a current search shows no position on Planned Parenthood or fetal tissue use on its website, I was a member of the American Nurses Association (ANA) years ago and tried to work within that organization at a state level on several ethical issues. I read every issue of ANA’s Journal of Nursing, particularly the political section. When the ban on partial birth abortion came up in Congress, I read nothing about it in the Journal.

Awhile later, I was watching a political talk show and one of the panelists mentioned that the ANA was against the ban. That was news to me so I searched for the information on the internet. It took some time but I finally found the letter.

I tracked down the public relations director of the ANA and called her. At first, she said that she didn’t know what I was talking about but eventually found the information herself and seemed surprised.

I told her that I no longer could be a member of ANA not only because of its’ stance on partial birth abortion but also because of the secrecy. We members were not polled or even informed. I also told her that I would encourage other ANA members to also leave if the ANA did not change its position or inform its membership.

The PR person apologized. I gave her my phone number and encouraged her to have someone from the ANA contact me.

I never heard back from them.

We need accountability from our professional organizations, especially since these organizations claim to represent the interests of groups of medical professionals.

———————————————————————————————————————————————–

In a letter dated August 3, a group of 18 medical societies, including the American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, ask the Senate and House leadership to continue to allow Planned Parenthood to participate in federal health programs.

https://filemanager.capwiz.com/filemanager/file-mgr/acog/Provider_Ltr_in_Support_of_Planned_Parenthood_Funding_Updated.pdf

August 3, 2015

The Honorable Mitch McConnell
Senate Majority Leader
S-230, U.S. Capitol Building
Washington, DC 20510
The Honorable John Boehner
Speaker of the House of Representatives
H-232, U.S. Capitol Building
Washington, DC 20515
Dear Leader McConnell and Speaker Boehner:

As organizations representing health care professionals and the people they serve across the country, we strongly oppose any effort to prevent Planned Parenthood health centers from participating in federal health programs, including Medicaid and the Title X family planning program. Any proposal to exclude Planned Parenthood from public health programs will severely curtail women’s access to essential health care services, including family planning, well-woman exams, breast and cervical cancers screenings, and HIV testing and counseling. At a time when we should be focused on improving the health of all people, it is frustrating to witness ongoing attempts to cut off access to life-saving preventive care.
Planned Parenthood health centers play a crucial role in improving the health and lives of people across the country. In fact, 2.7 million people rely on Planned Parenthood for health care. For many women, Planned Parenthood is their only source of care—offering basic preventive services that are fundamental to women’s health and well-being. Each year, Planned Parenthood health centers provide nearly 400,000 cervical cancer screenings and nearly 500,000 breast exams.

Additionally, Planned Parenthood provides over 2.1 million contraceptive services and nearly 4.5 million tests and treatments for sexually transmitted infections, including HIV. These services improve women’s health, prevent an estimated 516,000 unintended pregnancies, and decrease infant mortality.
Policies that would exclude Planned Parenthood from public health funding would hurt millions of women and undermine health care access in communities across the country. Approximately 60 percent of Planned Parenthood patients access care through Medicaid and Title X, in addition to those who rely on other essential programs, including maternal and child health programs and Centers for Disease and Prevention (CDC) breast and cervical cancer screening programs.

In some states, Planned Parenthood is the only provider participating in Title X, and more than 50 percent of Planned Parenthood health centers are located in a medically underserved or health professional shortage area. Because federal law already requires health care providers to demonstrate that no federal funds are used for abortion, prohibitions on funding for preventive care at Planned Parenthood health centers will only devastate access to these life-saving services.

Every day, we see the harmful impact that unequal access to health care has on women and communities across the country, and we therefore strongly support policies that improve access to affordable, quality health care. Policies that would deny Planned Parenthood public health funds only serve to cut millions off from critical preventive care, and we strongly oppose any effort to do so. Should you have any questions, please contact ACOG Government Affairs staff, Rachel Gandell at 202-863-2534 or rgandell@acog.org.

Sincerely,

American College of Nurse-Midwives
American Congress of Obstetrician and Gynecologists
American Medical Women’s Association
American Medical Student Association
American Public Health Association
American Society for Reproductive Medicine
Association of Reproductive Health Professionals
Association of Women’s Health, Obstetric and Neonatal Nurses
Doctors for America
GLMA: Health Professionals Advancing LGBT Equality
National Alliance to Advance Adolescent Health
National Association of Nurse Practitioners in Women’s Health
National Family Planning and Reproductive Health Association
National Hispanic Medical Association
National Physicians Alliance
Physicians for Reproductive Health
Society for Adolescent Health and Medicine
Society for Maternal-Fetal Medicine
cc: Senate Minority Leader Harry Reid
House Minority Leader Nancy Pelosi

TWO ARTICLES ABOUT ASSISTED SUICIDE MAY PREDICT ULTIMATE COURSE OF MEDICALIZED DEATH

nancyvalko assisted suicide, medical ethics, mental health

A July 31, 2015 article in Medscape (a subscription website for medical professionals) titled “Assisted Suicide for Mental Illness Gaining Ground” admits that:

“Euthanasia (referred to as assisted suicide in the Netherlands and Luxembourg, where it is also legal in cases involving suffering due to medical and psychiatric illness) has been legal since 2002 in Belgium, and the law was extended in 2014 to include emancipated children with suffering due to terminal illness.

Through a required process, patients must show their illness to cause “unbearable or untreatable suffering”; however, the definition is acknowledged to be subjective, Dr Thienpont told Medscape Medical News.

“By its nature, the extent to which the suffering is unbearable must be determined from the perspective of the patient him- or herself and may depend on his or her physical and mental strength and personality,” said Dr Thienpont.

Despite the ongoing criticism that very few assisted suicide requests in the US are referred for psychological/psychiatric consultations, this article examines a July 27, 2015 British Medical Journal article ““Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study”   that tries to make the case that mental illness itself can be grounds for assisted suicide.

In the meantime, an Irish website thejournal.ie has an August 2, 2015 poll asking “Poll: Would you consider euthanasia while still healthy?” based on a story about a healthy nurse who  legally ended her life in a Swiss clinic:

“A HEALTHY NURSE from England has opted to die via assisted suicide, rather than growing old.
Gill Pharaoh (75), a former palliative care nurse, chose to die at a Swiss clinic so she wouldn’t become a burden on her family or the health service.

In an interview with the Sunday Times shortly before her death, Pharaoh said her children struggled to cope with her decision, but understand where she is coming from.

Her husband accompanied her to the clinic.”

Unfortunately, the countries in Europe that have legalized euthanasia/assisted suicide apparently are the “canaries in the mine” warning us of a relentless march towards the acceptance of euthanasia on demand in the US and potentially worldwide.