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nancyvalko
A Nurse's Perspective on Life, Healthcare and Ethics
About Nancy Valko, RN ALNC
conscience rights
When Can We End Lockdowns for Covid 19?
January 7, 2021 nancyvalko Covid 19, culture, education, medical ethics, mental health
When the Covid 19 pandemic hit the U.S. early last year, little was known about this new infection.
But as the highly contagious Covid 19 virus was spreading around the world, President Trump issued a proclamation on March 12, 2020 declaring a national emergency with "preventive and proactive measures to slow the spread of the virus and treat those affected" and state lockdowns began.
Regular healthcare became virtually suspended as states went to lockdown with rules to shelter in place except for essential errands or work. Schools and many businesses were closed.
On March 18, the Centers for Medicare and Medicaid Services recommended that hospitals cancel all elective surgeries and nonessential medical, surgical and dental procedures to prepare for the expected deluge of patients with Covid 19 and the health system complied.
Then, although it received little media notice, a May 19, 2020 letter to President Trump signed by over 600 doctors detailed the physical and mental impact of the lockdown in the US due to Covid 19, calling it a "mass casualty incident" with "exponentially growing negative health consequences" to millions of non-COVID patients.
The doctors' letter stated that:
"Suicide hotline phone calls have increased 600%," the letter said. Other silent casualties: "150,000 Americans per month who would have had new cancer detected through routine screening."
"Patients fearful of visiting hospitals and doctors' offices are dying because COVID-phobia is keeping them from seeking care. One patient died at home of a heart attack rather than go to an emergency room. The number of severe heart attacks being treated in nine U.S hospitals surveyed dropped by nearly 40% since March. Cardiologists are worried "a second wave of deaths" indirectly caused by the virus is likely."
"The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse."
"It is impossible to overstate the short, medium, and long-term harm to people's health with a continued shutdown," the letter says. "Losing a job is one of life's most stressful events, and the effect on a person's health is not lessened because it also has happened to 30 million [now 38 million] other people. Keeping schools and universities closed is incalculably detrimental for children, teenagers, and young adults for decades to come." (All emphasis added)
Then on October 4, 2020, the Great Barrington Declaration was written and released by three public health experts from Harvard, Stanford, and Oxford. The Declaration was eventually signed by thousands of doctors and experts from around the world. The Declaration encouraged governments to lift lockdown restrictions on young and healthy people while focusing protection measures on the elderly.
These experts surmised that this would allow COVID-19 to spread in a population where it is less likely to be deadly, encouraging widespread immunity that is not dependent on a vaccine.
The Declaration stated:
"Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice. "
The Declaration was swiftly met with intense criticism from other medical experts who called the plan "practically impossible and highly unethical".
As the numbers of people with Covid 19 and who died from Covid 19 went up and down over the months, various U.S. states and counties ordered different degrees of lockdown and now many states seem to be guided more by politics than science when it comes to lockdowns.
We now have more people with Covid 19 surviving and leaving the hospital sooner due to a better understanding of what treatments work best in comparison to what was known when the pandemic started in the US.
And although seemingly impossible at first, new vaccines have been developed for Covid 19 and began being distributed in December 2021 due to Operation Warp Speed. Despite the controversy about some Covid 19 vaccines, it is hoped that the widespread use of vaccines may help the U.S. end the lockdowns.
In addition, the FDA (food and Drug Administration) approved the use of several rapid Covid 19 tests, some that can even be done at home. This can be a gamechanger with some experts saying that the massive distribution of rapid self-tests for use in homes, schools, offices, and other public places could replace harmful sweeping lockdowns with knowledge.
Lockdowns have caused enormous economic, physical, social and mental upheaval in the US.
When lockdowns are intermittent in intensity and duration in some states without clear scientific evidence that the lockdowns are working, it seems we need a reevaluation of their usefulness as we evaluate other measures to help end the Covid 19 pandemic.
Should a Covid 19 Vaccine be Mandatory?
December 17, 2020 nancyvalko Covid 19, law, medical ethics, vaccines	vaccines
As the first Americans are receiving a Covid 19 vaccine, a December 5 2020 Gallup poll reports that 63% of Americans say they are willing to take the vaccine. 37% are less willing, including some groups like non-white people and Americans age 45-64. But the percentage of Americans currently willing to get vaccinated may still be below where public health experts want it.
Now, there is a proposed bill in New York to make getting the vaccine mandatory to get sufficient immunity if not enough people are voluntarily getting them.
Why are some people unwilling to get the vaccine?
As I wrote in my last blog "Ethics and the Production of Covid 19 Vaccines", many people are concerned about the use of aborted fetal cells in some vaccines. I also included two lists of vaccines and whether or not such fetal cells were involved in their production. One list is from the Charlotte Lozier Institute and one is from the Children of God for Life organization. (The Charlotte Lozier Institute does disagree with the Children of God for Life organization on the Moderna vaccine.)
Other potential concerns are about the safety, side effects and the effectiveness of the vaccines.
EFFECTIVENESS AND SAFETY
A December 3, 2020 MedPage investigative article "Want to Know More About mRNA Before Your COVID Jab?" states that "While an mRNA vaccine has never been on the market anywhere in the world, mRNA vaccines have been tested in humans before, for at least four infectious diseases: rabies, influenza, cytomegalovirus, and Zika."
The Covid 19 vaccines use a synthetic mRNA, which is genetic information used to make the SARS-CoV-2 spike protein. When injected, the body produces a strong response to that protein to produce an immune response.
How long that response lasts is still unknown.
But, especially for certain groups of people, there are also concerns about safety.
According to the CDC (the U.S. Center for Disease Control) regarding immunocompromised patients such as those with HIV or who take immunosuppressive medications or therapies may take the vaccine but should be counseled about:
"– Unknown vaccine safety and efficacy profiles in immunocompromised persons
– Potential for reduced immune responses
– Need to continue to follow all current guidance to protect themselves against COVID-19″
Also according to the CDC, "There are no data on the safety of Covid 19 vaccines in pregnant women" but "Animal developmental and reproductive toxicity (DART) studies are ongoing" and more studies are planned.
Regarding breastfeeding, the CDC states that "There are no data on the safety of COVID-19 vaccines in lactating women or the effects of mRNA vaccines on the breastfed infant or milk production/excretion"
In a Nov. 23, 2020 CNBC article "Doctors say CDC should warn people the side effects from Covid vaccine shots won't be 'a walk in the park", a group of doctors told the CDC to warn people that the Covid 19 vaccine shots now being rolled out may have "some rough side effects so they know what to expect and aren't scared away from getting the second dose."
And a December 9, 2020 article in the Wall Street Journal "Covid-19 Vaccines Pose Potential Side Effects, Doctors Say" reported that "U.K. authorities warn people with severe allergies against receiving the Pfizer-BioNTech shots, after two Britons experience allergic reactions."
But a STAT news article a few days later on December 13, 2020, now reports that the CDC has changed its position from "Persons who have had a severe allergic reaction to any vaccine or injectable therapy (intramuscular, intravenous, or subcutaneous) should not receive the Pfizer-BioNTech vaccine at this time"(emphasis added) to that people who had "severe reactions to prior vaccines or injectable drugs can still get the Pfizer/BioNTech vaccine for Covid-19, but should discuss the risks with their doctors and be monitored for 30 minutes afterward".
Another concern is that although states rely on the percentage of positive Covid 19 tests for lockdown and other orders, there are many kinds of tests and both false positive and false negative results have been reported.
No wonder many people are confused and anxious!
SHOULD COVID 19 VACCINES BE MANDATORY?
Now we are seeing Covid 19 vaccines being rapidly distributed and more Covid 19 vaccines are coming, including a Johnson and Johnson single dose Covid 19 vaccine that is in testing and the results may be known by January.
Currently, the health care workers and residents and staff of long-term care facilities have first priority for a Covid 19 vaccine.
Although states have the authority to regulate public health and they have in the past mandated vaccines for diseases like smallpox and some mandatory vaccines are required by states before children can attend school, it seems unlikely that there will be a federal mandate for the Covid 19 vaccine.
It is more likely that only certain groups of people may be required to take the vaccine like healthcare workers, universities and some employers. Even then, the Civil Rights Act of 1964 may help people who have a religious objection to a vaccine as well as anti-discrimination laws and exemptions for medical reasons. An employer would have to make a reasonable accommodation as long as it's not too costly for the business.
It is also possible that airlines, stores, stadiums could also make vaccination a condition of doing business with a person.
The Covid 19 pandemic has taken a serious toll on everyone and we will not get back to "normal life" anytime soon, even with the Covid 19 vaccine.
But we still must make sure that any Covid 19 vaccines we take are ethical, effective and safe.
Ethics and the Production of Covid 19 Vaccines
December 2, 2020 December 16, 2020 nancyvalko abortion, Covid 19, medical ethics
I am hopeful that the new Covid 19 vaccines that are being approved soon will help stop Covid 19 but, like many people, I only want to take a vaccine that does not use cell lines from aborted babies.
But that information can be hard to find, confusing and the facts are sometimes disputed.
For example, a November 18, 2020 article from the Associated Press titled "Lung tissue from aborted fetus not used in AstraZeneca vaccine development" disputes an online video that claims tissue from an aborted baby was used. I discovered later that this AP headline was inaccurate.
And there are disputes even in Catholic and other religious circles.
For example, some Catholic bishops and priests questioned the use of some vaccines before Archbishop Naumann and Bishop Rhoades from the USCCB (the US Catholic bishops conference) wrote a memo citing three Vatican documents and stating that:
"Neither the Pfizer nor the Moderna vaccine involved the use of cell lines that originated in fetal tissue taken from the body of an aborted baby at any level of design, development or production. They are not completely free from any connection to abortion, however, as both Pfizer and Moderna use of a tainted cell line for one of the confirmatory lab tests of their products."
"There is thus a connection, but it is relatively remote," they continued. "Some are asserting that if a vaccine is connected in any way with tainted cell lines, then it is immoral to be vaccinated with them. This is an inaccurate portrayal of Catholic moral teaching."
"Most importantly, they all make it clear that, at the level of the recipient, it is morally permissible to accept vaccination when there are no alternatives and there is a serious risk to health."
However, other articles like the National Catholic Register's Nov. 25, 2020 "Measuring Moderna's COVID-19 Vaccine: Now's the Time to Press Hard for Ethical Options" by Stacy Trasancos, PhD, MA and Children of God for Life's Nov. 16, 2020 article "Moderna Covid-19 Vaccine – Facts – Not Fiction say that kidney cells from aborted babies were used in the development of the Moderna Vaccine but also adds that there are plenty of other ethical vaccines being developed.
After weeks of investigation, I found the simplest explanation of the vaccine production process and its' potential problems at The Charlotte Lozier Institute website.
I also found the most expansive list of current potential vaccines at the Institute's Update: COVID-19A Vaccine Candidates and Abortion-Derived Cell Lines. (The Institute does disagree with Dr. Trasancos and the Children of God for Life organization on the Moderna vaccine.)
For myself, I do want the Covid 19 vaccine when it is available but I will make sure that I am given one of the ethically uncontroversial vaccines. I will also insist on adequate information on the safety of such vaccines before I take the vaccine.
I am adding this addendum to my latest blog after I discovering some new information from both a medical and a pro-life website (LifeSiteNews December 4, 2020 article "Pfizer COVID jab warning: "No breastfeeding, avoid pregnancy for 2 months, unknown fertility impacts" about the possible effects of the Pfizer Covid 19 vaccine on pregnant and breastfeeding moms.
This disturbing news and another link from a blog reader made me realize that we must have confidence that any Covid 19 vaccine will be safe as well as ethically produced.
Therefore, I have added a final line to my blog: "I will also insist on adequate information on the safety of such vaccines before I take the vaccine."
Nancy Valko, RN ALNC
Caring for an Elderly Relative who Wants to Die
November 20, 2020 November 22, 2020 nancyvalko aging, assisted suicide, Compassion & Choices, disability, end-of-life, food and water, law, medical ethics, nursing, palliative care, terminal/palliative sedation
I was disturbed but not really surprised when I read the October 21, 2020 New England Journal of Medicine article by Scott D. Halpern, M.D, Ph.D., titled "Learning about End-of-Life Care from Grandpa".
Dr. Halpern, a palliative care doctor and ethicist at the University of Pennsylvania, wrote about his elderly grandfather who had been widowed for the third time and wrote "My life was over too, only existence remained," in a memoir for his family.
As Dr. Halpern writes, "It was downhill from there" as his grandfather coped with challenges like blindness, deafness and arthritis.
Family members offered to care for him but the grandfather chose to go into an assisted living facility where family members could visit him frequently. But then, Covid 19 visitations cut him off entirely from the outside world.
Eventually, the grandfather was allowed to see relatives one at a time outdoors at the facility.
Nearing his 103rd birthday, the grandfather started asking Dr. Halpern about "any plausible option to hasten death".
New Jersey had recently approved physician-assisted suicide, but Dr. Halpern was "ambivalent" about that option. In addition, his grandfather did not have a terminal illness but rather was "dying of old age, frailty, and more than anything else, isolation and meaninglessness".
Alarmingly, Dr. Halpern found that the medical code for this diagnosis called "adult failure to thrive" was being used not only used to access hospice but also to access physician-assisted suicide in some states.
Unable to find a New Jersey doctor willing to use physician-assisted suicide on his grandfather anyway, Dr. Halpern offered his grandfather the option of VSED (voluntarily stopping of eating and drinking) to hasten or cause death that the pro-assisted suicide group Compassion and Choices touts as "natural" and legal in all states.
THE TRUTH ABOUT VSED
Dr. Halpern wrote that his grandfather had trouble refusing food and water on his own. He started and stopped the process a few times.
Dr. Halpern was not surprised, writing that:
" For people with a consistent desire to end their life, unencumbered by mental illness or immediate threats to their survival, the only alternative — to stop eating and drinking — is just too challenging. Hospice experts around the country had warned me that less than 20% of people who try to do so "succeed," with most reversing course because of vicious thirst." (Emphasis added)
Finally, Dr. Halpern' write that his grandfather said "I just want it over with. Scott, do whatever you need to do."
Dr. Halpern writes that he consulted his hospice team and began treating his grandfather's thirst "as I treat other forms of discomfort — with morphine and lorazepam" (Emphasis added)
Even then, it took 12 long days for his grandfather to finally die.
The lessons that Dr. Halpern says he finally learned were that:
"despite many problems with physician-assisted dying, it may provide the most holistic relief possible for people who are not immediately dying, but rather are done living."
"stopping eating and drinking is largely impossible without knowledgeable family members and dedicated hospice care." (All emphasis added)
Dr. Halpern obviously loved his grandfather and tried to meet his grandfather's emotional and physical needs before telling him about the VSED option and eventually adding terminal sedation. And it seems that the imposed isolation because of potential Covid 19 infection was especially devastating for his grandfather.
But his justification for physician-assisted suicide as "the most holistic relief possible for people who are not immediately dying, but rather are done living" is chilling.
Unfortunately, that is an attitude seen all to often in medical professionals that has led to the expansion of some assisted suicide laws from terminal illness to non-terminal conditions like "completed life" and disabilities.
Both personally and professionally as a nurse, I know how difficult it can be on families when caring for a family member-especially an older relative-who says he or she wants to die.
But I also know that while we all can have sympathy for someone who says they want to die, the word "no" can be a powerful and loving response. The real answer is to help make living as good and meaningful as possible until death.
For example, I became the only caregiver when my elderly aunt developed diabetes and late-stage pancreatic cancer in 2000.
I went to doctor visits with her and went over the options with her. My aunt rejected chemo and radiation that had only a small chance of even slowing the cancer. She also refused hospice.
I offered to care for her in my home with my 15 year old daughter who also wanted to help. However my aunt felt it would cramp my daughter's lifestyle so she decided to stay in her own home until she died.
So I helped her at home and purchased my first cell phone so that she could contact me at anytime. At that time, I was a single parent and worked full time nights in an ICU.
However, one day my aunt asked me about stopping her insulin to die faster. I told her how that could put her at risk for a heart attack or stroke from high blood sugar with no one there to help.
So she changed her mind and then even began opening up about her condition with others. She was stunned when people told her how inspiring she was and offered to help her in any way.
My aunt became happier than I had ever seen her.
Eventually, my aunt did accept hospice care at a facility she knew. I visited and called often. My aunt was physically comfortable and alert.
One day when my daughter and I went to visit her, we found that she had just died quietly in her sleep. The nurses had just stepped out to call me.
My daughter later wrote a beautiful essay about her first experience with death for her high school and received an A+. Her essay was later published on a nursing website.
In the end, causing or hastening death does not really solve anything but rather can be seen as an abandonment of the suffering person and a destroyer of the necessary trust we all must have in the ethics of our healthcare system.
We must never discriminate when it comes to helping anyone contemplating suicide.
Shout Your ADOPTION!
October 22, 2020 nancyvalko abortion, adoption, Planned Parenthood
The National Association of Pro-life Nurses (NAPN) has loved to feature stories about adoption and wants to feature more such stories on our website.
As our president Sue Meyers has written:
"We have named the program, "Shout Your Adoption."
We would like to include more stories of adoption in our newsletter. Pro-Life people are all about offering alternatives to abortion and many adopt babies, children with disabilities and hard-to-place children. As a grandmother to a three-year-old, adorable (just ask me) grandson, I cannot imagine life without Andrew.
Please send your stories to me at lmeyers@nethtc.net .Don't worry about getting it written perfectly, we will polish it, if necessary. We won't use names unless you give us permission. Thank you so much! I can't wait to read your stories!"
When a new life is unexpected and in difficult circumstances, women are often encouraged or even coerced into an abortion and not considering the adoption option.
I saw this myself when my 18 year old daughter became pregnant in 1998.
But when my daughter received help and support, she chose adoption and never regretted knowing her daughter was in loving hands.
These stories may not only help future mothers and babies but also their families and other loved ones. And, especially today, with Planned Parenthood's "Shout Your Abortion" promotion, our society really needs to hear these pro-life stories.
In 2012, I wrote an article about my my daughter's and our family's adoption story for Voices magazine titled "Open Adoption: A Love Story" in the hope that other women and their families would be helped by our story.
I hope you will consider writing yours!
Protecting Premature Babies and Abortion Survivors
October 9, 2020 nancyvalko abortion, futility, law, medical ethics, ventilators/life support
On September 25, 2020, President Donald Trump signed an "Executive Order on Protecting Vulnerable Newborn and Infant Children" that states:
"Every infant born alive, no matter the circumstances of his or her birth, has the same dignity and the same rights as every other individual and is entitled to the same protections under Federal law. "
This executive order came after Speaker NancyPelosi and House Democrats refused to allow a vote on the "Born Alive Abortion Survivors Protection Act" over 80 times.
ELLIOT AND EMERY
The new executive order protects not only babies who survive abortions but also those babies born prematurely like twins Emery and Elliot who were denied medical treatment after being born at 22 weeks and 5 days, despite a doctor's prior assurances and despite the parents' desperate pleas for treatment after the boys were born.
In an interview, the twins' mother Amanda told me that the doctors predicted the babies would be stillborn or die shortly after birth because of their prematurity. However, the doctors were wrong: one of the boys lived for 45 minutes and the other for 2.5 hours.
Amanda and Shaun Finnefrock, the twins' parents, have been active ever since their boys' deaths in 2017 , advocating for "equal protection, equal treatment, the equal opportunity for survival — whether they survived an abortion or their mothers wanted them to live, like I did mine."
They have been working on an Elliot and Emery's Law for their home state of Ohio to protect other prematurely born babies.
Unfortunately, a 2015 University of Iowa study found that infants born at 22 weeks received potential lifesaving treatment at fewer than one in four hospitals. Almost all hospitals, the researchers found, will treat infants born at 25 weeks, but there is substantial variation among hospitals on whether they actively treat infants born at 23 or 24 weeks.
One obstacle is the fear that premature babies will be at an increased risk of disability as a result of the prematurity. But it is impossible to know at birth if the newborn will have disabilities because of prematurity.
The good news is that studies are now finding that the majority of premature babies born at 22 weeks survive if given care.
When I started my nursing career over 50 years ago, babies more than 3 months premature routinely died because of breathing problems. But when ventilators and especially surfactant to protect the babies' lungs were developed, "preemies" started to be saved at earlier and earlier stages with good results.
But most importantly, this progress was made because of the willingness of both parents and doctors to try to save these babies that made all the difference.
Think the Political and Cultural Divisions in Our Country are Bad? The Divisions in Medical Ethics Could Cost Your or a Loved One's Life!
September 21, 2020 September 27, 2020 nancyvalko abortion, advance directives, AMA, assisted suicide, brain death, brain injury, Compassion & Choices, conscience rights, euthanasia, food and water, law, medical ethics, nursing, Planned Parenthood
I wanted to be a nurse since I was 5. I was drawn to nursing not only because I wanted to help people but also because medical ethics standards were so high, especially in contrast to some of the corrupt business practices that I saw.
I graduated from a Catholic nursing school in 1969 and spent the next 50 years working mostly in intensive care but also in home health and hospice, oncology (cancer), kidney dialysis, volunteer work and on ethics committees.
I first noticed the change in medical ethics when the US Supreme Court's Roe v. Wade decision in 1973 legalized abortion for the first three months of pregnancy. I was working in intensive care at the time and found that my fellow medical professionals who supported the abortion decision angrily rebuked those of us who were shocked that the first rule of medical ethics we were taught-First, Do No Harm-was eroding.
Then in 1982, my doctor husband and I were shocked by the Baby Doe case where the parents received a judge's approval to let their newborn son with Down Syndrome die instead of repairing an easily correctable hole between the tube that leads from the throat to the stomach and the tube that leads from the throat to the windpipe and lungs. While lawyers were appealing his case and many parents (including my husband and me) wanted to adopt Baby Doe, the newborn starved and dehydrated to death without the desperately needed surgical repair.
My husband asked "What has happened to medical ethics??" but we both knew the answer: babies with Down Syndrome are often unwanted and aborted.
Five months after Baby Doe died, our third child Karen was born with Down Syndrome and a reparable heart defect but the heart doctor gave us a choice to "let" our baby die without surgery. We refused but my former trust in the medical system was shattered.
After I suddenly became a single parent in 1988, I had to return to a paid nursing job to support my three children but found a drastically different medical ethics system.
I found that during the 1970s, medical ethics began to evolve into the newer "bioethics", even in Catholic hospitals.
This new bioethics has essentially four principles:
1. Respect for autonomy (the patient's right to choose or refuse treatment)
2. Beneficence (the intent of doing good for the patient)
3. Non-maleficence (not causing harm)
4. Justice ("fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation") Emphasis added.
Unfortunately, those principles are malleable and then used to justify actions and laws that would have been unthinkable when I graduated from nursing school. That bioethics mindset changed not only medical and nursing education but also the principles that informed our work.
Even the Hippocratic Oath, the oldest and most widely known treatise on medical ethics that forbade actions such as abortion and euthanasia that medical students routinely took upon graduation, has now been revised or dropped at many medical schools.
SOME MEDICAL ETHICS DIVISIONS THAT CAN COST YOU OR A LOVED ONE'S LIFE
The American Medical Association, the American Congress of Obstetricians and Gynecologists and the American Nurses Association and other healthcare organization that used to condemn abortion are now supporting "abortion rights".
Abortion on demand and taxpayer-funded has now been deemed a "civil right" by Planned Parenthood and many Democratic politicians throughout pregnancy to birth and even beyond. Alternatives to abortion such as free pregnancy tests, counseling, ultrasounds, maternity and baby clothes, diapers, car seats, bassinets, etc. are not options at Planned Parenthood but rather at non-profit crisis pregnancy centers.
As a parent of an unwed teenage daughter, I support these services and give thanks for my now 22 year old granddaughter.
Assisted suicide/euthanasia
In the early 1970s when I was a young ICU nurse, none of us medical professionals had even heard of a "living will". There was a universal presumption for life and "quality of life" was something to be improved, not judged.
Nevertheless, sick people could and did refuse treatment and even check themselves out of the hospital against medical advice. When patients appeared to be dying, they or their families could agree to a "do not resuscitate" (DNR) order. Treatments could be ethically refused when such measures were considered medically futile or excessively burdensome for the patient. But one thing we didn't do was offer to withhold or withdraw medical care like tube or even spoon feedings to cause or hasten a patient's death. And it was unthinkable that medical professionals could assist even a dying patient's suicide.
Unknown to us, all this began to change after Louis Kutner, a Chicago lawyer, wrote a 1969 article in the Indiana Law Journal titled Due Process of Euthanasia: The Living Will, A Proposal" in 1969. (emphasis added).
By 1970, The Euthanasia Society of America (later renamed the Society for the Right to Die) distributed 60,000 living wills. In 1976, California passed the nation's first "living will" law and in 1990, The US Congress passed the Patient Self-Determination Act that requires information to be given to patients about their rights under state laws governing advance directives (commonly called "living wills), including the right to accept or refuse medical or surgical treatments.
Now, 8 states and the District of Columbia have assisted suicide laws and Compassion and Choices, the largest advocacy group for medically assisted suicide, is using the Covid 19 pandemic to push for telehealth (the provision of healthcare remotely by means of telecommunications) for medically assisted suicide.
In my nursing school 50 years ago, we were taught medical ethics and one example used was the case of a newborn with Down Syndrome who needed life-saving surgery but whose parents refused, choosing to let him die. We were told that the law would protect such children from medical discrimination-even by the parents.
Now we have cases like Charlie Gard and Simon Crosier and others whose parents chose life for their babies with disabilities but were thwarted by doctors and courts.
When I started working in an ICU in 1971, I had questions about the brain death diagnosis for organ harvesting but was told not to worry because there were strict rules.
However and over subsequent years, I discovered that the rules for organ donation have been changing from brain death to other criteria including severe brain injury. There have even been proposals for "presumed consent" state laws where people would have to register an "opt-out" or be automatically presumed to consent to organ donation.
I do not have an organ donor card nor encourage others to sign one. Instead, I once offered to give a friend one of my kidneys as a living donor. Although I was not able to donate then, my family knows that I am willing to donate tissues like corneas, bone, etc. that can be ethically donated after natural death and will only agree to that donation
Doctors and nurses used to be protected when asserting their conscience rights when refusing to deliberately hastening or causing a patient's death.
Now, even that protection-which protects both patients and medical professionals-is under attack.
I discovered this personally several years ago when I was almost fired for refusing to increase a morphine drip "until he stops breathing" on a patient who didn't stop breathing after his ventilator was removed.
The bottom line is that everyone must remain vigilant when they or a loved one becomes seriously ill, regardless of the hospital or institution. It is also important not to be afraid to ask questions.
There are also non-denominational, non-profit groups like the National Association of Pro-life Nurses, the Healthcare Advocacy and Leadership Organization and state and national pro-life organizations that have much useful information and resources for patients, families and the public.
The bottom line is that what we don't know-or allowed to know-can indeed hurt us. We need to demand transparency and the highest ethical standards from our doctors and healthcare system before they can earn our trust.
And without a change in laws, policies and attitudes promoting deliberate death as an answer to human suffering, those of us medical professionals who believe we should never cause or hasten anyone's death may become an endangered species-as well as our medically vulnerable patients.
Surprising New Test for Predicting Recovery after Coma
August 25, 2020 nancyvalko brain injury, disability, medical ethics, nursing
An April 29, 2020 Nature Journal article titled "Olfactory sniffing signals consciousness in unresponsive patients with brain injuries" found that nasal response to odors (sniffing) by 43 severely brain-injured patients predicted the likelihood of recovery and long-term survival.
According to Noam Sobel, PhD, of the Weizmann Institute of Science in Rehovot, Israel, one of the authors of the article and speaking to MedpageToday:
"If you sniff at an odorant, then it's 100% you will regain consciousness to at least a minimal level, and you will likely live for years," he told MedPage Today. "If you don't sniff at an odorant, that is a bad sign, but not all hope is lost." (Emphasis added)
Amazingly, he said that 37.5% of the unresponsive patients who didn't sniff did eventually regain consciousness.
Dr. Giacino, PhD of Harvard Medical School who helped write the 2018 American Academy of Neurology guidance on disorders of consciousness told Medpage that this study is "a cleverly and carefully designed study that adds another much-needed tool to the consciousness-detection toolbox" even though "Between 30% and 60% of patients who sustain severe TBI (traumatic brain injury) have diminished or complete loss of smell due to the mechanics of the injury.")
He also noted that, based on available evidence, about four in 10 patients who are deemed unconscious on bedside examination actually retain conscious awareness and that "A significant portion of these patients have covert consciousness — preserved cognitive function that cannot be expressed through speech or movement." (Emphasis added)
WHY IS THIS STUDY SO IMPORTANT?
As Dr. Giacino said in the Medpage article:
"Published evidence from Canada in a large cohort of ICU patients with traumatic brain injury [TBI] found that approximately 70% of the deaths were due to withdrawal of treatment and in about 60% of cases, the decision to stop treatment was made within 72 hours," he said. "It's possible that a positive sniff test might delay this decision, which is important since we know that about 20% of TBI patients who survive what appears to be catastrophic injury recover to a functionally-independent level by 5 years post-injury." (Emphasis added)
As we have seen over the past decades, whether or not a severely brain-injured person is or can become conscious has become a life and death matter. We have seen this in the cases of Nancy Cruzan, Terri Schiavo and Zach Dunlap even though, as I wrote in my August 18, 2018 blog, "Medical Experts Now Agree that Severely Brain-injured Patients are Often Misdiagnosed and May Recover".
THIS ISSUE HAS BEEN CLOSE TO MY HEART FOR DECADES.
Just before Drs. Jennet and Plum invented the term "persistent vegetative state" in 1972, I started working with many comatose patients as a young ICU nurse. Despite the skepticism of my colleagues, I talked to these patients as if they were awake because I believed it was worth doing, especially if it is true that hearing is the last sense to go. And why not do it to respect the patient as a person?
Then one day a 17 year old young man I will call "Mike" was admitted to our ICU in a coma and on a ventilator after a horrific car accident. The neurosurgeon who examined him predicted he would be dead by morning or become a "vegetable." The doctor recommended that he not be resuscitated if his heart stopped.
But "Mike" didn't die and almost 2 years later returned to our ICU fully recovered and told us that he would only respond to me at first and refused to respond to the doctor because he was angry when heard the doctor call him a "vegetable" when the doctor assumed 'Mike" was comatose!
After that, every nurse was told to treat all our coma patients as if they were fully awake. We were rewarded when several other coma patients later woke up.
Over the years, I've written about several other patients like "Jack", "Katie" and "Chris" in comas or "persistent vegetative states" who regained full or some consciousness with verbal and physical stimulation. I have also recommended Jane Hoyt's wonderful 1994 pamphlet "A Gentle Approach-Interacting with a Person who is Semi-Conscious or Presumed in Coma" to help families and others stimulate consciousness. Personally, I have only seen one person who did not improve from the so-called "vegetative" state during the approximately two years I saw him.
But I never even thought to give any of my patients a sniff test. What a simple test for medical professionals to do!
And even though this study is small and needs to be replicated and validated, I believe it is further evidence that we need to reevaluate our current medical ethics and laws that allow life-sustaining treatment to be withdrawn from people with severe brain injuries on the premise that such brain-injured people have no "quality of life" and that such injuries are routinely hopeless.
And I hope that the sniff test can become a standard part of all medical evaluations of people with severe brain injuries.
The World Brain Death Project: What It Means
August 11, 2020 August 11, 2020 nancyvalko brain death, end-of-life, futility, law, medical ethics, organ donation, ventilators/life support
THE HISTORY OF BRAIN DEATH
In December of 1967, the first successful heart transplant was performed in South Africa by Dr. Christian Barnard. At that time, there were no guidelines for the diagnosis of death for beating heart donors.
In September of 1968, the Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death was published with the purpose of defining irreversible coma as a new criterion for death.
This was done for two stated reasons:
"Improvements in resuscitative and supportive measures have led to increase efforts to save those who are desperately injured. Sometimes these efforts have only partial success so that the result is an individual whose heart continues to beat but whose brain is irreversibly damaged. The burden is great on patients who suffer permanent loss of intellect, on their families, on the hospitals and on those in need of hospital beds already occupied by these comatose patients."
"Obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation." (All emphasis added)
This report was quickly accepted by many and in 1968, the Uniform Anatomical Gift Act was passed in the US as a regulatory framework for the donation of organs, tissues and other human body parts. The Act allowed the donation of whole or part of a human body to take effect upon or after the death of the donor.
The Uniform Declaration of Death Act (UDDA) was drafted in 1981 by a President's Commission study to brain death and approved by both the American Medical Association (AMA) and the American Bar Association (ABA). It was intended to provide a model for states to emulate.
It offered 2 definitions of when a person could be declared legally dead to align the legal definition of death with the criteria largely accepted by the medical community:
"Irreversible cessation of circulatory and respiratory functions (the traditional definition of death); or
Irreversible cessation of all functions of the entire brain, including the brain stem (brain death)" (Emphasis added)
The UDDA in some form has since been adopted by all US states and the District of Columbia.
However, in the June 2020 issue of the American Journal of Bioethics, the well-known lawyer/ethicist Thaddeus Mason Pope wrote about a current effort "to revise the Uniform Determination of Death Act (UDDA) to assure a consistent nationwide approach to consent for brain death testing." (Emphasis added)
Why just consent to brain death testing?
According to Mr. Pope:
"Right now, a patient might be legally dead in Nevada, New York, or Virginia (where consent is not required). But that same patient might not be legally dead in California, Kansas, or Montana (where consent is required and might be refused). (Emphasis added)"
Instead, Mr. Pope proposes adding this to the Uniform Determination of Death Act (UDDA):
"Reasonable efforts should be made to notify a patient's legally authorized decision-maker before performing a determination of death by neurologic criteria, but consent is not required to initiate such an evaluation". (Emphasis added)
Mr. Pope states that typically, the Uniform Law Commission (ULC) follows a four-step process to change a law but notes that the Healthcare Law Committee has already skipped the first three steps and is ready for drafting the new language in the fourth step.
Ironically, there was a case last year in Michigan where the parents of a teenager pushed for a Bobby's Law after their son was taken off life support after being declared brain dead despite their objections. The law would "require a minor's parents to consent to withhold or withdraw life-sustaining treatment or to give do-not-resuscitate orders before medical professionals could end life support for a juvenile" and also allow the parents to defer an apnea test (taking the person off a ventilator to see if the person is able to breathe on his or her own) required to determine brain death. (Emphasis added)
THE WORLD BRAIN DEATH PROJECT
In an August 3, 2020 article in the Journal of the American Medical Association (JAMA) titled "Determination of Brain Death/Death by Neurologic Criteria- The World Brain Death Project" , the authors state that due to "inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries", there is a need to "formulate a consensus statement of recommendations on determination of BD/DNC". (Emphasis added)
In a August 3, 2020 Medpage article "Brain Death: What Does It Mean?" on the World Brain Death Project, the writer notes that the "guidelines recommend that consent not be required for apnea testing because of concerns over prolonged somatic support" while quoting a doctor who disagreed:
"Ostensibly, families should be asked to provide consent because the apnea test may lead to cardiovascular collapse in some patients, classifying it as procedure with risk," (All emphasis added)
MY JOURNEY TO DISCOVER THE FACTS ABOUT BRAIN DEATH
Back in the early 1970s when I was a young intensive care unit nurse, no one questioned the new innovation of brain death organ transplantation. We trusted the experts and the prevailing medical ethic of the utmost respect for every human life.
However, as the doctors diagnosed brain death in our unit and I cared for these patients until their organs were harvested, I started to ask questions. For example, doctors assured us that these patients would die anyway within two weeks even if the ventilator to support breathing was continued, but no studies were cited. I also asked if we were making a brain-injured patient worse by removing the ventilator for up to 10 minutes for the apnea test to see if he or she would breathe since we knew that brain cells start to die when breathing stops for more than a few minutes.
I was told that greater minds than mine had it all figured out so I shouldn't worry.
It was years before I realized that these doctors did not have the answers themselves and that my questions were valid.
I discovered that some mothers declared "brain dead" were able to gestate their babies for weeks or months to a successful delivery before their ventilators were removed and that there were cases of "brain dead" people like Jahi McMath living for years after a diagnosis of brain death or even recovering like Zack Dunlap.
If the legal definition of brain death is truly "irreversible cessation of all functions of the entire brain, including the brain stem", these cases would seem to be impossible.
The World Brain Death Project is riddled with potential problems in establishing a worldwide consensus on brain death criteria and testing using a "set of criteria that satisfies the lowest acceptable standard for practice". (Emphasis added) And changing the US Uniform Determination of Death Act to supersede states requiring consent before brain death testing will not inspire trust in the healthcare system or the law.
Personally, I will not sign an organ donor card or allow my organs to be taken by donation after cardiac death (DCD), a new category of severely brain-injured people who are not brain dead but who are on ventilators (breathing machines) and considered hopeless in terms of survival or predicted "quality of life". The ventilator is removed and the patient's heart is expected to stop. (However, a 2016 study showed that 27% of potential donors did not die within the window specified for organ recovery.)
Instead, my family knows that I am willing to donate tissues like corneas, skin, bones, etc. that can be ethically donated after natural death.
It is vitally important that everyone understands all the facts before signing an organ donor card.
And we all should demand transparency and rigorous medical ethics from our healthcare system.
Strongest "Simon's Law" Yet is Passed in Iowa
August 2, 2020 August 6, 2020 nancyvalko brain death, brain injury, futility, medical ethics, ventilators/life support
When baby Simon Crosier was born with Trisomy 18 and a heart defect in 2010, his parents and brothers fell in love with him despite his life-threatening diagnosis and the medical community's opinion that Trisomy 18 is "incompatible with life".
However, just days before three month old Simon was scheduled to see a cardiac surgeon, his parents begged for help at the Catholic hospital treating Simon when his condition started to deteriorate. They were shocked when the staff did not intervene. They did not know that the hospital had made their baby a Do Not Resuscitate and that Simon was given only so-called "comfort feeds" due to a secret futility policy. They had to helplessly watch as Simon died in their arms.
Heartbroken and outraged but determined that this would not happen to another child, the Crosiers went to legislator Bill Kidd who formulated Simon's Law. After five long years of frustration even getting the bill out of committee, Simon's Law was finally and unanimously passed in the Missouri legislature and signed by Governor Mike Parson last year.
The law prohibits "any health care facility or health care professional from instituting a do-not-resuscitate or similar order without the written or oral consent of at least one parent or legal guardian of a non-emancipated minor patient or resident."
I testified on Simon's Law myself because when my own daughter Karen was born in 1982 with Down Syndrome and a heart defect, I was tipped off that my pediatrician had secretly given Karen a Do Not Resuscitate order against my expressed wishes because she felt I "was too emotionally involved with that retarded baby". I protested and the order was withdrawn.
During the fight for Missouri's Simon's Law, other states passed similar laws. Some require only that parents be informed that doctors plan to write a DNR order for a child while others prohibit writing the order over parental objections. Hospital ethics committees are usually involved, especially when such cases go to court. And some states like Texas have problematic laws that give objecting parents 10 days to find a new healthcare facility if they disagree with doctors and ethics committees who decide to take a child off life-sustaining treatment.
However, the strongest type of "Simon's Law" yet was just signed into law in Iowa on June 29, 2020 by Governor Kim Reynolds.
The law states that:
"A court of law or equity shall not have the authority to require the withdrawal of life-sustaining procedures from a minor child over the objection of the minor child's parent or guardian, unless there is conclusive medical evidence that the minor child has died and any electronic brain, heart, or respiratory monitoring activity exhibited to the contrary is a false artifact." (Emphasis added)
This is stunning, especially since it requires conclusive medical evidence that the child has died using the most stringent criteria of no brain, heart or respiratory activity. (As one legislator explained in a video, the "false artifact" provision would prevent a "crooked parent" from keeping the child on life support indefinitely in a felony murder situation.)
In recent years, we have seen court cases like the teenager Jahi McMath who lived for years and even seemed to improve after a diagnosis of brain death and now the case of Baby Tinslee with heart and lung problems whose doctors want to remove her ventilator against the parents' wishes.
At the very least, this new Iowa law illustrates the necessity of better legal protections for both medically vulnerable children and their parents.
Palliative Care and Artificial Intelligence for Predicting Death
July 21, 2020 July 21, 2020 nancyvalko Compassion & Choices, dementia, economics, end-of-life, law, medical ethics, palliative care
Working in areas like critical care, oncology (cancer) and hospice for over 45 years, I know that it is often hard to predict how long someone may live or when that person may die.
I have seen very ill or injured people with an optimistic prognosis unfortunately die and I have seen people expected to die very soon who recovered and went on to live for years. Back then, we used pain and other specialists, social workers, ministers, etc. for all our patients when needed. Some of our patients went into hospice.
In recent years, a new specialty called palliative care was developed to improve the quality of life for patients who have a serious or life-threatening disease with the goal of preventing or treating as early as possible, the symptoms and side effects of the disease and its treatment, in addition to any related psychological, social, and spiritual problems.
So I was very interested to read a July 1, 2020 article in StatNews titled "An experiment in end-of-life care: Tapping AI's cold calculus to nudge the most human of conversations about using cutting-edge artificial intelligence (AI) models in palliative care that scan patient hospital medical records and generate emails to doctors about their patients considered most likely to die within a year.
In the case of one doctor who received such an email, she "was a bit surprised that the email had flagged" her patient who was in his 40s and seriously ill with a viral respiratory infection and too sick to leave the hospital. She thought "Why him? And should she heed the suggestion to have that talk?"
As the article states, those kinds of questions are increasingly cropping up among health care professionals at the handful of hospitals and clinics around the country using such AI models in palliative care, stating that:
The tools spit out cold actuarial calculations to spur clinicians to ask seriously ill patients some of the most intimate and deeply human questions: What are your most important goals if you get sicker? What abilities are so central to your life that you can't imagine living without them? And if your health declines, how much are you willing to go through in exchange for the possibility of more time?" (Emphasis added)
Some clinicians and researchers defend this AI by saying that doctors are "stretched too thin and lacked the training to prioritize talking with seriously ill patients about end-of-life care".
Not surprisingly, the leaders of this palliative care AI discourage doctors from mentioning to patients that they were identified by an AI system because, as one doctor put it, "To say a computer or a math equation has predicted that you could pass away within a year would be very, very devastating and would be really tough for patients to hear."
Shockingly, while this AI is built around patients' electronic health records, this article admits that some AI models also "sample from socioeconomic data and information from insurance claims." (Emphasis added)
CAN AI RELIABLY PREDICT DEATH?
As the article admits, AI predictions of death "are often spotty when it comes to identifying the patients who actually end up dying" and that there has not been "a gold-standard study design that would compare outcomes when some clinics or patients are randomly assigned to use the AI tool, and others are randomly assigned to the usual strategies for encouraging conversations about end-of-life care." (Emphasis added)
Nevertheless, using AI death predictions for earlier palliative care interventions is now also being tried for conditions like dementia. And last year in Great Britain, AI was touted as "better than doctors" in analyzing heart tests to determine which patients would die within a year.
ARE THERE OTHER AGENDAS?
The idea of basing medical decisions on a computer program to predict death is disturbing enough but there may be other agendas involved.
For example, in a May, 2020 Cancer journal article titled "Leveraging Advances in Artificial Intelligence to Improve the Quality and Timing of Palliative Care", the authors called palliative care "a discipline of increasing importance in the aging population of the industrialized nations." (Emphasis added
And according to a Hospice News article last year:
"Studies have found that palliative care saves health plans, health systems, and accountable care organizations close to $12,000 per person enrolled, as well as reducing hospital readmissions, emergency department visits, and hospice lengths of stay. "
Now Compassion and Choices (the former Hemlock Society) is not only fighting to legalize medically assisted suicide throughout the US, it has also been active in promoting training and expansion of palliative care with federal funding and now calls assisted suicide "one option in the palliative continuum" and that knowing assisted suicide "is an option is in itself palliative care." (Compassion and Choices already maintains that VSED (voluntary stopping of eating and drinking) is already an ethical and legal means of ending life in the US.)
Even worse, a large and growing number of medical organizations-including the American Academy of Hospice and Palliative Medicine (AAHPM)-have endorsed or taken a neutral position on the issue of physician-assisted suicide.
An artificial intelligence program predicting death cannot replace the importance of an ethical healthcare provider who knows and truly respects the lives of his or her patients.
Good palliative care can be wonderful but, as I have written before, palliative care can go horribly wrong when misused.
We need to know the difference before we are able to trust that our own healthcare providers will give all of us the care we need and deserve, especially at the end of our lives.
Home Health Care and Safety in the Age of Covid 19
July 6, 2020 July 6, 2020 nancyvalko Covid 19, economics, hospice, nursing
In the 1990s, I reluctantly had to leave my hospital position in oncology after an operation on my right foot surgery that left me unable to stand on my feet for even just a few hours. I decided to go into home health to support my children and possibly help my foot heal.
Surprisingly, I found that I loved home health nursing and I learned a lot that even helped my patients when I was finally able to resume hospital nursing some years later.
Home health nursing wasn't an easy job even back then. I drove up to 200 miles some days to care for just about every kind of patient from medical patients just needing blood work to hospice patients and even a young man unable to move below his neck after a diving accident. But I loved the independence and really getting to know my patients and helping them in their own environment.
In May, I wrote a blog "Covid 19 and Nursing Homes" about friends of mine who refused to go to extended care nursing facilities because of the outbreaks of Covid 19 which are especially dangerous to the elderly. Instead, these friends chose to stay home with help from home health caregivers, family and/or friends.
I wondered how home health nursing was now coping with the pandemic.
HOW COVID 19 IS CHANGING HOME HEALTH CARE
A May 18, 2020 article written by 3 geriatricians and titled "How coronavirus could forever change home health care, leaving vulnerable older adults without care and overburdening caregivers" reveals how Covid 19 is now changing a sector of health care that has received little attention during the pandemic.
According to the article, over 5 million people in the US are currently receiving paid home care from personal care assistants, home health aides, nurses and therapists. But even before Covid 19, there were not enough of these health care workers.
As the geriatricians write:
"(N)ow, not only must home care continue for older adults, and for those with disabilities, but many people with COVID-19 will need it too".
While home health care reduces the stress on hospital systems, Covid 19 means that home health care is facing new challenges. Because home health workers travel to multiple homes and people, this increases the risk of possible Covid 19 transmission both for the workers and their often frail and older patients. How can health care workers and their patients both stay safe during the pandemic?
The geriatricians researched the problem and came up with 10 recommendations to deal with Covid 19 and also improve home health care.
These recommendations include access to personal protective equipment (PPE), regular COVID-19 testing for both staff and patients, Centers for Medicare and Medicaid Services (CMS) expanding the definitions of "home health" and "homebound" to include "personal care" to help more patients, as well as increasing federal funding for community health workers.
They also recommend more flexibility using options like telehealth which has been particularly useful for one of my older friends.
ONE BIG REASON WHY I LEFT HOME HEALTH NURSING
Although this article did not address this issue, one of the big reasons I finally left home health when my foot improved was the danger of working in a large city like St. Louis that has several high-risk areas as well as the roving packs of wild dogs that were a problem at the time.
I often saw patients in these areas and sometimes even during the night when I was on call for the agency. On occasion, even the police stopped some of us nurses when were going in to see a patient in these high-risk areas and they offered to wait outside until we returned. I especially appreciated this because as a single mother, I was concerned about what could happen to my children if anything happened to me.
Personally, I saw guns in some households, was cut off by some young men trying to stop my car, dealt with some suddenly psychotic patients, tried to mitigate domestic disturbances, etc. Some areas were so high-risk that I took the fire escape for safety reasons rather than use the elevator to get to my patients' apartments.
It took many attempts before we nurses finally got our agency to help us get pepper spray and provide a security person to accompany us nurses to high-risk areas when we felt it was necessary.
But sadly, I could never consider going back to home health now with the protests, riots and escalating violence we are seeing in many cities like St. Louis and other areas.
I fervently hope and pray that the important issues that are tearing our country apart will soon be resolved for the safety of all of us.
Especially because I am a nurse, I do know how much every life matters.
Sweden and Covid 19: Families Complain That "Palliative Care" Instead of Treatment Is Being Given to the Elderly
June 22, 2020 nancyvalko Covid 19, family, medical ethics, palliative care, terminal/palliative sedation
A June 18, 2020 article in the Wall Street Journal titled "Coronavirus is taking a high toll on Sweden's elderly. Families blame the government" starts with a disturbing story:
"When 81-year-old Jan Andersson fell ill with Covid-19 at a nursing home in the Swedish town of Märsta, a doctor consulted by phone ordered palliative care, including morphine, instead of trying to help him fend off the infection.
Mr. Andersson's son, Thomas Andersson, says he was told his father was too frail for other treatment. The younger man disagreed and, after arguing with the physician, summoned journalists and insisted his father be given lifesaving care. Mr. Andersson has since recovered.
The county that runs Mr. Andersson's nursing home said all decisions on medical treatment for the residents were made by doctors employed by a company that provides medical services. (All emphasis added)
The Wall Street Journal reports that cases like this have sparked a public outcry from not only relatives but also from some doctors and nurses. There is now an investigation by Swedish national health-care authorities into the treatment of older patients in nursing homes and Stockholm hospitals. There are now 5,041 people in Sweden who have died from Covid 19 with about half being nursing home residents.
"Many people have died unnecessarily," said Yngve Gustafson, a geriatric-medicine specialist in Sweden, who looked into more than 200 cases in which people were denied care. He said that doctors were too quick to put patients on palliative care. He also said that he believed many would have survived and lived year longer had they been provided basic care.
Furthermore, a June 12, 2020 British Medical Journal article "Has Sweden's controversial covid-19 strategy been successful?" stated that Dr. Gustafson also spoke to the Svebsja Dagbladet newspaper and "expressed concern about the increasing practice of doctors recommending by telephone a "palliative cocktail" for sick older people in care homes.
He also was quoted as saying:
"Older people are routinely being given morphine and midazolam, which are respiratory-inhibiting," … "It's active euthanasia, to say the least."
Thomas Linden, chief medical officer of Sweden's National Board of Health and Welfare, said the triage guidelines for Covid 19 were developed to prepare the health-care system for a potential crisis while ensuring best-possible treatment for all patients.
However, the Wall Street Journal article reports that Swedish critics say these guidelines have too often resulted in older patients being denied treatment, even when hospitals were operating below capacity.
"Dr. Cecilia Söderberg-Nauclér, a physician at Karolinska University Hospital in Stockholm, said that "the ICU wards were comparatively empty "because elderly people were not taken to hospitals—they are given sedatives but not oxygen or basic care."
The Wall Street Journal article also notes that "About 90% of nursing-home residents who succumbed to Covid-19 in Sweden were never admitted to a hospital, according to official estimates. " (Emphasis added)
Most poignantly, Latifa Löfvenberg, a nurse for a company providing medical services to several nursing homes, said she sought treatment for residents with Covid-19 and was told by company physicians to administer morphine and a sedative.
She described what happened:
"People suffocated, it was horrible to watch. One patient asked me what I was giving him when I gave him the morphine injection, and I lied to him," said Ms. Löfvenberg, who is now working at a hospital in the Swedish capital. "Many died before their time. It was very, very difficult." (Emphasis added)
COULD-OR HAS-THIS HAPPENED IN THE US?
As I wrote in my May 20, 2020 blog "Covid 19 and the Culture of Death" about the dangerous and unethical responses to Covid 19 in the US:
"(T)he National Hospice and Palliative Care Organization (NHPCO) has a new resource for Crisis Standards of Care for the "ethical allocation of scarce medical resources during a disaster" that:
'provides a framework for healthcare professionals to utilize a predetermined framework to determine which individuals will receive life saving care during an emergency event or disaster and which ones will not.' With the event of the COVID-19 Public Health Emergency (PHE), it is important for palliative and hospice care providers to be familiar with Crisis Standards of Care." (Emphasis added)
However, access to the actual crisis standards is restricted to NHPCO members only.
But transparency is not the only problem.
Unfortunately, I have also personally and professionally seen cases of deliberate overdose sedation. I have written about this, most recently in my 2019 blog "When Palliative Care goes Horribly Wrong".
While Sweden has not yet legalized physician-assisted suicide, Sweden's National Board of Health and Welfare did authorize passive euthanasia in 2010, whereby "patients may request the termination of their treatment knowing that this will lead to their death". This ruling came in response to a request by a 32 year old woman who was totally paralyzed and dependent on a ventilator since the age of six. She requested it be shut off when she was asleep. Whether or not she received a "palliative cocktail" beforehand is unknown.
Now, Swedish officials seem to have forgotten the part about "patient request" when it comes to Covid 19 and the elderly.
In the US, we started down a similar path when "right to die" groups focused on "living wills" and withdrawal of even basic treatment before outrightly promoting physician-assisted suicide.
The bottom line for any country is that we must not lethally discriminate against anyone, regardless of age or condition like Covid 19 and we must hold palliative care to the high standards set by the late Dame Cicely Saunders, founder of hospice movement (1918 – 2005) who said:
"You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die." (Emphasis added)
Over 600 Doctors Send Powerful Letter to President Trump Calling the Covid 19 Lockdown a "Mass Casualty Incident"
June 4, 2020 nancyvalko Covid 19, culture, drug addiction, economics, end-of-life, media, medical ethics, suicide
Although it received little media notice, a May 19, 2020 letter to President Trump signed by over 600 doctors detailed the physical and mental impact of the lockdown in the US due to Covid 19, calling it a "mass casualty incident" with "exponentially growing negative health consequences" to millions of non-COVID patients.
As the highly contagious Covid 19 virus was spreading around the world, President Trump issued a proclamation on March 12, 2020 declaring a national emergency with "preventive and proactive measures to slow the spread of the virus and treat those affected".
Ironically, except for New York and other hotspots that received massive federal help including ventilators and emergency field hospitals, US hospitals wound up with many empty beds and even emergency room visits dramatically declined.
Many hospitals are now facing a financial crisis and health care professionals are being furloughed.
THE IMPACT OF THE LOCKDOWN ON AMERICANS' PHYSICIAL AND MENTAL HEALTH
The doctors' letter to President Trump focused on the devastating impact on Americans' physical and mental health of the lockdown and why the months-long lockdowns should be ending.
Here are some excerpts:
But while nearly all 50 states are starting to relax lockdown rules to some extent, some officials are threatening to keep many businesses closed and other draconian measures in place until August or even later. Many schools and universities now say they may remain closed for the remainder of 2020.
But as Dr. Marilyn Singleton, a California anesthesiologist and one of the signer of the letter said, "Ending the lockdowns are not about Wall Street or disregard for people's lives; it's about saving lives." (Emphasis added)
We know a lot more about Covid 19 now. The US Center for Disease Control's new 'best estimate' implies a COVID-19 Infection fatality rate below 0.3% with an estimated 35% of people with Covid 19 never having symptoms.
States have rescinded orders that forced long term care facilities with our most vulnerable people to admit Covid 19 patients after hospital discharge resulting in lethal outbreaks.
But as more states are slowly opening, Grace-Marie Turner of the Galen Institute writes:
"Will patients come back? COVID-phobia is deathly real.
Patients still are fearful about going to hospitals for heart attacks and even for broken bones and deep lacerations. Despite heroic efforts by physicians to deeply sanitize their offices, millions have cancelled appointments and are missing infusion therapies and even chemotherapy treatments. This deferred care is expected to lead to patients who are sicker when they do come in for care and more deaths from patients not receiving care for stroke, heart attacks, etc."
While still observing social distancing, sanitizing and other common sense measures to protect ourselves and others, it is my opinion that the more than 600 doctors writing to President Trump are right when they urge ending the Covid 19 shutdown as soon as possible for all Americans' physical and mental health.
Covid 19 and the Culture of Death
May 20, 2020 May 20, 2020 nancyvalko advance directives, Compassion & Choices, Covid 19, medical ethics, terninal/palliative sedation, ventilators/life support
"Ironically, the Covid 19 pandemic has pulled back the curtain on how far our healthcare ethics has fallen from the ideal of respecting every life to the dangerous notion that some lives are expendable-even our own."
I have written about how the Covid 19 pandemic has resulted in dangerous and unethical responses like ventilator rationing, unilateral DNRs, and some states ordering nursing homes and other long-term care facilities to accept coronavirus patients discharged from hospitals.
But now, the Covid 19 crisis has also spawned new ideas such as the American Clinicians Academy On Medical Aid in Dying's policy recommendations on medically assisted suicide requests by telemedicine in the context of Covid 19 and Covid 19 advance directives aimed at refusing potentially life-saving treatment.
Compassion and Choices, the former Hemlock Society that promotes assisted suicide, voluntary stopping of eating and drinking (VSED) and terminal sedation, now has a Covid 19 toolkit with a special Covid 19 addendum to add to an existing advance directive to refuse care if a person gets Covid 19. The addendum even contains the question:
"Do you want your healthcare proxy to have the ability to override any of these orders if he or she believes you have a reasonable chance of living a life consistent with your values and priorities based on the information provided by the doctor? Or, do you want these orders followed no matter what?" (Emphasis added)
Another organization "Save Other Souls", headed by an MD and an ethicist, has an "altruistic" advance directive for Covid 19 that states:
"In the event of shortages during the period of a declared emergency related to COVID-19, and in order to direct resources to others, I am willing to receive palliative care instead of: Critical medical equipment (ventilator, ECMO, etc.), Medication (other than palliative), Placement in a hospital care unit that provides critical care." (Emphasis added)
Even more disturbing, the National Hospice and Palliative Care Organization (NHPCO) has a new resource for Crisis Standards of Care for the "ethical allocation of scarce medical resources during a disaster" that:
"provides a framework for healthcare professionals to utilize a predetermined framework to determine which individuals will receive life saving care during an emergency event or disaster and which ones will not. With the event of the COVID-19 Public Health Emergency (PHE), it is important for palliative and hospice care providers to be familiar with Crisis Standards of Care." (Emphasis added)
The National Hospice and Palliative Care Organization (NHPCO), founded in 1978, is the nation's largest membership organization for providers and professionals who care for people affected by serious and life-limiting illness". NHPCO states that it "represents the interests of its members and the general public with legislative advocacy that helps to enhance and expand access to care that addresses holistic health and the well-being of communities." (Emphasis added)
Not surprisingly, the NHPCO has supported the problematic Palliative Care and Hospice Education and Training Act, currently still in the US Congress awaiting passage.
The Covid 19 pandemic is especially terrifying to many people but we must realize that just like any other serious or terminal illness, we must act responsibly and ethically in caring for people with Covid 19.
While medical treatment that is medically futile or unduly burdensome to the person can be ethically refused or withdrawn, refusing or removing ordinary medical treatment or deliberately oversedating a person in order to cause or hasten death is unethical. Even when we think it may help another person get care.
We need to know the difference, especially when it comes to making out "living wills" or other advance directives.
Ironically, the Covid 19 pandemic has pulled back the curtain on how far our healthcare ethics has fallen from the ideal of respecting every life to the dangerous notion that some lives are expendable-including our own.
Covid 19 and Nursing Homes
May 8, 2020 June 22, 2020 nancyvalko Covid 19, end-of-life, law, medical ethics
Recently, two good friends of mine with physical limitations who had been waiting for over a year to enter a carefully chosen assisted living/long term healthcare facility changed their minds about going. They found out that the facility had at least one resident with Covid 19. They are now staying at home with help from their sons, friends and a paid caregiver.
And my 97 year old friend Melissa with heart and mobility problems is adamant about staying at home to be cared for, primarily by her wonderful family. Recently, she developed a disturbing symptom but instead of going to her doctor as usual, her doctor was able to come to her via a telehealth visit by computer. Melissa is happy at home and knows that other options like home hospice are available if necessary.
Are these three people overreacting about nursing homes?
In my opinion, the answer is probably no at this time.
Unfortunately, long-term health facilities for the elderly have become hotbeds for Covid 19 despite those residents being the most at risk during the pandemic. A number of staff at those facilities have also caught Covid 19 and some have also died.
Even worse, as NBC News reported April 25, 2020:
"Three states hit hard by the pandemic — New York, New Jersey and California — have ordered nursing homes and other long-term care facilities to accept coronavirus patients discharged from hospitals." (Emphasis added)
On May 6, 2020, the Wall Street Journal reported that New York nursing homes may have nearly 5,000 Covid-19 related deaths and the next day, the California Mercury News reported that "at least 41 percent of all known coronavirus deaths in California have occurred among residents and staff of nursing homes and assisted living facilities." (Emphasis added)
And, unfortunately, these same people are usually dying alone due to restrictions for even family members in hospitals and nursing homes. Sadly, even funerals are changing with new restrictions for ceremonies and mourners.
According to an April 21, 2020 article "Nursing Homes Balk at COVID Patient Transfers From Hospitals" by the American Association for Retired Persons (AARP):
"The American Health Care Association says discharged hospital patients should return only to nursing homes with separate COVID-19 units. Ideally, those units are staffed with employees with access to personal protective equipment. The federal Centers for Medicare & Medicaid Services (CMS), which regulates nursing homes, endorsed the idea of separate COVID units this month." (Emphasis added)
I was personally shocked to discover that only 23 states publicly reported data for cases and deaths due to COVID-19 in long-term care facilities as of April 23, 2020.
However, the Trump administration has recently announced upcoming new regulatory requirements that:
"will require nursing homes to inform residents, their families and representatives of COVID-19 cases in their facilities. In addition, as part of President Trump's Opening Up America, CMS will now require nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC)." (Emphasis added)
When my mother with Alzheimer's disease was dying from cancer in 1988, there was no pandemic and we cared for her at home as long as possible before placing her in a nursing home nearby for safety reasons. So I do know that nursing homes and other long-term care facilities can be wonderful and even necessary options.
But until this pandemic dissipates, we need all the essential information necessary to protect and advocate for the most vulnerable among us.
CPR (Cardiopulmonary Resuscitation) in the age of Covid 19-What You Need to Know
April 25, 2020 May 8, 2020 nancyvalko Covid 19, CPR, law, medical ethics
Several years ago, a nurse friend was with her boyfriend at a concert hall when he collapsed with no heartbeat or breathing. She called for 911, started CPR and asked for an AED (automatic external defibrillator) , which is located in most offices and public buildings. An AED is a sophisticated, yet easy-to-use (even for a lay person with training), medical device that can analyze the heart's rhythm and, if necessary, deliver an electrical shock, or defibrillation, to help the heart re-establish an effective rhythm.
However, the concert staff didn't know where it's AED was.
My friend continued to deliver mouth to mouth an chest compressions while a crowd gathered, some of whom were physicians who told her to stop because it was hopeless.
Finally, an ambulance arrived and took the boyfriend to a local hospital. He not only survived but was discharged 3 days later in good condition and determined to start a healthier lifestyle.
So I was stunned to read an April 21, 202 New York Post article "NY issues do-not-resuscitate guideline for cardiac patients amid coronavirus" (Covid 19) that said New York state had just issued "a drastic new guideline urging emergency services workers not to bother trying to revive anyone without a pulse when they get to a scene, amid an overload of coronavirus patients." (Emphasis added)
While paramedics were previously told to spend up to 20 minutes trying to resuscitate a person in cardiac arrest, the new guideline was deemed "necessary during the COVID-19 response to protect the health and safety of EMS providers by limiting their exposure, conserve resources, and ensure optimal use of equipment to save the greatest number of lives.''
First responders were outraged and their union leader said "Our job is to bring patients back to life. This guideline takes that away from us."
Earlier this month, the Regional Emergency Services Council of New York had issued a new guideline that said cardiac arrest patients whose hearts can't be restarted at the scene should no longer be taken to the hospital for further life-saving attempts because the city hospitals had been "inundated with dying coronavirus patients to the point where there are frequently no ICU beds."
One paramedic acknowledged that only a small percentage of people in cardiac arrest-3 or 4 out of 100-are brought back to life through CPR and other aggressive interventions such as drugs and hospitalization but insisted that "for those three or four people, it's a big deal."
On April 22 and just hours after the initial New York Post article was published, the new guidelines were rescinded. New York City's Fire Department and first responders never adopted the no-revival directive from the state and kept using the traditional 20-minute policy.
WOULD YOU KNOW WHAT TO DO IF SOMEONE COLLAPSES WITH NO HEARTBEAT OR BREATHING?
When I started as a nurse in many decades ago, we were trained in CPR and taught how to use AMBU bags (mask, valve and self-inflating bag) to breathe for patients in arrest or distress in place of mouth to mouth resuscitation. AMBU bags are now standard equipment on ambulances and other rescue services.
Over the years, techniques for CPR changed especially in 2008 when the American Heart Association released new recommendations that bystanders can skip mouth to mouth resuscitation and use "Hands-Only CPR" to help an adult who suddenly collapses:
"In Hands-Only CPR, bystanders dial 9-1-1 and provide high-quality chest compressions by pushing hard and fast in the center of the victim's chest."
Now, the Covid 19 pandemic has changed CPR guidelines.
As the April 16, 2020 Notre Dame Fire Department concisely explains on pandemic-modified CPR guidelines for bystanders:
"Bystander CPR (cardiopulmonary resuscitation) improves the likelihood of an individual's survival from cardiac arrest occurring outside of the hospital. However, coronavirus is spread through respiratory droplets when an infected person coughs, sneezes or talks. If a rescuer breathes into a cardiac arrest individual's mouth, there will likely be an exchange of respiratory droplets. Household members who have been exposed to the individual at home should not hesitate to attempt life-saving rescue measures.
A non-household bystander who attempts to rescue a cardiac arrest individual should wear a face mask or cloth over his/her mouth and nose and place a face mask or cloth over the mouth and nose of the individual to reduce the risk of transmission.
In the case of an adult in cardiac arrest, lay rescuers should perform at least hands-only CPR. For children, lay rescuers should perform chest compressions and consider mouth-to-mouth ventilation, if willing and able, given the higher incidence of respiratory arrest in children.
To perform Hands-Only CPR, you place your hands in the center of the chest and pump hard and fast at a rate of 100 to 120 compressions per minute.
If an AED (automated external defibrillator) is available, please proceed with opening the AED and following the automated prompts to initiate life-saving intervention. Defibrillation is not expected to be a highly aerosolizing procedure. If an AED is not available, please proceed with Hands-Only CPR.
For all cardiac related emergencies, EMS (911) should be called…For more information, refer to the American Heart Association's interim CPR guidance.
As a nurse, I have participated in many instances of cardiac or respiratory arrest and it's always stressful. However, the joy of participating in saving someone's life is indescribable. And even when we were unsuccessful, we had the consolation of knowing that we did everything we could for that person.
I encourage everyone to take a course to learn CPR. To find such a course, you can contact your local hospital or go to the American Heart Association's Find A Course or to the Red Cross website.
And I personally thank the courageous New York Fire Department and first responders for upholding the standards of care for all their patients.
Health Care Rationing, Covid 19 and the Medical Ethics Response
April 13, 2020 May 8, 2020 nancyvalko CHA, Covid 19, disability, euthanasia, futility, law, medical ethics, ventilators/life support
While the key medical model in the US for Covid 19 deaths has just again been revised from 240,000 to 100,000 to now just 60,000 by August along with concerns about the possible overuse of ventilators in Covid 19, there is still a push for medical health care rationing guidelines.
As the April 8, 2020 Wall Street Journal article "As Coronavirus Peaks, New York City's Hospitals Prepare 'Live or Die' Guidance" notes, some hospitals and health care systems are coming up with guidelines and scoring systems to allocate ventilators. At the same time, New York lawmakers have recently passed a measure to protect hospitals and clinicians from certain medical malpractice lawsuits while the Covid 19 virus strains the health system.
Disability groups are complaining about discrimination in health care rationing plans that would "illegally deprive people based on age, mental cognition or disability". In addition, a recent Center for Public Integrity analysis shows that policies in 25 states would ration care in ways disability advocates have denounced.
While such rationing plans are usually said to be based on determining which patients have little if any chance of a good outcome, i.e. medical futility, even the American Medical Association has admitted in its Code of Ethics that "However, physicians must remember that it is not possible to offer a single, universal definition of futility. The meaning of the term "futile" depends on the values and goals of a particular patient in specific clinical circumstances." (Emphasis added)
THE CATHOLIC MEDICAL ETHICS PERSPECTIVE
Medical ethics in Catholic health care institutions are often considered the most stringent in terms of protecting human life from conception to natural death. So what do Catholic ethics authorities say about rationing?
On April 3, 2020, the US Catholic Conference of Bishops (USCCB) issued a powerful statement "Bishop Chairmen Issue Statement on Rationing Protocols by Health Care Professionals in Response to Covid-19" that stated:
"Every crisis produces fear, and the COVID-19 pandemic is no exception. However, this is not a time to sideline our ethical and moral principles. It is a time to uphold them ever more strongly, for they will critically assist us in steering through these trying times."
"Good and just stewardship of resources cannot include ignoring those on the periphery of society, but must serve the common good of all, without categorically excluding people based on ability, financial resources, age, immigration status, or race." (Emphasis added)
The statement cited other Catholic health care groups like Catholic Medical Association, the National Association of Catholic Nurses and the National Catholic Bioethics Center that all issued helpful statements.
However another Catholic group mentioned, the Catholic Health Association, has also issued a problematic statement on the rationing issue titled "Code Status and COVID-19 Patients " stating that:
"CPR may be medically inappropriate in a significant portion of elderly, critically ill patients with COVID-19 and underlying comorbidities. As per Parts 3 and 5 of the Ethical and Religious Directives for Catholic Health Care Services, if it is shown that the burdens exceed the benefits, it is morally acceptable to withhold such procedure." (Emphasis added)
And even worse:
"If treating clinicians, including more than one physician, determine that CPR is not medically appropriate, a Do Not Attempt Resuscitation Order (DNR) may be written without explicit patient or family consent." (All emphasis added)
In a separate April 7, 2020 statement from the National Catholic Partnership on Disability titled "Rights of Persons with Disabilities to Medical Treatment During the COVID-19 Pandemic , the NCPD states "As The Office of Civil Rights of the U.S. Department of Health and Human Services has recently reminded us, America's basic civil rights laws, including the Americans with Disabilities Act, prohibit discrimination:
"[P]ersons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person's relative 'worth' based on the presence or absence of disabilities. " (Emphasis added)
Over my many decades as a nurse, I have seen the question of "quality of life" deteriorate from what can we do to improve the quality of life for every patient to judging whether or not a patient has sufficient quality of life to justify treatment or care like a feeding tube.
During that time, Alzheimer's and major CVAs (strokes) in advanced age have come to be seen as fates worse than death that should not be a burden on people and their families or a waste of health care resources.
Before my own mother developed Alzheimer's and a terminal cancer, she often told me that she never wanted to be a "burden to her family". I never considered her a "burden" when I cared for her and she was comfortable and fed to her last day. I will never tell my children what my mother told me.
And especially with assisted suicide polls showing much public support, we cannot afford to play into the idea that some people are "better off dead" regardless of whether or not they "choose" a premature death or someone else "chooses" it for them.
We should also remember the lethal legacy of the 2005 Hurricane Katrina disaster. Flooding caused the New Orleans mayor to issue an unprecedented mandatory evacuation of the city with the exception of major hospitals. But when conditions worsened at the large Memorial Medical Center and evacuation efforts were slow, some medical staff allegedly euthanized some of the patients.
However and despite strong evidence, a massive PR campaign portraying those patient deaths as "compassionate" resulted in the 2007 grand jury refusing to indict the doctor and 2 nurses charged.
As we see this debate over medical ethics in crisis situations continue today, we must continue to insist that every person deserves a natural lifespan without discrimination.
Ventilator Rationing, Universal DNRs and Covid 19 (Coronavirus)
April 3, 2020 May 8, 2020 nancyvalko conscience rights, Covid 19, disability, Living wills, medical ethics, nursing, pro-life, ventilators/life support
As a nurse myself, it is hard to watch my fellow nurses bravely fighting on the front lines of this pandemic without being able to be there with them.
Nurses are a special breed. In my over 50 years as a nurse, I found that most of us chose nursing because we want to help people and alleviate suffering. We work the long hours on our feet, skip meals, hold hands and listen, cry when our patients die, etc. because we truly do care.
But the health care system has been changing. A dark new ethics movement is infecting our system and telling us not only that our patients have a right to choose to end their lives but also that some of our patients even "need" to die and that we can't care for all of them during the Covid 19 pandemic.
Worst of all, we are being told that we can now know how to decide which patients are "expendable".
VENTILATOR RATIONING
A 71 year old man with a heart condition arrives at a hospital is diagnosed with Covid 19. His condition worsens and he is placed on a ventilator to help him breathe. Then the infection rate spikes in the city and the hospital is overrun with severely ill patients, many between 20 and 50 years old and otherwise healthy.
The health care team is forced to decide which patients should they focus on and care for.
This is the scenario posed in a March 20, 2020 Medpage article "Ethics Consult: Take Elderly COVID-19 Patient Off Ventilator?— You make the call" along with an online survey with 3 questions:
1. Would you prioritize the care of healthier and younger patients and shift the ventilator from the elderly man to patients with a higher probability of recovering?
2. Would you change your decision if the elderly patient had been in intensive care for a non-COVID-19-related illness?
3. Would you prioritize the older man over college students who had likely been
infected during spring break trips?
After almost 4000 votes, the survey showed 55.65% voting yes on prioritizing the care of the healthier and younger patients, 78.11% voting no on changing their decision about the elderly patient if he didn't have Covid 19 and 71.12% voting no on prioritizing the elderly man over college students likely to have been infected on a spring break trip.
So while most people fear becoming infected with Covid 19, less well-known ethical dangers may also affect us-especially those of us who are older or debilitated.
Every day, we hear about the shortage of ventilators needed for Covid 19 patients and the overworked and understaffed health care professionals providing the care. Now both mainstream media and medical journals are publishing articles about the ethical dilemma of denying CPR (cardiopulmonary resuscitation) or a ventilator to older patients or those with a poor prognosis with Covid 19 in a triage situation.
Triage is defined as "A process for sorting injured people into groups based on their need for or likely benefit from immediate medical treatment. Triage is used in hospital emergency rooms, on battlefields, and at disaster sites when limited medical resources must be allocated." (Emphasis added)
But this definition does NOT include deciding how to triage people based on age or "productivity".
UNIVERSAL DNRs
A March 25, 2020 Washington Post article "A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic" posed the question: "how to weigh the 'save at all costs' approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion of coronavirus."
This is not just an academic discussion.
As the article reveals, "Northwestern Memorial Hospital in Chicago has been discussing a do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members — a wrenching decision to prioritize the lives of the many over the one." (Emphasis added) And Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon, described how colleagues at different institutions are sharing draft policies to address their changed reality.
Bioethicist Scott Halpern at the University of Pennsylvania is cited as the author of one widely circulated model guideline being considered by many hospitals. In an interview, he said a universal DNR for Covid 19 patients was too "draconian" and could sacrifice a young person in otherwise good health. He also noted that the reality of health-care workers with limited protective equipment cannot be ignored. "If we risk their well-being in service of one patient, we detract from the care of future patients, which is unfair," he said.
The article notes that "Halpern's document calls for two physicians, the one directly taking care of a patient and one who is not, to sign off on do-not-resuscitate orders. They must document the reason for the decision, and the family must be informed but does not have to agree." (Emphasis added)
This could not only upend traditional ethics but also the law as "Health-care providers are bound by oath — and in some states, by law — to do everything they can within the bounds of modern technology to save a patient's life, absent an order, such as a DNR, to do otherwise."
Both disability and pro-life groups have condemned such health care rationing with Covid 19, especially for older people and people with disabilities.
However, this and more is apparently already happening.
In an April 1, 2020 Wall Street Journal article "What the Nurses See: Bronx Hospital Reels as Coronavirus Swamps New York" a co-worker told the nurse interviewed that the nurses were no longer doing chest compressions to resuscitate Covid 19 patients because "it uses lots of protective gear and puts workers at greater risk than chemical resuscitations". This was corroborated by other nurses who said this has become an "unspoken rule."
How can we protect ourselves and our loved ones in these circumstances?
At the very least and whether or not we are older or have disabilities, we should consider or reconsider our advance directives.
As the Life Legal Defence Foundation writes in their "SPECIAL MESSAGE ABOUT COVID-19 AND ADVANCE HEALTH CARE DIRECTIVES":
As COVID-19 spreads around the globe, the public is learning about the importance of mechanical ventilators in providing temporary breathing support for many of those infected. Ventilators are saving lives!
A false understanding of respirators and ventilators has become commonplace in recent years. Many people think that these and similar machines' only role is prolonging the dying process. The widely publicized treatment of COVID-19 patients is helping to dispel that myth. Many patients rely on machines temporarily every day for any number of reasons and go on to make full recoveries.
Unfortunately, many individuals have completed advance health care directives stating or suggesting that they do not wish to receive breathing assistance through mechanical ventilation.
Please take the time to review any advanced medical directives (including POLST forms) signed by you or your loved ones to make sure they are clear that mechanical ventilation is not among the forms of care that are refused. If there is any ambiguity, you may want to consider writing, signing, and dating an addendum specifying that mechanical ventilation is authorized. (Emphasis in original)
I would add that other treatments or care such as DNRs and feeding tubes also not be automatically checked off. I believe it is safer to appoint a trusted person to insist on being given all information concerning risks and benefit before permission is given to withdraw or withhold treatment.
Even as the nation is racing to get more ventilators and staff as we cope with this terrible pandemic, we all must continue to affirm the value of EVERY human life.
Coping in the Time of the Covid 19 (Coronavirus) Pandemic
March 20, 2020 May 8, 2020 nancyvalko Covid 19, faith, family
Although we are in a time of national crisis that is causing disruption in all of our lives, we need to avoid panic and foster realistic optimism and resolve in ourselves and others. We are all in this together.
As a semi-retired nurse, I have been following the Covid 19 situation closely. We and our extended family and friends keep up with and strictly follow the sanitary and social isolation recommendations. If we all follow these precautions, this crisis may begin to abate in hopefully weeks or months.
There is cause for cautious optimism. Although the numbers of people infected will increase with more testing now available, most people will not die from Covid 19 and many will have no or mild symptoms. And a promising experimental vaccine against the Covid 19 virus has been developed in record time and is now being tested on humans. However it may take a year or more to prove its effectiveness. We must be patient.
Even better, a FDA drug long used to treat malaria has shown promise in treating Covid 19 patients in other countries and a clinical trial of the drug will start here.
However, the Covid 19 virus has and will continue to have an enormous impact on our lives for the foreseeable future not only in our homes but also in our work lives, education, the economy and the health care system.
But, as frightening as this crisis is now, in the end it may help us reorder our priorities from materialism and political/social divisions to a new appreciation for our families, our country and our ability to work together for the greater good.
One of the advantages of being older is that I am old enough to remember the polio virus epidemic in the 1950s that struck so many children and caused panic in my own parents until Dr. Jonas Salk developed a vaccine. As a nurse, I also remember the terrible AIDS virus epidemic in the 1980s and 1990s that killed so many people and even became the "poster child" for legalizing physician-assisted suicide until an effective treatment was developed in 1997. And I remember the relief and joy when the polio vaccines and AIDS treatments were found.
Like AIDS, polio and other deadly infections in the past, the Covid 19 crisis will also eventually pass. I recently asked my wonderful 97-year-old friend "Melissa" who lived through World War II about how people got through those terrible years of turmoil and sacrifice. She seemed surprised by the question and said, "We just did what we had to do". No wonder she is one of those people now celebrated as the "Greatest Generation" with the values of "personal responsibility, duty, honor and faith."
Those values are just as important today.
FIGHTING WORRY AND FEAR WITH GRATITUDE
In our current crisis, one way we can help ourselves cope is by being grateful for the often unrecognized blessings we do have. Gratitude is a potent antidote to the panic, worry and fear that can infect us, our loved ones and others.
So I am grateful that we live in a time when computers, smartphones (especially with text and FaceTime) and other devices that are available to most people now. How much worse would social isolation and access to critical information be in the past without these devices?
Personally, I am grateful that our grandchildren have access to online learning after their schools closed and that some of our adult children are now able to work by computer from home.
I am also grateful for my religious faith that encourages trust in God, prayer, hope and helping the less fortunate in times of crisis. And I am grateful that even though churches and other places of worship are closing, religious services and inspiration are easily available online or on television. And I am inspired by the efforts of religious groups like the St. Vincent DePaul Society that never stop caring for the less fortunate no matter what the crisis.
I am also grateful that I am healthy enough to help my more elderly or infirm neighbors by picking up items from the store or even just calling them on the phone to chat. We can all look for ways to help our community without endangering ourselves or others such as ordering take-out food from small businesses that had to close their dining rooms and lay off workers. I have always found that helping others promotes happiness and optimism in both the person receiving help and the person giving the help.
I am grateful for my husband and family, especially now that we are grandparents who can help care for our grandchildren-particularly those who are out of school and have (thankfully) working parents. In times of crisis, we have a great opportunity to get closer to all our loved ones and the entertainment value of family alone is worth it.
All of us should remember that it's the tough times that strengthen us most. We have a duty to set a good example for our families and our nation so that when the crisis is behind us, we all will be kinder, wiser and better people in the future.
Is Abortion More Important than Safety? The Case Now Before the US Supreme Court
March 6, 2020 nancyvalko abortion, law, medical ethics
In 1986, Missouri became the first state to pass an abortion law requiring abortion doctors to have admitting privileges at a hospital "in the community" to ensure the health and safety of women undergoing abortion.
Later, I was horrified to find out that a doctor was doing abortions just a few miles from my home in St. Louis. It turned out that his admitting privileges were in another country! The abortion clinic was closed.
As I wrote last August in "Pro-abortion Desperation in Missouri" :
"the last abortion clinic in Missouri lost its license because of numerous health and safety violations. The Planned Parenthood abortion clinic continues to operate only because of several temporary injunctions by a judge."
While the Missouri case is still ongoing, now the US Supreme Court is hearing arguments in the June Medical Services v. Russo case concerning whether Louisiana's law requiring abortion providers to have admitting privileges at a local hospital conflicts with the Court's 2016 Whole Woman's Health v. Hellerstedt decision along with a second issue about "whether abortion providers can legally represent the interests of women seeking an abortion when those providers sue to overthrow laws protecting those women's health and safety."
IS ABORTION MORE IMPORTANT THAN SAFETY?
In a powerful commentary titled "The OB-GYNs Who Play Politics With Women's Lives-Abortion is more important than safety to the American College of Obstetricians and Gynecologists" in the March 3, 2020 Wall Street Journal, Dr. Christina Francis calls out the American College of Obstetricians and Gynecologists (ACOG) for "offering a medically unsound recommendation in the furtherance of its extreme position on abortion".
Dr. Francis, a board-certified obstetrician-gynecologist and the chairman of the board of the American Association of Prolife OB/GYNS, refutes ACOG's friend of the court brief arguing that the admitting privileges requirement for abortionists is not "'medically justified' and therefore constitutes an 'undue burden' on a woman's right to abortion'" by stating:
"Yet every second counts in an obstetric emergency. A pregnant woman experiencing severe uterine hemorrhage can bleed to death in as little as 10 minutes. That's why its essential that anyone performing an abortion have the ability to admit a patient to a nearby hospital—preferably one closer than 30 miles away."
ACOG routinely puts politics ahead of medicine by adopting the most extreme positions on abortion. It has lobbied and briefed against parental notification of minors and informed-consent laws, and in favor of taxpayer-funded abortion. It has advocated for laws restricting speech around clinics and compelling pro-life pregnancy centers to tell women where they can go to obtain state-subsidized abortions. ACOG's work has gotten so political that in 2008 it added a lobbying arm. I was refused when I asked if I could direct our dues only to the organization's nonlobbying arm.
Eighty-six percent of OB-GYNs don't perform abortions, but ACOG's position is that you either support the most extreme abortion lobbying or you're off the island. Most of ACOG's abortion advocacy is undertaken free of consultation with its almost 60,000 members. Physicians who've left the organization, like me, support its general work but don't want to support abortion lobbying, especially when it comes to watering down or eliminating safety standards. (Emphasis added)
Dr. Ford also notes that:
"In any practice area other than abortion, a doctor performing an operation would have hospital-admitting privileges. In the case of complications that doctor would, at a minimum, call ahead to fast-track the patient to the appropriate emergency care. Abortion-clinic patients, on the other hand, are frequently kicked to the curb and told to make their own way to the emergency room."
Those of us in Missouri have seen the problems and attempted coverups at the hopefully last Planned Parenthood clinic in St. Louis. Just last year, it was reported that:
"Operation Rescue, with the help of Missouri pro-life activists, has documented 74 medical emergencies that have occurred at RHS Planned Parenthood in the past ten years, including three emergencies that required ambulance transport for women to a local hospital within a 22-day period ending on May 15, 2019." (Emphasis added)
The Supreme Court decision is not expected until June and is likely to have an enormous impact on the state of abortion in our country, especially since pro-abortion groups have now abandoned the old rhetoric about keeping abortion "safe, legal and rare'" in favor of tax-payer funded abortion on demand up to birth and even leaving babies to die after failed abortions.
In the meantime, considering choosing and supporting pro-life health care professionals and their professional organizations such as the American Association of Pro-life Obstetricians and Gynecologists (AAPLOG) and the National Association of Pro-life Nurses (NAPN).
Can a POLST be Hazardous to Your Life?
February 25, 2020 February 25, 2020 nancyvalko end-of-life, law, Living wills, medical ethics
First, we had the "living wills" developed in the 1970s by the Euthanasia Society US (later renamed the Society for the Right to Die) to allow people to states their wishes for or-most importantly-against certain medical treatments in case they become unable to communicate their decisions. By 1991, The Patient Self-Determination Act was passed and every health care facility was required to ask every patient if they had such a document.
Today, we have many types of such documents including the newest one called the "Physician Orders for Life-Sustaining Treatment" (POLST) that was developed in Oregon (the first state to legalize physician-assisted suicide) in 1991.
A POLST is a short document that people can carry with them with checkoffs for CPR (cardiopulmonary resuscitation) and tube feedings. And if the person is still alive but unable to communicate, the POLST has checkoffs for whether the person wants "Comfort measures only", "Limited Interventions" like antibiotics and IV fluids, or "Full treatment".
Although efforts to pass a national POLST law have failed so far, many states have passed their own versions that lead to serious concerns.
Most recently, Illinois is now considering a POLST bill SB 3524 that amends and expands the previous Health Care Surrogate Act.
Among the changes in the Illinois bill are changing "qualified physician" to "qualified health care practitioner" which "means an individual who has personally examined the patient and who is an Illinois licensed physician, advanced practice registered nurse, physician assistant, or licensed resident after completion of one year in a qualified graduate medical education program". (Emphasis added)
The bill also removes the requirement of a witness to the signature of the person, legal guardian or health care surrogate on the POLST form. This is an important requirement to be reasonably certain that the POLST reflects the person's wishes.
The bill defines a person's "qualifying conditions" for a POLST as "Terminal condition", "Permanent unconsciousness", or "Incurable or irreversible condition" (a definition that alarms many disability groups).
The bill also defines "Life-sustaining treatment" as "any medical treatment, procedure, or intervention that, in the judgment of the attending physician, when applied to a patient with a qualifying condition, would not be effective to remove the qualifying condition or would serve only to prolong the dying process". (Emphasis added)
Also, the bill states that the health care provider acting on the POLST in "good faith" is not "subject to any criminal or civil liability, except for willful and wanton misconduct, and may not be found to have committed an act of unprofessional conduct." (Emphasis added)
A February 16, 2020 editorial in the Journal of the American Medical Association titled "Physician Orders for Life-Sustaining Treatment and Limiting Overtreatment at the End of Life" had this chilling observation about physicians' attitudes and POLSTs:
"Even with the best of counseling, some patients will refuse any limitations of treatment—36% of the patients in the study by Lee et al1 had POLSTs that indicated "full treatment," presumably including admission to the ICU, mechanical ventilation, and cardiopulmonary resuscitation, if necessary. While receipt of these therapies would be considered POLST-concordant care, clinicians sometimes object to providing care that they perceive will be unbeneficial or even harmful. These conflicts between clinicians and patients or their surrogates are a common problem in ICU care and are seen as a major contributor to distress and frustration among clinicians." (Emphasis added)
A 2013 article "The Problem with POLST – Physician Orders for Life-Sustaining Treatment" succinctly describes the problems with POLST and what we should instead be striving for:
"POLST only makes sense in cases of patients with terminal illnesses, in end stage disease with no real options. By that point in time there are no therapeutic treatment decisions to be made. Yet, a patient who is under treatment who is living with a disease, there are alternative treatment decisions to be made. There are risks to weigh and an up to date informed consent required. It cannot be left up to a patient to research new literature and evidenced based medical standards.
POLST even precludes an assessment by a paramedic to make any decisions on overall survivability at the time of emergency care in the field. Surrogate decision makers are not consulted, advance health directives are not read or considered, and second opinions are not sought. Intelligent and experienced assessments are precluded by POLST. In cases of non-terminal patients POLST does not respect society's moral mandate to respect life and instead treats life cavalierly by simply pinning a card on a person's chest with life and death decisions of timely and clear origin." (Emphasis added)
As a former hospice, oncology and ICU nurse, I wholeheartedly agree!
Euthanasia: Canada, Conscience and Coercion
February 18, 2020 February 19, 2020 nancyvalko assisted suicide, conscience rights, euthanasia, medical ethics, mental health
A January 22, 2020 CNA article titled "Perform Euthanasia or Lose Government Funding", Canadian Hospice Told" revealed that a secular Canadian hospice was at risk of losing its government funding over its refusal to euthanize patients who request an "assisted death."
How could this happen?
First of all, Canadian health care (known to Canadians as "medicare") is 69% publicly funded for "medically necessary" care administered by the 13 provinces and territories with different rules. 31% of Canadian health care costs are paid by the private sector for services not covered or only partially covered by medicare, such as prescription drugs, dentistry and optometry.
The problems started when the Canadian Supreme Court legalized MAiD (Medical Assitance in Dying" in 2015.
Soon after, the province of Quebec drew up guidelines for MAiD and made "euthanasia kits" for lethal injections available to every doctor in Quebec. Now most MAiD deaths in Canada are done by lethal injection.
In September 2016, about three months after euthanasia became legal in Canada, British Columbia's Fraser Health Authority ( the publicly-funded organization responsible for administering healthcare in British Columbia) introduced a new policy which required all hospices receiving more than 50% of provincial funding for their beds to offer euthanasia to their residents. However, the hospice was operated by the non-profit organization the Delta Hospice Society, which is opposed to Canada's MAiD
One doctor said that there are "'strong lobbies' backing this new effort to expand MAiD into additional institutions which receive provincial funding, including faith-based hospitals or hospices." (Emphasis added)
HOW ONE CATHOLIC HEALTH CARE FACILITY RESPONDED TO MAiD
Unfortunately and in 2018, the Catholic Covenant Health system in the province of Alberta, Canada released a revised MAID policy:
"after consultations with more than 100 individuals and groups including doctors, Catholic bishops, Alberta Health Services, the Alberta government, patient advisers, families, ethicists and community members.
Under the policy, witnessing and signing of legal documents and assessments of eligibility can take place on Covenant Health sites. Patients deemed eligible for MAID would still be transferred to other facilities." (Emphasis added)
A current check of the Covenant website on MAiD shows no change in policy.
THE CANADIAN "SLIPPERY SLOPE" ALSO CONTINUES
In January, 2020 the Halifax Group, published "MAiD Legislation at a Crossroads: Persons with Mental Disorders as Their Sole Underlying Medical Condition" that supported MAiD not only for non-dying persons " experiencing enduring, intolerable and irremediable suffering from physical conditions" but also for persons who have "a mental illness as their sole underlying medical condition." (Emphasis added)
This month, The Expert Advisory Group responded to the Halifax group, warning that the Canadian medical suicide law is the "most permissive in the world".
THE EFFECT OF MAiD ON DOCTORS AND NURSES
Last year, The Canadian Catholic Nurses joined the National Association of Catholic Nurses in opposing the American Nurses Association's draft position for neutrality on physician-assisted suicide (unfortunately later approved) and gave a chilling look at what may be our future if legalized assisted suicide is not opposed:
"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."
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."
A 2018 study "Medical assistance in dying (MAiD): Canadian nurses' experiences" stated that:
"It is vital to understand how MAiD is influencing nurses in the Canadian context to ensure a smooth transition of this end‐of‐life care option across settings and communities. " (Emphasis added)
The study acknowledges some nurses' "moral distress" but describes "how participating in, or declining to participate in MAiD is shaping the participants' perceptions of nursing as a profession". The authors suggest promoting concepts like "Providing holistic care without judgment, Advocating choice, Supporting a good death" to positively reinforce that MAiD was "not a significant departure from their professional goals". (Emphasis added)
(Ironically, 77% doctors in Laval, Canada refused to provide MAiD 18 months after legalization with the most common reason that MAiD was "too much of an emotional burden to bear".)
Last year it was reported that "More than one in every 100 deaths in Canada is administered by a doctor" but that even this number is likely higher because parts of Canada currently do not report such deaths.
The numbers are also likely to get higher as the Canadian euthanasia laws expand the eligibility criteria and health care professionals worry about losing their jobs if they refuse to participate.
Unfortunately, most of the US mainstream media ignores the Canadian euthanasia experience while approvingly reporting on the increasing number of US states legalizing physician-assisted suicide.
What all of us need to understand is that the legalized killing of any patient ultimately leads to the destruction not only of the patient but also of a trustworthy health care system and a truly safe and civilized society.
Is there a "New" Catholic Medical Ethics?
February 10, 2020 February 10, 2020 nancyvalko end-of-life, futility, Living wills, medical ethics, nursing, palliative care, Simon's Law, terminal/palliative sedation
A few years ago, a middle-aged prolife nurse friend of mine had a sudden cardiac arrest after her mother died but was resuscitated. She was taken to the same Catholic hospital where I received my nursing education. She wound up sedated and on a ventilator to help her breathe, along with a feeding tube. Her 24 year old son wanted all efforts made to save her and several of us volunteered to help if and when she returned home.
Instead and after a week or two, her son was urged to remove her ventilator but, even then, she kept breathing even with the sedation medication used to control her tremors. But the son was horrified to see that her feeding tube was removed at the same time as the ventilator and against his wishes. The staff insisted that he agreed to this and that it was documented in the computer. He insisted he never agreed to this and demanded that the feeding tube be reinserted but the staff said they could not without a doctor's order.
The son stayed for hours waiting for a doctor but the staff said the doctor was busy. A nurse from hospice came in and pushed for hospice but the son said he wanted to take his mother home eventually so he and the volunteers could care for her. The hospice nurse then told him that his mother was dying and her organs were failing.
I happened to be there at the time and, as a critical care nurse myself, I told the hospice nurse that I saw that my friend's vital signs were normal and her kidneys were obviously functioning. I also questioned the dangerous increase in her sedation medication after her ventilator was removed because it could suppress her breathing. I was ignored. With a heavy heart, I lhad to leave to work my night nursing shift at another hospital but I told the son to call me if the doctor did not come.
The next morning, the son called me to tell me that the hospital just called to tell him his mother was dead.
He had stayed for several hours after I left but finally went home to get some sleep, thinking his mother was stable. He was devastated to later learn that his mother had been transferred to hospice against his wishes after he left. My friend then died a few hours later. She never got her a feeding tube or her sedation lowered or stopped. And she tragically died alone.
I still have nightmares about this.
THE "NEW" CATHOLIC MEDICAL ETHICS
While medically futile treatment has long been accepted as medically useless or gravely burdensome to the person, we now see a new bioethics with "quality of life", economics, societal and family burdens, etc. included in the determination of medical futility.
This January, I was horrified to find that the influential Catholic magazine Commonweal published an article titled "Giving Doctors a Say-Futility and End-of-Life Ethics" that also injects "respect for physicians as moral agents" to defend the rationale behind the (often secret) futility policies in Catholic hospitals by citing cases like the Charlie Gard and Simon Crozier cases where medical care was removed from two infants with life-threatening conditions against the parents' wishes. In Charlie Gard's case, the medical care was withdrawn by court order and in Simon Crozier's case the medical care was withheld without the parents knowledge. Both boys died.
Tragically, the outrageous Simon Crosier case occurred in the same Catholic hospital where I once worked and where my daughter with Down Syndrome and a critical heart defect was made a Do Not Resuscitate behind my back and against my expressed wishes.
As a nurse and a mother, I was shocked by the Commonweal article but not surprised.
I have been writing about the deterioration in medical ethics even in Catholic institutions for many years.
In the Commonweal article, Michael Redinger (co-chair of the Program in Medical Ethics, Humanities at Western Michigan University , and Law} defends medical futility and criticizes the Simon's Law passed in the Missouri legislature last year to prohibit "any health care facility or health care professional from instituting a do-not-resuscitate or similar order without the written or oral consent of at least one parent or legal guardian of a non-emancipated minor patient or resident". (Emphasis added)
Instead, Professor Redinger writes that "These efforts, collectively referred to as 'Simon's Law' legislation, are well-intentioned but misguided".
His Commonweal article concludes that:
"Given the coordinated efforts of Right to Life groups across the country and their ties to the Catholic Church, it is necessary to begin a broader conversation about the incompatibility of such laws with church teaching. Such a conversation would help guide individual Catholics at the end of life, and support Catholic bishops in their oversight of Catholic hospitals. Even better, it would relieve the medical staff at Catholic hospitals from the immense moral distress that comes from violating our oath to do no harm." (Emphasis added)
After years of research and my own experiences with Catholic hospitals and staff, I have seen the tremendous influence of the Catholic Health Association which boasts that it's health care ministry comprises "more than 600 hospitals and 1,600 long-term care and other health facilities in all 50 states", When I received my nursing education in a Catholic hospital in the late 1960s, rigorous ethics were an important part of our nursing education with "do no harm" to patients, report our mistakes, never lie, advocate for our patients regardless of age, socioeconomic status or condition, etc. incorporated as standard requirements. We happily took the Nightingale Pledge as our standard of excellence.
But now, as Catholic Health Association ethicists Fr. Patrick Norris and the late Fr. Kevin O'Rourke have stated in 2007 regarding futility :
"end-of-life decisions exemplify the principle of double effect, (wh)erein the withholding/withdrawing of life support is either morally good or neutral, the intention of the act being to remove either an ineffective or gravely burdensome treatment. The evil effect of the death is not a means to achieving the good effect (avoiding an inappropriate treatment), and, given appropriate circumstances, the good achieved is commensurate with the harm that occurs as a foreseen but unintended effect of a good action. The invocation of the principle of double effect in these cases properly distinguishes between physical causality and moral culpability." (Emphasis added)
I have been called by many distraught relatives who have said they thought their loved one was "safe" in a Catholic hospital but saw problems. One case involved an older woman who had a stroke (cerebral vascular accident) and was in a coma and expected to imminently die but continued to live several days later with normal vital signs. The woman had a pro-life living will to reject life-sustaining treatment, including a feeding tube, if she had a "terminal event" and was imminently dying. The relative wanted to know if this was indeed a "terminal event".
I asked if the woman was on a morphine infusion. She was and hadn't seemed to be in pain. I explained that the sedation could account for her coma and suggested that they ask the doctor about trying to slow or stop the morphine to see.
The relative called back to say that the morphine was stopped and that the woman started to wake up and even seemed to recognize them. However, the Catholic chaplain told the woman's sister who was her power of attorney for health care that her apparent response was only a reflex. The sister ordered the morphine turned back on.
The family was upset and considered legal action but decided that this would split the family so they gave up. Not surprisingly, the woman eventually died 2 weeks later.
After this case, I later wrote a blog "Living with 'Living Wills'" about the little-known pitfalls of advance directives and how they could work against what a person wants.
There are also non-denominational, non-profit groups like Hospice Patients Alliance and the Healthcare Advocacy and Leadership Organization (I am on the advisory board) that have much useful information and resources for patients, families and the public.
But without a change in policies and attitudes, those of us medical professionals who believe we should never cause or hasten death may become an endangered species as well as our medically vulnerable patients.
Roe v Wade 47 Years Later
January 28, 2020 nancyvalko abortion, disability, law, medical ethics
Like everyone else I knew, no one expected the US Supreme Court's case Roe v Wade to legalize abortion in 1973. I was shocked when the Court legalized abortion with virtually no restrictions during the first trimester stating:
"(a) For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman's attending physician. Pp. 163, 164.
(b) For the stage subsequent to approximately the end of the first trimester, the State, in promoting its interest in the health of the mother, may, if it chooses, regulate the abortion procedure in ways that are reasonably related to maternal health. Pp. 163, 164." (Emphasis added)
It wasn't until much later that I learned about the Doe v Bolton case (decided at the same time as Roe) that expanded the definition of "health", stating that the "medical judgment (for abortion) may be exercised in the light of all factors–physical, emotional, psychological, familial, and the woman's age–relevant to the well-being of the patient. All these factors may relate to health." (Emphasis added)
That redefinition of a woman's health opened the expansion of abortion.
Unfortunately, those of us who expressed horror about these decisions were quickly derided by those who supported legalized abortion. Even those of us who were medical professionals and knew better felt intimidated.
MY PERSONAL EXPERIENCE WITH ABORTION AND ITS EFFECTS
When I became a mother a few years after the Roe v Wade decision and read the prenatal development pamphlet given to expectant mothers, my heart ached for those mothers who chose abortion without such crucial information.
Eventually, I had a daughter born with Down Syndrome and a severe heart defect as well as another daughter who became pregnant at 18. I could understand the fear and desperation underlying an abortion decision and I was determined to help in some way by joining the pro-life movement.
Because of the pro-life movement, I have been better able to help desperate mothers, children with disabilities and their families as well as other people in danger of being seen as "inconvenient", "unwanted" or "better off dead".
THE ABORTION TRAJECTORY AND HOW IT IS CHANGING
After the Roe decision, it didn't take long before "abortion rights" to begin expanding and now we have at least 8 states legislating abortion on demand throughout pregnancy as well as at least 19 states allowing abortionists to leave babies to die who survive abortion.
Most recently, pro-abortion Democrats have blocked efforts to get Congress to vote on the "Born-Alive Abortion Survivors Protection Act" and in my home state of Missouri, the last Planned Parenthood clinic is still fighting closure over its health violations.
But despite all this activity on the pro-abortion side, many states have enacted strong protections for mothers and their unborn babies. Even the pro-abortion Guttmacher Institute acknowledges that:
"In 2019, conservative state legislators raced to enact an unprecedented wave of bans on all, most or some abortions, and by the end of the year, 25 new abortion bans had been signed into law"
And an encouraging new Marist/Knights of Columbus poll shows that a majority of Americans (65%) would vote for candidates who back abortion restrictions and nearly two-thirds of Americans oppose abortion if the child will be born with Down Syndrome.
In addition, there are more pregnancy help centers than abortion clinics to help women and their unborn babies.
As abortions are decreasing and the abortion movement is exposed for its radical goals, it appears that more and more people are seeing the truth about abortion and the pro-life movement. Personally, I have never felt more encouraged since the Roe v Wade decision 47 years ago and especially by the inspiring words of President Donald Trump, the first sitting president to address the annual March For Life in Washington, D.C.:
"We cannot know what our citizens yet unborn will achieve. The dreams they will imagine. The masterpieces they will create. The discoveries they will make. But we know this: every life brings love into this world. Every child brings joy to a family. Every person is worth protecting….
Together, we will defend this truth all across our magnificent land. We will set free the dreams of our people. And with determined hope, we look forward to all of the blessings that will come from the beauty, talent, purpose, nobility, and grace of every American child."
Lethal Problems with Medical Futility and Disability Bias
January 15, 2020 nancyvalko futility, law, medical ethics, nursing, Simon's Law
In 2018, Chris Dunn survived a freak diving accident that left him paralyzed, mostly blind and on a ventilator to breathe. He spent most of the next year in an ICU in rural Maine.
Unable to see, eat, breathe or move on his own, the 44 year old father and concrete work spent his days in bed listening to the History Channel and hoping for a chance to show he could do more.
Efforts to find a rehab center failed. Even worse, hospital administrators and others were encouraging Chris's mother Carol to put him in hospice to die. As the article states:
"Drugged up and confined to bed, Chris waited while dealing with a hospital staff that didn't know what to do with him. 'There would be nurses that would come in and tell me, 'You know you're making your son suffer,' says Carol. 'I mean, what's a mother to do with that?'" (Emphasis added)
However, Carol refused to give up trying to find help for Chris and after 7 months, finally contacted the United Spinal Association. Jane Wierbicky, a longtime nurse and a member of the Association's Resource Center team worked to help find a rehab center in Atlanta.
Now Chris only uses the ventilator a few hours a night, got outdoors to catch a fish, and returned home to spend Thanksgiving with his mother and girlfriend.
With the help of his mother and a team of advocates, Chris hopes to eventually live in an accessible apartment.
Medical care for Chris was not futile.
MEDICAL FUTILITY
The National Council on Disability defines "medical futility" as
"an ethically, medically, and legally divisive concept concerning whether and when a healthcare provider has the authority to refuse to provide medical care that they deem 'futile' or 'nonbeneficial'. A "medical futility decision" is a decision to withhold or withdraw medical care deemed "futile" or "nonbeneficial." (Emphasis added)
Because of my professional and personal experiences with disability bias as well as my volunteer work with people with disabilities, I have seen firsthand the potentially lethal effects of medical futility decisions based on disability. I have been writing on this topic for years, most recently on Missouri's Simon's Law enacted after the parents of a baby with Trisomy 18 and a heart defect who died later found out that doctors had ordered a "Do Not Resuscitate" and withheld life-sustaining treatment without their knowledge due to a secret medical futility policy at the Catholic hospital treating their son.
Recently, I found out that the National Council on Disability just published a 82 page comprehensive report titled "Medical Futility and Disability " as part of a five-report series on the intersection of disability and bioethics.
In a letter to President Trump, the Council chairman states that the series:
"focuses on how the historical and continued devaluation of the lives of people with disabilities by the medical community, legislators, researchers, and even health economists, perpetuates unequal access to medical care, including life-saving care.
and notes that:
"In recent years, there has been a push to regulate medical futility decisions on the state and institutional levels. State laws, which vary greatly in their content and approach, define the protections, or lack thereof, of a patient's wishes to receive life-sustaining treatment. Hospitals have turned to process based approaches, utilizing internal ethics committees to arbitrate medical futility disputes. Despite the increased attention, however, disability bias still finds its way into futility decision making." (All emphasis added)
The Council identifies four factors that are influencing the futility debate today: "Advanced life-saving medical technology, Changes in healthcare reimbursement, Evolving concepts of patient autonomy and the Rise of the right-to-die movement".
The report also extensively explores the legal issues and several court decisions involving medical futility like the Terri Schiavo and Haleigh Poutre cases.
The Council report also evaluated current state laws regarding medical futility decisions and found only 11 with strong patient protections, 19 without patient protections, 19 with weak patient protections, and 2 with time-limited patient protections.
Further complicating the state laws is the lack of transparency for patients or other family members regarding an institution's medical futility policies. Hospitals are rarely transparent with their medical futility policies, as in the Simon's Law case. The report is right when it states that "the disclosure of medical futility policies is essential to providing patients, their surrogates, and their families with the information they need to protect their rights and ensure accountability".
The Council also notes that "Disability nondiscrimination laws, including the ADA and Section 504 of the Rehabilitation Act, provide a viable, yet largely unexplored vehicle for enforcing the rights of people with disabilities in the medical futility context."
The report ends with recommendations for Congress, the executive branch, medical and health professional schools, professional accreditation bodies, healthcare insurers and state legislatures to combat the problem of disability bias in healthcare.
One of the reasons I chose to become a nurse decades ago was the strong ethical principles in medicine. We were educated to treat all patients to the best of our ability regardless of race, disability, socioeconomic status, etc. "Quality of life" was something to improve, not judge. The traditional hospice philosophy was to neither hasten nor prolong dying.
But over time, I saw ethics change. As the report itself notes, the advances in technology, changes in health care reimbursement, evolving concepts of patient autonomy and the rise of the right-to-die movement led to radical changes in both law and medical ethics.
The concept of medical futility was no longer limited to medically certain circumstances of treatment ineffectiveness but, all too often, also to the patient's (and sometimes the family's) perceived "quality of life".
Such disability bias is often unrecognized, even by the medical professionals caring for the person, but it is a real bias that must be eliminated in our society.
I admire people like Chris Dunn and his determined mother who show us the possibilities when people with even severe disabilities get a chance to have the best life possible.
Down Syndrome, the Gift of Innocence, and Abortion
December 30, 2019 December 30, 2019 nancyvalko abortion, disability, law, prenatal testing
In a beautiful op-ed in the December 23, 2019 Wall Street Journal titled "Down Syndrome and the Gift of Innocence" , William McGurn writes about a small group of contemplative nuns called the Little Sisters Disciples of the Lamb who reside in France.
The order was founded in 1985 by Mother Line, now prioress, and Sister Véronique, who felt a vocation but could not find an order to accept her because she has Down syndrome. Now there are 10 sisters (eight with Down syndrome) who exist so that "those who are in last place in the world"—women with Down syndrome—can "hold in the church the exceptional role of spouses of Christ. In practice this means that able-bodied sisters devote their lives to ensuring their fellow sisters with Down syndrome can live their vocations.":
"The smiling faces of our little sisters with Down syndrome are a great message of hope for many injured families," Mother Line tells me. "Our smallness will also say that we are made for very great things: to love and to be loved."
And while the rest of the world dismisses innocence as naïve or childish, Mr. McGurn writes that:
"the nuns choose to cherish and exalt innocence—and the unconditional love and trust that comes with it—as an example of how we are meant to live with one another."
DOWN SYNDROME AND ABORTION
In contrast to these wonderful nuns, a federal judge recently reversed his own ruling on a hard-fought pro-life abortion law passed in my home state of Missouri by blocking a provision that prohibits discriminatory abortions on unborn babies with Down syndrome.
Missouri was set to join several other states that passed such laws until U.S. District Judge Howard Sachs reversed his decision.
It is hoped that this decision will be appealed. As Justice Clarence Thomas has previously written about such laws that protect unborn babies from eugenic discrimination:
"… this law and other laws like it promote a State's compelling interest in preventing abortion from becoming a tool of modern-day eugenics."
"Although the Court declines to wade into these issues today, we cannot avoid them forever. Having created the constitutional right to an abortion, this Court is dutybound to address its scope." (All emphasis added)
AN "ACCEPTABLE" PREJUDICE?
A few days ago, the head of the American Civil Liberties Union (ACLU) Disability Rights Project Susan Mizner defended abortion for unborn babies with Down Syndrome writing that:
"There is no question that stigma, prejudice, and misconceptions about people with disabilities are widespread. But forcing someone to carry a pregnancy to term against their will does nothing to tackle underlying and systemic ableism and discrimination against people with disabilities.
"On the contrary, forced pregnancy threatens a person's physical, mental, and emotional health, as well as the stability and wellbeing of their family, including existing children." (All emphasis added)
As an RN and mother who had to fight medical discrimination against my daughter Karen who had both Down Syndrome and a heart defect as well as a past board member of the St. Louis Down Syndrome Association, I take great exception to this dangerously inaccurate statement. We can never eliminate prejudice by eliminating people with disabilities before or after birth.
I applaud the Little Sisters Disciples of the Lamb in France who cherish their sisters with Down Syndrome who have so much to give to the world and I am horrified by the several states that have now passed laws that allow abortion for any reason at any time during pregnancy or even after birth.
Although unborn babies with Down Syndrome are especially at risk, we must remember that ALL children enter the world with the "gift of innocence" and none deserve to be killed before birth.
Are We Witnessing the Coming Extinction of Conscience Rights?
December 13, 2019 September 15, 2020 nancyvalko abortion, assisted suicide, conscience rights, medical ethics
Last month, Wesley Smith, the well-known writer and lawyer who opposes assisted suicide and abortion, wrote an article titled "Bioethicist Wants to Morally Cleanse Medical Schools" about plans to weed out pro-life potential doctors and nurses from even entering medical and nursing schools:
"Make no mistake. Schuklenk and his ilk — such as the adamant opponent of medical conscience, Ezekiel Emanuel — are deadly serious about crushing all dissent within the medical professions to emerging cultural paradigms, and plan to morally cleanse the ranks of doctors, nurses, pharmacists, and institutions of all wrong thinkers, particularly of the religious and pro-life kind."
As Wesley warns after speaking with such prospective medical and nursing students, "such culling already occurs outside of official policy".
CONSCIENCE RIGHTS FOR HEALTH CARE INSTITUTIONS
Now health care institutions that forbid their employees from participating in abortion and euthanasia are at risk.
As an October 29, 2019 article in the Journal of the American Medical Association (JAMA) titled "Colorado End-of-Life Options Act-A Clash of Organizational and Individual Conscience" explains, a new court case may result in conscience rights being legally upheld when a doctor agrees to help a patient commit assisted suicide against a religious healthcare institution's policy.
This came about when the Colorado legislature could not pass a physician-assisted suicide in 2014 and 2015 but a new, problematic referendum was introduced and passed by Colorado voters in 2016.
While hospitals and clinics in other states with assisted suicide laws are allowed to prohibit their employees from participating, the Colorado, the referendum added a little-noticed provision in the 2016 Colorado referendum that stated:
"A health care facility may prohibit a physician employed or under contract with the facility from prescribing medication to an individual who intends to use the medication on the facility's premises. The facility must provide advance written notice of its policy to the physician and its patients. A health care facility may not discipline a physician, nurse, pharmacist, or other person for actions taken in good faith or for refusing to participate in any way." (Emphasis added)
As the JAMA article notes, "This provision virtually guaranteed the Colorado law would eventually be challenged".
This set up the current case "Mahoney et al v. Centura Health Corporation" involving Neil Mahoney, a Colorado man with advanced cancer, who wanted physician-assisted suicide and found geriatrician Barbara Morris, MD. Dr. Morris was willing to write the lethal overdose prescription. However, the religiously based Centura Health System where she was employed forbade participation in assisted suicide. Mr. Mahoney and Dr. Morris filed a lawsuit on August 21, 2019 and the doctor was fired on August 26 for violating the ethical directives provided for Catholic health care services.
The article concludes that:
"the case seems destined to have a potentially significant effect on national policy. If the courts rule that the Constitution allows hospitals to exert control over individual physicians' claims of professional conscience, it will be a victory for corporate medicine.
But if the state law is upheld, the case could establish that physicians' professional conscience claims hold or take precedence over the ethical and religious directives of religiously affiliated hospitals. It is possible that at least some religiously affiliated health systems might rather close than allow that outcome." (All emphasis added)
As Wesley Smith writes, eliminating pro-life health care providers and institutions is becoming part of an utilitarian agenda in the bioethics movement where "legalized euthanasia, free and unfettered abortion at all stages of gestation, infanticide, eugenic embryo engineering, invidious forms of health-care rationing based on 'quality of life,' etc., are all part of the mainstream bioethics agenda, or at the very least, are seen as respectable advocacy memes."
With the current support of a predominantly sympathetic mainstream media, well-funded and politically active groups like Planned Parenthood and Compassion&Choices are also putting pro-life health care providers and their supportive institutions in grave danger of becoming an endangered species in law, politics and health care.
If this happens, our health care system will radically change-especially for the unborn, the elderly and people with disabilities.
When dedicated and compassionate people are denied entry into the health care professions because they refuse to deliberately end lives, harassed and/or fired when they refuse to participate in a deliberate death decisions and religiously based healthcare institutions are forced by law to allow lives to be ended by "choice" or close their doors, will any of us be able to trust our healthcare system when we need it the most?
We need to educate ourselves and the public before it's too late.
Can Getting a DNR Tattoo be Hazardous to Your Health?
November 22, 2019 November 23, 2019 nancyvalko advance directives, end-of-life, futility, law, medical ethics
Cardiopulmonary resuscitation (CPR) is a lifesaving technique developed in the 1960s for emergencies such as a heart attack or near drowning when a person's breathing or heartbeat has stopped. Even non-medical people can be trained in basic CPR. However, not every person can be saved with CPR and some who do survive can have some brain damage.
In the early 1970s when I was a young ICU nurse, patients who appeared to be dying or their families could agree to a "do not resuscitate" (DNR) order.
But the 1991 Patient Self-Determination Act, along with the so-called "right to die" cases like Nancy Cruzan and Karen Quinlan, resulted in the widespread use of DNR orders in hospitals.
So now after years of concern with rising health care costs, older people worried about becoming a "burden" to their adult children, and the push for people to sign "living wills" to refuse certain treatments if they become incapacitated, it should not be a surprise that a growing number of people-including young, healthy people-are getting DNR (do not resuscitate) tattoos.
But what does that mean when an unconscious person is rushed to an emergency room?
Recently, there was a serious discussion of an actual case and a poll on ethics and DNR tattoos in MedPage, a newsletter for health care professionals.
The case involved a patient who arrived in an emergency room and unconscious after suffering a heart attack while jet skiing on vacation. He had 'Do Not Resuscitate' tattoo on his chest. There was a signature under the tattoo. However, the ambulance crew called restarted his heart with a defibrillator. The man was stabilized but hours later he has another heart attack.
The poll question and results from the 1580 votes were:
"Do you comply with the DNR tattoo or not?
Yes: 43.04%
No: 56.96%"
I was appalled that 43% would treat a DNR tattoo as the equivalent of a legal document and I agree with the reasoning of the lawyer/doctor reviewing this case who wrote that "the legally correct course of action would be to temporarily ignore the tattoo unless and until evidence that the tattoo reflects the patient's current thinking is brought forth."
PROBLEMS WITH DNR ORDERS
Unfortunately in hospital situations, DNR orders are sometimes misinterpreted as not wanting to live or "do not treat" when the person had assumed it would apply only in extreme circumstances.
For example, a new nurse was taking care of a young girl with mental retardation who was eating when she suddenly started choking. The new nurse ran to her head nurse in a panic and was told that, because the parents agreed to a DNR order, the nurses could only just hold her hand!
Obviously, relieving the choking by removing the food should have been done.
The results of not understanding DNR orders can be tragic but too many people-including medical professionals-don't realize the legal and ethical ramifications.
Personally, I chose to make a durable power of attorney for health care naming my husband as the decision maker if I could not speak for myself rather than a "living will" or other advance directive with various treatments to check off if I can't speak for myself.
I want all the options, risks and benefits of treatments fully explained to my decision maker based on my current condition so that he make an informed decision. This would include the use of a DNR if or when I am dying.
What we all desperately need now is more awareness and common sense when it comes to asking for or allowing a "Do Not Resuscitate" order, especially a DNR tattoo.
Accidental Oversight or Deliberate Omission in new Palliative Care and Hospice Education and Training Act?
November 11, 2019 nancyvalko assisted suicide, Compassion & Choices, end-of-life, euthanasia, medical ethics
With the enthusiastic support of Compassion and Choices (which promotes legalizing assisted suicide throughout the US), the first Palliative Care and Hospice Education and Training Act (PCHETA) was introduced in Congress in 2016 to allow millions of dollars in federal grants to, in the bill's words, "increase the number of permanent faculty in palliative care at accredited allopathic and osteopathic medical schools, nursing schools, social work schools, and other programs, including physician assistant education programs, to promote education and research in palliative care and hospice, and to support the development of faculty careers in academic palliative medicine."
While palliative care has been traditionally defined as "compassionate comfort care that provides relief from the symptoms and physical and mental stress of a serious or life-limiting illness" and hospice care as "compassionate comfort care (as opposed to curative care) for people facing a terminal illness with a prognosis of six months or less, based on their physician's estimate", the PCHETA bill may radically change such care.
I started writing about the potential dangers with the PCHETA bill in Congress in 2018 when it was passed by the US House of Representatives and sent to a Senate Committee for approval. The PCHETA stalled there, thought to be at least partially due to concerns by some U.S. senators about the bill's potential problems with hastening of death and legalized assisted suicide despite a "clarification" in the bill that that "None of the funds made available under this Act (or an amendment made by this Act) may be used to provide, promote, or provide training with regard to any item or service for which Federal funding is unavailable under section 3 of Public Law 105–12 (42 U.S.C. 14402)" such as assisted suicide, euthanasia or mercy killing.
So after the bill stalled, a second "clarification" was added to the Senate bill (now S. 2080) in July, 2019 that states "Sec. 5(b) ADDITIONAL CLARIFICATION.—As used in this Act (or an amendment made by this Act), palliative care and hospice shall not be furnished for the purpose of causing, or the purpose of assisting in causing, a patient's death, for any reason." (Emphasis added)
This second clarification is critical because, as the US Conference of Catholic Bishops representative Greg Schleppenbach, has written:
"This provision is important because for the first time anywhere in federal law or regulations it explicitly states that palliative and hospice care cannot be furnished for the purpose of causing or assisting in causing death. These protective provisions were added as a condition of our support for this bill." (Emphasis added)
But on October 28, 2019, the House PCHETA (HR 647) bill that does NOT contain the second clarification was reintroduced and quickly passed by the US House of Representatives on a voice vote and sent to the Senate for approval. That bill is now in the Senate Committee on Health, Education, Labor, and Pensions. (Senators can now be contacted by even email.)
OPPOSITION TO THE PCHETA BILL CONTINUES
Even with the second clarification, many groups continue to voice concern about the PCHETA bill because many of us nurses and doctors are seeing unethical practices such as assisted suicide, terminal sedation, voluntary stopping of eating, drinking (VSED) and even spoon feeding, etc. being used to cause or hasten death but often called palliative or "comfort care" for such patients.
We worry that the Palliative Care and Hospice Education and Training Act (2019) can allow federal funding to teach and even institutionalize such unethical practices without sufficient oversight, safeguards or penalties.
Julie Grimstad of the Healthcare Advocacy and Leadership Organization (HALO) also voices concerns about funding new palliative care and hospice programs, citing the 2019 Department of Health and Human Services Office of Inspector General report titled "Vulnerabilities in Hospice" that documented serious problems.
She also cites Dr. Farr A. Curlin, a palliative medicine specialist at Duke University, who warns that:
"When the goal of HPM (Hospice and Palliative Medicine) shifts from helping patients who are dying to helping patients die, practices that render patients unconscious or hasten their death no longer seem to be last-resort options," [emphasis added]
HALO is joined by other groups who officially oppose PCHETA S.2080 such as the National Association of Pro-life Nurses and the Euthanasia Prevention Coalition USA
Whether or not the omission of the second clarification in the bill sent to the Senate was intentional, the omission validates the genuine concern many of us have that the traditional end of life care ethic to neither hasten nor postpone dying is rapidly being replaced by "quality of life" judgments, economic concerns and patient "choice" to die.
Northern Ireland Forced into Legalizing Abortion on Demand
November 3, 2019 nancyvalko abortion, conscience rights, education, medical ethics, pro-life
My husband and I just returned from a long-anticipated and wonderful trip to Ireland with our friends, one of whom was born in Ireland to an unwed mother at the infamous Magdelene Laundries and adopted by a St. Louis family when she was 2 1/2 years old.
We traveled all around Ireland and Northern Ireland, enjoying the friendly people, beautiful old churches, stately castles, charming villages and great food.
We were able to see or read some news there but the topics were mainly about the Brexit deal for Ireland to leave the European Union.
Returning home, I was flabbergasted to read about the sudden legalization of abortion on demand in Northern Ireland forced by the UK that occurred October 22 when we were on our trip.
A BRIEF HISTORY OF ABORTION IN IRELAND
The United Kingdom legalized abortion with the Abortion Act in 1967, years before the 1973 Roe v Wade decision that legalized abortion in the US. But the Abortion Act was never extended to include Northern Ireland, a part of the UK, which then only allowed abortion for "a severe and long-term physical or mental risk to the woman's health".
In 2016, the United Nations tried to pressure Ireland into legalizing abortion on demand and overturn Ireland's Eighth Amendment that protected both unborn babies and their mothers equally as deserving a right to life. This made Ireland one of the safest places in the world for pregnant mothers and their unborn babies and with one of the lowest maternal mortality rates in the world.
But tragically in May 2018, a voter referendum to legalize abortion in Ireland passed. On January 1, 2019, the law took effect even though 95% of Irish doctors refuse to perform abortions.
And after the Irish voter referendum on abortion passed in May 2018, a poll by Amárach taken in October found that 60% of Irish residents oppose taxpayer-funded abortions, 80% say health care workers should not be forced to carry out abortions against their conscience, 79% favor a woman seeking an abortion being offered the choice of seeing an ultrasound before going through with the abortion and 69% of those surveyed believe doctors should be obliged to give babies that survive the abortion procedure proper medical care rather than leaving the babies to die alone.
But in Northern Ireland, recent rulings in the High Court in Belfast and the Supreme Court in London stated that the abortion situation in Northern Ireland was "incompatible with human rights legislation". So now, Northern Ireland is being forced to accept abortion up to 24 weeks or beyond if "the mother's health is threatened or if there is a substantial risk the baby will have serious disabilities". But, as happened in Ireland, hundreds of medical professionals-including doctors, nurses and midwives-say they will not participate.
Andrew Cupples, a Northern Irish GP, said that some medical professionals have even said they will walk away from the healthcare service itself if they are forced to participate in abortion services.
Nurses&Midwives4Life Ireland and Doctors For Life Ireland have been especially vocal and active in opposing abortion and those of us in the National Association of Pro-life Nurses have been enthusiastically supporting their efforts and encouraging others to do so as well.
My husband and I, as well as our friends, are very proud of our strong Irish heritage and firmly pro-life so this news about Northern Ireland was a blow.
But like the good doctors and nurses of Ireland, we will never give up.
As the abortion movement grows ever more hardened and radical, none of us must give up exposing the terrible truth about abortion as well as showing the life-affirming dedication to caring for both mother and unborn child that truly defines the pro-life movement.
A Very Special 6th Birthday Party
October 17, 2019 nancyvalko brain injury, disability, family, ventilators/life support
Recently, I was invited to a 6th birthday for a special boy.
"John" (as I will call him for privacy reasons) was born a healthy baby boy. But when he was a few months old, he stopped breathing and 911 was called. Apparently, John had a near-SIDS (sudden infant death syndrome) event.
John was resuscitated but the doctors in the emergency room told the parents that he had severe brain damage.
John's mom was a special education teacher and told the doctor that she often cared for severely brain-injured children and would do the same for her son. She was just so glad he survived.
I was called about John to help with information and support.
At one point months later, John became critically ill and was hospitalized. The doctors did what they could but said his chances of survival were bleak.
However, John surprised us all by getting better and going home. He was tough!
It takes a lot to care for a child on a ventilator and feeding tube at home but John's parents were up to the task, along with help from their church and family members. John's family later expanded when his two younger sisters were born. They obviously love their big brother.
When John had his 6th birthday a few weeks ago, it was a joyous occasion with family and friends. I was delighted to be invited. Although John is still severely brain-injured and still on a ventilator and feeding tube, he spent much of the party cuddled in his grandfather's arms. He was the center of attention.
John's grandfather told me about his brother who was born with cerebral palsy decades ago. The family was told that he would not live long but with supportive siblings and parents, the brother lived a good life until he died at age 60. The grandfather is still proud of his brother.
When my Karen was born with Down Syndrome in 1982, I didn't really know what to expect and I was shocked by negative attitudes-even from her medical professionals.
But that was wonderfully counteracted by the other parents in the St. Louis Down Syndrome Association who told me how their child was a blessing and how that child opened their hearts and eyes. I was awed by these other parents' concern, help and support for my daughter and our family.
I later asked these amazing parents if they were like this before their child was born. Every one of them said no and that it was their child that led them to open their hearts and eyes.
I eventually discovered how true this is even though my Karen only lived 5 1/2 months and I've been blessed by meeting other children with special needs and their parents.
Too often, people assume that a child with special needs is automatically a family tragedy.
The truth is that children with even severe disabilities can teach the rest of us so much about love, acceptance, true happiness and resilience.
And, of course, faith.
Exposing Abortion: "The Silent Scream" and "Unplanned"
October 7, 2019 nancyvalko abortion, culture, law, Planned Parenthood
In 1985, I was asked to show the new film "The Silent Scream" (still online) at a local community college for the students. I was anxious to show this amazing 30 minute film showing an actual abortion on ultrasound and narrated by the late Dr. Bernard Nathanson, a former abortionist who was the co-founder of the National Association for the Repeal of Abortion Laws (NARAL) in 1969.
Dr. Nathanson later deeply regretted his actions, and earned the enmity of the abortion movement by exposing the "deceptions, dirty tricks, and other tactics that helped make abortion legal and socially acceptable in the United States".
His "The Silent Scream" film was his effort to get the truth about abortion to the nation and it caused a lot of controversy.
When I showed the film at the community college, I was seven months pregnant and had a bumper sticker that said "Every child deserves a birthday". My mother supported my pro-life work but was worried about my speaking publicly. "Someone may try to shoot you!" she warned.
I just laughed at the time but when I got to the college I saw an armed guard also attending. He said he was there because there were death threats about showing this film. Although nothing happened and the students were very receptive to the film's message, I was a bit shaken but hopeful that this film would help end the abortion nightmare.
34 years later, the battle to end abortion continues.
I thought of Dr. Nathanson's film when I was finally able to see the 2019 movie "Unplanned" that, like "The Silent Scream", also caused tremendous controversy. Some theaters refused to show it and many film critics panned it but the movie was a surprising success at the box office.
"Unplanned" is a great sequel to "The Silent Scream" because it depicts the true story of Abby Johnson, an ambitious young woman who became the director of an abortion clinic and thought she was helping women.
Abby slowly and painfully finally learns the truth about both medical and surgical abortions and the real effects on women-including herself. The effect is both eye-opening and heartbreaking. Abby Johnson now helps other abortion clinic workers like herself as well as the public to see the truth about the enormous damage abortion causes.
Although "Unplanned" is no longer in theaters, it is available for purchase or online streaming on TV and well worth seeing and sharing with others.
Thank you, Abby Johnson and Dr. Nathanson, for your courage in sharing your stories. We will never know how many born and unborn lives you have saved!
Press Release: The National Association of Pro-life Nurses On Federal Judge Blocking North Dakota Law Informing Women of Abortion Pill Rescue Reversal
September 21, 2019 September 21, 2019 nancyvalko abortion, AMA, law, medical ethics
The National Association of Pro-life Nurses (NAPN) joins the American Association of Pro-life Obstetricians and Gynecologists, Heartbeat International and the Alliance Defending Freedom in responding to the September 13, 2019 decision by a federal judge granting the American Medical Association's (AMA) motion for a temporary injunction blocking the new North Dakota law requiring doctors to inform women seeking medical pill abortions about abortion reversal if they change their minds.
Already, 8 other states have passed abortion pill reversal informed consent laws with at least 750 babies saved.
The AMA's position is that this information is a "government mandated message that they would not otherwise recite and refer their patients to government-created materials and government-sanctioned referrals about an experimental medical treatment that has not been proven safe and effective or approved by the FDA, that violates accepted ethical standards and best practices in medical care, that undermines Physicians' ability to provide their patients with the highest standard of medical care, and that contradicts Physicians' viewpoints." (Emphasis added)
In reality, the abortion reversal drug progesterone is a natural pregnancy hormone to grow the placenta and provide nourishment for the unborn baby. It is sometimes given to pregnant women who have or have had bleeding, miscarriage, infertility or other problems as well as routinely with in vitro fertilization.
In medical pill abortions, the first abortion drug mifepristone blocks this natural progesterone while the second abortion drug misoprostol is usually taken by the woman 36-72 hours later to cause expulsion of the unborn baby.
If progesterone is given before the second abortion pill, the chances of the baby surviving increase from 25% (the survival rate without natural progesterone) to 68% (the average survival rate after giving natural progesterone). The timing between the first and second drug is the crucial window where abortion reversal if possible.
There is even a website at www.abortionpillreversal.com for information on abortion reversal that includes a hotline phone number at 1-877-558-0333.
But unfortunately, this is critical information that Planned Parenthood and the AMA apparently don't want women to get.
It is ironic that the abortion industry constantly proclaims that the public should just "trust women" when it comes to abortion but apparently it does not trust women with the truly informed consent required before any other treatment or procedure.
Marianne Linane RN, MS, MA, National Association of Pro-Life Nurses Executive Director
📞 (202) 556-1240
✉ Director@nursesforlife.org
Nancy Valko, RN ALNC Spokesperson for the National Association of Pro-Life Nurses
Website: www.nursesforlife.org
Facebook: https://www.facebook.com/Nurses4life/
Two Disturbing Articles about the Education of Doctors and Nurses
September 17, 2019 September 17, 2019 nancyvalko education, law, medical ethics, nursing
A September 12, 2019 Wall Street Journal op-ed titled "Take Two Aspirin and Call Me by My Pronouns- At 'woke' medical schools, curricula are increasingly focused on social justice rather than treating illness" exposed the problem with including politically popular courses at the expense of hard science.
This was preceded by an August 23, 2019 MedPage article titled "A Radical Change to Nursing Board Exams" that exposed a "A lack of situational teaching in clinical settings has led to inadequate skills in critical thinking and decision-making on the part of novice new graduate nurses" resulting "in an epidemic of poor clinical judgment among novice nurses, preventing them from making the best decisions for their patients and incurring huge costs to the institutions where they work for longer orientation periods and malpractice lawsuits." (Emphasis added)
It is hoped that this new nursing board exam will force nursing schools to make clinical judgment and clinical experiences a central part of nursing education.
I was shocked but not actually surprised by these two disturbing articles.
I started to notice the problems some new nurses were having several years ago after the traditional 3 year nursing diploma education in hospitals was phased out in favor of 2 year associate degree programs (ADN) and 4 year bachelor degree programs (BSN) with less clinical experience.
Many of our new nurses had trouble with decision-making and couldn't function well in the hospital. Many were demoted to nursing assistant or left after their trial period. I tried to personally help some of these new nurses who were obviously dedicated and wanted to do their best for their patients but many froze from the fear of making a wrong decision.
These new nurses needed more continuous help than I could give so I talked to nursing supervisors but the situation did not change much.
In the meantime, my hospital announced that every nurse now must have a bachelor degree in nursing (BSN) by 2021. This started at many hospitals after a 2010 Institute of Medicine paper recommended a goal that 80% of nurses have a BSN by 2020. RN to BSN programs then proliferated, eventually even online.
Most of my fellow nurses who took these BSN courses on their own time while working full-time complained to me that these courses were not especially helpful clinically and more geared to management preparation and community education. They also complained about exhaustion and difficulty managing family, work and study. Several wound up getting sick themselves.
Although the hospital helped with the expense of the BSN degree, the hourly salary increase for a BSN only went up to 10 cents more an hour when I was there.
In the September 12, 2019 Wall Street Journal op-ed "Take Two Aspirin and Call Me by My Pronouns" by Dr. Stanley Goldfarb, a former associate dean of curriculum at the University of Pennsylvania's School of Medicine, highlights another but similar problem. He asks "Why have medical schools become a target for inculcating social policy when the stated purpose of medical education since Hippocrates has been to develop individuals who know how to cure patients?"
He complains that:
"These educators focus on eliminating health disparities and ensuring that the next generation of physicians is well-equipped to deal with cultural diversity, which are worthwhile goals. But teaching these issues is coming at the expense of rigorous training in medical science. The prospect of this "new," politicized medical education should worry all Americans." (Emphasis added)
He also states that:
"The traditional American model first came under attack by progressive sociologists of the 1960s and '70s, who condemned medicine as a failing enterprise because increased spending hadn't led to breakthroughs in cancer treatment and other fields. The influential critic Ivan Illich called the medical industry an instrument of "pain, sickness, and death," and sought to reorder the field toward an egalitarian social purpose. These ideas were long kept out of the mainstream of medical education, but the tide of recent political culture has brought them in." (Emphasis added)
He concludes:
"Meanwhile, oncologists, cardiologists, surgeons and other medical specialists are in short supply. The specialists who are produced must master more crucial material even though less and less of their medical-school education is devoted to basic scientific knowledge. If this country needs more gun control and climate change activists, medical schools are not the right place to produce them." (Emphasis added)
After an apparent avalanche of criticism, the Wall Street Journal wrote an editorial defending Dr. Goldfarb's op-ed stating:
"Patients want an accurate diagnosis, not a lecture on social justice or climate change. Thanks to Dr. Goldfarb for having the courage to call out the politicization of medical education that should worry all Americans." (Emphasis added)
CONCLUSION AND SOLUTIONS
I became an RN fifty years ago in what I now call a "golden age".
Before we could even be admitted to nursing school, we had to submit a character reference. My fellow nursing students were as excited and dedicated as I was to become the best nurse possible for our patients. We regularly saw programs like "Marcus Welby, MD" and "Medical Center" where doctors and nurses worked tirelessly and bravely to help their patients.
When my preferred hospital changed its nursing program from a 3 year diploma program to a 2 year ADN program, I was worried but decided to trust the hospital. However, I felt somewhat unprepared after graduation and found a 1 year nursing internship program at another hospital that gave me supervised clinical experience in every area.
Not only did that increase my competency, it changed my mind from specializing in pediatrics to critical care. I think that such programs should be encouraged at every hospital for new nurses to help solve the problem of poor decision-making and clinical judgement. Nothing substitutes for actual clinical experience which is in short supply in many ADN and BSN programs.
Also 50 years ago, rigorous ethics were an important part of our nursing education with "do no harm" to patients, report our mistakes, never lie, advocate for our patients regardless of age, socioeconomic status or condition, etc. incorporated as standard requirements. We happily took the Nightingale Pledge.
However in the 1970s, I saw ethics slowly become "bioethics". The tried and true Hippocratic Oath principles requiring high ethical and moral standards for doctors including prohibitions against actions such as assisting suicide and abortion gave way to "bioethics" with essentially four principles:
4. Justice ("fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation")
Unfortunately, those principles are malleable and then used to justify actions and laws that would be unthinkable when I graduated. That bioethics mindset slowly changed not only medical and nursing education but also the principles that informed our work.
While we cannot recreate the past, we can reform our medical and nursing education and practice to return these professions-and our medical and nursing associations-to positions of trust. This is crucial not only for our professions but also for our patients and the public.
Here is What Sara Buscher Wrote to a Senator about the PCHETA
September 10, 2019 September 14, 2019 nancyvalko assisted suicide, economics, end-of-life, hospice, law, medical ethics, palliative care, terminal/palliative sedation
I have written before about the Palliative Care and Hospice Education and Training Act (PCHETA) that has now been reintroduced in 2019 but today, I have a guest column.
Sara Buscher recently wrote a well-researched letter to her congressman opposing the new PCHETA bill and has given me permission to use it here.
To find your state's House of Representative member, go to https://www.house.gov/representatives/find-your-representative
To find your US Senator. go to https://www.senate.gov/senators/index.htm and type your state into the search box near the end.
Via Email to sean_riley@ronjohnson.senate.gov
The Honorable Ron Johnson
RE: Palliative Care and Hospice Education Training Act (PCHETA),
2080 (in Senate HELP Committee) and related bill H.R. 647
Dear Senator Johnson:
I am a retired attorney and C.P.A. who served on Governor Tommy Thompson's task force on health care costs. I managed employee benefit programs for the State of Wisconsin and later at the University of Wisconsin. As a lawyer in private practice, I advocated for the elderly and disabled. I currently serve on the board of the Euthanasia Prevention Coalition – USA.
I urge you to object to this bill being "hot-lined," oppose it and vote against it. As one accountant to another, this bill is a rip off. In effect it will help create a second tier of health care where people receive poorer care, and are sometimes euthanized. The bill provides federal funding for palliative care medical education and a public awareness option for "selling" palliative care to patients and their families. Palliative care grew out of and includes hospice care. It provides an earlier pathway to hospice care.
Government Funding is Unneeded
Government funding is not needed. If enacted, the bill will cost the federal government $86 million over the next four years.[1] Palliative care has already spread rapidly.[2] Through 2006, the George Soros' Open Society Institute and the Robert Wood Johnson Foundation spent more than $200 million to develop and expand palliative care.[3] With philanthropic[4] funding, palliative care has grown to the point that more than 80% of US patients who are hospitalized for serious illness have access to it.[5] Over 2017-19, $40 million is being spent to develop community programs for serious illness.[6]
We know that philanthropic funding did not stop when the bill failed to pass two years ago. During that time, palliative care has continued to expand. If enacted, this bill would replace philanthropic dollars with federal tax dollars. So, this bill would benefit those who want to reshape medicine for the rest of us according to their worldview.
Elusive Cost Savings
If there are any savings, which is questionable as discussed below, providers would likely keep them. When the government pays a flat fee, like Medicare and Medicaid do for hospitalizations, the providers keep all the savings.[7] For example, if Medicare or Medicaid pays $20,000 per case and the hospital spends only $13,000, thereby saving $7,000, the government still pays $20,000 and provider keeps $7,000. The same is true of all the managed care programs and hospice. Industry proposals would have Medicare pay for palliative care like it does for hospice with a flat daily fee.[8]
I am concerned that palliative care, like its older sister hospice will not live up to its cost savings hype. Palliative care researchers are claiming they can save end of life costs that hospice and advance care planning also claim to be saving. It just isn't possible to save the same costs (use of Intensive Care Units (ICUs), reducing hospitalizations, and reducing aggressive care at the end of life) more than once.
A study done for the Medicare Payment Advisory Commission (MedPAC) found Medicare hospice benefits have not lowered Medicare costs in the last year of life.[9] According to the consultant, some researchers showed hospice saved money by picking time periods that compared apples to oranges.[10]
Enactment Could Erase Medicare Fraud Recoveries
The HHS Office of Inspector General says hospices are defrauding Medicare of hundreds of millions of dollars by enrolling people who are not terminal and then billing Medicare at the highest rates.[11] Hospices are already using palliative care as a "loss leader" to enroll more patients into hospice earlier.[12] Hospices make more money by enrolling people who are not eligible for hospice as they need less care.[13] As a result, for-profit hospices are the most profitable Medicare-financed health service. Id. They expect palliative care to become as profitable.[14] Competition will drive out small non-profit hospices.[15]
The PCHETA bill could erase Medicare fraud recoveries by extending palliative care including hospice to those with a "serious or life threatening illness," the definition of which is to be decided after enactment with input from hospice and palliative care insiders (Bill Section 4 creating section 904(c)(3)). If defined in a way that allows end of life hospice-like care to be called palliative care, it would legitimize enrolling the people who are now being fraudulently enrolled in hospice. Medicare spent $9.5 billion on hospice benefits for patients who outlived their terminal prognosis in 2016.[16] Nearly half of hospices are unsure they could pass a government audit, saying their biggest concern is their enrollment of people who are not terminal. Id. So, this bill could benefit those who game the system.
A Government Stamp of Approval May Hoodwink People
Palliative care can start alongside normal medical care and then eventually shift to hospice care without access to normal medical care. The HHS Office of Inspector General (OIG) reported that people were inadequately informed about the consequences of enrolling in hospice and some were placed in hospice completely without their knowledge.[17] In California, the Senior Medicare Patrol reported that elderly people living in their own homes were approached by nurses and sold housekeeping services that turned out to be Medicare hospice enrollment, leaving them without access to their medications and with unpaid medical bills.[18]
A government stamp of approval may lead more people to poor palliative care and in some cases, euthanasia. Last year, the HHS-Office of Inspector General (OIG) reported that hospice enrollees were receiving poor care.[19] More recently, HHS-OIG reported that 80% of hospices had deficiencies that posed risks to beneficiaries, with 20% jeopardizing patients' health.[20]
Instances of patients being overdosed to unconsciousness until they die (this is called "palliative sedation" or "terminal sedation") have increased according to Duke University professor Farr Curlin, M.D.:
Many patients and their families don't trust HPM [Hospice and Palliative Medicine] and are resistant to it.… These individuals tell stories about loved ones who declined slowly over time, fighting the good fight with the support and companionship of their family members and friends. When HPM professionals became involved in their care, their loved ones were put on powerful drugs, became unconscious and unresponsive, and were soon dead. These stories are clearly shared within communities and powerfully shape people's perceptions of HPM, which many see as a sophisticated and seductive way of getting people to die.[21]
I was involved in a case where a family member authorized pain relief for her sister and was assured the staff would keep her warm in a snugly blanket because she was always cold. Three hours later, she was dead after massive repetitive doses of powerful drugs.
To maximize profits, the director of Novus Health Services regularly directed nurses to make hospice patients "go bye-bye" with overdoses of drugs like morphine.[22] Novus is now facing a $60 million Medicare fraud indictment.[23]
Clinical practices in palliative medicine regularly result in shortening lives.[24] In one study, 39% of physicians and nurses said they intended to shorten survival with medications and treatment withdrawals.[25] A survey of over 800 hospice and palliative care physicians revealed 45% would sedate patients who were not actively dying to unconsciousness and then withhold food and fluids until they died.[26] One-fourth of them said it did not matter to them how long the patient had to live. Id.
I hope you will do everything you can to kill this bill.
Sara Buscher
[1] https://www.cbo.gov/publication/54309
[2] https://www.medscape.com/viewarticle/892289
[3] Palliative Care Grantmaking Snapshot Report 2009 (data up to 2006) at page 4, available at amydwrites.com/yahoo_site_admin/assets/docs/Palliative_Care_Grantmaking_Snapshot_Report.13155115.pdf
[4] "Mr. Soros is now funding a project that focuses on the development of palliative care globally. We help governments develop pain and palliative care initiatives and policies." https://www.mskcc.org/experience/physicians-at-work/kathleen-foley-work
[5] See note 2.
[6] https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.0653 grant from Gordon and Betty Moore Foundation.
[7] J. Brian Cassel, Whose Costs Are Saved When Palliative Care Saves Costs?, Health Affairs Blog Sept. 2014 at https://www.healthaffairs.org/do/10.1377/hblog20140929.041603/full/
[8] See proposals via links at https://www.nationalcoalitionhpc.org/aahpm-pacssi-payment-model-ptac-results-a-win-for-patients-and-families/
[9] Spending in the Last Year of Life and the Impact of Hospice on Medicare Outlays (Updated August 2015), MEDPAC http://www.medpac.gov/docs/default-source/contractor-reports/spending-in-the-last-year-of-life-and-the-impact-of-hospice-on-medicare-outlays-updated-august-2015-.pdf?sfvrsn=0
[10] See note 9 at the Appendix.
[11] https://oig.hhs.gov/oei/reports/oei-02-16-00570.asp linking to the complete report.
[12] https://hospicenews.com/2019/05/14/study-71-of-u-s-adults-have-never-heard-of-palliative-care/ A loss leader is a service sold below cost to attract more customers who will then buy more profitable services. www.businessdictionary.com/definition/loss-leader.html
[13] For-profit hospices saw profit margins exceed 15 percent in 2012, according to a new report from the Medicare Payment Advisory Commission, known as MedPAC, which advises Congress on health policy. No other Medicare-financed health service was as profitable. https://www.huffpost.com/entry/hospice-report_n_55b1307ee4b0a9b94853fc7a
The 2016 profit margin was 16.8%. http://www.medpac.gov/docs/default-source/data-book/jun19_databook_entirereport_sec.pdf?sfvrsn=0 at p 190.
[14] See note 12.
[15] hospicenews.com/2019/08/27/confessions-of-a-board-member-small-hospice-non-profits-will-not-survive/
[16] homehealthcarenews.com/2018/10/nearly-half-of-hospice-providers-uncertain-they-would-survive-an-audit/
[18] https://cahealthadvocates.org/beneficiaries-pay-the-price-for-hospice-fraud/
[21] Farr A. Curlin, MD Hospice and Palliative Medicine's Attempt at an Art of Dying, ch 4 in Dying in the Twenty-First Century, edited by Lydia Dugdale, MD, MIT Press 2015 at page 48.
[22] https://www.bizjournals.com/dallas/news/2016/03/30/novus-hospice-ceo-directed-nurses-to-overdose.html
[23] https://www.justice.gov/usao-ndtx/pr/sixteen-individuals-charged-60-million-medicare-fraud-scheme
[24] Cohen L, et al., Accusations of Murder and Euthanasia in End of Life Care, J Pall Med 2005.8.1096 at 1102.
[25] See note 24 at 1099.
[26] Plots created by Sahr N, Ph.D from data reported on in Maiser S et al., A Survey of Hospice and Palliative Care Clinicians' Experiences and Attitudes Regarding the Use of Palliative Sedation, J Pall Med 2017 Sep;20(9):915-92.
Nurse Vindicated After Being Forced to Participate in an Abortion
September 2, 2019 September 2, 2019 nancyvalko abortion, Compassion & Choices, conscience rights, law, Planned Parenthood
In 2018, I wrote about "The New Federal Conscience and Religious Freedom Division" established by the Trump administration as a desperately needed help for those of us health care professionals whose conscience rights have been ignored or threatened and included a link to report complaints even online. Now in fiscal 2018 alone, the division says it has received and dealt with more than 1300 complaints.
Most recently and thanks to the Conscience and Religious Freedom Division and with help from the American Center for Law and Justice, an unnamed nurse who was forced into assisting in an elective abortion in 2017 has been vindicated.
On August 28, 2019, the US Department of Health and Human Services, Office for Civil Rights (OCR) announced that, after a thorough investigation and attempts to resolve the issue, the OCR issued a Notice of Violation to the University of Vermont Medical Center (UVMMC) for forcing that nurse to assist in an elective abortion over her conscience-based objections and even though other nurses were available.
The OCR found that the UVMMC had discriminatory policies that assign or require employees to assist abortion procedures even after they record their moral or religious objections. UVMMC now must conform its policies to the long-standing Church amendments that protect the conscience rights of individuals or entities that object to performing or assisting abortions and take corrective action or "face potential action by the HHS from which UVMMC has received federal funding".
The notice also noted that for the last 3 years UVMMC "reported that it cumulatively expended $1.6 million of federal financial assistance."
The unnamed nurse, who no longer works at UVMMC, told the American Center for Law and Justice that she was misled into thinking she was assisting in a miscarriage but then found out that it was an elective abortion. However, her superiors "callously refused to relieve her". Fearing retaliation, she went through with assisting the abortion and was traumatized.
According to the American Center for Law and Justice, at least four other nurses, have now confirmed that they had been subjected to similar violations of their conscience rights.
As the American Center for Law and Justice also noted, even though the Church amendments were enacted after the US Supreme Court legalized abortion in 1973, they always lacked a mechanism for enforcement by private citizens. Enforcement depended on the Health and Human Services department. Unfortunately that enforcement has, for all intents and purposes, been nonexistent until recently.
Now the new division has put some teeth into enforcement.
As I have written before, groups like Compassion and Choices (the former Hemlock Society) and Planned Parenthood have vehemently criticized the Conscience and Religious Freedom Division, claiming that it would allow medical professionals "to impose their own religious beliefs on their patients and withhold vital information about treatment options" as well as "pave the way for discrimination against people for a variety of reasons."
The fundamental right not to perform or assist in deliberate death procedures terrifies these organizations that depend on medical professionals willing to assist suicides or perform abortions.
Therefore, we must all make sure that the whims of politics never again interfere with the fundamental right of medical professionals to "Do no harm". This is not only for their protection but also for our own.
The National Association of Pro-life Nurses Statement Opposing the Palliative Care and Hospice Education and Training Act (2019)
August 22, 2019 August 22, 2019 nancyvalko assisted suicide, Compassion & Choices, conscience rights, education, hospice, law, medical ethics, nursing, palliative care
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.
Pro-abortion Desperation in Missouri
August 19, 2019 August 19, 2019 nancyvalko abortion, law, Planned Parenthood, pro-life
In May of 2019, Missouri Governor Parsons signed one of the strongest pro-life laws in the country, the "Missouri Stands for the Unborn Act, and the last abortion clinic in Missouri lost its license because of numerous health and safety violations. The Planned Parenthood abortion clinic continues to operate only because of several temporary injunctions by a judge.
In an attempt to reverse the "Missouri Stands for the Unborn Act", the pro-abortion American Civil Liberties Union of Missouri attempted to mount a public referendum against the abortion restrictions. However, the ACLU gave up this week, contending that it was impossible to collect the roughly 100,000 voter signatures needed for the referendum in the two weeks before most of the law takes effect.
Nevertheless, now the Missouri public defenders office is warning that "taxpayer-paid attorneys could soon face the prospect of defending poor women charged with felonies for knowingly performing or inducing their own abortions". The Republican sponsors of the law have rejected this idea, citing that the law states a "woman upon whom an abortion is performed or induced in violation of this subsection shall not be prosecuted for a conspiracy to violate the provisions of this subsection." (Emphasis added)
These developments, along with other defeats such as the 10 other states passing strong pro-life laws just this year (some blocked by courts or currently facing lawsuits), is now revealing both the desperation and the extremism of Planned Parenthood and other pro-abortion groups to protect the abortion industry nationwide.
No longer is abortion called just a health care "choice".
Decades ago when I joined the pro-life movement, I thought that once people learned the truth about the humanity of the unborn child as well as the damaging effects of abortion on the mother and society, the public would reject abortion as a solution.
I also thought the selfless and voluntary efforts by the pro-life movement to help desperate mothers and their families would change hearts as well as minds.
Instead, the pro-life movement was called "dangerous" and "heartless" by the politically powerful and media-supported abortion establishment.
But since 1973 when the infamous Roe v Wade decision by the US Supreme Court opened the floodgates of killing by "choice", the pro-life movement continued to persist with every small positive step and every life saved celebrated as a victory.
Now, Planned Parenthood and other pro-abortion groups have dropped their self-described goal of mere "choice" to embrace and work for abortion on demand up to birth (and even beyond) without apology as a "civil right"-and preferably taxpayer-funded.
However, as Missouri shows, a dedicated and positive pro-life movement can succeed in changing laws as well as attitudes about respecting every human life.
Marketing Death and Alzheimer's Disease
August 9, 2019 nancyvalko Alzheimer's, assisted suicide, dementia, economics, Living wills, medical ethics, nursing
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"
"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)
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.
Press Release: The National Association of Pro-life Nurses Condemns the American Nurses Association Decision to Drop Its Long-standing Opposition to Assisted Suicide
July 24, 2019 July 25, 2019 nancyvalko ANA, assisted suicide, Compassion & Choices, conscience rights, medical ethics, pro-life
In June 2019, the American Medical Association (AMA) House of Delegates decisively approved reaffirming the AMA's long-standing policy opposing physician-assisted suicide despite enormous pressure from assisted suicide supporters and groups like Compassion and Choices as well as some other professional associations to change its position to "neutrality".
But a few weeks later, the American Nurses Association (ANA) dropped its long-standing policy opposing physician-assisted suicide. Instead its' new "The Nurse's Role When a Patient Requests Medical Aid in Dying (aka physician-assisted suicide)" insists that it is really about "high-quality, compassionate, holistic and patient-center care, including end-of-life care".
As the new position states, "A nurse's ethical response to a patient's inquiry about medical aid in dying is not based on the intention to end life. Rather, it is a response to the patient's quality-of-life self-assessment, whether based on loss of independence, inability to enjoy meaningful activities, loss of dignity, or unmanaged pain and suffering." (Emphasis added)
This response includes even being present when the patient takes the lethal overdose: "If present during medical aid in dying, the nurse promotes patient dignity as well as provides for symptom relief, comfort, and emotional support to the patient and family." (Emphasis added)
For nurses who object to assisted suicide, the position states that "Conscience-based refusals to participate exclude personal preference, prejudice, bias, convenience, or arbitrariness" and that "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)
In other words, nurses would have to abandon their vital role in preventing and treating suicide for some of their patients when the issue is assisted suicide. And a conscience-based refusal to participate depends on whether or not another nurse willing to participate is available.
Although the ANA insists that their position "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", the effect is chilling for those of us who cannot or will not help our patients kill themselves even where legal.
Already, Compassion and Choices (the former Hemlock Society) is praising the ANA for "dropping opposition to 'medical aid in dying'", stating that "It's no surprise that the largest national nursing association recognized the growing public demand for medical aid in dying and updated their policy to allow nurses to better support their patients at life's end." (Emphasis added)
But the ANA may eventually have to again update their position on assisted suicide since we are now seeing, as in a (thankfully failed) recent bill in New Mexico, further attempts to change the definition of terminal illness to expected death in the "forseeable future", non-physicians such as advance practice nurses able to prescribe assisted suicide, inclusion of people with mental health disorders, approval by "telemedicine" and no state residency requirement.
Right now, 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 should reconsider its new position on assisted suicide for the good of all nurses and even society itself.
In the end, who will remain or want to enter a healthcare profession that allows helping some patients kill themselves? And how many of us would be just as trusting with a nurse who is as comfortable with assisting our suicide as he or she is with caring for us?
📞 (314)504-5208
American Nurses Association Damages Good Nursing with Misleading "No Stance" on Assisted Suicide
July 18, 2019 nancyvalko assisted suicide, Compassion & Choices, conscience rights, medical ethics, nursing
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.
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.
Final Federal Conscience Protection Rule Delayed Because of Lawsuits
July 12, 2019 July 12, 2019 nancyvalko abortion, assisted suicide, Compassion & Choices, conscience rights, law, medical ethics, Planned Parenthood
Last year, I wrote about the new 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". The division specifically mentioned "issues such as abortion and assisted suicide in HHS (Health and Human Services)-funded or conducted programs and activities". The division also included a link to file a conscience or religious freedom complaint "if you feel a health care provider or government agency coerced or discriminated against you (or someone else) unlawfully".
The rule mandates that institutions receiving federal money be certified that they comply with more than two dozen laws protecting conscience and religious freedom rights.
Despite fierce opposition by groups like Compassion and Choices and Planned Parenthood, HHS announced on May 2, 2019 that the Final Conscience Rule Protecting Health Care Entities and Individuals would go into effect July 22, 2019.
However, lawsuits were quickly filed by groups like Americans United for Separation of Church and State and the Center for Reproductive Rights, delaying implementation of the Final Conscience Rule until at least late November. The first lawsuit was filed by San Francisco within hours of the announcement of the Rule.
WHAT IS THE PROBLEM WITH CONSCIENCE RIGHTS?
While Roger Severino, the head of the HHS Office for Civil Rights has said that the Final Rule did not add any new laws but rather strengthened the enforcement of rules already on the books, the San Francisco lawsuit alleged that if San Francisco does not comply with the rule ""it risks losing nearly $1 billion in federal funds that support critical health care services and other vital functions."
In a press release, San Francisco city attorney Dennis Herrera stated the Final Conscience Rule:
"would have allowed health care professionals to refuse to provide service to patients based on the staffer's personal beliefs, threatening medical access for women, lesbian, gay, bisexual, and transgender people, and other medically or socially vulnerable populations."
"Hospitals are no place to put personal beliefs above patient care. Refusing treatment to vulnerable patients should not leave anyone with a clear conscience."(All emphasis added)
Of course, ethical healthcare professionals respect all patients without bias. The problem is being forced to participate in actions that violate our consciences.
ARE CONSCIENCE AND RELIGIOUS RIGHTS NECESSARY?
Dr. Donna Harrison, director of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) makes the crucial point that:
"Those who oppose the HHS Conscience Rule demonstrate their clear intention to squeeze out of the medical profession any doctor who still abides by the Hippocratic Oath, and to squelch any opposition to forcing doctors to kill human beings at the beginning and end of life."
Those of us who are nurses have been especially vulnerable.
As I have written before, I was threatened with termination when I refused to cause a patient's death by increasing a morphine drip "until he stops breathing". I know many other nurses who have had similar experiences.
And in 2013, 12 New Jersey nurses who had a long-standing, in-writing agreement exempting them from participating in abortions apart from a medical emergency were nevertheless threatened with termination when the hospital initiated a new mandatory policy to participate in all abortions. These nurses were finally vindicated in court but litigation is time-consuming and expensive.
And even the liberal NPR recently noted the rise in conscience complaints for health care workers since the Division of Conscience and Religious Freedom was established.
Obviously, there is a great need for this conscience rights protection for all healthcare workers. Now there is a way to stand up to bullying and discrimination so that we can properly care for our patients.
A few years ago, a worried student nurse asked if there was any area of nursing where her conscience rights would not be threatened. This was an important question because over the past several decades, new threats to conscience rights have widened from refusing to participate in abortions to other deliberate death decisions like withdrawal of feedings from people with serious brain injuries, VSED (voluntary stopping of eating and drinking), terminal sedation and physician-assisted suicide.
Most recently, the American Nurses Association wrote a draft position paper potentially changing its' opposition to assisted suicide to neutrality and requiring that nurses must be nonjudgmental in discussing assisted suicide with a patient and even participate if no other willing nurse is available.
As assisted suicide and other such death decisions continue trying to expand, it is more necessary than ever to support ethical healthcare professionals both in law and in practice.
We all need the Conscience Rights Protection rule to ensure that ethical healthcare professionals can continue in their professions and help to restore trust in our healthcare system.
The Last Planned Parenthood Clinic in Missouri Again Evades Closure
July 1, 2019 July 1, 2019 nancyvalko abortion, Planned Parenthood, pro-life
My most vivid memory of prayerful witnessing at the Reproductive Health Services Planned Parenthood clinic in St. Louis happened in 1987. I joined a large pro-life group with signs not just decrying abortion but also offering help to women considering abortion.
At that time, I was pushing my 18 month old daughter in a stroller and obeying the instructions to stay on the sidewalk when my daughter suddenly bolted from the stroller and ran across the grass towards the clinic's door.
I quickly grabbed her and put her back in her stroller, hoping no one from the clinic staff noticed. Even though I am opposed to abortion, I followed the rules.
32 years later, that daughter is firmly pro-life and expecting her second child while that same Planned Parenthood clinic-the last one in Missouri-is getting yet another court-ordered reprieve from closure after the Missouri Department of Health and Senior Services (DHSS) decided not to renew the facility's license on May 31, 2019. The department cited dozens of serious health and safety violations.
Public records show numerous problems at the clinic including unreported failed abortions, life threatening complications, an illegal abortion at 21 weeks, insufficient supervision of medical residents (students) performing abortions and inaccurate medical records among the many other violations. According to an ABC News report, the DHSS director said "the decision to deny their health department license was based on the fact that of 30 deficiencies found in the department's review of the clinic, only four have since been addressed by Planned Parenthood".
Missouri is one of the most pro-life states in the US and Governor Parsons just signed one of the most protective pro-life laws in the nation but, as usual, abortion is usually more about politics than facts.
Planned Parenthood sued Missouri health officials several weeks ago over the licensing dispute and a judge kept issuing temporary injunctions to keep the abortion clinic open until the judge sent the case to the Administrative Hearing Committee. On June 28, 2019, that committee's commissioner granted Planned Parenthood's motion for a stay that will allow abortions to continue at least until he hears the case later this year.
PROTECTING ABORTION, IGNORING SAFETY
In 2016 US Supreme Court case Whole Women's Health v Hellerstedt, the court overruled the requirements in Texas that abortionists have admitting privileges at a nearby hospital and that abortion clinics have facilities comparable to an ambulatory surgical center. The judges ruled 5-3 that these requirements constituted an undue burden on abortion access and were thus unconstitutional.
Ironically and just two years later , the true life movie "Gosnell: The Trial of America's Biggest Serial Killer" was released and opened many eyes. The movie is about the notorious Philadelphia abortionist who ran an outrageously filthy but politically protected abortion clinic and who eventually was convicted of murder. Dr. Gosnell executed late-term unborn babies who survived abortion by callously cutting their spinal cords. In addition, some of the women died, suffered serious complications or contracted diseases from dirty instruments during the 30 years he operated his clinic without penalty from the Pennsylvania Department of Health.
Of course Planned Parenthood is desperate to keep their last abortion clinic in Missouri open but public opinion is apparently turning on abortion "rights" in general, especially after at least 8 states have now stripped away all legal protections for unborn babies and allowing them to be aborted for basically any reason up to birth.
A recent Gallup poll now shows that 60% of Americans want all or most abortions made illegal and 9 state governors have recently signed laws giving even more protections to unborn babies. In addition, a federal appeals court just ruled that the Trump administration can defund Planned Parenthood of almost $60 million dollars in taxpayer funding.
While the well-funded and politically connected Planned Parenthood organization will continue to file lawsuits against even common sense health and safety requirements in states like Missouri, we all must never stop trying to protect both women and their unborn babies!
Press Release: The National Association of Pro-life Nurses comments on recent AMA decision
June 20, 2019 June 20, 2019 nancyvalko assisted suicide, conscience rights, medical ethics, nursing, pro-life
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.
Great News: American Medical Association Votes to Continue Opposition to Physician-assisted Suicide. But Will the American Nurses Association Follow?
June 16, 2019 June 16, 2019 nancyvalko assisted suicide, Compassion & Choices, conscience rights, medical ethics, nursing
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:
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.
Compassion & Choices
fetal tissue
Simon's Law
terminal/palliative sedation
terninal/palliative sedation
ventilators/life support