nursing

Victory: “After Initial Hope, Medically Assisted Suicide Bill Won’t Move Forward in Maryland”

nancyvalko ANA, assisted suicide, conscience rights, culture, education, end-of-life, euthanasia, food and water, law, medical ethics, nursing, VSED

In 2019, I testified in Maryland against another “medically assisted suicide” bill that was expected to pass and wrote a blog about it titled “Lessons from the Victory against Assisted Suicide in Maryland”. It failed to pass by one vote.

Now, yet another attempt to pass an assisted suicide bill in Maryland failed by “one or two votes”, according to a Baltimore Sun article titled “After initial hope, medically assisted suicide bill won’t move forward in Maryland”, thanks to efforts like that of Mary Bogdan BSN, MA-C, DNP-S, ALNC who wrote an excellent expert witness testimony stating in part:

“The physician assisted suicide bill has been called many things: medical aid in dying, euthanasia, withholding of food and water, etc., etc., etc. The bottom line is this: I did not become a nurse to kill people. The American Nurses Association (ANA) says that nurses should support patient autonomy, the desire to have control over one’s life. I submit this; if we allow patients to end their lives as desired by them, we subject ourselves to unfathomable consequences.” (Emphasis added)

Note this sentence from the article in the Baltimore Sun “I think that as we slowly got closer to the vote and had more in depth discussions with their constituents, folks just expressed unreadiness to move on it at this time,” Smith said. “I’m obviously very disappointed, but you have to respect the decisions of the individual senators who were listening to their constituents and listening to their conscience.” (Sen. Will Smith is chair of the Judicial Proceedings Committee and a previous sponsor of the bill)

CONCLUSION

Nurse Bogdan’s testimony ends with a powerful quote from Dr.  Harvey Max Chochinov, MD, PhD in his December 2023 recent Medpage article ” Intensive Caring: Reminding Patients They Matter— How to care for those who no longer care about themselves”:

“There is abundant evidence that patients approaching death are susceptible to feeling that they no longer matter. When patients feel life is no longer worth living, healthcare professionals must affirm their intrinsic worth to patients for all that they are, all that they were, and all that they will become in the collective memories of those they will eventually leave behind.” (Emphasis added)

Virginia is now facing SB 280, an assisted suicide bill.

Unfortunately, the assisted suicide proponents never seem to give up and we must continue to be vigilant in every state and continue to educate legislators, healthcare providers, and the general population about these dangerous assisted suicide laws.

Victory on Assisted Suicide, Conscience Rights and AMA Proposed Resolutions

nancyvalko AMA, ANA, assisted suicide, conscience rights, culture, euthanasia, law, medical ethics, nursing

“First Do No Harm-Hippocrates”

Last November, I wrote my blog “NAPN Position Paper on AMA Considering New Resolutions on Assisted Suicide”.

Now, the Life Legal Defense Foundation has announced a great victory on this as well as conscience rights.

I have personally worked with The Life Legal Defense Foundation for years and they are awesome!

Here is their statement:

VICTORY over DEATH PEDDLERS in the American Medical Association…! – LIFE LEGAL DEFENSE FOUNDATION

/ Active Euthanasia / By Life Legal / January 9, 2024:

“In 2022, Life Legal sued California Attorney General Rob Bonta to stop enforcement of SB 380, which would have prohibited physicians from opting out of the state’s assisted suicide scheme. SB 380 required doctors to provide most of the documentation needed for their patients to receive so-called “aid-in-dying” drugs – even if doctors were morally opposed to participating in assisted suicide. The law imposed draconian punishments on physicians who refused to comply, including civil and criminal penalties and professional discipline.

Life Legal, along with Alliance Defending Freedom, represented the Christian Medical and Dental Association (CMDA) in the lawsuit – and we won! After a hard fight, we were able to get the law enjoined (blocked). Life Legal, Alliance Defending Freedom, and the CMDA were victorious in protecting physicians’ rights of conscience – but the wins did not stop there.

Recently, the CMDA joined with members from the Catholic Medical Association (CMA) to oppose two American Medical Association resolutions supporting physician-assisted suicide. As a result of the pro-life stance taken by the CMDA and the CMA, the American Medical Association declined both resolutions. This means the AMA officially remains in opposition to assisted suicide, holding 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.”

We are honored to represent pro-life physicians and we are grateful for their powerful witness in opposition to assisted suicide.” (Emphasis in original)

CONCLUSION

We nurses are also grateful for this victory and so should everyone who cares about healthcare ethics!

INSPIRATIONAL GERONTOLOGIST TRANSFORMED DEMENTIA CARE

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

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

MY STORY

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

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

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

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

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

NAOMI FEIL’S STORY

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

Here are some excerpts from the obituary:

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

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

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

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

NAOMI’S HISTORY

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

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

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

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

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

“No lies

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

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

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

CONCLUSION

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

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

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

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

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

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

Are “Anti-abortion activists” Really Looking “To Rebrand Themselves As Not Religious”?

nancyvalko abortion, assisted suicide, conscience rights, culture, euthanasia, law, medical ethics, nursing, pro-life

Last May, I was interviewed by Dr. Anne Whitesell, an Assistant Professor of Political Science at Miami University “as part of a research project to understand the work of pro-life organizations post-Dobbs and common misconceptions about the movement.”

Dr. Whitesell was very gracious during the interview, and we had a long conversation about what motivates pro-life people-and especially nurses.

I told her about our National Association of Pro-life Nurses and the why and how we do what we do because we call about all lives.

I also told her that the National Association of Pro-life Nurses was not a religious organization but rather open to nurses of any religion or none.

I explained how the National Association of Pro-life Nurses is a “registered non-profit organization that brings nurses together who look for excellence in advancing ethics in nursing practice “and “seeks to establish and protect ethical values of the nursing profession. The organization educates its members on a wide range of bioethical issues” from conception to natural death”.

I also told Professor Whitesell that we are not about being judgmental but rather about truly caring and offering help to desperate people in crisis situations and the people around them before-or even after- a person has chosen abortion or is considering medically assisted suicide. (see “Pro-Life and Other Resources for Help and Information to Protect Human Life”)

Our motto is “I Care” and we even have developed a button with that simple message for our nurses to wear.

PROFESSOR WHITESELL’S NOVEMBER 6, 2023 ARTICLE

Professor Whitesell said she would send me a copy of her eventual article but instead I discovered her November 6, 2023 article titled “As Ohio and other states decide on abortion, anti-abortion activists look to rebrand themselves as not religious.”

Here are some excerpts:

“My research shows that anti-abortion organizations in the U.S. fall into one of three camps. Some are openly religious. Others may have religious staff, but refrain from using religion in their advocacy. A small proportion outright reject the use of religion.

“In my interviews, anti-abortion rights activists said they understood that the public views their movement as anti-woman and driven by conservative Christians. More recently, the movement has adopted pro-woman messaging to counter the perception that they do not support women.

These organizations are increasingly choosing to speak less about religion and more about human rights and science to combat the narrative that the anti-abortion movement is solely a Christian movement.”

and

“Most of the activists I interviewed said their organization does not have a formal stance on religion. Approximately one-quarter of the 45 activists I interviewed, however, said their organizations are explicitly Christian. (Emphasis added)

Professor Whitesell concludes that:

“Instead of using religion to bolster their arguments against abortion, these activists frame abortion as a human rights issue. For them, any loss of human life is tragic, whether it is from abortion, war or the death penalty.

This kind of framing could help the anti-abortion movement shift conversations about abortion away from religious beliefs.” (All emphasis added)

CONCLUSION

Unfortunately, the abortion rights movement’s animus against using religious beliefs in discussions about abortion has real world consequences.

For example, a January 16, 2024, CNA article titled “Religious Americans’ lives possibly at risk in 2024, new report by U.S. bishops says” states:

“Since the overturn of Roe v. Wade in the June 2022 Supreme Court Dobbs v. Jackson Women’s Health Organization decision, attacks against the Catholic Church as well as pro-life organizations have risen considerably. The bishops said that annual hate crime statistics gathered by the FBI in 2022 reported anti-Catholic crimes as nearly 75% higher than for any other bias.“

All this is compounded with, the bishops said, a “general failure” on the part of the “federal government to apprehend and prosecute the perpetrators of such attacks.” (All emphasis added)

It is disheartening that articles like Professor Whitesell’s and most mainstream news reporting about abortion and the pro-life movement continue to misrepresent the “anti-abortion movement” as primarily religious rather than a movement based on science, human rights and, above all, helping those involved in crisis situations.

Intensive Caring: Reminding Patients They Matter

nancyvalko assisted suicide, Cancer, culture, dementia, disability, end-of-life, medical ethics, nursing

Last month, there was a beautiful article on Medpage titled “Intensive Caring: Reminding Patients They Matter-How to care for those who no longer care about themselves” by Harvey Max Chochinov, MD, PhD.

Dr. Chochinov quotes Dame Cicely Saunders, the founder of the modern hospice movement, for her famous statement “”You matter because you are you, and you matter to the last moment of your life”.

That statement became an integral part of medical and nursing education in the past and a powerful argument against the current push for legalizing medically assisted suicide.

As Dr. Cochinov states in his article;

“There is abundant evidence that patients approaching death are susceptible to feeling that they no longer matter. When patients feel life is no longer worth living, healthcare professionals must affirm their intrinsic worth to patients for all that they are, all that they were, and all that they will become in the collective memories of those they will eventually leave behind.” (Emphasis added)

and

” A foundational element of this approach is nonabandonment, which demands committed, ongoing care and caring, even when patients no longer care about themselves. Absent someone who cares, suffering, like cancer, can grow, spread, and even kill.” (Emphasis added)

and in contrast:

“Intensive caring sees healthcare professionals hold or contain hope when patients can no longer do so themselves. This means expanding one’s therapeutic imagination to include the possibility that patients may find psychological, spiritual, and physical comfort, tolerable suffering, and for those near the end, a peaceful death. Toward the end of life, hope tends to conflate with meaning and purpose and may be nurtured through connections to those who, or things that, matter.” (Emphasis added)

MY EXPERIENCE

As a new nurse, I was nervous when I was assigned to terminally ill patients.I asked the senior nurses how to approach these patients and if I should be solemn or cheerful. The senior nurses said they didn’t know.

So I came up with a plan. After I clocked out after my shift, I started just visiting with them and listening to whatever they had to say.

I found that there were two basic questions that needed to be answered: “What do you want?” and “What are you afraid of?”

These patients opened up about wanting to die at home without burdening their families and not being in terrible pain at the end. I was able to tell them about good home healthcare options, pain management and being open with their doctors and families. This opened the door to great conversations and often even a lot of laughter!

(I was later chastised by some nurses who criticized the laughter coming from these rooms. I responded by asking them who needed to laugh more than patients in these situations?)

I also started spending time with the relatives who had questions of their own. They were relieved to talk about their fears and sadness and wanted to know how to help their loved ones.

Once, on an on an oncology (cancer) floor, an elderly woman with terminal cancer told me that she wished she could have just one more overnight sleepover with her granddaughter before she died. I told the other nurses and they all enthusiastically joined in with snacks and sodas to make it happen during one night shift, remembering their own special times with their grandmothers.

It was a great success, even though I was caught by an administrator who said I should not make this a habit.

In another case, an elderly woman with advanced cancer was considering another chemo treat but confided that she feared becoming more of a “burden” on her daughter’s family with whom she lived.

I told her that I had just spoken to her daughter the day before and the daughter told me how grateful she was for her mother’s presence and help. For example, the daughter said that since she and her husband both worked, they were relieved to have the mother there for their school-age children when classes ended. The daughter told me how the children loved climbing into bed with grandma and telling her about their day.

My elderly patient was almost reduced to tears by this revelation but then she laughed and admitted that sometimes she fell asleep when the children were talking to her.

I told my patient that whatever else she needed to consider before agreeing to the chemo, fear about being a “burden” should be eliminated.

CONCLUSION

Sadly, Dr. Chochinov cites studies that have shown when patients feel abandoned and bereft of care, they are more likely to contemplate or die by suicide. In addition, he cites studies on the desire for death in the terminally ill “report lower family support relative to those who don’t.”

According to an October 4, 2023 Medical Net news article “Review of Oregon’s assisted dying law finds significant data gaps”:

“Since 2017, fear of being a burden has been cited by around half of those opting for assisted death“. (Emphasis added)

It’s important to remember that no one has to be a medical professional to ask a friend, neighbor, church member, etc. in difficult circumstances to ask “What can I do to help?”.

Just visiting with the person, watching tv with them or bringing a favorite food can be a real day brightener and give family members a much needed boost.

Personally, I know how lonely it can be taking care of a loved one with a terminal illness or a disabling condition without the support of friends or family. Family caregivers also need support and encouragement.

But I also know the wonderful benefits of helping others, both personally and professionally, even just by being there.

NAPN: Ohio’s Issue 1 Abortion Vote Marks a Temporary Setback, Not a Surrender

nancyvalko abortion, adoption, conscience rights, culture, education, law, medical ethics, nursing, pro-life

FOR IMMEDIATE RELEASE

November 7, 2023

National Association of Pro-Life Nurses

Contact: media@nursesforlife.org

Columbus, Ohio – The National Association of Pro-Life Nurses (NAPN) is expressing deep disappointment over the passage of Ohio’s extreme, deceptive abortion initiative. Despite the passage of Issue 1, NAPN remains committed to upholding ethics in healthcare practice.

Issue 1 undermines common-sense health and safety protections by lowering the standard of care in Ohio. Its passage will enshrine discriminatory abortion practices into the state’s constitution, including for reasons of gender or disability. Further, the ballot initiative will expand abortion into the third trimester, when a preborn child is capable of feeling pain. Issue 1 is radically out of touch with the 7 in 10 Americans who support common-sense abortion limits after 15 weeks. NAPN firmly believes in upholding the principles of compassion, empathy, and respect for all human life, echoing the fundamental principles of the nursing profession.

Executive Director Marie Ashby, on behalf of the NAPN, stated, “While we are deeply concerned by the passage of extreme, anti-life legislation, it does not diminish our resolve to protect human life in all its stages. We must continue to support families facing unexpected pregnancies through pregnancy resource clinics and Federally Qualified Health Centers. NAPN remains steadfast in advancing a higher standard of patient care, which is fundamentally incompatible with abortion.”

NAPN will continue to push back against healthcare disinformation, as it paves the path forward for excellence in nursing practice. The National Association of Pro-Life Nurses calls upon policymakers to consider the profound ethical implications of legislation that erodes patient protections. The association stands ready to counter public health threats by educating lawmakers and healthcare providers on policies that seek to undermine patient care.

The National Association of Pro-Life Nurses is a not-for-profit organization uniting nurses who are dedicated to promoting respect for every human life from conception to natural death, and to affirming that the destruction of that life, for whatever reason and by whatever means, does not constitute good nursing practice.

###

For further inquiries or interviews, please contact:

Marie Ashby

Executive Director

National Association of Pro-Life Nurses

marie@nursesforlife.org

www.nursesforlife.org

NAPN Position Paper on AMA Considering New Resolutions on Assisted Suicide

nancyvalko AMA, assisted suicide, Compassion & Choices, law, medical ethics, nursing, suicide, VSED

A May 1, 2023, article by Dallas R. Lawry, DNP, FNP-C, AOCNP® from the University of California, San Diego in the Journal of the Advanced Practitioner in Oncology titled “Rethinking Medical Aid in Dying: What Does It Mean to ‘Do No Harm?’” at Rethinking Medical Aid in Dying: What Does It Mean to ‘Do No Harm?’ – PMC (nih.gov) reveals that:

“Until 2019, the American Medical Association (AMA) maintained that MAID (medical aid in dying aka assisted suicide) was incompatible with their code of ethics and a physician’s responsibility to heal (AMA, 2022)“.

 But now, the AMA Medical Code of Ethics is considering two provisions that support both positions on MAID, including: “Physicians who participate in MAID are adhering to their professional, ethical obligations as are physicians who decline to participate” (AMA, 2019, 2022; Compassion & Choices, 2022) (Emphasis added)

Now, such ethical dissonance has now led the AMA to considering two new resolutions  at the Interim meeting of the AMA House of Delegates on November 10-14, 2023:

“Resolution 4 is to change the position of the AMA on Medical Aid in Dying (Resolution Link).

Resolution 5 is for the AMA to adopt a neutral stance on Medical Aid in Dying (Resolution Link).”

and, as Alex Schadenberg writes:

“It is important to note that Resolution 4 would remove the AMA statement on not performing euthanasia or participating in assisted suicide:

Physicians must not perform euthanasia or participate in assisted suicide. A more careful examination of the issue is necessary. Support, comfort, respect for patient autonomy, good communication, and adequate pain control may decrease dramatically the public demand for euthanasia and assisted suicide. In certain carefully defined circumstances, it would be humane to recognize that death is certain and suffering is great. However, the societal risks of involving physicians in medical interventions to cause patients’ deaths is too great in this culture to condone euthanasia or physician- assisted suicide at this time.

Both resolutions use the term Medical Aid in Dying (MAiD) rather than Physician Assisted Suicide. The term Medical Aid in Dying is not limited to assisted suicide, it also includes euthanasia. The assisted suicide lobby wants to legalize euthanasia (medical homicide) in America.”

NURSES AND ASSISTED SUICIDE

In 1995, the American Nurses Association stated:

“The American Nurses Association (ANA) believes that the nurse should not participate in assisted suicide. Such an act is in violation of the Code for Nurses with Interpretive Statements (Code for Nurses) and the ethical traditions of the profession. “ (Emphasis added)

But in 2017, the ANA revised its’ position on VSED (voluntary stopping of eating and drinking) “with the intention of hastening death” to “People with decision-making capacity have the right to stop eating and drinking as a means of
hastening death.” (Emphasis added)

In 2019, the American Nurses Association revised their position on assisted suicide titled “The Nurse’s Role When a Patient Requests Medical Aid in Dying”, stating that nurses:

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

• Have an ethical duty to be knowledgeable about this evolving issue.

• Be aware of their personal values regarding medical aid in dying and how these values might affect the patient-nurse relationship.

• Have the right to conscientiously object to being involved in the aid in dying process. (But “Conscience-based refusals to participate exclude personal preference, prejudice, bias, convenience, or arbitrariness”)

• Never “abandon or refuse to provide comfort and safety measures to the patient” who has chosen medical aid in dying (Ersek, 2004, p. 55). 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)

But while the ANA is states that “It is a strict legal and ethical prohibition that a nurse may not administer the medication that causes the patient’s death“, it is silent when some states with assisted suicide laws like Washington state’s where Governor Jay Inslee signed a new expansion to the law in April 2023 to “allow physician assistants and advanced nurse practitioners to be one of the medical providers who sign off on the procedure”, “eliminates a two-day waiting period for prescribing the drugs” and “allow the necessary drugs to be mailed to patients instead of picked up in person”. (Emphasis added) https://www.axios.com/2023/04/24/washington-death-with-dignity-law

CONCLUSION

NAPN opposes both AMA resolutions and the ANA policy on assisted suicide, not only for the safety and welfare of our most vulnerable people but also because there are now many state and national medical professional organizations that support assisted suicide, and other problematic ethical issues and this will have a discouraging effect on idealistic, ethical people considering or remaining in health care which would be devastating to our trust in the healthcare system itself.

Repost from 2018: My Book Review on “Nurses and Midwives in Nazi Germany: The ‘Euthanasia Programs’”

nancyvalko conscience rights, culture, disability, economics, euthanasia, food and water, law, medical ethics, mental health, nursing

In view of the current war in the Middle East, I am reposting this blog. I was shocked to learn that 31 US states don’t require schools to teach about the Holocaust.

When I was in school in the 1960s, we not only learned about the Holocaust but also read Anne Frank’s book “The Diary of a Young Girl”. We were both horrified and inspired by her courage.

In nursing school in 1969, we nurses were taught about the Holocaust as the lowest point in medical ethics and we took medical ethics very seriously. Tragically, now the majority of nursing and medical schools do not include Holocaust and genocide studies in the curriculum. In view of the current deterioration in healthcare ethics, these schools should require it.

“Nurses and Midwives in Nazi Germany-The ‘Euthanasia Programs’”
Edited by Susan Benedict and Linda Shields
Routledge Studies in Modern European History. London: Routledge 2014

My book review (abstract) was just published in the Linacre Quarterly journal. Here are some excerpts from my review. with all emphasis added only for this blog.

In my nursing education during the 1960s, the Nazi euthanasia program was covered during a class but mainly as a ghastly aberration that was unthinkable today with our now strong ethical principles. As students, we were shocked and horrified by the revelation that nurses were integral to Nazi killing programs. We had little knowledge of the mechanisms that existed to encourage nurses to kill those patients whose lives were deemed “not worth living.”

Unfortunately, it is difficult these days to find information about nurses during the Nazi regime, even on the American Nurses Association website. Thus, the editors of this book do nurses and the public a great service by examining the little-known but crucial role of nurses in the Nazi euthanasia programs. Knowing this history is more important than ever as efforts to legalize assisted suicide and euthanasia continue to grow.

The authors explain the history, education, propaganda, and pressures that led so many nurses to participate in the killing of hundreds of thousands of helpless men, women, and children in the 1930s and 1940s; they also propose a model for teaching nursing ethics using the Nazi euthanasia program to encourage nursing students to examine ethical principles and their own values as a nurse in today’s health-care system.

……

The authors start with the rise of the influential eugenics movement in the early twentieth century in countries like the United States where the American Eugenics Society even held conferences on eugenics, such as the 1937 one which included the topic “The Relation of Eugenics to the Field of Nursing.” Eventually, the US eugenics movement fell out of favor after the Nazi euthanasia programs were discovered in World War II.

Even prior to World War II, German professional nursing publications discussed eugenics as “providing a scientific basis for the positive eugenics promoting reproduction among the healthy (often of northern European descent) middle to upper classes and negative eugenics encouraging limited reproduction and forced sterilization of the ‘unfit’ (who were often poor, uneducated, and more recent immigrants) as reasonable”.  Eugenic language was most prevalent in public health and psychiatric nursing texts and in discussions of poverty, immigrants, cleanliness, and social problems.

The editors also point to the influence on Adolf Hitler of the 1920 book titled Approval of the Extermination of Worthless Human Lives by Germans Karl Binding, a jurist, and Alfred Hoche, a psychiatrist. Binding and Hoche noted that there were no legal arguments preventing legalizing the killing of those whose lives were considered not worth living. (Emphasis added)

There was extensive propaganda aimed at increasing the acceptance of euthanasia by the public and health-care providers. Only a few months after Hitler seized power, the first law, affecting people diagnosed with psychiatric conditions, was passed. It mandated sterilization for people with hereditary disorders including alcoholism and epilepsy. Propaganda emphasized wastefulness of providing health care to the chronically mentally ill and the hereditary nature of undesirable physical, mental, and social traits.

Hitler did not propose the systematic killing of psychiatric patients during peacetime because he anticipated the opposition of the churches and the German people. The beginning of World War II muted moral objections and distracted the populace with concerns of conserving resources for the war effort and was the start of state-sponsored euthanasia. The first documented killing occurred in 1939 when Hitler granted the euthanasia request of a father whose son was born blind, missing a leg and part of an arm and who “seemed to be an idiot” .

In 1939, the German Ministry of Justice proposed two new clauses:

1.“Whoever is suffering from an incurable or terminal illness which is a major burden to himself or others can request mercy killing by a doctor, provided it is his express wish and has the approval of a specially empowered doctor.”

2. “The life of a person who, because of incurable mental illness, requires permanent institutionalization and is not able to sustain an independent existence may be prematurely terminated by medical measures in a painless and covert manner” . (Emphasis added)

The program started targeting those in asylums and the disabled in nursing homes for death by lethal gas, starvation, drugs, and neglect. The Jewish population was especially targeted regardless of health.

………

In 1933, Adolf Bartels, the deputy leader of the Reich’s medical profession, provided a blueprint of the future of nursing under the Nazis. He emphasized that German nurses in social and medical service had to meet standards in the new Reich that were very different from before. The new Reich not only wanted to look after the sick and weak but also wanted to secure a healthy development of all Germans “if their inherited biological predisposition allows for it” (p. 38). Above all, the new state wanted to secure and promote a genetically sound, valuable race, and, in contrast to the past, “not to expend an exaggerated effort on the care of genetically or racially inferior people”. (Emphasis added)

As a Nazi politician stated, “a nurse is the one who should carry out the will of the State in the health education of the people”. It was not necessary for the majority of nurses to become ardent supporters of the Nazi regime for them to do the will of the Reich. One source noted that the majority of nurses who participated in a secret euthanasia program known as T4 tried to remain good nurses; an estimated 10 percent or fewer were enthusiastic supporters of Nazi practice. But, as in other areas of public life, the Reich absorbed professional nursing organizations, leaving the nursing profession with no means of expressing opposing or dissenting views as well as no organizational support for refusing to participate. (Emphasis added)

……

Using midwives, the Reich took various measures both to prevent those regarded as having a “hereditary disease” or who were “racially inferior” from reproducing while increasing the birth rate of those considered valuable and healthy. Thus, the traditional midwife focus on the mother and child was changed to focus on the nation as a whole.

Midwives could initiate proceedings for forced sterilization, and it was now a duty for midwives to report to public health officers “deformed” births and small children with disabilities before their third birthday. Reports received from doctors and midwives were reviewed by medical examiners, and based solely on the reports, the examiners decided whether the child was to be killed or spared.

Parents with such children were told about institutions for children who needed special care that were being established through the country. They were persuaded to admit these children and were assured that the children would receive the best possible care. Parents could refuse but had to sign forms stating their responsibility to supervise and care for their children. The identified children in these institutions were killed by starvation or lethal injection. Parents were told that their children had died from natural causes.

……..

The world was riveted by the 1945 Hadamar trial, the first mass atrocity trial after the Nazi regime was defeated in World War II. This trial came before the infamous Nuremburg trials that included doctors. Hadamar was covered extensively by American media but ignored by the American Journal of Nursing even though nurses were charged.

The trial involved one of the largest and most important killing centers, Hadamar Psychiatric Hospital, one of the six institutions in Germany designated for killing the mentally ill. In 1943, a ward (called an “educational home”) was set up for mixed-race children with Jewish heritage within Hadamar. Completely healthy children were killed with lethal injections. The actual numbers are not known because employees were required to take an oath of secrecy. It is estimated that more than 13,000 patients were killed in 1941 and 1942, even before the ward was set up.

In the first Hadamar trial, Head Nurse Irmgard Huber was tried with six others for killing over 400 men, women, and children. Nurse Huber was charged with “obtaining the lethal drugs, being present when some of the fatal injections were given, and being present when the false death certificates were made out”. Two male nurses were charged with administering the lethal injections. All pleaded not guilty. Their defense was that they were powerless and had inadequate knowledge to judge the morality of their actions. All denied accountability. (Emphasis added)

Trial testimony confirmed that the nurses prepared patients for their deaths, directed the entire nursing staff of the institution, and were present at the daily conferences where the falsified death certificates were completed. Duties to patients were limited to so-called kindnesses that consisted of bringing small gifts to pediatric patients and taking care to prevent patients from knowing that they would soon be killed. Head Nurse Huber insisted that she wished to render a last service to these patients and did not want to do them any harm and that she had a clear conscience.

…….

The second Hadamar trial in 1947 did not receive the same attention as the first. Twenty-five members of the Hadamar staff were charged. At this trial, Head Nurse Huber was charged with killing 15,000 German mental patients. All but one of the defendants were found guilty and served sentences ranging from two and a half to five years. The one nurse found not guilty claimed she had feigned pregnancy in order to achieve release from the killing center. (Emphasis added)

In the end, Head Nurse Huber was released from prison in 1952; the others by 1954.

………

The book presents a model used for two innovative teaching programs about this subject, one in Israel and one in Australia, perhaps the most important contribution of this book. The editors believe that the Nazi era should be taught to students, “highlighting the danger of failing to see each individual as a valuable member of human society. And while the heart of nursing and midwifery continues to be care and caring practices, it is fundamental for students to confront this history to develop insights into the causes and social constructs that enabled nurses and midwives to distort the goal of nursing practice and theory to harm and murder patients.”

The results of these programs and the responses by students appear encouraging. The editors hope that by raising these issues, students will be forced to confront their own values and beliefs, sometimes an intensely uncomfortable experience. They also believe students who are exposed to this “dark element of nursing and midwifery history” will be better prepared to face pressure or to report and oppose violations of the trust that is central to any relationship between nurses and patients

CONCLUSION

Decades after the Nazi atrocities, we are seeing a resurgence of the same “life unworthy of life” justification that drove Nazi eugenics. We see how this perspective increasingly approves the deliberate termination of some lives as “merciful” and “humane.” There is an emerging, shocking consensus that we can—or perhaps even should—choose to have our own lives terminated when our lives are considered not worth living either by ourselves or by others if we cannot speak for ourselves.

The authors of this book make it clear: we all need to know and understand the past in order not to repeat it. Hopefully, it is not too late to turn the tide of history back toward respect for all life.

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Planned Parenthood’s Expansion into “Transgender Care”

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

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

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

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

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

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

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

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

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

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

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

CONCLUSION

As the article points out:

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

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

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

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

Catholic Hospital in Canada Under Fire for Naming Euthanasia Provider as Palliative Care Director-Why Should We Care?

nancyvalko AMA, assisted suicide, Compassion & Choices, conscience rights, dementia, disability, economics, education, end-of-life, euthanasia, food and water, futility, hospice, law, media, medical ethics, mental health, nursing, palliative care, terminal/palliative sedation, ventilators/life support, VSED

In a shocking Sep 16, 2023 article from the Catholic News Agency titled Catholic hospital under fire for naming euthanasia provider as palliative care director | Catholic News Agency, Dr. Danielle Kain, a palliative care specialist who is associate professor and division co-chair of palliative medicine at Queen’s University, was appointed to the directorship of palliative care at Providence Hospital in Kingston, Ontario in Canada despite being “is both a staunch proponent and practitioner of euthanasia.”

Providence Hospital is one of 22 health care institutions in Ontario under the sponsorship of Catholic Health Sponsors of Ontario (CHSO). Canada has one of the most expansive assisted suicide laws in the world and is now considering adding people whose sole medical condition is mental illness. (Emphasis added)

The article also states that “Kain has argued that all publicly funded institutions, including Catholic hospitals, should be compelled to offer MAiD (Medical Aid in Dying) She has also expressed support for the Effective Referral Policy: doctors who have conscientious objections to euthanasia must refer patients to MAiD-offering doctors. In a 2016 Twitter post, Kain wrote: “Making an effective referral is not an infringement of rights.” (All emphasis added)

And

“A variety of professional associations of Canadian Catholic health care providers, including the Canadian Federation of Catholic Physicians, have made appeals to both the CHSO and the local ordinary, Archbishop Michael Mulhall, to intervene….but “The archbishop’s office did not respond before publication to a request for comment.” (Emphasis added)

RECENT HISTORY

In 2019, The National Association of Pro-life Nurses joined the Euthanasia Prevention Coalition USA and other organizations in opposing the  Palliative Care and Hospice Education and Training Act (2019) H.R. 647, S.2080 (known as PCHETA) introduced in the US Congress.

We stated that:

“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.

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)

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.”

NOW A NEW PCHETA BILL HAS NOW BEEN PROPOSED

The 2019 PCHETA did not pass in Congress but now a new and almost identical version US SB2243 has just been has been introduced into the US Senate.

A new addition is included to “develop and implement a strategy to be applied across the institutes and centers of the National Institutes of Health to expand and intensify national research programs in palliative care in order to address the quality of care and quality of life for the rapidly growing population of patients in the United States with serious or life-threatening illnesses.”(Emphasis added)

A letter of support for the new 2023 PCHETA bill was signed by a multitude of groups including the Alzheimer’s Association, American College of Surgeons, American Academy of Pediatrics, American Geriatrics Society, the American Heart Association, American Psychological Association, Association of Pediatric Hematology/Oncology Nurses, American Academy of Association of Professional Chaplains, Hospice Action Network Hospice and Palliative Nurses Association, Leukemia & Lymphoma Society Motion Picture & Television Fund, etc.

Even the United States Conference of Catholic Bishops (USCCB) and the Catholic Health Association of the United States have also sent a letter of support for the 2023 PCHETA, citing that it “includes crucial clarifications which ensure that the palliative and hospice care training programs abide by the provisions found in the Assisted Suicide Funding Restriction Act of 1997 (P.L. 105-12) and are not furnished for the purpose of causing or assisting in causing a patient’s death for any reason.” Unfortunately, as we have long observed, practices such as terminal sedation, withdrawal of food and water, etc. are routinely called just “patient choice” or routine comfort care-even in Catholic institutions.

And, as lawyer Sara Buscher of the Euthanasia Prevention Coalition USA writes, the 2023 HHS Office of Inspector General’s report cites problems with hospice and she says that the PCHETA’s “safeguards are illusions”, “unenforceable and pretty much meaningless.”

CONCLUSION

In September 3, 2023 article titled ” by Jonathan Turley, a 19 year-old woman with is critically ill with a rare genetic mitochondrial disease that is progressively degenerative but conscious and communicative and on a ventilator, feeding tube and dialysis wanted to be allowed to travel to Canada for an experimental treatment but doctors opposed her plan saying that “she is not accepting the realities of her terminal illness.” She and her family appealed to a court but “Nevertheless, the judge found that she is mentally incapable of making decisions for herself because “she does not believe the information she has been given by her doctors”  and “Accordingly, the court ruled that decisions about ST’s further care should be determined by the Court of Protection based on an assessment of her best interests. Her “best interest,” according to the doctors, is to die.” (all emphasis added)

As lawyer Turley writes: “Thus, the courts have declared that ST cannot choose to continue life-extending treatment and can be forced into palliative care against her will.”

Thus the “choice” of a “right to die” can trump the choice of a right to live and even become a “duty to die”.

We need to be able to trust out healthcare system to provide ethical, life-affirming and compassionate care when we need it most.

A good first step would be to make sure the 2023 PCHETA does not become law.