No Blank Bullets

Commentary by Nancy Valko, RN

This was originally published in the January-March 1996 edition of the Patients Rights Council newsletter.

Commentary: No Blank Bullets: By Nancy Valko

Ready… aim… fire!

All the B-movie scenes I watched as a child flashed through my mind when I heard that a convicted murderer had been recently executed by firing squad. My visceral reaction was to cringe, instantly imagining the terror of being blindfolded and waiting for the bullets to hit. What I couldn’t imagine, though, were the feelings of being one of the men called to pick up and aim a piece of cold, hard steel at another human being. Would the man cope by pretending it was just another round of target practice? Would he try to remember the details of the murders and the tears of the victims’ families to muster the outrage that such crimes call for? What did he feel after the execution — sadness or satisfaction?

I was not surprised to later learn that one of the firing squad guns contained only blank bullets. In such circumstances, it is sensible to protect each executioner from the certain knowledge that he personally ended another’s life. In the more common lethal injection executions, the process is said to include at least two people and two buttons to start the process. Again, the procedure for legally terminating another life tries to protect those whom society asks to perform the awful task.

It is ironic, therefore, that society is considering the addition of yet another kind of execution to the legal list — assisted suicide — but this time without the blank bullets.

Few people would seriously consider legalizing relative– or family-assisted suicide. The inherent dangers of this type of private killing are much too obvious. Thus, the goal must be physician-assisted suicide or, more accurately, health care professional-assisted suicide, since nurses also must necessarily be involved when the assisted suicide occurs in a health facility or home health situation. We doctors and nurses are the ones society is now considering asking to perform the act of terminating lives, but unlike the firing squad or the lethal injection team, we will know and have to live with the certain knowledge that we caused death.

It is doubly ironic that when a convicted murderer tries to discourage efforts by lawyers to stop his or her execution, this is considered as a sign of stress or mental disorder, while a sick person’s willingness to die is considered an understandable and even courageous decision! How do we reconcile the two views that killing is the ultimate punishment for a convicted murderer and, at the same time, the ultimate blessing for an innocent dying or disabled person?

Both the American Medical Association and the American Nurses Association have recently issued strong statements against assisted suicide and euthanasia. While acknowledging the very real deficiencies too often found in care at the end of life, these organizations call for more education and access to help instead of the simple but dangerous option of killing terminally-ill or severely-disabled people or helping such people kill themselves. It is eminently logical that our concern for life should not be limited to just the curable.

And, although some polls show that a significant number of doctors and nurses, like the general public, say they could support assisted suicide in a hypothetical case, when faced with the realities and ramifications of legalizing the practice, most express deep concerns and fears regarding its implementation.

Society has long insisted that health care professionals adhere to the highest standards of ethics as a form of protection for society. The vulnerability of a sick person and the inability of society to monitor every health care decision or action are powerful motivators to enforce such standards. For thousands of years doctors (and nurses) have embraced the Hippocratic standard that “I will give no deadly medicine to any one, nor suggest any such counsel.” Should the bright line doctors and nurses themselves have drawn to separate killing from caring now be erased by legislators or judges?

As a nurse, I am willing to do anything for my patients — except kill them. In my work with the terminally ill, I have been struck by how rarely these people say something like, “I want to end my life.” And the few who do express such thoughts are visibly relieved when their concerns and fears are addressed and dealt with instead of finding support for the suicide option. I have yet to see such a patient go on to commit suicide.

This should not be surprising. Think about it. All of us have had at least fleeting thoughts of suicide in a time of crisis. Imagine how we would feel if we confided this to a close friend or relative who replied, “You’re right. I can’t see any other way out either.” Would we consider this reply as compassionate or, instead, desperately discouraging? The terminally-ill or disabled person is no different from the rest of us in this respect.

I often wonder if right-to-die supporters really expect us doctors and nurses to be able to assist the suicide of one patient and then go on to care for a similar patient who wants to live without this having an effect on our ethics or our empathy. Do they really want to risk more Jack Kevorkians setting their own standards of who should live and who should die?

The excuse that the only real issue is the patient’s choice would be cold comfort to us doctors and nurses when we have to go home and face the fact that we helped kill another human being or had to remain silently powerless while some of us legally participated. There will be no blank bullets then for us — or for society.

Nancy Valko, R.N., is an oncology nurse and the author of numerous articles on bioethical issues. She is also listed in the 1996-1997 edition of Who’s Who in American Nursing.

2001 Voices: Hard Sell on Stem Cells

Voices Online Edition
Michaelmas 2001, Volume XVI No. 3

Bioethics Watch:
Hard Sell on Stem Cells
by Nancy Valko, RN

“My life is more important than the life on a few cells in a petri dish”.

— Letter to the editor from a woman with a spinal cord injury, New York Times. 8/11/01.

“To use human embryos or fetuses as the object or instrument of experimentation constitutes a crime against their dignity as human beings having a right to the same respect that is due to the child already born and to every human person… ”

–Donum Vitae

(Instruction on Respect for Human Life In its Origin and on the Dignity of Procreation: Replies to Certain Questions of the Day, Sacred Congregation for the Doctrine of the Faith, 1987)

This summer, the entire country has been involved in an extraordinary discussion about the beginning of life and what that means. The topic is stem cell research on human embryos and the two statements above illustrate the stark differences and high stakes involved.

The origin of the current controversy began with the little-noticed Dickey amendment passed by Congress in 1995, which prohibited federal funding of research which involved destroying human embryos.

In 1999, however, the Clinton administration approved new National Institutes of Health (NIH) guidelines that would allow funding for research using stem cells obtained from excess embryos developed from in vitro fertilization (IVF, the so-called “test tube baby” technology).

Ironically, IVF long ago disproved the US Supreme Court Roe v. Wade decision’s contention that we do not know when life begins.

With IVF, the actual moment of conception can be observed as well as the development of the unique new human being over several days before the embryo is either destroyed, frozen or introduced into a womb.

In natural motherhood, the newly conceived embryo continues to grow during its ride down the fallopian tube instead of in a petri dish — for those several days before it reaches the womb and implants.

Although this simple scientific fact has long been known, the American College of Obstetrics and Gynecology redefined conception as “the implantation of the fertilized ovum” in 1965. This was a linguistic maneuver intended to separate artificial contraception, that prevented the new life from implanting in the womb, from abortion, which was illegal at that time.

The redefinition did not change the reality, however, and later consequences have included not only widespread ignorance about artificial contraception but also legal and social confusion over the status of the embryo conceived outside the mother by artificial reproduction.

The issues of surrogate motherhood, cloning, custody battles over frozen embryos, and the current controversy over destroying human embryos for their stem cells are all by-products of this scientifically inaccurate redefinition of conception.

Pope Paul VI’s 1968 encyclical Humanae Vitae is was prescient when it condemned the separation of physical union from reproduction and predicted dire consequences.

Science vs. Humanity

It was inevitable that IVF would lead to scientists experimenting on the “leftover” embryos. Just in the past few years, scientists have been able to separate cells from the early embryo before they become differentiated into brain, heart, muscle or any other of the 200+ kinds of cells in the human body. By manipulating these cells, known as embryonic stem (ES) cells, scientists hope that these cells can be developed into specific organs and tissues to cure a multitude of diseases and conditions. The ethical problem is that taking these cells causes the death of the embryo.

Despite the publicity, so far such research (now done by private research groups both in the US and other countries) has yet to yield such cures. And, despite massive public relations efforts to frame the ethical issue as “only” involving excess embryos from IVF that “would be discarded anyway”, scientists are now experimenting with stem cells from aborted babies and even creating embryos in the lab expressly for the purpose of “harvesting” their stem cells.

On the other hand, stem cells discovered in adults and other alternative sources have already resulted in new therapies and even cures. For example, umbilical cords obtained after delivery have proven to be a rich source of stem cells and have already restored the immune systems of several children that had been destroyed by cancer. Using these stem cells does not involve the destruction of life and thus presents no ethical problem. Such stem cells are usually referred to as adult stem cells.

Despite the fact that scientists are discovering that such adult stem cells, like embryonic stem cells, can be manipulated to grow into various other types of cells, supporters of destructive embryo research maintain that embryonic stem cells are superior because of a theoretical ability to develop into any kind of cell.

But even that theoretical ability seems to have some troubling drawbacks. Scientists do not yet know how to “switch off” the growth of such cells and this presents the potential for causing tumors and other problems instead of cures.

This was most recently demonstrated in March of this year when it was reported that cells from aborted babies injected into the brains of Parkinson’s patients resulted in devastating and permanent complications in a number of these patients while it did not cure any of them.

The Bush Decision

The new NIH guidelines allowing federal funding for the use of embryonic stem cells were immediately condemned by pro-life groups and others concerned with research ethics. The guidelines became a campaign issue in the last presidential election, with George W. Bush opposing federal funding of destructive embryo research and Al Gore supporting such funding.

Congressional hearings were held, with Michael J. Fox, Christopher Reeve and other famous people with currently incurable conditions weighing in with their support of using embryos to try to find cures for their diseases.

Even formerly staunch pro-life people — such as Senator Orrin Hatch — supported the research, claiming that embryos outside the womb do not have the same moral status as those within the womb. He maintained this position despite the congressional testimony of a couple who adopted two such “unwanted” embryos and now have 2 healthy sons.

Many other arguments were also tried: The victim embryo was referred to as a “pre-embryo”, blastocyst, or “potential human life” by many scientists and liberal commentators in an effort to portray the embryo as something less than human. The long-discredited argument that we may as well get some benefit from lives that would soon be terminated anyway was resurrected. And talk shows were inundated with calls from relatives of people with diabetes, Alzheimer’s disease, etc. who maintained that anyone with personal knowledge of the suffering of sick people would surely support such research.

As a last resort, newspaper editorials began to appear, defending the NIH guidelines as a way to “regulate” the ethics of private research groups in the US, which were already performing destructive embryo research using other sources of funding instead of government funding.

The controversy had reached fever pitch when, on August 9, President George W. Bush presented a “compromise” solution that eloquently defended the sanctity of life and prohibited federal funding for further destructive embryo research but allowed the use of already existing stem cell lines (stem cells from already destroyed embryos cultured to reproduce indefinitely) for research.

The US Conference of Catholic Bishops and many pro-life groups condemned the Bush decision as “immoral”, while some other pro-life groups cautiously endorsed the decision to prohibit federal funding involving further destruction of embryos. (The USCCB statement is available at http://www.nccbuscc.org/pro-life/issues/bioethic/fact801.htm).

A poll taken just after the Bush decision showed that more than 60% of those polled supported the Bush compromise, a reversal of previous polls showing up to 70% support for embryo research.

The good news is that the president’s speech announcing the decision seems to have resonated with the majority of the public against the destruction of human life. The bad news is that the decision allows funding for research already unethically performed. This provides a kind of amnesty for unethical research that might later be considered useful, and opens a whole Pandora’s box of legal maneuvering to find loopholes or expand the compromise on the already existing stem cell lines.

The embryonic stem cell debate is far from over, but it is becoming increasingly clear that the wise caveat that the end does not justify the means is no longer recognized as a universal principle in science.

Nancy Valko, RN, of St. Louis, is a contributing editor for Voices.

2008 Voices: Catholic San Fransisco article on the End of Life Conference. Nancy was one of the three speakers.

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

Conference spotlights thorny end – of – life questions
By Michael Vick

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

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

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

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

Click links below for complete article.