2014 Voices: Should a Pro-Life Person Become a Nurse?

Voices Online Edition
Vol. XXIX, No. 2
30th Anniversary Issue

Should a Pro-Life Person Become a Nurse?
by Nancy Valko, RN

Recently I received an email from a nurse friend asking if I could reply to a letter from a student nurse. Unfortunately, this student nurse’s concerns are common, and I’ve often wondered how many wonderful pro-life people have been intimidated from pursing a medical career because of such concerns and so many media outlets’ bias against the pro-life movement.

Because of the urgency, at first I replied to this student with suggestions about specialties that had few if any ethical conflicts, such as same-day surgery clinics and pro-life doctors’ offices.
But then I realized that this reply missed the real issue: Is it worth it to become a pro-life nurse? So I sent this student my revised reply.

LETTER AND REPLY

The following is this anonymous student nurse’s letter and my reply:

I am a nursing student with big questions. I am 100% pro-life — anti-abortion in ALL cases, anti-birth control, anti-euthanasia, anti-sex change, and the like. Is there any hope for me in the culture of death nursing field? I’ve emailed a few right-to-life folks. They tell me that there is a desperate need for pro-life nurses. I would agree, but, from the anti-life demeanor of some bloggers, becoming a nurse seems akin to being thrown to the lions. So, my question: what area of nursing can I move into that does not demand that I do things that I absolutely will not do?

Some nurses say that a nurse must take care of all patients and their every medical need and that a nurse could become “dis-barred” if they dare refuse to care for someone. I don’t want to sacrifice any more of my family’s time by finishing this degree if I end up getting fired everywhere I go or having to hire a lawyer to defend my pro-life, God-given conscience! I have a family to support financially. I am very, very concerned. I have to pay for this fall’s classes by the end of the month or else I’m out of the program.

Do you have any advice for me? Am I being too over the top about the whole thing? I don’t know what the “real” nursing world is like.

MY REPLY:

I’ve been a pro-life nurse for 45 years working in hospice, intensive care, general medicine/surgery, oncology, dialysis, and home health, along with some other jobs both paid and volunteer. I never wanted to be anything but a nurse.

I’ve just retired this month from hospital nursing but not from nursing itself. I’ve taken courses to become a legal nurse consultant mostly to become a more effective pro-life advocate.

I have never regretted becoming a nurse.

When I started in the 1960s, all medical professionals were on the same page except for oral contraceptive pills, which were just being developed. Back then, the focus was entirely on helping patients. I went to my first job interview not even knowing what I would be paid or what benefits were available. I just wanted to help relieve suffering.
When I started as a registered nurse in 1969, the camaraderie was amazing. We were all so dedicated and willing to do anything to help. We were inspired by TV medical shows like Medical Center, Marcus Welby, MD, and others that portrayed medicine as a vocation and even ministry. And we lived it.

When the American Academy of Obstetricians and Gynecologists (now the American Congress of Obstetricians and Gynecologists) in 1965 quietly changed the definition of the beginning of life from fertilization to implantation in the uterus, things began to change rapidly. This was done to allow contraception to become not only legal but also promoted as a beneficial development.

By 1973 when Roe v. Wade made abortion legal, I was a 23- year-old intensive care unit nurse and the decision was a shock to all of us. A few doctors and nurses thought it might be okay since we all thought abortions were only done in very early pregnancies. Besides, the abortion promoters told us that women would go for help more readily instead of to “back alley” abortionists. We were told that with such help, more women would have the support to have their babies.

However, abortion was soon promoted as a positive good and a women’s right issue. The traditional ethic that was the bedrock of our medical professions — of never harming or causing the death of our patients — was undermined.

But I was unaware of all this (the facts about abortion and contraception) when I left nursing temporarily in 1976 to raise my children. However, I was still a nurse and the volunteer opportunities were a way that I could still be involved. This was one of the happiest times of my life and I knew I was still a nurse.

However, in 1982 I learned firsthand how awful things had become when my baby Karen was born with Down syndrome and a critical heart defect. At the same time there was a national case involving a baby with Down syndrome who had an easily treated problem with his esophagus but the parents — on the advice of their OB/GYN — refused the routine surgery because they said their son would be better off dead. The baby died of starvation and dehydration about two weeks later. I was very upset and wondered what had happened to medical ethics during the time I was away from hospital nursing.

When my Karen was born, I came face to face with what is rightly called the culture of death when I was offered — even encouraged by some — to refuse surgery for my daughter and just let her die. As I told her cardiologist, “When exactly do her constitutional rights kick in? She’s not even a ‘fetus,’ for God’s sake!”

The cardiologist immediately backtracked and said he would do everything to save my daughter’s life. I knew he was a good man but I could never completely trust him again. What frightened me the most was that he and so many of the doctors and nurses involved with Karen had been seduced into a “better dead than disabled” mentality. I finally realized how much medical and nursing education had changed and a lot of that was due to the deterioration of ethics starting with contraception. Young doctors and nurses were no longer being taught sanctity of life but rather quality of life.

My daughter Karen finally made me a committed pro-life advocate.

Eventually I saw even utilitarian economics become a growing part of medical ethics. That’s why we have such issues as in vitro fertilization, assisted suicide/euthanasia, and organ donation problems.

I went back into hospital nursing in 1989 when I suddenly became a single mom and the sole support of three children. However, things had changed radically. Nurses were being laid off and I found that my volunteer pro-life work was frowned upon by many.

However, I didn’t give up, and instead of talking about prolife topics, I set my sights on being the best nurse possible. It worked.

As time went on I got on ethics committees where I could make a difference by talking about cases from a traditional ethics/natural law perspective, which is really the basis of pro-life health care. My fellow nurses eventually decided I was a good nurse even if I didn’t agree that abortion should be legal. I was even able to help a fellow nurse who was considering abortion get more information and she eventually had a healthy baby — and her first girl.

I was also able to advocate for my chronically ill, terminally ill, elderly, and disabled patients. Sometimes it worked, sometimes it didn’t, but I knew that at least I tried and I saw some minds and hearts changed in the process.

Only once was I threatened with firing in a situation where I could not “opt out” but I knew my rights. This is where groups like California Nurses for Ethical Standards (ethicalnurses.org) and the National Association of Pro Life Nurses (nursesforlife. org, where I am a spokesperson) can help. In that case, not only was I not fired but my stand helped a whole floor of other nurses say no — in unison — to a doctor who ordered something unethical.

So my point is not that is easy to be a pro-life nurse. My point is that it is a privilege and a mission to be a pro-life nurse!

I ended my reply by giving this student my email address and home phone number.

CONCLUSION

The culture of death is big and intimidating but I believe that the vast majority of doctors and nurses do want to give the best care to their patients. Sadly, between groups promoting death issues like abortion and euthanasia with the help of a sympathetic and biased media and the deteriorating ethical standards taught in many medical and nursing schools, many doctors and nurses are unaware that there is a better philosophy of health care. Too many think that legal automatically means ethical. We need to help educate them, not just with words but with truly excellent and patient-safe health care.

The situation will continue to be difficult because culture of death supporters know that if enough doctors and nurses refuse to participate in their agenda, their movement is dead. Long ago, I resolved never to become angry or criticize people for their views but I also resolved to be steadfast on the front lines of the battle between killing and caring. Although the episode of my attempted firing could have ended differently and I actually did not expect the positive outcome, I was willing to lose my job rather than participate in a deliberate death decision.

Conscience rights are crucial, especially in today’s world. We need strong conscience rights on all life issues enshrined in law and in practice to protect ethical health care providers and their patients.

In the end and despite the occasional difficulties, I can attest personally that it has all been worth it and that I am truly blessed to be a pro-life nurse.

======================================================================================

Nancy Valko, RN ALNC, a contributing editor for Voices and long-time advocate of ethical and patient-safe health care, writes the regular “Bioethics Watch” column for Voices. A registered nurse since 1969, she is a spokesperson for the National Association of Pro Life Nurses, past president of Missouri Nurses for Life, and past co-chair of the St. Louis Archdiocesan Respect Life Committee.

Voices copyright © 1999-Present Women for Faith & Family. All rights reserved.

2014 Voices: Brain Death and Catholic Teaching

Voices Online Edition
Vol. XXIX, No. 1
Pentecost 2014

Brain Death and Catholic Teaching

by Nancy Valko, RN ALNC

Earlier this year, the public was transfixed by two news stories involving brain death. The circumstances of Jahi McMath and Marlise Muñoz were very different on the surface, but the legal and ethical questions concerning the diagnosis of brain death and the use of life support in both women started a firestorm of controversy even within the Catholic Church.

No wonder the average person, Catholic or not, is confused.

It is important to first scrutinize the facts of both cases to begin to understand why there is a lack of unity on such life and death matters even among respected Catholic sources.

JAHI MCMATH

Jahi McMath, a 13-year-old girl, underwent a routine surgery for sleep apnea in December 2013 at a California children’s hospital. That night she started bleeding and eventually her heart stopped. Her heart was restarted and she was placed on a ventilator to stabilize her condition, but soon the doctors declared her brain dead and prepared to remove the ventilator. However, the family insisted that the ventilator be continued, hoping that Jahi might eventually get better.

The doctors disagreed, insisting that Jahi was legally dead by brain death criteria. The parents went to court to keep the doctors from removing her ventilator but after a series of legal battles lasting weeks, a judge eventually gave Jahi’s family permission to transfer her to another facility that would continue the ventilator.

Virtually all the ethicists and other experts contacted by most media outlets condemned the family’s actions as denying the reality of brain death. In January the National Catholic Bioethics Center issued a statement that said, in part, “… the determination of death by the rigorous application of the neurological criteria is considered legitimate by the Catholic Church, which accepts the findings of science in such a determination.”1

In a January 10, 2014 USA Today article, ethicist Arthur Caplan, head of the bioethics division at New York University’s Langone Medical Center, condemned the judge’s decision for Jahi’s family, declaring that brain dead people will eventually “start to decompose,” even if the ventilator was continued.2

However, almost 3 months later in a March 28, 2014 interview with NBC Bay Area News,3 Jahi’s mother reported that her daughter now moves her arms, legs, and head spontaneously but “is still asleep” and unable to move on command. Jahi is currently being fed by a feeding tube, sustained on a ventilator on room air (no extra oxygen) and receives physical therapy 3 to 4 times a week. At the time of this interview, Ms. McMath had just received an award from the Terri Schiavo Life & Hope Network as a relative who protects “a loved one against overwhelming odds.”

While Jahi’s movements described by her mother were dismissed by some experts as merely “spinal reflex movements,”4 it was a foot movement in the 2008 case of Zack Dunlap5 that led doctors to rethink their diagnosis of brain death in him and stop an imminent organ donation. Although Zack made a very fast recovery and Jahi’s continued lack of apparent conscious movement is not as hopeful, critics of brain death point to these kinds of developments as showing how much we still do not know about the human brain and its capabilities.

Although the medical criteria used to determine brain death vary — often widely — from one hospital to another, the definition of brain death is supposed to show an irreversible lack of function of the entire brain and brain stem. In Zack Dunlap’s case, he had more testing, including a test showing a lack of blood flow to the brain, than the average person diagnosed as brain dead.

MARLISE MUNOZ

Marlise Muñoz was a 33-year-old woman who was 14 weeks pregnant with her second child in November 2013 when she collapsed from a suspected blood clot and stopped breathing at home. She was taken to a Texas hospital and, like Jahi McMath, revived and put on a ventilator. Like Jahi, Mrs. Muñoz was also declared brain dead within a short time; but in this case, the roles of the family and hospital were reversed. Mrs. Muñoz’s husband was ready to remove the ventilator and the hospital objected because of a Texas law, like those in several other states, that prohibits the withdrawal of life support from a pregnant woman so that the baby has at least a chance to survive to birth.

Mr. Muñoz strenuously disagreed, stating that his wife told him she would not want to live in such a state and, in several news reports, voiced his concern that the lack of oxygen and effects from resuscitation might have damaged his unborn child. He went to court to force the hospital to remove the ventilator.

This time, virtually all the many ethicists and experts contacted by the media supported the husband’s decision to remove the ventilator. Many argued that the 1989 Texas law was only meant to apply to pregnant women in conditions like a “vegetative state,” not a brain-dead woman. Some even claimed that removing the ventilator was similar to a legal late-term abortion. As the case wound its way in court for weeks, lawyers for Eric Muñoz eventually claimed that tests showed the now-22-week-unborn child was “distinctly abnormal” with fluid building up inside the skull, a possible heart problem, and lower extremities “deformed to the extent that the gender cannot be determined.”6 In an interview on CNN’s Anderson Cooper 360°, Mrs. Muñoz’s mother “described in agonizing detail in the interview how towards the end, her daughter’s body had begun to visibly deteriorate, making it difficult to look at an empty shell of what had been her beloved daughter.”7

A judge ordered that life support be removed, and on January 24, 2014, both mother and baby died.

While many commentators stated that it was virtually impossible for a pregnant mother declared brain dead to deliver a healthy baby, a 2010 British Medical Journal study reported that “In 12 (63%) of 19 reported cases, the prolonged somatic support [of the mother declared brain dead] led to the delivery of a viable child.”8

In the Muñoz case, virtually all pro-life and Catholic ethicists agreed that giving the unborn child at least a chance to be born was the ethically correct position. And, of course, birth defects do not make a baby unadoptable.

CONFUSION AMONG CATHOLICS

The controversy about brain death has been simmering among Catholic ethicists, medical experts, and theologians for many years.

It all started with a 1968 Harvard paper titled “A Definition of Irreversible Coma — Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death.”9 Within a very few years, all 50 states included brain death in the legal definition of death. This allowed brain death criteria to be used for the purpose of organ transplantation. Before this, organ transplantation was virtually impossible in patients declared dead by the traditional standard of irreversible cessation of breathing and heartbeat. In those cases, vital organs were too damaged by lack of blood flow and oxygen to be useful. Brain death allowed organs to be harvested while a ventilator supported breathing and the heart was still sending blood to vital organs.

In 1975, the Committee on Health Affairs of the United States Catholic Conference issued “Guidelines for the Determination of Brain Death,” which concluded that criteria for brain death to provide “moral certainty” of brain death were “morally sound and acceptable.” In 1981, the Pontifical Council “Cor Unum” stated that the determination of the moment of death is a medical, not a theological, judgment.10

The Pontifical Academy of Science studied the question of determination of death in 1985 at the request of Pope John Paul II. The Academy concluded “From the debate it emerged that cerebral death is the true criterion of death, since the definitive arrest of the cardiorespiratory functions leads very quickly to cerebral death.”11 Apparently searching for greater clarity, Pope John Paul II raised the question again with the Pontifical Academy in 1989. The Academy reached the same conclusion.

In 1995, the Pontifical Council for Pastoral Assistance to Health Care Workers under Fiorenzo Cardinal Angelini issued its Charter for Health Care Workers. The legitimacy of neurological criteria was accepted by this body as well, and it concluded, “When total cerebral death is verified with certainty, that is, after the required tests, it is licit to remove organs and also to surrogate organic functions artificially in order to keep the organs alive with a view to a transplant.”12

In 2000, Pope John Paul II gave an address to a Vatican conference on organ donation where he stated:

Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology. Therefore a health-worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgment which moral teaching describes as “moral certainty.” This moral certainty is considered the necessary and sufficient basis for an ethically correct course of action. Only where such certainty exists, and where informed consent has already been given by the donor or the donor’s legitimate representatives, is it morally right to initiate the technical procedures required for the removal of organs for transplant.13

Nonetheless, the Pontifical Academy of Sciences published a statement in 2008 under the title “Why the Concept of Brain Death Is Valid as a Definition of Death.”14

In November 2008, Pope Benedict XVI gave an address to a prestigious international conference on organ transplants in which he stated:

In an area such as this, in fact, there cannot be the slightest suspicion of arbitration and where certainty has not been attained the principle of precaution must prevail. This is why it is useful to promote research and interdisciplinary reflection to place public opinion before the most transparent truth on the anthropological, social, ethical and juridical implications of the practice of transplantation. However, in these cases the principal criteria of respect for the life of the donator must always prevail so that the extraction of organs be performed only in the case of his/her true death.15

In the meantime, other respected Catholic doctors and ethicists like Paul Byrne MD, Alan Shewmon MD, and E. Christian Brugger PhD, as well as other doctors, nurses, and ethicists raised alarms about the validity of brain death criteria, including the lack of standards for testing from one hospital to another and the continued survival of some patients declared brain dead for years. They cite cases where such patients grew, achieved puberty, gestated their unborn baby for months, etc., as well as the reported cases of recoveries like Zach Dunlop’s.

In response to the paucity of such critiques at Vatican conferences, a conference called “Signs of Life,” featuring critics of brain death from all over the world, was held near the Vatican in February 2009.16

Now with more and more people alarmed about the issue of brain death, especially when organ transplantation is involved, it seems that the controversy is far from over.

PERSONAL OBSERVATIONS

Back in the 1970s when I was a young intensive care unit nurse, no one I knew questioned the new innovation of brain death. We trusted the experts.

However, as the doctors diagnosed brain death in our unit and we cared for these patients until their organs were harvested, some of us became uncomfortable. For example, doctors told us that these patients would die anyway within two weeks even if their ventilators were continued, but no studies were cited. I asked many questions but was told that greater minds than mine had it all figured out. It was years before I realized that these doctors did not have the answers to my concerns either.

Over the ensuing years, I began to see many more changes in brain death diagnosis and organ transplantation that alarmed me.

These include the innovation in the 1990s of Donation after Cardiac Death (DCD, formerly known as non-heart beating organ donation), in which brain death need not be determined but instead is based on when (or if) a critically ill — but not brain dead — patient stops breathing within an hour after the ventilator is removed with the agreement of the family.

While the general public is mostly unaware of DCD, such organ donor protocols are now policy in both Catholic and secular hospitals. Ironically while so many Catholic ethicists and conferences endorse brain death as the true standard for death, the lack of brain death standards in DCD is virtually ignored. One of the innovators of DCD organ transplantation, Dr. Michael DeVita, even admitted “the possibility of [brain function] recovery exists for at least 15 minutes” after heartbeat and breathing stops but stated that “the 2-minute time span (before organ removal) probably fits with the layperson’s conception of how death ought to be determined.”17

It is frightening but perhaps illuminative that one of the first known potential DCD donors was a conscious woman with severe multiple sclerosis who requested that her ventilator be removed and that her organs be taken when she stopped breathing.18 (In the end, like a significant number of other DCD donors,19 she continued to breathe for too long for her organs to be usable.)

Other developments and proposals were also disturbing: Paying living donors for organs, presumed consent so that only people who signed a paper saying that they did not want their organs taken were exempt, some doctors in Belgium touting their success pairing assisted suicide/euthanasia with organ transplantation20 and even some ethicists proposing that the dead donor rule itself be eliminated in order to get more organs to transplant.21 The dead donor rule is an ethical norm that states that the donor must be dead before organs are harvested and the harvesting itself must not cause the death of the donor.22

On the other hand, I also saw cases where families were told that their loved one was brain dead for the purpose of withdrawal of treatment, not organ transplantation. When I pointed out that some of these patients continued to breathe on their own after the ventilator was removed and thus were obviously not brain dead by any criteria, I was often met with shrugs and comments like “close enough” or “she was going to die soon anyway.” Attitudes like that chilled me to the bone. It seemed that pessimism, hubris, and misplaced sympathy — rather than evil intent — trumped ethical integrity. The secular media often echoes this apathy, especially when it erroneously equates coma or the so-called “vegetative state” with brain death itself. The result can be lethal.

After years of study and prayer, my personal stand is rejection of two extremes: that brain death is settled science and ethics that no one dare even question; and that withdrawal of ventilators with or without organ donation is always tantamount to murder.

I believe that ventilators, like all other forms of treatment, are subject to the same traditional principle: Treatments that are futile in terms of survival or unduly burdensome to the person can be ethically withdrawn according to strict principles ensuring that death is not intended. I believe in the traditional hospice philosophy to neither hasten nor prolong death.

Personally, I have not signed a standard organ donor card because the wording is so vague (death, not brain death or DCD, is all that is mentioned) and in some states that card can even automatically override family decision-making. I have told my family that I agree to the donation of every tissue that can be used after a careful determination of natural death. Tissues like corneas, heart valves, bone, and skin are not dependent on immediate harvesting after determination of death.

I do not take this position lightly. Right now, I have a daughter-in-law who is in desperate need of a kidney transplant, the most common transplant. She has studied the issue and told her doctors that she wants a living donor. Living donors are generous family members, friends, or even strangers who willingly offer one of their two kidneys for transplant after testing for compatibility.

My daughter-in-law’s decision was based not only on ethical concerns about brain death and non-heart beating organ donation but also on the facts that organ availability is greater with living donor kidneys and that such kidneys last almost twice as long as cadaver kidneys and work immediately.23

Unfortunately, it is uncertain whether the controversy over brain death or even DCD will ever be completely resolved, even within the Catholic community of experts and authorities. However, I do have hope that the issue of organ transplantation that is such a prime motivator of brain death determination and DCD may someday become moot.

Not only have treatments like adult stem cell transplants and improved therapies helped many people with end-stage organ disease survive, but great strides are being made toward developing artificial organs. For example, just last year scientists in Australia grew a tiny but functioning kidney using human skin cells.24 If a person’s own cells can be used to grow an organ, that could eliminate the rejection problem that causes so many transplants to fail, as well as the need for the current powerful and expensive drugs used to prevent rejection.

In the meantime, there must be the honest, respectful discussion about the critical issues of brain death, DCD, and organ donation, based on the highest ethical principles and scrutiny.

FOOTNOTES

1 “Jahi McMath and Catholic Teaching on Determination of Death.” National Catholic Bioethics Center Resources. January 7, 2014. ncbcenter.org/resources/jahi-mcmath-and-catholic-teaching-on-the-determination-of-death

2 “Ethicists criticize treatment of teen, Texas patient” by Liz Szabo. USA Today. January 10, 2014. usatoday.com/story/news/nation/2014/01/09/ethicists-criticize-treatment-brain-dead-patients/4394173/

3 “‘She’s Still Asleep,’ Jahi McMath’s Mother Says of Brain-Dead Daughter” by Lisa Fernandez. Friday, Mar 28, 2014. NBC Bay Area. nbcbayarea.com/news/local/Shes-Still-Asleep-Jahi-McMaths-Mother-Says-of-Brain-Dead-Daughter-252700851.html

4 Ibid

5 “Was Zack Dunlap’s Recovery a Miracle?” by Nancy Valko, RN. Voices. Pentecost 2008. wf-f.org/08-2-Valko.html

6 “Brain-Dead Marlise Munoz’s Fetus Is ‘Distinctly Abnormal.’ Please, Texas, Let This Nightmare End” by Emily Bazelon. Slate. January 23, 2014. Online at:http://www.slate.com/blogs/xx_factor/2014/01/23/marlise_munoz_case_the_fetus_of_a_brain_dead_texas_woman_is_said_to_be_distinctly.html

7 “Husband of brain dead woman who sued to have pregnant wife’s life support turned off may be forced to pay for her hospital stay” UK Daily Mail. February 2, 2014. dailymail.co.uk/news/article-2550352/Marlise-Munoz-case-Husband-brain-dead-woman-sued-pregnant-wifes-life- support-turned-forced-pay-hospital-stay.html

8 “One life ends, another begins: Management of a brain-dead pregnant mother-A systematic review.” by Majid Esmaeilzadeh, Christine Dictus, Elham Kayvanpour, et al. BMC Medicine. 8:74, 2010. biomedcentral.com/1741-7015/8/74

9 “A Definition of Irreversible Coma-Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death.” Journal of the American Medical Association. August 5, 1968, 205(6): 337-340.Online at:

http://jama.jamanetwork.com/article.aspx?articleid=340177

10 “Catholic Teaching Regarding the Legitimacy of Neurological Criteria for the Determination of Death” by John M. Haas, PhD, STL, KM. National Catholic Bioethics Center Quarterly. Summer 2011. Reprinted on CatholicCulture.org: catholicculture.org/culture/library/view.cfm?id= 9719

11 Ibid.

12 Ibid. (Cf. FAQ on “Brain Death”: ncbcenter.org/page.aspx?pid=1285# receiveOrgan).

13 Address to the 18th International Congress of the Transplantation Society. Pope John Paul II, August 29, 2000, §5.

Online at: http://w2.vatican.va/content/john-paul-ii/en/speeches/2000/jul-sep/documents/hf_jp-ii_spe_20000829_transplants.html

14 “Why the Concept of Brain Death Is Valid as a Definition of Death.“ Online at: http://www.casinapioiv.va/content/accademia/en/publications/extraseries/braindeath.html

15 “Address of His Holiness Benedict XVI to Participants at an International Congress Organized by the Pontifical Academy for Life.” November 7, 2008. Online at: https://www.wf-f.org/BXVI_Life08.html

16 “‘Brain Death’ is Life, Not Death: Neurologists, Philosophers, Neonatologists, Jurists, and Bioethicists” by Hilary White. LifeSiteNews.com. February 26, 2009. lifesitenews.com/news/archive/ ldn/1990/22/9022604

17 “The Death Watch: Certifying Death Using Cardiac Criteria” by Michael A. DeVita, MD, University of Pittsburgh Medical Center. Prog Transplant 11(1):58-66, 2001. Summary online at: http://www.researchgate.net/publication/11979624_DeVita_MA_The_death_watch_Certifying_death_using_cardiac_criteria

18 Michael A. DeVita and James V. Snyder, “Development of the University of Pittsburgh Medical Center Policy for the Care of Terminally Ill Patients Who May Become Organ Donors after Death Following the Removal of Life Support” in Procuring Organs for Transplant. Robert M. Arnold, et al, eds. Kennedy Institute of Ethics Journal. 1993 Jun; 3(2): 131-143. Abstract online at: http://muse.jhu.edu/login?auth=0&type=summary&url=/journals/kennedy_institute_of_ethics_journal/v003/3.2.devita01.html

Full issue at: http://muse.jhu.edu/journals/kennedy_institute_of_ethics_journal/toc/ken.3.2.html

19 “Organ Procurement after Cardiocirculatory Death: A Critical Analysis,” Mohamed Y. Rady, MD, PhD; Joseph L. Verheijde, PhD, MBA; and Joan McGregor, PhD. Journal of Intensive Care Medicine. 23(5), 2008. jic.sagepub.com/cgi/reprint/23/5/303.pdf

20 “Initial Experience with Transplantation of lungs recovered from Donors after Euthanasia,” by D. Van Raemdonck, et al. Applied Cardiopulmonary Pathophysiology. 15:38-48, 2011. applied-cardiopulmonary-pathophysiology.com/fileadmin/downloads/acp-2011-1_20110329/05_vanraemdonck.pdf

21 “The Dead-Donor Rule and the Future of Organ Donation,” by Robert D. Truog, MD; Franklin G. Miller, PhD; and Scott D. Halpern, MD, PhD. New England Journal of Medicine. 369:1287-1289, 2013. nejm.org/doi/full/10.1056/NEJMp1307220

22 “Is Organ Procurement Causing the Death of Patients?” by James Dubois. Issues in Law and Medicine. 18(1):21-41. citations. Excerpt online at: https://www.questia.com/library/journal/1G1-90440011/is-organ-procurement-causing-the-death-of-patients 2002-2003; cited in “Dead Donor Rule Definition,” duhaime.org/LegalDictionary/D/DeadDonorRule.aspx

23 “Living Donor Kidney Transplant,” Barnes Jewish Hospital. barnesjewish.org/living-donor-kidney-transplant

24 “Kidney grown from stem cells by Australian scientists,” by Jonathan Pearlman. The Telegraph. December 13, 2013.

http://www.telegraph.co.uk/news/worldnews/australiaandthepacific/australia/10520058/Kidney-grown-from-stem-cells-by-Australian-scientists.html

===================================================================================

Nancy Valko, RN ALNC is a spokesperson for the National Association of Pro-Life Nurses and a Voices contributing editor. She and her family live in St. Louis.

Voices copyright © 1999-Present Women for Faith & Family. All rights reserved.

2013-2014 Voices: What do Pro-Lifers Really Do?

Voices Online Edition
Vol. XXVIII, No. 4
Christmastide 2013-2014

What do Pro-Lifers Really Do?

by Nancy Valko, RN

“Pro-life Groups Don’t Really Protect the Unborn,”1 blared the headline of an opinion article that appeared September 4, 2013 on the Yahoo news site. The author was Elizabeth Jahr, described as a senior at Marymount University in Arlington, Virginia, majoring in politics and theology and religious studies. Obviously, this Yahoo opinion piece, which also appeared in the Christian Science Monitor the same day, was especially aimed at young people.

Ms. Jahr states bluntly that “Religious and political groups that funnel tremendous resources into a legal war to limit and even ban abortion in America are at best, wasting time, and at worst, damaging efforts to protect the unborn.”

The comments that appeared on the Yahoo version of the article were outrageous — applauding the author for exposing people in the pro-life movement as politically aggressive morons.

This is stunning, especially when you consider that Planned Parenthood, the most visible face of abortion in the US, received 542.4 million taxpayer dollars in 2012 alone2 while nonprofit and volunteer groups like Birthright and Our Lady’s Inn here in St. Louis struggle to help countless women in crisis pregnancies and even after birth.

It is no accident that too many good people feel intimidated about expressing their pro-life beliefs, sometimes even with friends and family members. Ridicule, anger and scorn are difficult to handle but, as the old adage goes “All that is necessary for evil to triumph is for good men to do nothing.”

If any group ever needed a great publicity agent or public relations firm, it would certainly be the pro-life movement. However, the pro-life movement never has had the time, money, or inclination to burnish its image. People in the pro-life movement have been too busy saving lives and assisting the vulnerable to defend their work and motivations.

ONE OF THE GREATEST VOLUNTEER MOVEMENTS EVER

I consider myself a latecomer and draftee to the pro-life movement. I was a 23-year-old intensive care unit nurse when the Roe v. Wade decision came down. Like most people, I was shocked when abortion was legalized. I was vaguely aware of the Roe case, but, like most people I knew, I didn’t believe the case had a chance. Abortion was a nasty business only whispered about when I was growing up. As a medical professional, I couldn’t imagine good doctors and nurses condoning — much less participating in — such a brutal act. And I couldn’t imagine that Roe and its companion case Doe v. Bolton would extend abortion for the entire pregnancy.

However, I was professionally offended by the pro-life argument that legalizing abortion would lead to the legalization of infanticide and euthanasia. It was one thing to deny the truth with an early and unseen unborn baby but it was quite another to imagine any doctor or nurse looking a born human being in the eye and killing him or her. So I remained relatively silent but supportive except with people I knew well until almost 10 years later. It was 1982 when I found that my newborn daughter with Down syndrome almost became a victim of lethal medical discrimination because of the abortion mentality generated by Roe. I finally discovered the truth that the pro-life movement had predicted years before. It was then that I discovered that no group was fighting harder for people like my daughter as well as the inherent right to life of all of us than the growing pro-life movement.

What I found when I finally joined the pro-life movement was a large and diverse group of people committed to serving as well as saving the most vulnerable among us. I saw people who volunteered time and personal effort to ensuring that pregnant women had the resources to give birth and raise their children as well as find real help after the trauma of an abortion. Others were involved in programs assisting the poor and elderly. Some were caring for large families or ill family members themselves but still made the time to help in some way. To this day, I never met a pro-life person who was not involved in actively helping others. The pro-life movement is committed to people and principle, not politics.

PRO-LIFE LEGISLATION

I was also impressed by how much the pro-life movement was doing at the state and national level to legally protect the vulnerable as much as possible. Over the years, I saw pro-life laws — like informed consent, safety regulations for abortion clinics, the Born-Alive Infant Protection Act, laws against assisted suicide, etc. — proposed and even passed with great time and effort by pro-life people.

Although I was impressed with how much the pro-life movement was doing, I was initially discouraged to discover that even duly passed common sense pro-life laws are routinely held up — sometimes for years — by judges and special interest groups with deep pockets, like Planned Parenthood. For example, the widely supported Illinois parental notification law for minor girls was just now finally upheld after 18 years.3 Was it expensive? Yes! Was it worth the trouble? Of course. After all, pro-life legislation is educational for the public as well as protective for women and others at risk. Even when legislation fails, more and more people find out important truths about the abortion and euthanasia issues from the discussion.

Enforcement of these laws can be even more challenging. For example, the Born-Alive Infant Protection Act has been widely ignored.4 The Kermit Gosnell post-abortion killings show the wisdom of the Act and are now putting pressure on states and government officials.

CONCLUSION

After staying in the pro-life movement now for more than three decades, I recognize the argument that legalized abortion would lead to infanticide and euthanasia was absolutely true. As a nurse as well as a mother, I have been horrified to see the ever- increasing expansion of what we now call the Culture of Death to include the disabled, elderly, frail and seriously ill as well as the unborn.

But pro-life people are nothing if not resilient and creative.

With dedication and commitment, I have seen the pro-life movement increase in numbers and rise up to meet every new challenge to the right to life. I see smiling, positive people who refused to be permanently discouraged by setbacks or media stereotypes.

As a result of those initial efforts, today we see more and more abortion clinics closing (a record 44 so far this year!)5, waiting lists for adoption of babies with disabilities, few doctors and nurses jumping on the assisted suicide bandwagon, and other signs of progress. Despite the media hype and propaganda like Ms. Jahr’s article, the pro-life movement is alive, well, and growing.

And most importantly, hearts and minds are being opened and thus lives are being saved!
***
Notes

1 Elizabeth Jahr, “Pro-life groups don’t really protect the unborn.” September 4, 2013. Yahoo.com: http://www.csmonitor.com/Commentary/Opinion/2013/0904/Pro-life-groups-don-t-really-protect-the-unborn

2 American Life League’s STOPP International “Analysis of Planned Parenthood Federation of America Annual Report 2011-2012.” January 13, 2013: stopp.org/pdfs/2012/STOPP_PPFA_ 2011_2012_Final.pdf

3 Naomi Nix, “Illinois Supreme Court backs parental notification for abortions.” July 11, 2013. Chicago Tribune: articles. Online at: http://articles.chicagotribune.com/2013-07-11/news/chi-abortion-parental-notification-20130711_1_illinois-supreme-court-said-lorie-chaiten-parental-notification

4 Kathryn Jean Lopez, “How About Enforcing the Born-Alive Infant Protection Act?” May 15, 2013. The Corner at the National Review Online: nationalreview.com/corner/348430/how-about-enforcing-born-alive-infant-protection-act-kathryn-jean-lopez

5 Operation Rescue Staff, “Two more abortion clinics close: that makes 44 this year” LifeSiteNews.com. September 20, 2013. Online at: lifesitenews.com/news/two-abortion-clinic-closures-up-the-tally-to-44-this-year?utm_source=LifeSiteNews.com+ Daily+Newsletter& utm_campaign=83c2820b88-LifeSiteNews_ com_US_Full_Text_06_19_2013&utm_medium=email&utm_term=0_0caba610ac-83c2820b88-326224910
=========================================================================================

Nancy Valko, a registered nurse from St. Louis, is a spokesperson for the National Association of Pro-Life Nurses and a Voices contributing editor. She and her family live in St. Louis.

Voices copyright © 1999-Present Women for Faith & Family. All rights reserved.

vOICES 2013: Kermit Gosnell: Truths and Repercussions

Voices Online Edition
Vol. XXVIII, No. 3
Michaelmas 2013

Kermit Gosnell: Truths and Repercussions
by Nancy Valko, RN

When abortionist Kermit Gosnell went on trial for the horrifying killings of late-term unborn babies who survived his abortions and the negligent death of at least one of the mothers, the mainstream media and others tried to ignore it. But thanks to some courageous journalists like those on the Fox network and an electronic outpouring of outrage from the pro-life community, the shoddy veneer of “safe, legal” abortion was stripped away — at least for a short while near the end of the trial.

Court transcripts and the grand jury investigation and report1 on the Gosnell case showed that abortionist Gosnell had performed abortions for decades with many complaints and lawsuits. He was protected by state health agencies and boards who dismissed complaints or refused to investigate them. Holding abortion clinics to the standards we would expect for any other outpatient surgery has long been considered by abortion groups to be an obstacle to women seeking abortions. Thus, Gosnell was able to flout Pennsylvania abortion limits, cut the spinal cords of babies who survived his abortions, use unlicensed personnel to perform medical procedures, use and reuse unsanitary equipment leading to transmission of venereal diseases, store dead baby body parts for years, etc., with impunity.

In May 2013, Kermit Gosnell was found guilty of murdering three babies and of the manslaughter of a 41-year-old mother in an abortion and sentenced to life in prison. These were not all of the victims named in the beginning but these met the burden of proof for the jury.

THE CONTROVERSY CONTINUES

When Kermit Gosnell was convicted, it seemed that the media quickly dropped the story with apparent relief, but surprisingly, the issues in the case were reignited in unusual ways.

When the national mainstream media finally started covering the Gosnell case, reporters went to the usual abortion activists and groups for comment. In the face of the convictions, these activists disowned Gosnell as a legitimate abortion provider and many even blamed the pro-life movement’s opposition to abortion for “forcing” desperate women to go to him.

However, abortion activists had a much more difficult time responding to the issue of Dr. Gosnell’s gruesome killing of late-term babies born alive after abortion. Abortion activists tried to dodge the issue at first. However, in testimony on a proposed Florida bill requiring doctors to care for babies born alive after abortion, a Planned Parenthood lobbyist stated “We believe that any decision that’s made [regarding the fate of the baby] should be left up to the woman, her family, and the physician.”2

Then, in June 2013 the Texas legislature was ready to pass a bill that would prohibit most abortions after 20 weeks and hold abortion clinics to the same standards as any other ambulatory surgical center, when Texas representative Wendy Davis filibustered the bill for 11 hours. This allowed time to expire for approving the bill even though the votes for passage were a certainty.

Overnight, Ms. Davis became a national sensation. The media devoted daily coverage to her “heroism.” Abortion supporters — including paid demonstrators — poured into Texas. Some chanted “Hail, Satan,” tried to throw obscene items, threatened physical violence, and generally tried to disrupt the next attempt to pass the bill. They were unsuccessful and the bill passed. But the intense media coverage of the Wendy Davis effort required coverage of at least some of the shocking behavior of the demonstrators. This was not the abortion movement’s greatest public relations moment.

Newspaper editorials and op-ed abortion supporters then turned to strong condemnation of the Texas bill, mostly focusing on the 20-week legal limit for abortion provision. Once again, just as in the partial-birth late-term abortion debate, the specters of women with life-threatening pregnancies and babies with lethal birth defects were raised. A 20-week limit on abortion was decried as inhumane and judgmental.

THE TRUTH BEHIND LATE-TERM ABORTIONS FOR THE HEALTH OF THE MOTHER

During the debate on the proposed ban of late-term partial-birth abortion in the late 1990s, abortion activists maintained that such late-term abortions were rare and performed only for maternal health or devastating birth defects in the unborn child. The abortion movement was stunned when Ron Fitzsimmons, the executive director of the National Coalition of Abortion Providers, told the New York Times that late-term partial-birth abortions were primarily done on healthy women and healthy fetuses.3 But the myth has persisted.

Instead, according to a 2006 study in Perspectives on Sexual and Reproductive Health4 involving hundreds of women who had second-trimester abortions (up to 27 weeks), the reasons the women gave for the delayed abortion were:

68% had no pregnancy symptoms

58% didn’t confirm the pregnancy until the second trimester

45% had trouble finding abortion provider

37% unsure of date of last menstrual period

30% had difficulty deciding on abortion

The researchers themselves noted that “many women seeking second-trimester abortions simply lacked pregnancy symptoms or were unaware of their last menstrual period and therefore took a long time to recognize and test for pregnancy” and concluded that the findings “underscore the need for second-trimester abortion to remain legal and accessible.” Maternal risk and fetal defect were not mentioned in the study.

But while some women do have medically high-risk pregnancies, modern medicine has made great strides in protecting the health of both mother and baby. In September 2012, an international group of more than 140 obstetricians and other physicians met in Dublin and issued a statement denying that abortion is ever medically necessary for women.5

Take, for example, the case of a woman with breast cancer who finds she is pregnant. Many doctors used to feel that an immediate abortion was necessary to save the mother’s life with chemotherapy and/or radiation.

Now, however, even the National Cancer Institute says “Because ending the pregnancy is not likely to improve the mother’s chance of survival (with breast cancer), it is not usually a treatment option.”6

Women with high-risk pregnancies deserve a doctor with high-risk experience who is willing to do his or her best to protect both mother and baby rather than quickly recommending abortion.

LATE-TERM ABORTION FOR BIRTH DEFECTS

While recent polls show support for a ban on abortions after 20 weeks,7 there is apparently still strong support for abortions for babies with lethal or serious birth defects.

For example, a July 2013 USA Today editorial tried to make the case against a ban on late-term abortion by arguing that a ban on abortions after 20 weeks was too soon because of potential lethal birth defects or even non–life-threatening conditions like Down syndrome.

Here is an excerpt from the editorial:8

While some genetic conditions, such as Down syndrome, can be detected with amniocentesis at 16 to 22 weeks, even then it can take two weeks to get results. Add specialists, research and time to reflect, and a 20-week ban forces women and couples to make heartrending decisions against a ticking clock.
Of course, killing an unborn baby does not prevent birth defects and there is an increasing amount of help (including perinatal hospice and support sites like benotafraid.net) for babies predicted to have life-threatening or other conditions.

However, I cannot help but take it personally when people with Down syndrome are singled out as the usual “hard case” in order to justify abortion. The problem lies not in the condition but in society’s strange attitude that allows it to celebrate the Special Olympics and the accomplishments of people with Down syndrome while condoning the abortion of 90+% of unborn babies with Down syndrome.

Back in 1982 when my daughter Karen was born with Down syndrome and a heart defect, it was hard to find support from doctors or even from family. My main source of support and encouragement came from the parent-run Down Syndrome Association here in St. Louis and I will be eternally grateful to them. I lost Karen after only 5 1/2 months but I stayed involved in the association to help improve conditions, especially for children with Down syndrome.

I had never met such kind and generous parents like those I met in the Down Syndrome Association and I asked them if they had always had these qualities. Every single parent said exactly the same thing: “My child made me this way.”

No wonder there is a waiting list of prospective adoptive parents for children with Down syndrome, including the hundreds who recently came forward to adopt after finding out that a Virginia couple was planning to abort their child!9 This child’s life was saved and many more could be if people only knew the facts.

We would not shoot a child with disabilities after birth. Why should we tolerate the killing of that same child before birth?

A “GOSNELL EFFECT”?

Kermit Gosnell first vaulted into public view in 1972 (before the Roe v Wade decision) when he staged a publicity event for abortion on Mother’s Day.10 Dr. Gosnell brought 15 poor Chicago mothers to Philadelphia to undergo second trimester abortions using a so-called super coil that expanded into razor-sharp plastic coils. Nine of the 15 mothers suffered major medical complications and some dubbed the event the “Mother’s Day Massacre.” Dr. Gosnell survived that debacle with apparently no repercussions.

It took more than 40 years to stop Gosnell, but even with his recent convictions for manslaughter and infanticide, a May 2013 Gallup poll showed that 54% did not follow the Gosnell case.11

This is not surprising in view of the lack of coverage of the trial by the mainstream media but the repercussions of the Dr. Gosnell case are still spreading and his case may eventually prove to be a turning point in the abortion debate.

Texas just joined eight other states in banning abortions after 20 weeks12 and as of this writing, Senator Marco Rubio of Florida has announced he will be introducing a 20-week abortion ban in the Senate. Several states are considering bills to increase oversight and regulation of abortion clinics in the wake of the Gosnell revelations.

Some members of the national mainstream media have admitted to bias in the lack of coverage of the Gosnell case and abortion groups like Planned Parenthood have shown that they do not support any limits on the timing of abortions. This is good education for the general public.

The full impact of the Gosnell case has yet to be seen but the exposure of the real truth of abortion has affected untold numbers of people and — most importantly — will save the lives of some mothers and their unborn babies.

Notes

1 “Report of the Grand Jury” January 14, 2011. Online at: phila.gov/districtattorney/pdfs/grandjurywomensmedical.pdf

2 Ben Johnson, “Planned Parenthood official defends post-birth abortions”. Lifesitenews.com. April 1, 2013. Online at: lifesitenews.com/news/planned-parenthood-official-defends-post-birth-abortions

3 “Partial-Birth Abortion:’ Separating Fact from Spin.” NPR.org. February 21, 2006. Online at: npr.org/2006/02/21/5168163/partial-birth-abortion-separating-fact-from-spin

4 “Second Trimester Abortion: Logistics and Lack of Symptoms are Factors.” Perspectives on Sexual and Reproductive Health. Vol. 38 No. 2, June 2006. Online at: guttmacher.org/pubs/journals/3811806b.html

5 “Abortion ‘absolutely never medically necessary’: maternal care expert symposium” by Hilary White. Lifesitenews.com. September 10, 2012. Online at: lifesitenews.com/news/abortion-absolutely-never-medically-necessary-maternal-care-expert-symposiu/

6 “Breast Cancer Treatment and Pregnancy,” National Cancer Institute, US National Institutes of Health. Online at: cancer.gov/cancertopics/pdq/treatment/breast-cancer-and-pregnancy/Patient/page5#Keypoint28

7 “Late-Term Abortion Bans Have Support.” Wall Street Journal. July 24, 2013. Online at: online.wsj.com/article/SB10001424127887324564704578626063938088812.html

8 “20-week abortion ban too soon: Our view” by the Editorial Board. USAToday. July 2, 2013. Online at: usatoday.com/story/opinion/2013/06/30/20-week-abortion-ban-editorials-debates/2477579/

9 Sarah Petersen, “Virginia pastor’s Facebook post prevents abortion for unborn baby with Down syndrome”. Deseret News, July 15, 2013. Online at: deseretnews.com/article/865583124/Virginia-pastors-Facebook-post-prevents-abortion-for-unborn-baby-with-Down-syndrome.html?pg=all

10 James Taranto, “Back-Alley Abortion Never Ended”. Wall Street Journal. April 18, 2013. Online at: online.wsj.com/article/SB10001424127887324493704578429431398819380.html

11 “Americans’ Abortion Views Steady Amid Gosnell Trial.” Gallup.com, May 10, 2013. Online at: gallup.com/poll/162374/ americans-abortion-views-steady-amid-gosnell-trial.aspx

12 “State Policies in Brief as of July 1, 2013”. Guttmacher Institute. Online at: guttmacher.org/statecenter/spibs/spib_PLTA.pdf
=====================================================================================

Nancy Valko, a registered nurse from St. Louis, is a spokesperson for the National Association of Pro-Life Nurses and a Voices contributing editor. She and her family live in St. Louis.

Voices copyright © 1999-Present Women for Faith & Family. All rights reserved.

2013 Voices: The “Helpful” Doctor and the Power of the Pro-Life Message

Voices Online Edition
Vol. XXVIII, No. 2
Pentecost 2013

The “Helpful” Doctor and the Power of the Pro-Life Message
by Nancy Valko, RN

In 2011, a survey study in the journal Obstetrics & Gynecology reported that only 14% of practicing obstetrician/gynecologists are willing to perform abortions.1 In Oregon, the first state to legalize assisted suicide in 1994, just a small number of physicians have been writing the majority of lethal overdose prescriptions.2

Still, many mainstream media outlets report overwhelming support for both abortion and the so-called “right to die” as politically correct and humane, while opponents are cast as unfeeling religious bigots. Those people and families damaged from abortion and assisted suicide are usually ignored, as are the majority of medical professionals who do not want to participate in either.

Shapers of public opinion — including some politicians and ethicists — have carefully constructed an unreal world of safe, celebrated abortion “rights” and “victimless” assisted death. This has had a destructive effect not only on the public but also in the attitudes of otherwise good and caring medical professionals.

Here are two recent examples from our family’s life.

As many of you know from my previous article, last year we lost Noah, our precious six-year-old grandson, from complications after his successful bone marrow transplant for a rare autoimmune disease called familial hemophagocytic lymphohistiocytosis (HLH).

Noah was a real fighter in his long battle against this disease. He endured multiple pneumonias, compression fractures, and extreme (but thankfully rare) body swelling that made him virtually unrecognizable. We and his doctors remained hopeful despite these setbacks.

However, a young doctor in training confronted Noah’s parents one day asking how long they were going to make their son suffer. That comment came at a time when Noah’s intensive care specialist was still optimistic, but it devastated Noah’s parents, who then reported the doctor to his superiors. They never imagined that trying to save their son’s life could ever be construed as a kind of torture.

They reported the doctor in the hope of preventing other parents from enduring such a negative “right to die” attitude. This young doctor probably meant to be helpful, but without an ethical foundation built on firm principles, he was harmful to his patients and families if left uncorrected.

Noah rallied for a while and plans were being made to take him back home for recovery and rehabilitation. Noah’s parents understandably refused to let the offending doctor near their boy.

Sadly, Noah later took a final turn for the worse and it became obvious that he was truly dying. But just when we thought the situation couldn’t be any harder, something else happened.

While we were all standing vigil for Noah two days before he finally died, Noah’s parents received the difficult news that a special prenatal test showed that Liam, Noah’s unborn brother, also had HLH. The abortion option was brought up. This happened even though little Liam himself would have an excellent chance for a bone marrow transplant cure, especially since his bone marrow transplant could be planned before he showed any sign of the disease.

I was so proud of my stepdaughter when she instantly replied to the abortion “option” with outrage. She told the doctor that it was unthinkable that she would be offered the “choice” of killing one of her children while watching another one of her children die!

The “helpful” doctor who suggested abortion probably thought that she was only being sympathetic, but, like too many people in our society, she saw abortion as an acceptable solution to a tough situation. My stepdaughter enlightened the doctor not only about the truth of abortion as killing but also about the effects on the family. So-called “therapeutic” abortion is never therapeutic for either the child or the family. How can killing a child ever prevent grief and guilt? How can anyone rationalize the very real difference between dying and being killed?

Liam Isaiah was born April 4, 2013 at 9:07 p.m., weighing in at 8 lbs. 14 oz. and 20 inches long. He is big, beautiful, and vigorous. His bone marrow transplant is planned for sometime in the near future, pending his health and a good donor marrow match. His healthy three-year-old sibling, Eli, is excited about being a big brother. We are all celebrating Liam’s birth and looking forward to his future with hope.

CONSEQUENCES OF THE “CULTURE OF DEATH”

Attitudes have consequences — whether we are lay people, medical professionals, or clergy — because the “culture of death” is so insidious and powerful. Too many of us remain silent and intimidated in the face of this evil until we ourselves are confronted. This is unfortunate because moral principles really do matter and will affect us all in the end. Publicly unrefuted claims from the “culture of death” are becoming embedded in the public consciousness.

Medical professionals are not immune from these challenges — especially our young men and women who have already been steeped in a popular culture that depends on slogans and soundbites rather than thoughtful analysis. Their teachers, who are older and presumably know better, have also been shaped over time to think of life ethics in terms of legal liability and “choice.” The lack of both accurate information and honest examination of issues — and the rhetoric of organizations such as Planned Parenthood — have created an atmosphere that discourages or even penalizes the pro-life students we so desperately need for a patient-safe health care system.

Many years ago, a Catholic ethicist confronted me after a “right to die” debate and demanded that I stop telling stories about my relatives, my patients, etc. He said this was unfair. I responded that Jesus Himself taught in the form of stories called parables. This encounter made it clear to me that the power of personal experiences — of real-life stories — to convey a message is far greater than dry statistics and sterile theoretical debates.

Our pro-life movement has many compelling stories that are based on unvarnished reality and promote a deeper understanding of the issues and the people involved. Some of our stories expose the frightening truth and expanding agenda of the “culture of death.” Other stories are inspirational lessons on the value of true justice, compassion, and moral principles. These stories highlight what love, faith, hope, support, selflessness, and respect for life can accomplish. Such stories are all around us if we only look. By telling our stories and those of others, we are helping to push back the culture of death.

Noah’s parents stood up against the culture of death twice, and although we may never know the full impact of their actions, I am certain that at least some medical minds were opened and will never forget the life lessons of little Noah and Liam.
***
Notes:

1 “Abortion Provision Among Practicing Obstetrician– Gynecologists” by Debra B. Stulberg, MD, MAPP; Annie M. Dude, MD, PhD; Irma Dahlquist, BS; Farr A. Curlin, MD. Obstetrics & Gynecology: September 2011,118:3, 609-614. Abstract online at: journals.lww.com/greenjournal/Abstract/2011/09000/Abortion_Provision_Among_Practicing.16.aspx

2 “Cornering the market on physician-assisted suicide” by Kenneth R. Stevens Jr. MD. Oregon Live. March 10, 2010. Online at: http://www.oregonlive.com/opinion/index.ssf/2010/03/cornering_the_market_on_physic.html
====================================================================================
Nancy Valko, a registered nurse from St. Louis, and a Voices contributing editor, is a spokesperson for the National Association of Pro Life Nurses (NAPM): nursesforlife.org.

Voices copyright © 1999-Present Women for Faith & Family. All rights reserved.

2013 Voices: When children die, where is God?

Voices Online Edition
Vol. XXVIII, No. 1
Lent-Easter 2013

When children die, where is God?

by Nancy Valko, RN

On October 18, 2012, we lost our 6-year-old grandson Noah after a long and often brutal battle with a rare autoimmune disease called familial HLH (Hemophago-cytic lymphohistiocytosis). Less than two months later, on December 14, 2012, twenty children around our Noah’s age — along with other victims — were viciously gunned down at Sandy Hook Elementary School by a disturbed young gunman. While the Sandy Hook tragedy affected the whole country and Noah’s death affected a smaller group of family and friends, I kept hearing the same question: Where is God or does He even exist?

The answer is that God is where He always has been when we grieve and suffer: with us and even carrying us through the roughest times, as the famous “Footprints in the Sand” poem depicts.1 But what does that really mean?

Almost forty four years ago, I witnessed my first death of a child as a student nurse. Thirty years ago, my baby daughter Karen who had Down Syndrome died from complications of pneumonia. Three years ago, my oldest daughter Marie died by suicide. And now, there are Noah and the Sandy Hook victims. Personally and professionally as a nurse, I have also been with countless parents and others who have lost loved ones. I would like to share what I discovered as my personal “survival guide” for coping with grief as a Catholic woman. It consists of three decisions I made years ago.

I CHOOSE TO LIVE

All death is hard because it involves loss, but the death of a child seems especially cruel no matter whether the death resulted from violence, accident, or illness. No parents expect to outlive their child. When the supposed “natural order” of life and death is breached, it shakes all of us to the core even when the child is not our own. Especially in today’s secular world, even people of faith can feel lost and helpless.

When a child dies, shock, denial, and even alcohol and drugs can cushion the crushing grief for awhile but eventually reality sets in. It is hard to even consider facing years and years of living without that precious person. Life is totally disrupted and even the routine of being at a hospital or bedside feels like a loss. In my case when I lost my daughters, I had to remind myself that my husband, children, and others needed me, but at times even that thought seemed totally overwhelming rather than motivating.

Recently Cesar Millan, the famous “dog whisperer” talked about his suicide attempt after a number of losses and how he learned to cope with bereavement from his experience with dogs.2 When dogs grieve, he recommends three things: exercise, discipline, and affection. He said he found this also helped him.

Looking back, I found that these three techniques had helped me. Exercise decreased my anxiety and pain. Discipline meant appreciating even the most mundane routines of life or work and embracing the distraction. Hugging my loved ones and friends gave me a renewed sense of connection with the world and even with God.

However, I know that life will still contain many challenges. For example, while Noah’s 2 1/2-year-old brother Eli is free of HLH, we recently discovered that Noah’s unborn baby brother Liam, who is due in April, does have the disease and will also need a bone marrow transplant. We pray that he will achieve the cure that eluded Noah but we face the future with our confidence in God intact. I will never be a cockeyed optimist but I do know that storms can be weathered and that we can be better rather than bitter as a result.

I CHOOSE TO BE HAPPY

This is perhaps the hardest decision that I or any other bereaved parent has made but it is crucial. Years ago I was with a young mother who tragically lost her 2-year-old son. We spoke almost daily for a long time. Finally, she told me that she couldn’t see ever getting past her grief. I asked her if she had laughed yet. Embarrassed, she said she was watching a TV comedy show the night before and realized that she thought she heard a sound resembling a laugh come out of her. I told her that any laughter was the beginning of healing. I reassured her that she would laugh again and have moments of pleasure more and more in the future and that she should celebrate those moments rather than feel guilty. Life may never be “normal” in the old sense but life still had the potential to be good, perhaps even great.

From other bereaved parents who helped me, I learned that you don’t have to hold onto the grief to hold onto the love you feel for your child. That beloved child would not want your life to be blighted by his or her death any more than you would want your children to be forever sad after your death. And, in our rich Catholic tradition, we honor Jesus’ mother Mary as Our Mother of Perpetual Help, not Our Mother of Perpetual Mourning.

I now look at working toward happiness and fostering a generally cheerful outlook as a tribute to my daughters and grandson. This doesn’t mean that I am immune from being blindsided by grief and longing when I accidentally hear certain songs, see another person their age, witness another death, etc. Like probably everyone else I still have what my husband kindly refers to as my “moments” when life seems like a long, hard slog. But I continuously strive to foster an attitude of gratitude for what — and especially who — I have left. I don’t want the children’s legacy to be one where their deaths destroyed a family.

There is no set timeline for grief and bereaved parents and other relatives need to be patient with themselves and those around them. I remember the old days in medicine when grieving relatives were immediately offered a tranquilizer. I knew even then that this often just delayed the process instead of helped. There is no “good” or “bad” way of grieving. Everyone has their unique journey although it is not a sign of weakness to ask for or offer professional help when necessary.

I was surprised by the depth of grief I felt for the Sandy Hook victims and their relatives. I found it excruciating to watch the relentless TV coverage of the tragedy but I also found it hard to turn away. However, in watching the story unfold, I was struck by the fact that although I have spoken with many other bereaved parents over the last three decades, I never met a parent who said they wished their beloved child had never been born rather than to have faced the grief the parent endured. Obviously, you can never lose when you truly love and I was so glad that the Sandy Hook parents were surrounded by loving, supportive people in their community and countless other caring people throughout the country who wanted to help.

Pain is an inescapable part of the grief journey, but we may hope that we all can eventually get to the point where it is the life, not the death, of our beloved child that is the most important to us.

I CHOOSE NOT TO REJECT GOD

I’ll never forget reading about a famous and outwardly successful man who said he gave up on the idea of God when his little sister died. This gentleman wound up with a series of failed marriages and despite his millions of dollars, is bitter and unhappy.

There is no question that faith is often challenged when tragedies like the death of a child happen. But rejecting God means rejecting the greatest source of love and healing that we so desperately need at our worst times.

I eventually realized that I never did and never will have total control over my or anyone else’s life and that this is tolerable because God has a Divine Plan. I’ll never forget the wonderful Visitation nuns who taught us that life is like a tapestry that is large, beautiful, and intricate. However, on this earth we see the tapestry only from the back. We see dark colors, chaos, and loose threads that seem to go nowhere. Nothing in the tapestry appears to make sense, much less beauty. It is only when we die that God turns the tapestry around and we can finally see the amazing result. God doesn’t cause tragedies but rather brings good out of the evil we see.

It was when my Karen was born that I discovered that God is communicating with us all the time. It was then that I started noticing what I call the “miracles of grace” that God seems to send at some of our most heart-searing times. Over the years there have been some great ones: The depressed friend intent on suicide who was saved at the last moment by a smile from Karen. The young person who came back to the Church when Marie died. The many people who have volunteered to become bone marrow donors in honor of Noah and to help others like his little brother Liam.

The big miracles of grace also taught me to look for and appreciate the smaller mercies that comforted me and let me know that God is there: The woman who told me that baby Karen had done more good in her short life than most 80 year olds. Visits from Marie’s friends who told me wonderful stories about her that I never knew before. Great friends who seemed to call at exactly the right moment when Noah was so sick.

When I was a little girl, I was often irritated by my mother’s admonitions to “offer it up for the poor souls in Purgatory” when I was hurting either physically or emotionally. It took years for me to understand that offering up my pain for such souls or any other good intention for others often acted as a kind of pain reliever and, at the same time, made my pain meaningful in a good way. I also learned that even little acts of kindness performed in memory of a loved one were a great form of honor and gratitude for those lives that are still joined to us in God’s community of love.

Today, I would ask those of you who read this to consider offering up a frustrating situation or performing some small act of kindness in honor of Noah, Karen, Marie, and the Sandy Hook victims.

Those children are now in God’s Hands. The world is still in ours and we can make it better.

NOTES

1 “Footprints in the Sand” by Mary Stevenson. The Official Footprints in the Sand Page. footprints-inthe-sand.com/index.php?page=Poem/Poem.php

2 “Cesar Millan, ‘The Dog Whisperer’ Reveals Suicide Attempt” by Christie D’Zurilla. Los Angeles Times. November 16, 2012. articles.latimes.com/2012/nov/16/entertainment/la-et-mg-cesar-millan-dog-whisperer-suicide-attempt-20121116
========================================================================================
Nancy Valko, a registered nurse from St. Louis, is president of Missouri Nurses for Life, a spokesperson for the National Association of Pro-Life Nurses, and a Voices contributing editor.

Voices copyright © 1999-Present Women for Faith & Family. All rights reserved.

2012 Voices: Open Adoption: A Love Story

Voices Online Edition
Vol. XXVII, No. 4
Advent-Christmas 2012

Open Adoption: A Love Story

by Nancy Valko, RN

In 1998, I wrote an article in the National Catholic Register titled “A Crisis Pregnancy Close to Home — When it’s your own unmarried daughter facing a staggering ‘choice,’ are you still pro-life?”1 with the permission and encouragement of my daughter Marie, who was 18 years old and pregnant at the time. A Washington Post columnist had just written yet another Roe v. Wade anniversary article that repeated the old canard that pro-lifers were only pro-life until their teenage daughters became pregnant. We were both offended.

At that time, Marie was wrestling with the choice between keeping her baby and adoption. Abortion was never an option because, as Marie said at the time, “I could never kill my baby. I know too much.” I told Marie that the most important question was what would be best for the baby and I assured her that I would totally support her decision to either keep the baby or release him or her for adoption. But the decision had to be hers since she was an adult and she would be the one to live with her decision.

I always intended to write a follow-up to that article but it has taken me almost 15 years to write about what happened later. I do so now in the hope of greater understanding and compassion for all involved in the crucial and emotional issue of adoption. There are many kinds of adoptions and each situation and decision is unique. This is our experience.

OPEN ADOPTION AS AN OPTION

Around 1.2 million US babies are lost yearly to abortion while only an estimated 18,000 infants are adopted by non-relatives.2

At the same time, there are large numbers of couples, usually experiencing infertility problems, who are desperate for a child. Some unfortunately choose in vitro fertilization or surrogate motherhood because of the difficulties finding a baby to adopt. Some turn to international adoptions or foster care. Some open their hearts to older children or children with special needs. Some are never able to adopt for various reasons.

In the meantime, adoption practices have changed radically. Unlike the routine closed adoptions of just a few decades ago where the birth mother would never know the adoptive parents or usually ever see her child again, now there is the newer practice of open adoption, which allows the birth mother to choose the adoptive parents and have updates or even contact if the adoptive parents agree.

According to a recent Wall Street Journal article,3 today about 95% of adoptions involve some degree of openness, according to a study published in March by the Evan B. Donaldson Adoption Institute in New York, a nonprofit focused on adoption policy and practice. Some of these arrangements involve legal contracts but the expectations and arrangements are still evolving. Despite the potential problems, some new reports show positive results for birth parents, adoptive parents, and the children themselves.4

MARIE’S STORY

Marie never hid her pregnancy as she explored her options. We discussed the challenges of being a teen mom trying to work and finish college as well as the pain of not raising her child herself. For Marie, what finally tipped the scales toward adoption was the heartbreak of finding out that the father of her baby had some severe, unresolved problems and Marie didn’t want to take a chance on the father having unsupervised access that could put the baby at risk. At the same time, Marie also wanted to make sure her baby had the best life possible with two loving parents. This was an incredibly hard decision to make and Marie’s resolve was tested many times, even up to the very end.

Surprisingly, although many of Marie’s friends would describe themselves as “pro-choice,” they were uniformly opposed to her aborting her baby. However, most of them were equally opposed to adoption, which they considered tantamount to abandonment. Marie remained determined but privately, I wondered how many babies are aborted due to such misguided attitudes about adoption.

When we explored the adoption options, Marie was adamant that she would only consider open adoption. She couldn’t stand the thought of always wondering where and how her child was.

My first choice for adoption information was the Birthright organization, where I knew their policies and integrity. However, Marie had fallen away from religion during her teen years and decided to explore other agencies and options, including online profiles and classified ads.

When Marie let it be known that she was looking for a couple to adopt her baby, I was flabbergasted by the attitudes of some of the couples who contacted her or even me. One couple promised a pony for the baby if she chose them. Another promised to give the baby back in three years if Marie wanted. But the most astonishing plea was from a couple who wrote that they had great success with their “fur children” (animals) and now felt ready to try a “skin” child! I had to wonder what happened to the traditional view of a child as a blessing and a privilege rather than a commodity.

Marie decided that using an agency would be safest. She settled on one and reviewed their prospective couples. One couple was “John and Mary” (not their real names) but Marie rejected them for being “too religious” even though she really liked them personally. She instead chose another couple, “Tiffany and Josh” (not their real names).

Personally, I preferred John and Mary if Marie went through with adoption but Marie was impressed with the other couple’s views and lifestyle. Marie refused any money — even for medical expenses — from the agency, telling me that she never wanted her baby to think that he or she was “sold.” Instead, while living at home, Marie worked two jobs and attended college part-time until a couple of weeks before her baby was born. Naturally, I worried, but I so admired Marie’s spirit and sacrifice!

However, shortly before Marie gave birth, Tiffany and Josh backed out. They told the agency that they had second thoughts about the problems of the birth parents and didn’t want to “take a chance on a possibly imperfect baby.”

I thought Marie would be devastated but she said she was glad that this couple’s real attitudes had come out before it was too late. As she said, “they probably would have aborted my sister Karen” who was born with Down Syndrome. I brought up John and Mary but, once again, Marie was reluctant because of their religious devotion. I told her that instead of labeling their views as religious, Marie might consider something else. “What kind of values do you want your child growing up with?” I asked.

Ultimately, Marie chose John and Mary, who turned out to be exceptional people, who not only let Marie’s brother, sister, and I see Marie’s beautiful daughter occasionally but who also welcomed Marie into their lives as little “Sue” (not her real name) grew up. Sue and her older sister (also adopted) were even Marie’s flower girls when she married in 2005.

John and Mary’s generous spirit started long before they met Marie. Twice before, a birth mother had changed her mind about adoption at the last minute. I asked John and Mary how they coped with such heartbreak but Mary told me that they accepted these decisions as God’s will and reassured the young mothers of their support. I thank God everyday that it was John and Mary who became Sue’s parents.

We lost Marie tragically almost three years ago5 but one of my favorite memories is when she gave birth to Sue and I was her labor coach. As a nurse, I had seen births before but watching my first grandchild enter the world was overwhelmingly special. I had tears in my eyes when I had the honor of cutting the umbilical cord and finally holding this amazing little person for the first time. It had been a long, often hard, nine months, especially with some of the attitudes we encountered, but we all had finally made it to this extraordinary moment.

There were tears and last-minute cold feet that September weekend in 1998 but for Marie, there was a real feeling of peace when she finally placed little Sue into the arms of John and Mary.

Over the often difficult years that followed, Marie told me that Sue was the greatest joy of her life even though she missed not raising Sue herself. Being able to watch her daughter grow and bloom was a blessing that Marie never took for granted. At the end, her most prized possessions were her photos and Sue’s Mother’s Day cards to her.

POSTSCRIPT

A couple of months ago, I attended my now-14-year-old granddaughter’s community play and I marveled at her talent as well as her beauty and grace. She looks so much like her mother — although with my freckles — and even has some of Marie’s mannerisms.

I was so proud and grateful for this young girl and when I hugged Sue after her performance, I hugged her for Marie also.

Notes:

1 “A Crisis Pregnancy Close to Home” by Nancy Valko. National Catholic Register. March 22-28, 1998. Online at: ncregister.com/site/article/8454

2 “Domestic Newborn Adoption.” The Adoption Guide. Online at: theadoptionguide.com/options/domestic-adoption

3 “One Baby, Two Moms: a Rise in Open Adoptions” by Mara Lemos Stein. Wall Street Journal. August 14, 2012. Online at: online.wsj.com/article/SB10000872396390444184704577587150909159234.html

4 Ibid.

5 “Mary, Marie, and a Mother’s Love”. Voices. Advent-Christmas 2009. Online at: http://archive.wf-f.org/09-04-Valko.html

========================================================================================

Nancy Valko, a registered nurse from St. Louis, is president of Missouri Nurses for Life, a spokesperson for the National Association of Pro-Life Nurses, and a Voices contributing editor.

Voices copyright © 1999-Present Women for Faith & Family. All rights reserved.

2012 Voices: Right to Health Care, Duty to Die?

Voices Online Edition
Vol. XXVII, No. 3
Michaelmas 2012

Right to Health Care, Duty to Die?

by Nancy Valko, RN

I was a 23-year-old intensive care unit nurse when the US Supreme Court’s Roe v. Wade decision shockingly declared abortion legal. Nearly 40 years later I am still an ICU nurse, as the Patient Protection and Affordable Care Act (also known as the ACA, popularly known as Obamacare) has been shockingly declared legal as a tax by the Supreme Court.

The first Supreme Court decision ushered in the Culture of Death. Will the second decision establish it as a right?

THE PAST AS PROLOGUE

In 1973, the public was told that the Roe v. Wade decision just made abortion legal for the first three months of pregnancy and would save thousands of lives of women who foolishly but desperately sought out so-called back alley abortionists. The doctors and nurses I worked beside were surprised but hoped for the best. We were told that once abortion was out in the open, it would become easier to help these women have their babies. Abortion would only be a last resort. The real consequences came later.

Now we have Planned Parenthood clinics operating as politically correct abortion businesses, subsidized by hundreds of millions of taxpayer dollars every year. Articles about women seriously harmed or even dying from legal abortions rarely make even the local news.

Conscience rights for health care providers and religious organizations are being dismantled, most recently by the Obama administration’s Health and Human Services department mandating so-called free birth control including contraceptives, sterilizations, and abortifacients as “essential preventive health care” regardless of religious, moral, or even medical objections.

Reasoned dissent from the expanding abortion agenda is increasingly marginalized as “extremist” and an unconstitutional intrusion of religion. In 1973, such developments were unthinkable but if fertility and babies can now be characterized as “diseases” to be prevented, what can we expect regarding people with chronic illnesses, disabilities, old age, etc. following this latest Supreme Court ruling?

THE AFFORDABLE CARE ACT

During the 2010 battle to pass the Affordable Care Act, House speaker Nancy Pelosi (D-CA) made the notorious comment “We have to pass the bill so that you can find out what is in it.”

However, one of the biggest dangers may not lie in what the bill specifically states but rather its mechanism for setting up an unelected but powerful panel called the Independent Payment Advisory Board (IPAB), which, along with the existing United States Preventive Services Task Force and other government agencies, will strongly determine how health care will be distributed. But even before this latest panel takes effect, we are already beginning to see the effects of a utilitarian economic mindset on healthcare. “Living wills” and other advance directives are increasingly promoted as an effective way to reduce Medicare costs at the end of life. The impact of these panels and agencies will be enormous if and when the ACA takes full effect.

NURSING ECONOMIC$

Nursing is often cited the most trusted profession, even above doctors. I believe that this is due, at least in part, to the fact that we are not paid by the amount of care provided nor do we command enviable salaries. Traditionally, we are advocates for the individual patient regardless of age, socioeconomic status, etc. But with such great trust comes great responsibility. Whether or not we deserve this as nurses depends in large part on our education and motivation. Unfortunately, both are at greater risk than ever now as educational, legal, and cultural influences are undermining a profession of caring.

Recently, I had a startling glimpse into the possible future nightmare facing both healthcare and nursing when I read “How Can We Afford to Die?” the May-June 2012 issue of Nursing Economic$. (No, the “$” is not a typo but evidently a mindset.)

This influential nursing journal, written by nurse educators and others in health care policy positions, devoted the whole issue to death, dying, and cost containment. The agenda quickly became clear as the costs at the end of life were endlessly cited, but concerns about potential abuses were dismissed and conscience rights were not even mentioned in the six articles I read.

Note these quotes from an articled titled “End of Life Care in the United States: Current Reality and Future Promise”: “Health care professionals have an ethical responsibility to assist patients to achieve the care and life they want for their last days, and in many cases that may involve assisting them to die with dignity in a surrounding of their choice, and embraced by those they have loved for a life-time” (emphasis added); and from the conclusion “Simply put, we can begin to control the cost of end-of-life care and afford to die with dignity if we act today” (emphasis added).1

In another article titled “Quality in Life and Death: Can We Have the Conversations?”, Deborah B. Gardner PhD, RN enthusiastically cites polls purporting to show overwhelming public support for physician-assisted suicide and euthanasia, while apparently bemoaning a poll showing a majority of physicians against this. She dismisses the idea of a “slippery slope” with legalized euthanasia but ironically states that “To offer assisted dying effectively, it must be integrated into the practice of medicine” (emphasis added). Also disturbing in light of the Supreme Court decision, she also states that “As nurses, we participate in providing social justice through the delivery of health care” (emphasis added).2

In the editorial for this issue of Nursing Economic$, Donna M. Nickitas, PhD, RN says that “Nurses are well positioned to advocate for death with dignity” and unapologetically even advocates for “punitive reimbursement policies for excessive end-of-life treatments that only prolong life.”3

If enacted, such penalties will certainly intimidate many doctors regarding how aggressively to treat you if you are terminally ill, elderly, critically or chronically ill, or even potentially disabled.

This issue of Nursing Economic$ was given in conjunction with the Hospice-Palliative Care Action Plan presented at the Fifth Nursing Economic$ Summit “How Can We Afford to Die?” on June 6, 2012 in Washington, DC, in which an 8-point action plan was also presented. One of the points discussed the importance of getting everyone over the age of 18 to sign “living wills” and other advance directives. But this point had one interesting 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”4 (emphasis added).

In other words, not choosing a potentially premature death can upset the economic imperative to reduce costs.

LOSS OF ETHICS AND CONSCIENCE RIGHTS

We are fast losing two of the most effective protections against an economics-obsessed, utilitarian health care system: traditional ethics and conscience rights. Without these two bulwarks, laws and regulations tend to follow the latest bias, pressure group, or opinion poll and ignore such basic human rights as life, religion, and freedom of speech.

When assisted suicide promoter Dr. Timothy Quill can become director of the American Academy of Hospice and Palliative Medicine5 — and our own United States government can by decree force Catholic institutions and other moral objectors to suddenly cover abortifacients and sterilizations — we must realize that we are already far down the road to an enforced Culture of Death that recognizes no bedrock principles or, in the end, even choice.

NOTES

1 “End-of-Life Care in the United States: Current Reality and Future Promise — A Policy Review” by Lisa A. Giovanni, MSN, RN. Nursing Economic$. May-June, 2012. Online: https://www.nursingeconomics.net/ce/2014/article3003127134.pdf

2 “Quality in Life and Death: Can We Have the Conversation?” by Deborah B. Gardner. Editorial. Nursing Economic$. pp 1-4. Summary online at: http://wedestr1302.pbworks.com/w/page/59237429/Roxie%20Summary

3 “The Dialogue about Death and Dying: It’s Time” by Donna M. Nickitas, PhD, RN, NEA-BC, CNE. Nursing Economic$, May-June 2012, Vol. 30/No.3. pp 122, 147. Online at: https://www.nursingeconomics.net/necfiles/specialissue/2012/editorial_Nickitas.pdf

4 “’Affordable’ Death in the United States: An Action Plan Based on Lessons Learned from the Nursing Economic$ Special Issue. Online at: nursingeconomics.net/necfiles/specialissue/2012/plan_Kovner.pdf

5 “Meet AAHPM President Timothy E. Quill, MD FACP FAAHPM”  AAHPM-Spring Quarterly. Online at: http://digitaleditions.walsworthprintgroup.com/article/Meet+AAHPM+President+Timothy+E.+Quill,+MD+FACP+FAAHPM/1010399/105036/article.html

Note: Dr. Quill was the respondent in the 1997 US Supreme Court case Vacco v. Quill challenging the ban on assisted suicide in New York, arguing that there is no difference between refusing lifesaving medical treatment and assisted suicide. The court ruled unanimously that there was no constitutional right to assisted suicide. Full disclosure: I was personally involved in writing the amicus brief for the National Association of Pro Life Nurses (nursesforlife.org) in this case.

========================================================================================

Nancy Valko, a registered nurse from St. Louis, is president of Missouri Nurses for Life, a spokesperson for the National Association of Pro Life Nurses, and a Voices contributing editor.

Voices copyright © 1999-Present Women for Faith & Family. All rights reserved.

2012 Voices: Then and Now: The Descent of Ethics

Voices Online Edition
Vol. XXVII, No. 2
Pentecost 2012

Then and Now: The Descent of Ethics

by Nancy Valko, RN

I feel blessed to have grown up and become a nurse in the era of TV programs like Marcus Welby, MD, Ben Casey, and Medical Center. I couldn’t wait to be part of such a noble profession and I proudly recited the “Florence Nightingale Pledge,” the nursing equivalent of the Hippocratic Oath, at my graduation from a Catholic nursing school in 1969.

Written in 1893 and named in honor of nurse/hero Florence Nightingale, the pledge reads:

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.1

Forty-three years later, I still subscribe to those simple but powerful principles but the healthcare world around me has changed dramatically. On the plus side, I have witnessed the great advances in treating illnesses, pain, etc. However, on the minus side, I have witnessed an increasing rejection of traditional ethics that has turned the world I knew upside-down in so many ways. In 1969, I could never have imagined that the crime of abortion would be declared a constitutional right or that euthanasia in the guise of “physician assisted suicide” would become legal in any state. And could any of us ever have imagined a time when a US president would try to force even Catholic healthcare institutions into violating their conscience rights?

These changes did not happen overnight and neither were they the result of new scientific discoveries. The tragedy is that this all began with small, deliberate steps.

CONTRACEPTION AND ABORTION

In 1965, the American College of Obstetricians and Gynecologists (ACOG) redefined conception from the union of sperm and egg to “the implantation of a fertilized ovum,”2 allowing hormones — like those in the Pill — that can interfere with implantation to be classified as contraceptive rather than potentially abortifacient. Eventually, this opened the door not only to widespread acceptance of artificial contraception but also later developments such as abortifacient “morning after” pills, embryonic stem cell research, and in vitro fertilization (IVF).

Unsurprisingly, abortion itself was legalized a mere eight years after the ACOG redefinition of conception when the stage was already set for a pervasive contraceptive mentality making childbearing merely a “choice.” Now, we not only have abortion celebrated as a right but also infertile couples who want to adopt having to compete with same-sex couples for a smaller and smaller pool of available children to love and raise. Some desperate infertile couples resort to IVF, artificial insemination, or surrogate motherhood. Today, unborn babies themselves routinely have to pass “quality control” prenatal tests to escape abortion. And just recently, two parents won almost $3 million in a “wrongful birth” lawsuit because they claimed that they would have aborted their daughter with Down Syndrome if the prenatal tests had been accurate.3

Moreover, according to two ethicists writing in a recent article in the Journal of Medical Ethics, even a newborn without disabilities does not necessarily have any right to live. Ethicists Alberto Giubilini and Francesca Minerva baldly state that “what we call ‘after-birth abortion’ (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled.” This, they argue, should be permissible because, like a fetus, the newborn is only a “potential person.”4

ORGAN DONATION

In 1968, an ad hoc committee at Harvard Medical School issued a report defining a type of irreversible coma as a new criterion for death, stating that “[t]he 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” and the “[o]bsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation.”5

Since then, all 50 states have adopted laws adding brain death to the definition of death but each hospital can determine its own, often widely varying, criteria for what counts as brain death.

When brain death did not provide enough organ donations to transplant, some ethicists and doctors devised a new way of obtaining organs. Now, we have non-heart-beating organ donation (aka donation after cardiac death) for people who do not meet the brain death definition6 and doctors like Robert Truog, who argues that the traditional “dead donor rule” before organ transplantation should be eliminated in favor of taking organs from living patients on life support with “valid consent for both withdrawing treatment and organ donation.”7

In a final step, doctors in Belgium have already combined euthanasia with organ donation.8 Could this happen here? Just last year, the New York Times published an article from a death row inmate in Oregon arguing for the right to donate his organs after his own capital punishment by lethal injection, and started an organization promoting this for other prisoners.9

TTHE “RIGHT TO DIE” AND EUTHANASIA

The 1970s brought the invention of “living wills” and the Euthanasia Society of America changed its name to the Society for the Right to Die. The so-called “right to die” movement received a real boost when the parents of Karen Quinlan, a 21-year-old woman considered “vegetative” after a probable drug overdose, “won” the right to remove her ventilator with the support of many prominent Catholic theologians. Karen continued to live 10 more years with a feeding tube, much to the surprise and dismay of some ethicists. Shortly after the Quinlan case, California passed the first “living will” law.

Originally, “living wills” only covered refusal of life-sustaining treatment for imminently dying people. There was some suspicion about this allegedly innocuous document and, here in Missouri, “living will” legislation only passed when “right to die” advocates agreed to a provision exempting food and water from the kinds of treatment to be refused.

But, it wasn’t long before the parents of Missouri’s Nancy Cruzan, who was also said to be in a “vegetative” state, “won” the right to withdraw her feeding tube despite her not being terminally ill or even having a “living will.” The case was appealed to the US Supreme Court, which upheld Missouri law requiring “clear and convincing evidence” that Nancy Cruzan would want her feeding tube removed, but, in the end, a local judge allowed the feeding tube to be removed. Shortly after Nancy’s slow death from dehydration, Senators John Danforth and Patrick Moynihan proposed the Patient Self-Determination Act (never voted upon but became law under budget reconciliation), which required all institutions to offer all patients information on “living wills” and other advance directives. Since then, such directives evolved to include not only the so-called “vegetative” state and feeding tubes but virtually any other condition a person specifies as worse than death and any medical care considered life-sustaining when that person is deemed unable to communicate.

But has this choice become an illusion? The last several years have also seen the rise of so-called futility policies and even futility laws in Texas that can override patient or family decisions to continue treatment on the basis that doctors and/or ethicists know best.

In the early 1990s, Jack Kevorkian went public with his first assisted suicide and the “right to die” debate took yet another direction. By the end of the decade, Oregon became the first state to allow physician-assisted suicide. At first, the law was portrayed as necessary for terminally ill people with allegedly unrelievable pain. Within a short time, though, it was reported that “according to their physicians, the patients requested assistance with suicide because of concern about loss of autonomy and control of bodily functions, not because of concern about inadequate control of pain or financial loss.”10

In 2008, Washington became the next state to legalize assisted suicide and in 2009, Montana’s state Supreme Court declared that it was not against public policy for a doctor to assist the suicide of a competent terminally ill person. Relentless efforts to legalize assisted suicide in other states have failed so far, but many euthanasia proponents support terminal sedation as a stopgap alternative to assisted suicide for the present.11 Ominously, just last year assisted suicide activist and terminal sedation advocate Dr. Timothy Quill was named president-elect of the American Academy of Hospice and Palliative Medicine (AAHPM).

In just the last few months, popular health expert Dr. Mehmet Oz voiced his support for physician-assisted suicide on his TV show and Dr. Phil McGraw hosted a segment on his widely seen TV show featuring a Canadian woman who wanted her adult disabled children to die by lethal injection. Ironically, the mother, along with former Kevorkian lawyer Geoffrey Feiger, argued that removing their feeding tubes was an “inhumane” way to end the lives of the adult children. Tragically, when the studio audience was polled, 90% were in favor of lethal injections for the disabled adults.

THE CHALLENGE AHEAD

After 43 years, I don’t miss the starched nursing uniforms and glass IV bottles of my youth but I certainly do miss the idealism and ethical unity that I shared with my colleagues during that time.

Back then, Catholic nursing education like mine added a level of ministry to our efforts but, Catholic or not, we all shared the common goal of providing the very best health care for every patient regardless of age, socioeconomic status, or condition.

But now, in capitulation to the new ideal of “choice,” we doctors and nurses find ourselves ostracized from our professional organizations for being “politically incorrect” when we oppose abortion and stand up for discrimination-free medical care for the disabled. We are warned not be “judgmental” when a terminally ill person asks to die. At the same time, we see our conscience rights being legally dismantled with excuses such as “Doctors, nurses and pharmacists choose professions that put patients’ rights first. If they foresee that priority becoming problematic for them, they should choose another profession.”12

This did not happen overnight but rather by small and ever deepening steps. The result has not been a more compassionate and just society but rather a culture with a false sense of power and entitlement. We have been seduced into believing not only that we deserve control over having or not having children but also the degree of perfection of those chosen children. We think we deserve a life in which the seriously ill or disabled don’t financially or emotionally burden us. We think we deserve to decide when our own lives are not worth living, and have a right to be painlessly dispatched by a medical person. And we desperately but ultimately futilely want to believe that our actions and attitudes will not have terrible consequences.

It will take all of us openly and constantly challenging this culture of death to restore the traditional respect for life that protects all our lives.

Notes

1 American Nurses Association. Online at: http://nursingworld.org/FunctionalMenuCategories/AboutANA/WhereWeComeFrom/FlorenceNightingalePledge.aspx

2 American College of Obstetricians and Gynecologists Terminology Bulletin. Terms Used in Reference to the Fetus. No. 1. Philadelphia: Davis, September, 1965.

3 “Jury awards nearly $3 million to Portland-area couple in ‘wrongful birth’ lawsuit against Legacy Health” by Aimee Green. The Oregonian. Online at: http://www.oregonlive.com/portland/index.ssf/2012/03/jury_rules_in_portland-area_co.html

4 “Killing babies no different from abortion, experts say” by Stephen Adams. The Telegraph. February 29, 2012. Online at:

http://www.telegraph.co.uk/news/health/news/9113394/Killing-babies-no-different-from-abortion-experts-say.html

5 “A Definition of Irreversible Coma — Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death, The Journal of The American Medical Association. August 1968. Excerpt jama.ama-assn.org/content/205/6/337.extract

6 “Death and the Organ Donor” by Nancy Valko, RN. Voices, Eastertide 2009. wf-f.org/09-01-Valko.html

7 “The dead donor rule: can it withstand critical scrutiny? By Miller FG, Truog RD, Brock DW. Journal of Medicine and Philosophy, 2010 Jun; 35(3):299-312. Online at:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916748/

8 “Initial Experience with Transplantation of Lungs Recovered from Donors after Euthanasia”. Applied Cardiopulmonary Pathophysiology 15: 38-48, 2011. applied-cardiopulmonary-pathophysiology.com/fileadmin/downloads/acp-2011-1_20110329/05_vanraemdonck.pdf

9 “Giving Life after Death Row” by Christian Longo. March 5, 2011. New York Times: Online at: http://www.nytimes.com/2011/03/06/opinion/06longo.html

10 “Legalized Physician-Assisted Suicide in Oregon — The Second Year” by Amy D. Sullivan, PhD, MPH, Katrina Hedberg, MD, MPH, and David W. Fleming, MD. The New England Journal of Medicine, 2000; 342:598-604 February 24, 2000. nejm.org/doi/full/10.1056/NEJM200002243420822

11 Timothy E. Quill, MD and Ira R. Byock, MD for the ACP-ASIM End-of-Life Care Consensus Panel, “Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids”, Annals of Internal Medicine. 2000; 132:408-414. Abstract: annals.org/content/132/5/408.abstract

12 “An Unconscionable Conscience Rule”, St. Louis Post-Dispatch editorial, December 24, 2008: stltoday.com/news/opinion/columns/the-platform/an-unconscionable-conscience-rule/article_8c777b41-d4f4-539c-bd82-2760fd738037.html

========================================================================================
Nancy Valko, a registered nurse from St. Louis, is president of Missouri Nurses for Life, a spokesperson for the National Association of Pro-Life Nurses and a Voices contributing editor.

Voices copyright © 1999-Present Women for Faith & Family. All rights reserved

2012 Voices: Special Needs, Special Gifts

Voices Online Edition
Vol. XXVII, No. 1
Lent – Eastertide 2012

Special Needs, Special Gifts

by Nancy Valko, RN

Last October during National Down Syndrome Awareness month, a new test for detecting Down syndrome as early as 10 weeks into pregnancy was announced with great fanfare by many news organizations.1 Routinely mentioned was also the sad fact that around 90% of babies diagnosed with this condition are then aborted. Indeed, although more people than ever identify themselves as pro-life in public opinion polls, there is still majority support for abortions in the so-called “hard case” of birth defect.

Ironically and also in October, a new study was published in the American Journal of Medical Genetics2 on how the vast majority of people with Down syndrome and their parents viewed their lives as happy. For example, 99% of people with Down syndrome said they were happy with their lives, 96% of siblings expressed affection, and 97% of parents said they were proud of the child with Down syndrome.

These statistics might surprise the average person but not those of us who have had a child with special needs. And while Down syndrome has become the template of public attitudes toward abortion for unborn babies with birth defects, Down syndrome is only one of thousands of conditions that can result in special needs.

When I was a young student nurse, I had part of my training at Cardinal Glennon Children’s Hospital here in St. Louis. I met many parents who were caring for children with a variety of problems, some devastating or even lethal. I was amazed and inspired by the parents I met but I knew for sure that I could never do what they did.

When I started my family, I wondered how I would cope if one of my children was born with special needs but I was reassured by the old axiom that “God never gives you more than you can handle”. Since I didn’t think I could handle a child with special needs very well, I decided I was “safe”.

But in 1982, with the birth of my daughter Karen, I discovered the real truth about the old axiom: God is always ready to give us the grace, joy, and love to deal with any situation.

This is why I was so honored to be asked to contribute to an extraordinary new book titled A Special Mother is Born: Parents Share How God Called Them to the Extraordinary Vocation of Parenting a Special Needs Child by Leticia Velasquez. Leticia is a talented Catholic writer and mother of three girls, one of whom has Down syndrome. She is also the cofounder of Keep Infants with Down Syndrome (http://keepinfantswithdownsyndrome.blogspot.com/)

This book is not only a memorable collection of stories about families responding to a variety of conditions affecting their children but also a great resource for parishes, pro-lifers, educators, health care professionals, parents, and virtually anyone whose life has been touched by a person with special needs. The book can be purchased at aspecialmotherisborn.blogspot.com/ as well as other sites such as Amazon.com and Barnes and Noble.

One thing I have learned over the years is that special needs are not limited to children at birth. Some of our children are affected by conditions or problems that can occur long after birth. But the truth remains the same: God is always with us.

With permission from Leticia, the following is my contribution to her book.

CHAPTER 15-THE HOSPITAL VISIT

I didn’t have a plan for this.

It was 1982 and I just stayed awake, crying and smoking five packs a day in my hospital bed after my daughter was born. The fact that Karen had Down syndrome was a shock but the news that, according to the cardiologist, she only had two weeks to two months to live because of an inoperable heart defect was unbearable.

At the time, I had a 5-year-old son and a 3-year-old daughter excitedly waiting for their new sister and a husband recovering from depression. I was sure we could all adjust to the Down syndrome but I couldn’t imagine any of us capable of watching our baby die. In desperation, I asked the nurses if they knew of anyone who had gone through the death of a child. No one knew of anyone like that but one nurse did suggest a co-worker who took in foster children. I couldn’t understand how that nurse could possibly help but, as I said, I was desperate.

Anna came in late one night and I poured my heart out to her. I admitted that I was afraid to get close to my baby because of the pain of losing her and I agonized about letting my other children get too attached to Karen. And, of course, I was worried about my husband’s depression spiraling out of control.

Anna told me that every time she gave up a foster child to adoption, it was like a little death to her because that child was gone, possibly forever. Then she told me something surprising. She told me that she could tell I was the kind of person who would automatically give my heart to my child. I remember thinking at the time that she had more faith in me than I had in myself.

Then she told me something I would never forget. Anna said that giving my heart to my child was a no-lose proposition. “If Karen dies, you will have the comfort of knowing that you gave her everything possible and, if she lives, you will have the comfort of knowing that you didn’t waste any time”, she said. Anna also told me to trust God.

Those words were like a healing balm because they were so true and just what I needed.

It turned out that the doctors were wrong and 3 weeks after Karen was born, we found out that her heart defect was indeed operable. Unfortunately, Karen died at 5 1/5 months from complications of pneumonia and just before her open-heart surgery. But her short, precious life did indeed prove the wisdom of Anna’s words.

Not long after Karen died, I went back to the hospital to thank Anna for her advice. But even though I had graduated from nursing school at that hospital and knew the nurses there, no one could remember Anna or even anyone like her.

I finally talked to the supervisor, an old friend who came to see me after Karen was born. She was positive that no one like Anna was there at the time but — and this made the hairs on both our necks stand up — she suggested that perhaps Anna was an angel.

Of course, we’ll never know for sure but Saint Ann is not only my namesake but also the mother of the Blessed Virgin herself. And I can certainly imagine Saint Ann speaking those same words of wisdom to one of her suffering children like me.

Notes:

1 “A Less Risky Down Syndrome Test Is Developed” by Andrew Pollack. New York Times. October 17, 2011. online at: http://www.nytimes.com/2011/10/18/business/sequenom-test-for-down-syndrome-raises-hopes-and-questions.html

2 “Self-perceptions from people with Down syndrome” by Brian G. Skotko, et al. American Journal of Medical Genetics. October 2011. onlinelibrary.wiley.com/doi/10.1002/ajmg.a.34235/full

========================================================================================
Nancy Valko is a registered nurse from St. Louis, president of Missouri Nurses for Life, a spokesperson for the National Association of Pro-Life Nurses, and a Voices contributing editor.

Voices copyright © 1999-Present Women for Faith & Family. All rights reserved.