2008: Conference spotlights thorny end – of – life questions

Catholic San Fransisco article on the End of Life Conference. Nancy was one of the three speakers.

Conference spotlights thorny end-of-life questions

By Michael Vick

November 5th, 2008

Nancy Valko, one of three speakers at the Sept. 13 End – of – Life Issues Conference held at St. Mary’s Cathedral in San Francisco, came to the field of bioethics through deep personal tragedy. In 1982, Valko gave birth to her daughter Karen, born with Down syndrome and a rare heart defect.

Valko’s doctor gave the child only two months to live, saying the defect was so severe it seemed inoperable. She refused to accept the prognosis, and decided to use her training as a nurse to research other alternatives. She found a surgery that could correct the defect that had a 90 percent chance of success.

Reviewing the surgery, the doctor agreed, but made it clear to Valko he would support her either way.

“Either way for what?” Valko asked. She then realized the doctor would approve of withholding treatment, not because it had no potential for success, but because her child had Down syndrome.

Go to link for full article

2001 First Things magazine: A Lethal Evolution

A Lethal Evolution

by Nancy Valko

December 2001

It started with a headache. It ended with a shocking death, a devastated family, a tarnished reputation for a hospital, and growing concern about the state of ethics in Catholic health care.
While considerable attention is now focused on assisted suicide, a quiet but lethal evolution of the so-called “right to die” has been taking place in hospitals and nursing homes all over the U.S., even in Catholic health care institutions

The tragic “right to die” case of Steven Becker in St. Louis last year was the first such case in a Catholic hospital to garner any media attention, and this was only because Steven’s mother, Marge Sutter, was willing to take legal action to save her son. Few family members are courageous enough to take on a legal system that rarely supports the right to life in such cases.

Steven Becker was a twenty“eight“year“old father of three small boys who was admitted to St. John’s Mercy Medical Center in St. Louis in March 2000 because of severe headaches. According to his family, Steven knew the situation was serious and that brain surgery was contemplated.

On admission, he was offered a health care directive as required by law but he refused to sign it. Such directives, which encompass the well“known “living will” as well as documents assigning health care decision making to a family member or others, are designed to allow a person to refuse even life“saving treatment or medical care if the person becomes mentally incapacitated.

A few days later, Steven unexpectedly became unresponsive during a test and an emergency operation was performed to relieve the pressure on his brain. He was placed on a ventilator for a few days until he could breathe on his own again, but he did not regain full consciousness.

Rehabilitation was started and, according to family members and progress notes included in the public record, Steven showed some signs of responsiveness. But several weeks after the operation, Steven’s wife, Christie, accepted the prognosis that Steven would not improve and acquiesced to the hospital ethics committee’s recommendation of withdrawing his tube feedings. She was supported in her decision by her parish priest.

According to public court records, St. John’s helped Christie make funeral arrangements and offered counseling for the children in anticipation of Steven’s impending demise.

Alarmed at the unusual speed with which her son was declared a hopeless case, Steven’s mother, Marge, asked for guardianship of Steven, her only child, and a judge granted a temporary stay of the food and water withdrawal pending a court hearing three months later. The court also appointed James Wright, Jr., a lawyer, as a temporary guardian to investigate the situation and make a recommendation. Mr. Wright made it clear from the beginning that his main concern was whether or not Steven was in a “permanent vegetative state” and thus had no chance for a “meaningful life.” The case made the front page of the St. Louis Post“Dispatch on June 2, 2000, which portrayed it as just another tragic family dispute. But many readers were alarmed that a Catholic hospital was supporting death by dehydration for a non“dying disabled man.

In a newspaper interview, Sister Pat Talone, the hospital’s ethicist, defended the committee’s recommendation to withdraw treatment by saying that the group “examines medical reality as well as social, spiritual, and ethical principles before making a recommendation.”

Pro-life and disability activists picketed the hospital, protesting its intention to withdraw feedings. A month later, Archbishop Justin Rigali issued a statement reiterating the Church’s position on such matters, citing several Church sources including Pope John Paul II’s 1998 statement calling medically assisted food and water “an ordinary means of preserving life.”

When it was revealed that rehabilitation efforts were also stopped with the decision to end the tube feedings and that even antibiotics were now considered “life support,” an editorial in the St. Louis Review (the archdiocesan newspaper) pointed out that “In a situation where the health of the patient depends not only upon food and water, but on other forms of care and treatment, the purpose of providing food and water should not be undermined by a neglect of the other forms of care. A patient’s life might depend not only upon basic forms of medical treatment such as antibiotics, but upon simple care designed to minimize infection and bolster physical, mental, and physiological functioning.”

After September court hearings, which were closed to the public and press, Judge Mark Seigel accepted the recommendation of the court“appointed guardian and gave guardianship of Steven to his wife. Mr. Wright, the lawyer/guardian, maintained that, even in the absence of a “living will” or other advance directive, Steven would have wanted to die in order to spare his family further grief and cited the six-year-old son’s question, “When is daddy going to leave the hospital and go to heaven?” to justify the need to speed Steven’s death.

A few days after the court decision, while an appeal was being planned, Steven was spirited out of the hospital during the night. The hospital, which had finally accepted the Archbishop’s position and thus would not allow Steven’s feeding tube to be removed on its premises, now refused to disclose his whereabouts.

An emergency restraining order against withdrawing feedings was obtained by Steven’s mother, but no one was able to serve it because his location was unknown. As a desperate search began, the Post=Dispatch reported that the feedings had already been stopped.

Several days later and just one hour before a court hearing on extending the restraining order against withdrawing feedings, it was announced that Steven had died at home, attended by a nurse, a doctor, and a parish priest.

In the aftermath of the case, Steven’s mother was left with thousands of dollars in legal bills and the pain of losing a son whose death she was unable to prevent or even witness. Sr. Talone, the St. John’s ethicist, was subsequently promoted to director of ethics for the Catholic Health Association. Meanwhile, Archbishop Rigali’s intervention was publicly condemned by several prominent Catholic theologians and ethicists.

Thirty years ago, I worked as a nurse in the intensive care unit (ICU) at the very same St. John’s Mercy Medical Center. In those days, Euthanasia Education Councils and “living wills” did not yet exist, and calling a patient a “vegetable” was a slur, not a diagnosis.

At that time, there was a consensus among the medical and nursing professions that it was wrong to cause or hasten death, and we knew the difference between ordinary and extraordinary treatment decisions. Medical and nursing students were taught that those patients who could not speak for themselves”for example, infants and the severely disabled”deserved special protection from harm because of their vulnerability. Removing a feeding tube to end a patient’s life was simply unthinkable.

Back then, when a patient’s death appeared to be inevitable, we talked to families about DNR (do not resuscitate) orders and about the option of not initiating more aggressive treatment. But one thing we did not do was talk about withdrawing treatment in order to speed the patient’s death.

I particularly remember one young man who was admitted in a coma after a car accident. The neurosurgeon who examined him predicted he would be dead by morning or become a “vegetable.” I was shocked that the doctor said this in front of the patient.

But “Mike” didn’t die, and, after a few weeks, he could move a finger on command and say hi. We nurses were excited, but became baffled when Mike didn’t respond to the neurosurgeon, even with deep pain stimulation. Mike left our unit and we assumed he would spend the rest of his life in a nursing home.

Two years later, a handsome young man strode into our ICU, announced he was Mike, and thanked us for saving his life. We were stunned. Laughing, I told him that he wouldn’t remember this, but he used to respond a little to us nurses but didn’t for the neurosurgeon. The laughter stopped when Mike revealed that he purposely hadn’t responded to the doctor because he had heard him call him a vegetable and it made him angry. Today, Mike would probably be dead because of his refusal to respond to a doctor.

In hospitals all over the country today-Catholic and non-Catholic alike-families are told by doctors with supreme confidence that their loved ones are hopeless and that all treatment should be withheld or withdrawn in order to allow them to die. This often happens within hours, days, or weeks of a person suffering a brain injury, stroke, or critical illness. I have even seen such patients described as “brain dead” so that reluctant families might be induced to withdraw treatment.

There is now a proliferation of “end of life” educational programs that equate the care of the severely brain-injured with the care of the truly dying. Thus death is virtually celebrated as a way to be reunited with God as well as a legal exercise in choosing the so“called “right to die.” Even routine medical treatment often seems to be viewed as an impediment to these happy results.

As is often the case, today’s troubling practices have their origins in the bad ideas of the past. The theological rationale for withdrawing feedings from the so“called “vegetative” person was first provided by such ethicists as Father Kevin O’Rourke, now director emeritus of The Center for Health Care Ethics in St. Louis. Like some other ethicists, he claimed that the presumed absence of mental function precluded “vegetative” patients from pursuing the “spiritual purposes of life,” and thus that a simple feeding tube was an example of extraordinary treatment which could be ethically withheld or withdrawn. In a 1991 interview, Fr. O’Rourke even dismissed the moral imperative of spoon“feeding such patients, asserting that it should be undertaken only “if there is medical evidence that the (brain) injury is reversible”that [the patient] would be able to know, love, relate to people.”

There was no medical breakthrough that initiated this new way of thinking about brain-injured people, but rather a change of spiritual outlook. The example of the Good Samaritan who saved the unconscious man and even paid for his care was replaced with concerns about mental and spiritual “quality of life.”

Borrowing from the new secular ethic of “compassionate death,” even the Catholic Health Association now publishes articles encouraging “futility policies” for hospital ethics committees that enable them to force the withdrawal of treatment from patients or families who do not make the “right” choice. Articles on rationing health care are presented as being motivated by concerns over “social justice,” which simply means that the community is assumed to take precedence over the individual patient.

What can we do to reverse this trend? Policies like those of Archbishop Rigali, which forbid the denial of food and water to the non“dying in St. Louis Catholic institutions, are certainly a promising start. But better educational resources are also needed. Pope John Paul II himself has said that “a great teaching effort is needed to clarify the substantive moral difference between discontinuing medical procedures that may be burdensome, dangerous, or disproportionate to the expected outcome””what the Catechism of the Catholic Church calls “the refusal of ‘over“zealous’ treatment” (2278)””and taking away the ordinary means of preserving life, such as feeding, hydration, and normal medical care.”

On a more practical level, much more can be done to improve the lives of the “vegetative.” Rather than the common policy of discharging such patients to nursing homes when family members insist on continued treatment or the insurance money runs out, Catholic institutions could develop sorely needed long“term rehabilitation facilities that could build on the encouraging work being done with such patients in England and Israel. As Dr. Eugene Diamond has written, such a facility “might well be a place where Christian witness and science combine to investigate PVS (persistent vegetative state) and enhance its favorable outcome.”

Going further, the federal law mandating that all patients be offered “living wills” or other advanced directives to “pre“choose” withdrawal of treatment could be met in Catholic hospitals by offering documents that are more protective and clearly reflect Catholic principles. And perhaps the bishops could provide oversight of Catholic ethics teaching and practice on the order of the new oversight of Catholic theology in Catholic universities.

At the very least, we need to counteract the prevailing attitude that it is better to be dead than disabled, and that people in need are burdens to themselves and others. True dignity is inherent in us all and is not extinguished by dependence on others. Which is to say, we need above all to bring back the ideal of the Good Samaritan.

Nancy Valko, an intensive care nurse, is spokesperson for the National Association of Pro-Life Nurses and president of Missouri Nurses for Life.

1990’s St. Louis Post-Dispatch Op-Ed: The Issue is Equality

The Issue is Equality

Nancy Guilfoy Valko
Reproduced with Permission

It happened more than 10 years ago. I was pregnant with my third child and the controversy over Baby Doe was still swirling.

Baby Doe was a newborn boy who was born with Down Syndrome and a defect in his esophagus that needed surgical correction before he could drink from a bottle. Although this operation was routine for newborns with this problem, Baby Doe’s parents refused it, and a court upheld their decision. Several parents came forward offering to adopt Baby Doe and even pay for the operation. They were rebuffed, and Baby Doe died six days later without being fed.

I was shocked. Why didn’t the court or the law protect Baby Doe from such obvious discrimination? How could the parents’ lawyer maintain that it was a “loving decision”? Did that mean that parents who make sure their disabled children receive life–saving treatment are unloving?

Four months later I gained a new understanding of the gravity of those questions when my daughter, Karen, was born with Down Syndrome and an even more serious condition than Baby Doe’s: a life–threatening heart defect. I was stunned when Karen’s doctor said that there was an operation available with an 80 to 90 percent success rate, but that he would support my husband and me “100 percent” even if we chose not to operate.

I was furious. As a nurse, I knew that such an operation would have been presented as a technological blessing, not an option, if my baby were not mentally retarded. I told the doctor that I resented such discrimination, that my daughter had rights of her own, and that if he was prejudiced against children with Down Syndrome, he could not touch her.

To the doctor’s credit, he recognized his well–intentioned mistake and promised that he would do his absolute best for my daughter. And he did.

But it frightened me that there was such a biased attitude among even good, caring doctors. Could I really trust any of those health–care providers on whom my child and I depended? I came to realize that Baby Doe’s parents “private” decision had an enormous impact on public policy and attitudes, leaving my baby at risk if I did not protect her.

Even though both Baby Doe and my Karen died several years ago (one by parental decree, one despite the best medical care), I found them often on my mind as I followed the Christine Busalacchi controversy. She, like Baby Doe and Karen, had mental disabilities, although at different points on the disability spectrum. Christine’s father, like Baby Doe’s parents, felt his child had no quality of life and went to court to prevent feeding. Mr. Busalacchi also “won” the right not by changing the law but by political and judicial aquiescense.

But the same question raised in the Baby Doe case must be raised again: Should parents have absolute power over their children’s lives or do the state and society have an obligation to ensure that everyone, disabled or able–bodied, has a right to necessary care and treatment?

We have forgotten that, before the Baby Doe case, the answer used to be obvious.

Why do we view harm to children and the elderly as an issue that the state and society must address regardless of family involvement, while maintaining that no one may even question whether a father has a right to act on his opinion that his mentally disabled daughter would be better off dead? Are mentally disabled people any less vulnerable?

The Busalacchi controversy was not about making a medical decision: Christine was neither dying nor too sick to receive food. In fact, in 1991, she was able to take most of her food by mouth before her father insisted that only the feeding tube be used.

The controversy was not about the severity of disability: There are many people who cannot smile, eat, or laugh like Christine could (even as a so–called “reflex”) who are currently receiving care and treatment. And despite the offensive and medically untestable label of “vegetative,” a recent study showed that most of the families studied were unwilling to withdraw food and water.

No, the issue is really about equality. No one should be denied care or treatment required for others just because he or she has a mental disability.

But for now, the Missouri Supreme Court and the state administration have refused to act on cases such as Busalacchi’s, allowing family choice to be the overriding issue. And, as I personally found out, it is not hard to find doctors or others who would be willing to concur with the family in death decisions.

It is families like mine who have tried to give their mentally disabled loved ones the best quality of life possible who must now watch sadly as the planned death of Christine Busalacchi is portrayed as a victory for family rights.

The disability rights movement has had great success in ensuring access to parking spots, public buildings and education for the disabled. It’s a tragedy when the disabled cannot be ensured access to something as simple as food and water.

1997 National Catholic Register: Fetal Reduction: Good Medicine or Atrocity?

Fetal Reduction: Good Medicine or Atrocity?

A procedure for the age of multiple pregnancies gains acceptance and contributes to the mentality that ‘inconvenient lives are disposable’

by Nancy Guilfoy Valko, Register Correspondent Sunday, Dec 14, 1997 2:00 AM Comment

WHEN BOBBI MCCAUGHEY made history by giving birth to seven living babies, one of the first questions asked was “Why?”.

As the media quickly pointed out, most women facing multiple births of four or more babies opt for a procedure called “fetal reduction,” an abortion procedure that eliminates one or more unborn babies in the hope of giving the other babies a better chance of survival.

Prematurity, the major danger of multiple pregnancies, increases the chances of death or disability in newborns. Before McCaughey, it was thought an impossibility to carry seven babies past 28 weeks, the “magic number” that gives premature infants a good chance of survival.

Multiple births used to be rare, but with the advent of new reproductive technologies, the number of pregnancies involving three or more babies has tripled since 1980. Fertility drugs such as those McCaughey used and in vitro fertilization (“test tube” babies) are primarily responsible for the tremendous increase. In vitro clinics in the United States, unlike those in most other countries, are under no laws regulating the number of embryonic babies that can be placed in a womb. The more embryos placed into a womb, the greater the chance that at least one baby will survive—and the success rate of the clinic be improved.

When multiple babies result either naturally or with technology, however, doctors usually offer or suggest fetal reduction—a procedure that is adding a new wrinkle to the abortion debate. The physical and emotional risks of fetal reduction are little explored though, in contrast to the litany of the potential complications of prematurity that invariably accompany every article on the multiple births.

Although many people had never heard of fetal reduction until the birth of the McCaughey seven, the procedure has been in use for more than a decade. With the development of ultrasound and other prenatal tests, doctors could usually discover the number, positions, and often the health of babies in a multiple pregnancy. However, the mechanics of eliminating one or more unborn babies without endangering the mother, losing all the babies, or causing harm to the remaining baby or babies has been the major stumbling block.

Ironically, one of the first cases to gain media attention had nothing to do with the health of the mother or the number of babies, but rather with the termination of a baby with a disability in a twin pregnancy. In the 1980s, a mother threatened to abort the entire pregnancy if the twin with Down syndrome was not eliminated. This fetal reduction was hailed as a medical breakthrough when the “right” baby was delivered safely.

Several methods of fetal reduction have been used, including exsanguination (bleeding to death), injections of air, and suction abortion. The current method of preference involves using ultrasound to target the most accessible babies and inserting a long needle through the mother’s abdomen and into the babies’ hearts. Next, a lethal dose of potassium chloride is injected to stop the heart and end the babies’ lives.

This abortion procedure is usually performed at nine to 13 weeks of gestation. The timing is important to ensure that the dead babies’ bodies dissolve and are reabsorbed. Besides reducing the risk of infection from dead tissue, reabsorption also has the advantage of sparing the mother— and the doctor—from seeing the results of the fetal reduction. A small number of such procedures are still selectively performed at 18 to 24 weeks, to eliminate unborn babies with abnormalities.

Occasionally doctors note an unusual complication: the “reduced” babies were found to be still alive upon later ultrasound. Even at nine weeks, some babies’ hearts are apparently so resilient that they restart on their own. Such occasions usually result in the doctors repeating the lethal injection until the targeted babies die.

Contrary to popular reports, the abortion procedure involves physical risks. Permanent damage to the surviving babies, infection, and premature labor are some of the potential complications that can occur with fetal reduction.

Rather than automatically ensuring the survival of the remaining babies, fetal reduction itself can cause miscarriage or premature birth. Estimates of the loss of all the surviving babies range from 7% to 22%. And, the larger the number of babies in the original pregnancy, the more likely a miscarriage, even after reduction, according to Dr. Mark Evans, a physician at Hutzel Hospital in Detroit, Mich.

Evans, a pioneer in fetal reduction, has analyzed data from physicians performing fetal reductions at six medical centers nationwide. He told the Electronic Times Union that approximately 40% of the mothers undergoing fetal reduction are carrying no more than triplets and that most mothers with multiple pregnancies reduce the number of babies to two.

Additionally, even though carrying twins is not considered risky, obstetricians are seeing a small but growing number of mostly older fertility patients seeking to reduce a twin pregnancy to a single one because of lifestyle or financial concerns. Dr. Evans sees no problems with even this: “If reducing from one to zero is acceptable in this society, then why not from two to one?” he asks.

That attitude, which considers any pregnancy disposable, is not universally shared by the women undergoing fetal reduction. These women and their husbands, who have invested so much emotion, energy, and money in their quest to conceive and finally reach their goal of becoming pregnant, experience great anguish when they feel they have to abort some of their babies.

The Nov. 21, 1997 issue of The Wall Street Journal recounted several poignant stories of women undergoing fetal reduction. A Florida woman who aborted one of her quadruplets said that even after two years she still struggles with her decision.

“There was never a moment when it felt right. My husband and I were bawling our eyes out during the whole thing,” she said.

Another mother agreed to undergo fetal reduction to eliminate one of her triplets with a reporter observing. But, afterwards, she wiped her tear-filled eyes and was unable to speak to the reporter at all. Yet another mother told of aborting two of her quadruplets only to lose the surviving twins in a premature birth—though she continued to defend her decision.

“I don’t think it’s fair having children that are premature and don’t have a chance,” she insisted.

She is not alone. The birth of the McCaughey seven has sparked a national debate with some ethicists, doctors, and other commentators suggesting that, despite status of abortion as a legal right, parents like the McCaugheys are unnecessarily risking the lives of their babies and causing enormous health care costs when they reject fetal reduction.

Others, like Janet Bleyl, a mother of triplets and founder of Triplet Connection, and Dr. Ian MacIsaac of Australia who has spoken on the subject, feel that the dangers of multiple pregnancies are often exaggerated and used to scare patients into fetal reduction. After all, the successful delivery of quintuplets no longer makes national news.

The McCaugheys’ decision to reject fetal reduction because of their faith in God has also rankled some commentators. As columnist Richard Cohen wrote in the Nov. 25 Washington Post, “It has become commonplace in this country to use religion as an all-purpose excuse for not using your head.”

Franciscan Father Germain Kopaczynski, director of education at the Pope John Center for the Study of Ethics in Health Care in Boston, disagrees.

“Choosing some humans to die so others might live is putting into human hands a decision that shouldn’t be made. It means you’re playing God, but unfortunately, we don’t play God as God plays God,” Father Kopaczynski told Catholic News Service.

In the end, McCaughey and the other women who refuse to abort any of their babies, seem to have much to teach doctors and other observers. The bottom line according to McCaughey is that “any child is a gift from God no matter whether it’s one at a time or seven at a time.”

Nancy Guilfoy Valko, a registered nurse, is based in St. Louis, Mo.

2014 in Public Discourse: I Lost My Daughter to Suicide: A Nurse’s Response to Brittany Maynard’s Campaign for Assisted Suicide

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I Lost My Daughter to Suicide: A Nurse’s Response to Brittany Maynard’s Campaign for Assisted Suicide

by Nancy Valko
within Bioethics, Healthcare

October 24th, 2014
2288 335 3427

Do assisted suicide supporters really expect doctors and nurses to be able to assist the suicide of one patient, then go on to care for a similar patient who wants to live, without this having an effect on their ethics or their empathy? Do they realize that this reduces the second patient’s will to live to a mere personal whim—one that society may ultimately see as selfish and too costly?

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Right now, twenty-nine-year-old Brittany Maynard is standing on a virtual window ledge, while the crowd below shouts its support for her “right” to jump. She says November 1 will probably be the day she kills herself.

Brittany is a beautiful young newlywed. Tragically, Brittany has a brain tumor that is expected to end her life in the near future. She and her family have moved to Oregon so she can legally take a doctor-prescribed lethal overdose, to avoid the suffering she expects as she approaches death.

Maynard has also joined with “Compassion and Choices” to promote their campaign to legalize physician-assisted suicide throughout the United States. In the last few weeks, C&C’s video telling her story has gone viral and been picked up by news organizations all over the world, including People magazine.

Groups supporting physician-assisted suicide now call the promotion of Ms. Maynard’s story “a tipping point” in their decades-long push to gain public support for changing laws.

A Different Point of View

I am a registered nurse with forty-five years of experience caring for many suicidal people, both personally and professionally. I also lost a beautiful, physically healthy thirty-year-old daughter five years ago to suicide. After a sixteen-year battle with substance abuse, my daughter committed suicide after visiting suicide websites and reading Final Exit by Derek Humphry, the founder of the Hemlock Society (the former name of Compassion and Choices). The medical examiner called my daughter’s suicide “textbook Final Exit.” It was not an easy death for her, or for those of us who loved her.

While I am sure Ms. Maynard is sincere and well-meaning, campaigns like hers can have a devastating impact on vulnerable people like my daughter, and be misused to promote a one-sided debate on legalizing assisted suicide.

Unlike most suicides, assisted suicide involves two parties. It’s worth looking at the impact of this agenda on both of them.

Groups promoting assisted suicide routinely dismiss suicide victims like my daughter as collateral damage, while some even provide how-to instructions that can be accessed by any depressed person. The central focus of the legal agenda is the frail elderly. Consistently, the median age of people taking their lives under Oregon’s assisted suicide law has been seventy-one. Less than 1 percent are under thirty-five years old. And there is a generation gap on this issue. As the Newark Star-Ledger has reported: “A recent poll showed that people over 65 oppose assisted suicide by a 12-point margin while those under 35 support it by 18 points.”

Brittany Maynard’s position is consistent with that of others in her age group. Yet the elderly—the people overwhelmingly affected by these laws—say “No.” They know how hard it can be to convince younger generations that they still have lives worth living and worth respecting. Others who strongly disagree with C&C are the people with disabilities who belong to groups such as Not Dead Yet. Those with disabilities face a great deal of bias from able-bodied people who seem to think people with their conditions are “better off dead.”

Ironies abound in this debate. For example, when a convicted murderer tries to discourage efforts by lawyers to stop his or her execution, this is often considered as a sign of stress or mental disorder, while a sick person’s wish to die is considered an understandable and even courageous decision. How do we reconcile the two views that a lethal overdose is the ultimate punishment for a convicted murderer and, at the same time, the ultimate blessing for an innocent terminally ill or disabled person?

Healing or Harming: What about Those Who “Assist”?

Then there are the medical professionals being called on to “assist.” Few people would seriously consider legalizing friend- or family-assisted suicide. The inherent dangers of this type of private killing are much too obvious. So the goal is to lend this act professional respectability by promoting physician-assisted suicide—or, more accurately, medically assisted suicide, since nurses also are necessarily involved when the assisted suicide occurs in a health facility or home-health situation. Many people are not aware that groups such as C&C oppose conscience rights for medical professionals like me, as well as for hospitals that believe that helping to terminate a life is unethical.

Medical groups such as the American Medical Association, the American College of Physicians, and the American Nurses Association oppose legalization of physician-assisted suicide. The AMA has said that allowing physicians to participate “would cause more harm than good,” observing that “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.”

When I worked as a hospice nurse years ago, our guiding principle was that we neither prolong nor hasten dying. I felt great satisfaction helping my patients and their families live as fully and meaningfully as possible until natural death. We nurses not only made sure that our patients were physically comfortable—we also helped with spiritual, emotional, and practical concerns.

Unfortunately, with the help of the media, assisted-suicide groups have had some success trying to convince both medical personnel and the public that natural death is agony and that medically assisted suicide should be a civil right. Yet this drive for totally controlling death profoundly changes the medical system, even for people who may recover or who may live with disabilities—and for patients who would never consider suicide.

The Ethical Impact

Society has long insisted that healthcare professionals adhere to the highest standards of ethics, as a protection for society. Without that clear moral compass, it has been said, the physician is the most dangerous man in society. The vulnerability of a sick person, and the inability of society to monitor every healthcare decision or action, are powerful motivators to enforce such standards. For thousands of years doctors (and nurses) have embraced the Hippocratic standard that “I will give no deadly medicine to any one, nor suggest any such counsel.” Erasing the bright line doctors and nurses have drawn for themselves—which separates killing from caring—is a decision fraught with peril, especially for those who are most vulnerable.

As a nurse, I am willing to do anything for my patients—but I will not kill them nor help them kill themselves. In my work with the terminally ill, I have been struck by how rarely such people say anything like, “I want to end my life.” I have seen the few who do express such thoughts become visibly relieved when their concerns and fears are addressed, instead of finding support for the suicide option. I have yet to see such a patient go on to commit suicide.

This should not be surprising. Many of us have had at least fleeting thoughts of suicide in a time of crisis. Imagine how we would feel if we confided this to a close friend or a relative, who replied, “You’re right. I can’t see any other way out either.” Would we consider this reply as compassionate, or desperately discouraging? The terminally ill or disabled person is no less vulnerable than the rest of us in this respect. And to think that an entire society, through its laws, can give such a response—to you, and to anyone with a similar health condition—may be the ultimate form of suffering.

Do assisted suicide supporters really expect us doctors and nurses to be able to assist the suicide of one patient, then go on to care for a similar patient who wants to live, without this having an effect on our ethics or our empathy? Do they realize that this reduces the second patient’s will-to-live request to a mere personal whim—perhaps, ultimately, one that society will see as selfish and too costly? How does this serve optimal health care, let alone the integrity of doctors and nurses who have to face the fact that we helped other human beings kill themselves?

Stories like Brittany Maynard’s can feed into a society that is fascinated by tragic love stories, but does not understand how such stories are used as propaganda to promote a dangerous political agenda that can affect us all—and our loved ones.

Personally, I will continue to care for people contemplating suicide or who have made an attempt regardless of their age, condition, or socio-economic status. I reject discrimination when it comes to suicide prevention and care. I hope our nation will do so as well.

Nancy Valko, RN, ALNC, is a longtime writer and speaker on medical ethics issues who recently retired from critical care nursing to devote more time to consulting and volunteer work. She is also a spokesperson for the National Association of Pro Life Nurses.

1995 Op-ed in St. Louis Post-Dispatch: OREGON VOTES FOR DEATH LEGALITY CANNOT SUBSTITUTE FOR MORALITY

Wednesday, January 25, 1995, Section: EDITORIAL, St. Louis Post-Dispatch
OREGON VOTES FOR DEATH LEGALITY CANNOT SUBSTITUTE FOR MORALITY

by Nancy Valko, RN
Have polls replaced consciences? Can right and wrong be put to a vote? On Nov. 8, Oregon voters approved, by a margin of 51 percent to 49 percent, the legalization of lethal overdoses for the terminally ill. Ballot Measure 16 (or M-16 as some in Oregon are beginning to call it) immunizes doctors from prosecution if they prescribe lethal overdoses for people expected to live six months or less.

Immediately, a state task force was formed to devise regulations to make the new law work. According to Jono Hildner, acting administrator of the state health division, members of the task force are state bureaucrats, hospital representatives, lawyers and doctors who were chosen to avoid debate about the ultimate wisdom or morality of the law. “It’s not our purpose to debate whether it’s good law or bad law,” he said. “It is the law.”

But substituting legalities for ethics does not necessarily make things simpler. Already, some disturbing facts are beginning to emerge. Cheryl K. Smith, an attorney who helped draft Measure 16, has admitted that “in about 20 percent of cases deaths will take up to four days to occur. Most of the time it will work, but the death won’t be spontaneous. It will be long and drawn out, which means families will have to be educated about this. Otherwise, they’ll have some emotional trauma watching loved ones take two, three and four days to die.”

Derek Humphry, founder of the Hemlock Society, which proposed this measure, is already dissatisfied with the law and has written: “The new Oregon way to die will only work if, in every instance, a doctor is standing by to administer the coup de grace (lethal injection) if necessary.”

Already, some euthanasia supporters are using the same arguments used in the Nancy Cruzan case to argue that the suicide “benefit” must necessarily be extended to people who cannot speak for themselves. Others point to the suffering of the chronically disabled as equivalent to the suffering of the terminally ill in an attempt to include that group in so-called death-with-dignity laws.

Also alarming is the fact that, earlier this year, Oregon obtained a waiver from the Clinton administration to begin rationing health care for the poor under Medicaid, but ironically, lethal overdoses would now be covered by the state health-care plan under “comfort care” according to the chairman of the Oregon Health Services Commission.

Therefore, you could be denied treatment you might want under Medicaid if you were terminally ill, but you would have your medicalized suicide covered by Medicaid!

Even the supposed safeguards are causing consternation in many quarters as common sense collides with Measure 16. For example, even though studies have shown that 95 percent of all suicide victims have a diagnosable mental disorder at the time of their suicide, psychological examinations are not mandatory. That is left up to the doctor’s discretion even though disorders such as depression are notoriously underdiagnosed, especially in the elderly and terminally ill.

Also, according to Measure 16, families need not be notified of the death decision of a loved one until after death has occurred. Can you imagine how you would feel if you were denied even a final moment with your mother (much less a chance to convince her of the folly of suicide) by being purposely left in the dark?

Actually, the only real safeguard in Measure 16 turns out to be not for the patient, but instead for health-care providers who will be, in the words of the measure, “immune from civil, criminal liability for good-faith compliance.” And, as one doctor has said, if doctors are allowed to kill their patients, “who will care about a little paperwork?”

A medical person is really not required for suicide. For example, a running car and a closed garage are notoriously “successful” in causing death. Medical people are only necessary to add a patina of respectability.

Euthanasia supporters attempt to reassure the public that very few people would take advantage of legalized suicide. If that is true, then why should we change our laws, our standards for health-care professionals, even our suicide prevention programs to accommodate these few people who insist that we approve their actions? Must we now accommodate every person’s desires no matter what the consequences might be for society?

As a full-time cancer nurse, I know how vulnerable people with terminal illnesses can be. I know how cancer patients worry about the cost of their care and about being a burden to their families. But I also know that a dignified and meaningful death cannot be achieved by doctors and nurses killing their patients.

There really is a difference between allowing inevitable death and actually causing death. It is ironic that when we have so many ways to help and support the terminally ill and their families, euthanasia supporters insist that only a lethal overdose at the hands of a doctor will satisfy their desire for a “good death.”

Thankfully, the Oregon law is on hold as judges determine its constitutionality. But the larger question remains: Can a society dispense with its most basic principle that innocent people cannot be legally and privately killed without dissolving into a kind of moral anarchy on life and death issues?

Unfortunately, if some of us are willing to risk legalizing euthanasia and the rest of us are intimidated into a silent “tolerance,” we all will have to live (or die) with the answer to that question.

Publication Details, Copyright © 1997 Post Dispatch and Pulitzer Technologies Inc. Published here with Nancy Valko’s permission.

1988 Op-Ed in St. Louis Post-Dispatch: FEEDING IS NOT EXTRAORDINARY CARE– DECISION IN THE NANCY CRUZAN CASE ADDS TO THE LIST OF EXPENDABLE PEOPLE

Op-Ed in the St. Louis Post-Dispatch (no longer online)
Friday, August 12, 1988
FEEDING IS NOT EXTRAORDINARY CARE– DECISION IN THE NANCY CRUZAN CASE ADDS TO THE LIST OF EXPENDABLE PEOPLE

By Susan Harvath and Nancy Guilfoy Valko

Just a few years ago the Missouri Legislature passed a ”living will” law that specifically excluded food and water from the kinds of care that may be withdrawn from a patient. In 1984, the National Conference of Catholic Bishops stated that legislation should ”recognize the presumption that certain basic measures such as nursing care, hydration, nourishment and the like must be maintained out of respect for the human dignity of every patient.”

Therefore, it is hoped that the Missouri Court of Appeals will overturn the recent Circuit Court decision that would deny tube feedings for Nancy Cruzan, a severely disabled woman cared for at the Missouri Rehabilitation Center. The anguish felt by the Cruzan family, which initiated the suit, is understandable. However, directly causing the death of an innocent person – even for reasons of mercy – violates that person’s basic human rights.

The Cruzan case is perceived by many to be an issue of allowing a person to die. Cruzan has been categorized by some experts as being in a ”persistent vegetative state,” an unfortunate and imprecise term at best. However, she is not dying or brain-dead. Rather, she is severely disabled from brain damage and needs no special technology to survive. Withdrawing her feeding tube would not ”allow” her to die – it would ”force” her to die. She would not die from her injuries, but rather from starvation and dehydration.

Also, starvation and dehydration cause a protracted, agonizing death in a fully conscious person. Some experts have stated that Cruzan would feel no pain if her feedings were stopped. Yet Cruzan’s nurses have testified that she has cried, smiled and even laughed in response to stimuli.

The possibility of pain during the length of time before death occurs has led some to propose lethal injections as a more ”humane” way to cause death than starvation. The passive euthanasia of withdrawing feeding logically leads to active euthanasia by injection or other means. Both are unacceptable.

A recent trend has been to classify tube feedings as medical treatment. However, unlike other medical treatments, denial of food from any person (sick or healthy, in or out of coma) will always result in that person’s death.

Ethically, treatments may be withdrawn if they are useless or burdensome to the patient. However, tube feedings are not excessively expensive or burdensome to the patient and do maintain life and prevent the discomfort of hunger and thirst. In deciding what treatment may ethically be withdrawn one must be careful to judge the treatment itself, not the ”quality” of the patient’s life. A person’s limitations do not decrease a person’s humanity or worth.

In the past few years we have seen many court cases similar to Cruzan’s in other states. Some have involved people less severely disabled than Cruzan. A recent case in North Dakota resulted in a judgment that even feedings by mouth may be stopped. In most cases it is not the patient who requests that feedings be stopped but rather a third party, usually a family member. Often, as in the Nancy Cruzan case, there is no clear and convincing evidence that the patient would even want the feedings stopped.

Some courts have gone even further and have stated that third parties do not need the approval of a court before a patient’s food and water is withdrawn unless there is disagreement, for example, among family members. This trend has unfortunate implications for all people with mental impairments.

There is a vast difference between not prolonging dying and causing death. In the last two decades we have seen killing promoted as a humane and compassionate response to unwanted unborn children, newborns with handicaps and the terminally ill. Let us not add a new category of people (the non-dying, severely disabled) to the list of expendable human lives.

Nancy Guilfoy Valko, R.N., is co-chairperson and Sue Harvath is program director of the St. Louis Archdiocesan Pro-Life Committee.

Welcome!

Women for Faith and Family has published Voices magazine until 2014, the 30th anniversary of Women for Faith and Family.

I have been privileged to be a contributing editor for this magazine. It has been one of the best experiences of my life.

Women for Faith and Family was kind enough to start a webpage for me with my articles, interviews, etc. and I am preserving these articles on this website.

I have two blogsites, the one here is for my older articles from my Women for Faith and Family webpage titled “Nancy Valko” up to 2014 and one titled “Nancy Valko-A Nurse’s Perspective on Life, Healthcare and Ethics” at www.nancyvalko.com for blogs since June, 2015. Please feel free to visit both sites.

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