The National Association of Pro-life Nurses Statement Opposing the Palliative Care and Hospice Education and Training Act (2019)

The National Association of Pro-life Nurses joins the Euthanasia Prevention Coalition USA and the Healthcare Advocacy and Leadership Organization (HALO) and other organizations in opposing the  Palliative Care and Hospice Education and Training Act (2019) H.R. 647, S.2080.  (HALO has issued an action alert with the contact numbers for legislators on the Senate committee considering this bill.)

As nurses, we strive to care for our seriously ill, disabled and terminally ill patients with compassion and the highest ethical standards. We applaud the medical innovations and supportive care options that can help our patients attain the highest quality of life possible.

However now many of us nurses are now seeing unethical practices such as assisted suicide, terminal sedation (with withdrawal/withholding of food, water and critical medicines), voluntary stopping of eating, drinking and even spoon feeding, etc. used to cause or hasten death but often called palliative, “comfort” or routine hospice care for such patients.

We believe that the Palliative Care and Hospice Education and Training Act (2019) will allow federal funding to teach and institutionalize such unethical practices without sufficient oversight, safeguards or penalties.

For example, the Section 5 Clarifications (p. 21) against federal funding for objectionable practices “furnished for the purpose of causing, or the purpose of assisting in causing, a patient’s death, for any reason” is toothless. Such practices are already  considered acceptable by many influential hospice and palliative care doctors like Dr. Timothy Quill, a board-certified palliative care physician, 2012 president of the American Academy of Hospice and Palliative Medicine and promoter of legalizing physician-assisted suicide and terminal sedation.

It is also disturbing the Compassion and Choice, the largest and best funded organization promoting assisted suicide and other death decisions,  has a mission statement stating:

“We employ educational training programs, media outreach and online and print publications to change healthcare practice, inform policy-makers, influence public opinion and empower individuals.”

and a “Federal Policy Agenda / 2016 & Beyond”  goal to:

Establish federal payment for palliative care consultations provided by trained palliative care professionals who will advocate for and support the values and choices of the patient….” (All emphasis added)

As nurses, we are also very concerned that the Act contains no conscience rights protection for those of us-doctors and nurses alike-who will do anything for our patients except deliberately end their lives or help them kill themselves.

Many of us have already faced threats of termination of employment for refusing to participate in unethical, life-ending practices without support from our nursing organizations like the American Nurses Association that recently dropped their traditional opposition to physician-assisted suicide and voluntary stopping of eating and drinking.

For the sake of protecting our patients, the integrity of our medical and nursing professions as well as our healthcare system, we urge the public and our congressional representatives to oppose this dangerous Act.

 

Marketing Death and Alzheimer’s Disease

An April, 2019 study in the Journal of the American Medical Association titled “Attitudes Toward Physician-Assisted Death From Individuals Who Learn They Have an Alzheimer Disease Biomarker” found that  approximately 20% of cognitively normal older adults who had elevated beta-amyloid — a biomarker that is thought to increase the risk of Alzheimer’s disease — said they would consider physician-assisted suicide if they experienced a cognitive decline. Not everyone with amyloid plaques goes on to develop Alzheimer’s disease.

Although no state with legalized physician-assisted suicide currently allows lethal overdoses for people with Alzheimer’s or other dementia, Emily Largent, JD, PhD, RN (one of the authors of the  study) said that:

“Our research helps gauge interest in aid-in-dying among a population at risk for developing Alzheimer’s disease dementia and grappling with what they want the end of life to look like”

And

“Public support for aid-in-dying is growing…Now, we are seeing debates about whether to expand access to aid-in-dying to new populations who aren’t eligible under current laws. That includes people with neurodegenerative diseases like Alzheimer’s disease.”

CHOOSING DEATH

As the US birth rate declines to a 32-year low  while people are living longer, now there are more people older than 65 than younger than 5. This has major economic and cultural implications, especially with diseases such Alzheimer’s that usually affect older people.

Back in 2012, I wrote   about a Nursing Economic$ Summit “How Can We Afford to Die?” that had an 8 point action plan. One of the points discussed the importance of getting everyone over the age of 18 to sign “living wills” and other advance directions that also included the caveat: “if many patients have advance directives that make positive, cost-conscious systemic change impossible, most of the other efforts discussed as part of our  action plan will go for naught”. (Emphasis added).

It should not be a surprise that the latest Oregon physician-assisted suicide report   shows that 79.2% of those people dying by assisted suicide were age 65 or older and most reported concerns such as “loss of autonomy” and “burden on family, friends/caregivers”.

With Alzheimer’s disease routinely portrayed as the worst case scenario at the end of life for a person (and their family), there are now programs to “help” people plan their own end of life care.

Such programs include Death Cafes where “people drink tea, eat cake and discuss death” and the Conversation Project  that is “dedicated to helping people talk about their wishes for end-of-life care”. The Conversation Project was co-founded by journalist Ellen Goodman after years of caring for her mother, who had Alzheimer’s.

Compassion and Choices (the former Hemlock Society) is the largest and best funded organization working for decades to change laws and attitudes about assisted suicide and other deliberate death options. Compassion and Choices now has a contract rider for people in assisted living facilities that:

 “will respect Resident’s end-of-life choices and will not delay, interfere with nor impede any lawful option of treatment or nontreatment freely chosen by Resident or Resident’s authorized healthcare proxy or similar representative, including any of the following end-of-life options” which include:

“Forgoing or directing the withdrawal of life-prolonging treatments

Aggressive pain and/or symptom management, including palliative sedation,

Voluntary refusal of food and fluids with palliative care if needed

Any other option not specifically prohibited by the law of the state in which Facility is located.” (Emphasis added)

CONCLUSION

I have both a professional and personal interest in Alzheimer’s disease.

Having taken care of a mother with Alzheimer’s until her death, I treasure many of the moments I had with her. It is possible to both begin the eventual mourning and still appreciate the special moments that indeed do come. My mom was a very high-strung woman who constantly worried about everything. The Alzheimer’s calmed her down somewhat and especially blunted her anxiety about the presence of a tracheotomy for her thyroid cancer.

One of my favorite memories is sitting on a couch with my mom on one side and my then 2 year-old daughter on the other. Sesame Street was on and I noticed that both Mom and my daughter had exactly the same expression of delight while watching the show. A friend thought that was sad but I found it both sweet and profound that their mental capacities had intersected: One in decline, one in ascension. Perception is everything.

Also, I often took care of Alzheimer’s patients as a nurse and I enjoyed these patients while most of my colleagues just groaned. Even though such patients can be difficult at times, I found that there is usually a funny, sweet person in there who must be cared for with patience and sensitivity. I found taking care of people with Alzheimer’s very rewarding.

And although I might be at a higher risk of developing Alzheimer’s disease myself because of my mother, I won’t be taking a test for biomarkers to try to predict the future.

Instead, I will spend my time living the best life I can and hopefully helping others. I believe that life is too  precious to spend time worrying about things that might happen.

American Nurses Association Damages Good Nursing with Misleading “No Stance” on Assisted Suicide

In 2017 and despite opposition by nurses and groups like the National Association of Pro-life Nurses, the American Nurses Association (ANA) approved a new position on “Nutrition and Hydration at the End of Life” supporting a form of suicide called VSED ( voluntary stopping of eating and drinking) to “hasten death”.

The ANA also stated regarding VSED that nurses who have “an informed moral objection….should communicate their objections whenever possible, to provide safe alternative nursing care for patients and avoid concerns of patient abandonment” (Emphasis added)

In March 2019, the American Nurses Association (ANA) then wrote a draft position paper “The Nurse’s Role When a Patient Requests Aid in Dying” that would have dropped the ANA’s long-standing opposition to physician-assisted suicide and even change the term “physician-assisted suicide” to “medical aid in dying”. The paper would require nurses to be “non-judgmental when discussing end of life options with patients”, and that nurses who object to assisted suicide are still “obliged to provide for patient safety, to avoid patient abandonment, and to withdraw only when assured that nursing care is available to the patient.

In other words, nurses would have to abandon their vital role in the prevention and treatment of people with suicidal ideation for some of their patients when the issue is assisted suicide. Conscience rights could only be invoked if free from “personal preference, prejudice, bias, convenience, or arbitrariness”. (Emphasis added)

Many people responded with shock and dismay, including many nursing organizations like the National Association of Pro-life Nurses and even the Canadian Catholic Nurses Association  that warned about their experience after assisted suicide was legalized there in 2015:

“we experience ongoing demands for access to lethal injections for new categories of patients, including “mature minors;” those who write advanced directives; and those whose mental illness is the sole condition underlying their request.” (Emphasis added)

THE FINAL POSITION

Now the ANA has issued its final position on “The Nurse’s Role When a Patient Requests Medical Aid in Dying” (aka physician-assisted suicide) that claims it is not “a stance for or against medical aid in dying but rather to frame the nurse’s compassionate response within the scope of practice”. (Emphasis added)

However, this new final position has the same problems as the draft when it states that a nurse should:

 “Remain objective when discussing end-of-life options with patients who are exploring medical aid in dying”

And now, a new requirement is added for the nurse who objects to participating in assisted suicide:

“Never ‘abandon or refuse to provide comfort and safety measures to the patient’ who has chosen medical aid in dying. Nurses who work in jurisdictions where medical aid in dying is legal have an obligation to inform their employers that they would predictively exercise a conscience-based objection so that appropriate assignments could be made.” (All emphasis added)

This obligation to preemptively inform employers about objections to participating in terminating life opens a nurse to potential discrimination, bullying or even termination of employment, not to mention the chilling effect on ethical men and women considering a nursing career.

CONCLUSION

In its press release on the final position, the ANA states that its new position is “a step in a new direction for ANA and provides guidance for almost 1 million registered nurses in the U.S. who practice in the nine jurisdictions where medical aid in dying (MAID) is legal.” The ANA also states that “This statement is intended to reflect only the opinion of ANA as an organization regarding what it believes is an ideal and ethical response based on the Code of Ethics for Nurses with Interpretive Statements.” (All emphasis added)

However, the ANA also claims that it ‘is the premier organization representing the interests of the nation’s 4 million registered nurses’ even while  less than ten percent of the nation’s nurses are members of the ANA or other professional organizations” and that number is declining.

The ANA along with the American Medical Association (AMA) are the best known health care professional organizations and both are very politically active.

Ironically and just last month, the AMA House of Delegates decisively reaffirmed the AMA’s long-standing opposition to assisted suicide while the ANA has now surrendered its influence to the pro-assisted suicide movement.

Just as bad, the ANA has now effectively abandoned ethical nurses’ conscience rights when it comes to deliberate death decisions.

Although we now have the Conscience and Religious Freedom Division established by the Trump administration in the Office for Civil Rights to enforce already existing “federal laws that protect conscience and the free exercise of religion and prohibit coercion and discrimination in health and human services” and has a link to file a conscience or religious freedom complaint, it’s final rule implementation has now been delayed by lawsuits.

As assisted suicide and other such deliberate death decisions continue trying to expand, it is more necessary than ever that all of us-the public as well as healthcare professionals-understand and fight the pro-death movement to regain our trust in the healthcare system.

Press Release: The National Association of Pro-life Nurses comments on recent AMA decision

The National Association of Pro-life Nurses comments on recent AMA decision

This month, the AMA House of Delegates overwhelmingly approved a strong report from AMA’s Council on Ethical and Judicial Affairs reaffirming current AMA policy on physician-assisted suicide stating that:

“permitting physicians to engage in assisted suicide would ultimately cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.”

This happened despite the enormous pressure from assisted suicide supporters and groups like Compassion and Choices as well as some other professional associations to change its’ long standing opposition to physician-assisted suicide to “neutrality”.

But this is not just about doctors.

Earlier this year the American Nurses Association (ANA) wrote a draft position paper about also dropping its longstanding opposition to assisted suicide. The ANA draft paper also proposed changing the term “assisted suicide” to ““aid in dying”, requiring that nurses to be “non-judgmental when discussing end of life options with patients”, and that nurses who object to assisted suicide are still “obliged to provide for patient safety, to avoid patient abandonment, and to withdraw only when assured that nursing care is available to the patient.”  (Emphasis added)

In other words, nurses must abandon their vital role in detecting and preventing suicide for some of their patients when the issue is assisted suicide. This kind of discrimination is not only lethal to the patient but also discourages dedicated, ethical people from entering or remaining in the healthcare professions.  The National Association of Pro-life Nurses strongly opposed the proposal due to conscience concerns raised by it.  The objections can be found on the NAPN website, www.nursesforlife.org.  No formal position has yet been taken.

Although most doctors and nurses are not members of the ANA or AMA, if such organizations capitulate to the pro-assisted suicide groups, legalized assisted suicide throughout the US may be inevitable.

Hopefully, the ANA will follow the AMA example of continued opposition to assisted suicide and begin to restore the public’s trust that we will never kill our patients or help them kill themselves.

Contact

Marianne Linane RN, MS, MA, National Association of Pro-Life Nurses Executive Director

📞  (202) 556-1240
✉  Director@nursesforlife.org

Great News: American Medical Association Votes to Continue Opposition to Physician-assisted Suicide. But Will the American Nurses Association Follow?

Over the last few years the American Medical Association (AMA) has been under enormous pressure from assisted suicide supporters and groups like Compassion and Choices as well as some other professional associations to change its’ long standing opposition to physician-assisted suicide to “neutrality”.

This month, the AMA House of Delegates decisively approved a strong report from AMA’s Council on Ethical and Judicial Affairs reaffirming current AMA policy on physician-assisted suicide stating that:

“permitting physicians to engage in assisted suicide would ultimately cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.”

Dr. Shane Macaulay, MD, of Kirkland, Wash., speaking for the Washington delegation supported the report, stating that:

“Oregon legalized assisted suicide in 1997 with repeated assurances that it would stay contained and would not become euthanasia” (but) “Just last month, the Oregon state House of Representatives approved a bill to allow patient death by lethal injection, showing the inevitable progression from assisted suicide to euthanasia once physicians have accepted the idea that taking a patient’s life is permissible.”

Dr. David Grube, the national medical director of the pro-assisted suicide organization Compassion and Choices, countered that physician-assisted suicide is:

“a rarely-used request from patients, and yet it’s a response we can give to them when they’re suffering. The enemy is not death, but the enemy is terminal suffering; responding to that in ways that provide comfort is what matters the most.”

Ironically, physician-assisted suicide laws themselves do not require that pain or other suffering be present but rather death expected within six months.

In the Compassion and Choices article titled “AMA contradicts itself by passing resolution saying medical aid in dying is unethical, but ethical doctors can practice it”, Dr. Grube further criticizes the decision, saying:

“The report by the AMA Council on Ethical and Judicial Affairs (CEJA) reinterpreted the AMA’s Code of Medical Ethics (CEJA) by maintaining that ‘physician-assisted suicide’ (i.e., medical aid in dying) is ‘fundamentally incompatible with the physician’s role as healer,’ while paradoxically saying physicians can provide medical aid in dying ‘according to the dictates of their conscience without violating their professional obligations.’” (Emphasis added)

However, the report itself concluded that:

“Because Opinion E-5.7O   powerfully expresses the perspective of those who oppose physician-41 assisted suicide, and Opinion E-1.1.7   (on the exercise of conscience) articulates the thoughtful moral basis for those who support assisted suicide, the Council on Ethical and Judicial Affairs recommends that the Code of Medical Ethics not be amended, that Resolutions 15-A-16 and 14-A-17 (on neutrality) not be adopted, and that the remainder of the report be filed.”

As I wrote in my 2016 blog “Neutrality Kills”:

In 1997, Oregon became the first state to pass a physician-assisted suicide law. This came after the Oregon Medical Association changed its position from opposition to neutrality. 21 years later and after multiple failed attempts, the California state legislature approved the latest physician-assisted suicide law after the California Medical Association changed its opposition to neutrality.

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

BUT THIS IS NOT JUST ABOUT DOCTORS

Earlier this year the American Nurses Association (ANA) wrote a draft position paper  about dropping its longstanding opposition to assisted suicide. The ANA draft paper also proposed changing the term “assisted suicide” to ““aid in dying”, requiring that nurses to be “non-judgmental when discussing end of life options with patients”, and that nurses who object to assisted suicide are still  “obliged to provide for patient safety, to avoid patient abandonment, and to withdraw only when assured that nursing care is available to the patient.” (Emphasis added)

In other words, nurses must abandon their vital role in detecting and preventing suicide for some of their patients when it comes to assisted suicide. This kind of discrimination is not only lethal to the patient but also discourages dedicated, ethical people from entering or remaining in the healthcare professions.

Although most doctors and nurses are NOT members of the ANA or AMA, if such organizations capitulate to the pro-assisted suicide groups, legalized assisted suicide throughout the US may be inevitable.

Hopefully, the ANA will follow the AMA example of continued opposition to assisted suicide and begin to restore the public’s trust that we will never kill our patients or help them kill themselves.

 

Abortionists and the American College of Obstetricians and Gynecologists (ACOG)

In an ironically titled May 4, 2019 MedPage article Panel: Abortion Providers Are People, Too,  a panel of  “abortion providers” claim that “Doctors (are) a lost voice in abortion political battle, media coverage”.

The panel was held at the American College of Obstetrics and Gynecologists (ACOG) annual meeting and maintained that “Abortion providers are fighting an uphill battle against a societal narrative that has attached so much stigma to the procedure, and trying to regain some of their humanity as people, not just abortion providers.” (Emphasis added)

These doctors cite the “incendiary” coverage of abortion and that the more than 300 pieces of abortion-related state legislation introduced in the first 3 months of 2019 has led to confusion about what they are and aren’t allowed to do.

One woman doctor who said she was once anti-abortion but now performs abortions claimed that she was “doxxed” (harassed when her personal information was revealed online) when she “came out” as an “abortion provider”. She complained that media stories about abortion rarely include references to “maternal care doctors, or physician specializing in maternal-fetal medicine-in other words, the doctors actually performing the procedures.”

Instead she says much of the media coverage is focused on the dangers to the doctors performing abortions and that as a result, “abortion is seen as inherently dangerous“.

Also cited was a recent online survey of 321 abortion providers showed that nearly all of the respondents were women and that 1/5 were not currently doing abortions. The respondents discussed a so-called “false dichotomy” between being pro-choice and pro-child that increases tension for the abortion provider since “59% of women who have an abortion already have children.”

One abortion provider claimed that becoming a parent “reinforced her commitment and passion for her profession” and helped her better bond with her patients, given the stigma of abortion.

“ACOG, PLANNED PARENTHOOD PROUD TO FIGHT FOR WOMEN’S HEALTHCARE”

A second article from the ACOG annual meeting titled “ACOG, Planned Parenthood Proud to Fight for Women’s Healthcare” had the subtitle “Organizations collaborated on Washington advocacy”. Cecile Richards, outgoing president of Planned Parenthood, gave a lecture on the History of Planned Parenthood.

Hal Lawrence, MD, ACOG executive vice president and chief executive officer, praised Planned Parenthood for providing, among other “services”, “300,000 mammograms per year”, even though Planned Parenthood does not do mammograms. Dr. Lawrence also spoke:

“about the hope for the future on a clinical level in the form of telemedicine for women’s healthcare, including medication abortion.

“It’s going to solve our access problem,” he said. “If we don’t use telemedicine, we’ll never solve the access problem because we don’t have enough providers.” (Emphasis added)

CONCLUSION

There are many reasons why there are not “enough” abortionists.

As a nurse, I left the American Nurses Association many years ago because of its’ support for even partial birth abortion, lack of support for real conscience rights and my ultimately futile attempts to change this. I am not alone. I also know many other doctors and nurses who left their national organizations over their support for legalized abortion. It’s an outrage that these national organizations claim to speak for nurses and doctors when just a fraction of us belong or agree with their positions.

Instead, many of us personally work to provide women and their babies the help and support they need regardless of their circumstances. Abortion is not the answer.

In addition, those doctors (and nurses) who perform abortions are also wounded by abortion and in need of our prayers, witness and compassionate outreach as Abby Johnson has shown in her book and movie “Unplanned”.

At the same time, all of us must also continue working tirelessly towards a world where every life is respected and abortion is unthinkable.

Assisted Suicide and “Failure of Unconsciousness”

As a nurse, I have seen patients assumed to be unconscious while in a coma or sedated on a ventilator later tell me about some memories and feelings during that time. This is why I always cared for such patients as if they were awake.

Now in a stunning February, 2019 Association of Anaesthetists article titled “Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying”, a group of international doctors explore the difficulty in ensuring unconsciousness to death in lethal injection capital punishment and assisted suicide/euthanasia. (Note: Since the authors are international, some quoted terms here are spelled differently than here in the US)

Believing that “A decision by a society to sanction assisted dying in any form should logically go hand‐in‐hand with defining the acceptable method(s)”, the authors reviewed the methods commonly used and contrast these with an analysis of capital punishment in the US. They “expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used.”

They were wrong.

They found that with self-administered lethal overdoses “with death resulting slowly from asphyxia due to cardiorespiratory (heartbeat and breathing) depression”, helium self-suffocation and the Dutch lethal injection that resembles US capital punishment, “there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re‐awakening from coma (up to 4%), constituting failure of unconsciousness.” (Emphasis added)

The authors take no position on assisted suicide and state their intention to “dispassionately examine whether the methods used to induce unconsciousness at the point of death in assisted dying achieve their objective”. With many of the authors being anesthesiologists themselves, they used the most recent research into “accidental awareness” during anesthesia to try to find an “optimal means” that could better achieve unconsciousness.

ASSISTED SUICIDE AND CAPITAL PUNISHMENT

It was difficult for the authors to find discussion of actual methods to cause death but the Dutch have published guidelines for both “passive participation” where the doctor prescribes a high-dose barbiturate and “active participation where the doctor administers a high dose of IV anesthetic and a neuromuscular (paralyzing) drug.

Notably, the authors found that a lethal injection is recommended by the Dutch when self-ingestion death fails to occur within 2 hours and that this is “an explicit recognition” that self-ingestion can fail.

The Dutch lethal injection resembles (except for the use of potassium to stop the heart) the US method of capital punishment so the authors looked at the US method of lethal injection capital punishment because it is “designed to be ‘humane’ and bears technical similarities” to lethal injection assisted suicide/euthanasia. The US lethal injection protocols also includes technical aspects such as drugs, dosage and monitoring of the patient.

However, as the authors note, “prisoners have been reported to be clearly awake and in distress during some executions”. Two death row prisoners even petitioned the US Supreme Court to consider a requirement for a physician to confirm unconsciousness before the lethal drugs are given. They argued that they “might be awake but paralysed at the point of death, making the method a ‘cruel or inhumane punishment’ which violated the US constitution’s Eighth Amendment”. (Emphasis added) The authors note that this “situation has clear parallels with the problem of ‘accidental awareness during general anesthesia’, where the patient awakens unnoticed and paralysed during surgery, which is known to be a potent cause of distress.” However, the US Supreme Court rejected this argument in 2008, “concluding that the anaesthetic doses used reliably achieved unconsciousness without any need to check that this was the case.” (All emphasis added)

As the authors state, “We now know that the Court was wrong.” (Emphasis added)

DO US ASSISTED SUICIDE LAWS GUARANTEE A PEACEFUL DEATH?

The US assisted suicide laws mandate secrecy in reporting requirements and the little yearly data available about complications is self-reported by the doctors who are not required to be with the person during the process or even afterwards to pronounce death.

However, the authors were able to use data from the Dutch protocols, and other similar methods used elsewhere and state that after taking the lethal overdose:

“patients usually lose consciousness within 5 min. However, death takes considerably longer. Although cardiopulmonary collapse occurs within 90 min in two‐thirds of cases, in a third of cases death can take up to 30 h(ours) 3133. Other complications include difficulty in swallowing the prescribed dose (in up to 9%) and vomiting thereafter (in up to 10%), both of which prevent suitable dosing, and re‐emergence from coma (in up to 2%). Each of these potentially constitutes a failure to achieve unconsciousness, with its own psychological consequences, and it would seem important explicitly to acknowledge this in suitable consent processes.” (Emphasis added

The authors also note:

“that the incidence of ‘failure of unconsciousness’ is approximately 190 times higher when it is intended that the patient is unconscious at the time of death 3133, as when it is intended they later awaken and recover after surgery (when accidental awareness is approximately 1:19,000)21, 22. (Emphasis added)

CAN TECHNOLOGY ENSURE UNCONSCIOUSNESS?

The authors discuss the limitations of just using EEGs (brain wave tests) and the isolated forearm technique (IFT) where the person can move their single, non-paralysed forearm to signal their awareness.

Instead the authors state:

“Recent lessons from anaesthesia lead us to conclude that, if we wish better to ensure unconsciousness at the point of death… then this can be achieved using: (1) continuous drug infusions at very high concentrations; (2) concomitant EEG‐based brain function monitoring, targeted to the very low, burst suppression or isoelectric values; and (3) clinical confirmation of unconsciousness by lack of response to command or to painful/arousing stimuli (and this last could include an IFT). Alternative methods that do not include these elements entail a higher, possibly unacceptable, risk of remaining conscious and so, by definition, are suboptimal.” (Emphasis added)

However, the authors acknowledge practical problems with this protocol such as the technical requirements requiring the involvement of trained practitioners like anesthetists.

And the “optimum method” for ensuring unconsciousness is so medicalized that:

“Society or individuals might prefer to retain a choice for alternative methods, even if these are suboptimal and carry a greater risk of consciousness at the point of death 54. If so, then legal frameworks and consent processes should explicitly acknowledge this choice. ” (Emphasis added)

CONCLUSION

The assisted suicide legalization movement led by Compassion and Choices portrays assisted suicide as an easy and dignified death, even one that can be a cause of celebration.

Polls about assisted suicide like the latest Gallup poll find 65% say “yes” when asked “When a person has a disease that cannot be cured and is living is severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patient requests it?” even though assisted suicide laws don’t mention pain and state that the person must be terminally ill and expected to die within 6 months.

But how many people, especially legislators, would still say “yes” to legalizing assisted suicide after learning the truth in this article about the so-called “peaceful” assisted suicide?

And how many people would still pursue assisted suicide if they knew they might be conscious and in more distress during the process?

Unfortunately and right now, no assisted suicide law requires that kind of  explicit “informed consent”.

The obvious solution is to fight all assisted suicide laws and support all suicidal people.

 

While Opposition to Nursing Involvement in Assisted Suicide Grows, a Dire Warning from Canada

In March, I wrote a blog “Is the American Nurses Association Ready to Drop Opposition to Assisted Suicide?” about  the ANA draft position paper changing its stance from opposition to assisted suicide to “The Nurse’s Role When a Patient Requests Aid in Dying”. “Aid in Dying” is the ANA’s new term for assisted suicide. I included a link for public comments on this change that gave a deadline of April 8, 2019.

Although the ANA  claims that it ‘is the premier organization representing the interests of the nation’s 4 million registered nurses’, less than ten percent of the nation’s nurses are members of the ANA or other professional organizations” and that number is declining.

I belonged to the ANA decades ago but left when I saw the organization take radical positions without even informing us. Now, no nurse I know belongs-unless he or she is in politics, academia or administration.

Even though I regularly get medical and nursing news updates along with constant ads from the ANA, I never see ANA’s proposed new position changes on hot button issues like VSED (voluntary stopping of eating and drinking to hasten death) and assisted suicide until alerted by people in my network. Unfortunately, although some of us wrote public comments opposing nursing involvement in VSED, the ANA approved the change in 2017

This time, the ANA’s draft position on assisted suicide led to an outpouring of criticisms and pleas not to approve the change.

SOME RESPONSES TO THE ANA DRAFT RECOMMENDATIONS

The Catholic Medical Association issued a statement opposing the ANA’s draft position stating:

“These guidelines compromise not only the patient’s life, but also the conscience rights of nurses everywhere,” said Dr. John Schirger, President of the CMA.”

“A nurse or any health care provider should never abandon a patient or refuse comfort and care to a patient. But AID is not care and is the ultimate abandonment of a patient. Forcing the nurse to facilitate AID makes the nurse complicit in such abandonment,” said Dr. Marie Hilliard, Co-Chair of the CMA’s Ethics Committee.”

The National Association of Catholic Nurses issued their comments on the ANA’s draft such as:

“All the legal system can do is decriminalize AID so that nurses and physicians are not prosecuted for killing patients or helping them to kill themselves.  AID is the antithesis of social justice.”

“Nursing is a moral endeavor and much is at stake when nurses breach the moral obligation to first do no harm.  Harm is precisely what support of AID does.  It harms  the patient who is killed, the nurse who must make themselves indifferent to the patient’s suffering and convince themselves that killing is okay, the professional relationship that is built on trust that the nurse will not harm the patient, and society that will come to view nurses as potential accomplices in killing rather than as true healers and providers of authentic compassionate care.  As Florence Nightingale is quoted to have said, “The very first requirement in a hospital, is that it should do the sick no harm.”

The National Association of Pro-life Nurses (NAPN) responded in their comments that:

“Social and legislative shifts” do not make a previously immoral act moral. ”

“Aid in dying IS euthanasia. It is the deliberate taking of a life whether it is requested by the patient or not.”

Wesley Smith of the Discovery Institute’s Center on Human Exceptionalism asked “Now Will Nurses Only Prevent Some Suicides?” wrote:

“I hope the membership of the ANA will oppose their leaders’ attempt to accommodate the culture of death. If nurses become “non-judgmental” — e.g., indifferent — to some suicides, the consequent failure to request specialized preventative interventions could become the precipitating omission that sends some suicidal patients into the abyss.”

And over 1000 people signed an online petition opposing the ANA draft position by the April 8, 2019 deadline.

A DIRE WARNING FROM CANADA

The Canadian Catholic Nurses joined the National Association of Catholic Nurse in opposing the ANA’s draft position and gave a chilling look at what may be our future if  legalized assisted suicide is not stopped:

“Our association formed in 2018 primarily in response to Canadian nurses’ moral distress regarding the nation-wide legalization of medically induced death. Professional associations and licensing bodies across Canada endorsed the legal changes, requiring conscientious objectors to participate in “Medical Assistance in Dying” by “effective referral” to facilitate access at the patient’s request. Faith-based health care facilities are pressured to participate. Nurse practitioners are trained and qualified to prescribe and administer lethal doses of medication to patients that they or others deem eligible for euthanasia.”

 Social justice demands that nurses advocate for the protection of life until natural death, not for increased access to induced death. The Canadian experience with assisted suicide and euthanasia provides evidence for your continued resistance to the practice.

Unlike Oregon, Canada has not experienced a growth in palliative care along with the rapid expansion of induced death. Instead, we experience ongoing demands for access to lethal injections for new categories of patients, including “mature minors;” those who write advanced directives; and those whose mental illness is the sole condition underlying their request. We urge the ANA to maintain its courageous opposition to assisted suicide and euthanasia.” (All emphasis added)”

Legalized assisted suicide is more than a legal, medical or nursing problem. It is a corrupting influence on our society that will destroy the essential protections of truly ethical healthcare for us all.

Is the American Nurses Association Ready to Drop Opposition to Assisted Suicide?

In 2013, the American Nurses Association (ANA) stated this : “The American Nurses Association (ANA) prohibits nurses’ participation in assisted suicide and euthanasia because these acts are in direct violation of Code of Ethics for Nurses with Interpretive Statements (ANA, 2001).” (Emphasis added)

But now in 2019, the ANA is proposing a new position paper to change this. Not only is the ANA attempting to change its previously used term assisted suicide to “aid in dying” (the approved term of Compassion and Choices), but also the Code of Ethics itself.

The draft position paper is titled “The Nurse’s Role When a Patient Requests Aid in Dying” There is an online form for public comments which must be submitted before April 8, 2019. There is no requirement that you have to be a member of ANA or even a nurse to make a public comment. The ANA can also be contacted by email at customerservice@ana.org or by phone at 1-800-284-2378.

There is much in the draft position that I find shocking both as a nurse and a patient. For example, the draft position begins:

“It is the shared responsibility of professional nursing organizations to speak for nurses collectively in shaping health care and to promulgate change for the improvement of health and health care” and “(t)he nurse should remain non-judgmental when discussing end of life options with patients, who are exploring AID” (a.k.a. physician-assisted suicide). (Emphasis added)

This statement flies in the face of the way nurses have traditionally cared for patients considering suicide, whether they are terminally ill or not. Unfortunately, this follows the lead of several medical, nursing and hospice/palliative care organizations that have changed their positions on assisted suicide to “neutrality” or even support.

The ANA draft also states, “The nurse has the right to conscientiously object to being involved in the AID process” but “Nurses are obliged to provide for patient safety, to avoid patient abandonment, and to withdraw only when assured that nursing care is available to the patient.”  (Emphasis added)

The draft suggests that such nurses can “ensure the ongoing care of the patient considering AID by identifying nurse colleagues willing to provide care.”

This is forced cooperation and does nothing to protect nurses’ conscience rights. Such a position would impact not only current nurses but also potential future nurses who have strong ethical principles against helping patients kill themselves.  Many nurses already are worried about the impact of other ANA positions, such as the 2017 “Nutrition and Hydration at the End of Life”  which states, “People with decision-making capacity have the right to stop eating and drinking as a means of hastening death. (Emphasis added)

In a section titled Social Justice, the draft position states:

“Nurses must continually emphasize the values of respect, fairness, and caring,”(ANA, 2015a, p.35). Statutes that allow AID are not present in every state, which presents geographic inequity in terms of access. Additionally, AID medication is expensive, which presents an additional barrier to access for those who cannot afford it, even if they live in a jurisdiction or state where this option is legal. Nurses act to reduce or eliminate disparities. While this is most commonly associated with health promotion and disease prevention, the current AID landscape raises questions of fairness which require ethical reflection.” (Emphasis added)

I find it outrageous to encourage nurses to become social justice warriors  fighting for more access to assisted suicide and cheaper lethal overdoses. And one recommendation in the ANA draft position eliminates all doubt about a radical departure from the 2013 Code of Ethics prohibition of  “participation in assisted suicide”: “Nursing research is needed to provide an evidence base for AID.”

NON-JUDGMENTALISM: IS IT REALLY IN OUR PATIENTS’ BEST INTERESTS?

When I first met “Frank” (not his real name) many years ago, I was puzzled. Frank was a terminally ill man who had just been admitted to my oncology unit for control of his “unbearable pain”. However, Frank didn’t seem to be in any physical pain.

I talked privately to Frank’s wife, Joan, who tearfully confided that Frank was cleaning his gun collection when he asked her if she would still be able to live in their home if, in his words, “anything happened”.

Joan said she knew he was talking about shooting himself and even though she was horrified, she said she thought the right thing to say was: “I will support any decision you make”. However, she later panicked and called the doctor to say that Frank was having unbearable pain. The doctor agreed to admit him and ordered morphine to be given as soon as he arrived.

When I suggested to Joan that Frank’s real question might not be about their home but rather about whether his lingering dying might be too hard on them both, she was stunned. This had never occurred to her. She said she loved Frank and she wanted to care for him until the end. I told her that she and her husband needed to talk.

Frank and Joan then finally had a long overdue open discussion about their sorrow and fears. I told the doctor what I discovered and when I last saw Frank and Joan later that day, they were holding hands and smiling as they left the hospital.

I learned that Frank died peacefully — and naturally — a few weeks later with his wife at his side.

I believe that this situation shows how being “non-judgmental” can itself be lethal. Unfortunately, the public as well as we healthcare professionals are being given the message that a patient’s “right to self-determination” is the most important ethical principle.

What I did with Frank and his wife was a lot like a recent UCLA project started when California legalized physician-assisted suicide. The project showed that “most of what patients needed was to discuss their feelings about their approaching death and process their grief and sense of loss.” The project also found that “only” 25% of these patients seeking assisted suicide went on to use assisted suicide.

When someone is suicidal, it should not matter whether they are terminally ill. Instead, we should treat them with the same care and concern we would give a physically healthy suicidal person.

Anything less would be discrimination and I am telling this to the ANA.

 

 

 

 

Why Can’t We Protect Babies who Survive Abortion?

I still remember my shock when nurse Jill Stanek came forward to describe how she discovered a baby with Down Syndrome born alive after a late-term abortion who was left in a dirty utility room to die at Christ Hospital in Oak Lawn, Illinois in 1999. She found that these second or even third trimester babies were sometimes born alive after an induced labor abortion. At great risk both professionally and personally, Jill Stanek fought this barbaric practice publicly and testified in Congress. This resulted in the passage of the Born-Alive Infants Protection Act of 2002.

Just a year later, Congress was finally able to pass The Partial Birth Abortion Ban Act of 2003  many years after it was discovered that abortionists could ensure the death of the baby by delivering the baby feet first except for the head and then suctioning out the baby’s brain.

But in October 2003, abortionist Warren Hern wrote an article explaining how he got around the new law:

“I reassured her (a patient) that I do not perform the “partial-birth” procedure and that there is no likelihood that the ban’s passage would close my office and keep me from seeing her. The fetus cannot be delivered “alive” in my procedure—as the ban stipulates in defining prohibited procedures—because I begin by giving the fetus an injection that stops its heart immediately.” (Emphasis added)

And just last year, the US House passed the Born-Alive Abortion Survivors Protection Act (H.R. 4712) that:

  • Requires health care practitioners present at the time a child is born alive during an abortion or attempted abortion to exercise the same degree of care to preserve the life and health of the child as any health care practitioner would provide to a child born alive at the same gestational age;

  • Requires that children born alive during an abortion or attempted abortion be transported and admitted to a hospital immediately following the administration of emergency care;

However and just days ago, this Act was blocked from unanimous consent in the US Senate by Democrats .

This happened despite the controversial on-air comments by Democrat Governor Northam of Virginia defending a bill allowing abortions up to birth. When asked what would happen if the baby was born after the abortion, Gov. Northam said that “the infant would be resuscitated if that’s what the mother and the family desired, and then a discussion would ensue between the physicians and the mother.” (Emphasis added)

In other words, the same infanticide by neglect that nurse Jill Stanek discovered in 1999.

The Virginia abortion bill thankfully died in committee but there is now a frenzy among abortion supporters to pass radical pro-abortion laws like New York’s in other states like Rhode Island  and Vermont that allow abortions up to birth, allow non-doctors to perform abortions and to prohibit any effort to “deny, regulate or restrict” abortion.

The most recent and extreme bill just passed the House in New Mexico. This bill redefines abortion as merely “health care” and even removes conscience rights for medical professionals who refuse to participate. Governor Michelle Lujan Grisham has promised to sign the bill into law if it passes the New Mexico Senate.

CONCLUSION

In my home town of St. Louis, Missouri, the US Supreme Court voted 7-2 in the infamous 1857  Dred Scott v Sandford decision about slavery which held that black people were an “inferior class of beings”  and thus ” had no rights or privileges but such as those who held the power and the Government might choose to grant them”.

It took a civil war and the Emancipation Proclamation to end this travesty. The Dred Scott decision is now remembered as a turning point that ignited a political firestorm.

Will these current outrageous efforts to also make unborn babies an “inferior class of beings” with “no rights or privileges” prick the conscience of the American people and become a turning point in the fight to restore respect for the lives of preborn human beings?

We must never give up trying!