2009 Mercatornet: Have death panels already arrived?

Have death panels already arrived?

The case against: an experienced nurse worries that Obamacare will entrench an existing quality-of-life ethic.

Nancy Valko | Nov 12 2009 | comment

Medical ethics are concerned with care for a patient’s welfare, something huge institutions are not very good at. The controversy about “death panels” in proposed health care reform legislation is to be expected. As a nurse, despite all the soothing noises from the Obama administration, I do believe there is cause for serious concern.
For example, Compassion and Choices (the name of the pro-euthanasia Hemlock Society after its merger with another “right to die” group) boasted that it “has worked tirelessly with supportive members of Congress to include in proposed reform legislation a provision requiring Medicare to cover patient consultation with their doctors about end-of-life choice.”

“End-of-life choice” might have been an innocent term a generation ago, but now in three American states “end-of-life choice” includes legal assisted suicide. No wonder people were worried when they read these words in HR 3962 (also known as the Pelosi bill). It even includes a whole section on “Dissemination of Advance Care Planning Information” that is problematic and misleading.

In addition, although the idea of health care rationing was originally dismissed as a myth, ethicists and the mainstream media admit that health care rationing is necessary. Government committees have been proposed to set rules for health care services.

Is ethical health care reform needed? Of course. In 2003, I was privileged to serve on a Catholic Medical Association task force on health care reform. Many good ideas, such as health-savings accounts, ways to help the uninsured poor, and strong conscience-rights protections, were discussed. The results were published in a 2004 report entitled “Health Care in America: A Catholic Proposal for Renewal”. The Obama Administration has rejected most of these proposals.

Ethics and health care reform

Since I first started writing about medical ethics and serving on hospital ethics committees, I have seen ethics discussions evolve from “what is right?” to “what is legal?” to “how can we tweak the rules to get the result we think is best?” This attitude is not very reassuring when we are considering a massive overhaul of the US health care system.

Former vice-presidential candidate Sarah Palin has been ridiculed for coining the term “death panels”. But it resonated with me. In 1983 my daughter Karen was born with Down syndrome and a severe heart defect. Even though Karen’s father and I were told that her chances for survival were 80 to 90 percent after open heart surgery, we were also told that the doctors would support us if we refused surgery and “let” Karen die. We refused to allow such medical discrimination against our daughter.

Later on we were shocked to learn that one doctor had written a “do not resuscitate” order without our knowledge. Apparently he thought I “was too emotionally involved with that retarded baby”.

In later years, I was asked if I was going to feed my mother with Alzheimer’s. And then, after my oldest daughter died from an apparently deliberate drug overdose, I was told that it is usually a waste of time to save suicide attempters.

Did evil people say these things? No. These doctors and nurses were otherwise compassionate, caring, health care professionals. But they are just as vulnerable as the general public to the seductive myth that choosing death is better than living with terminal illness, serious disability or poor “quality of life”.

When government committees and accountants take over health care, will things get better?

Common sense and ethics

Health care does not occur in a vacuum. Real people — patients, families and health care providers alike — are affected when economics and new ethical rationales trump basic needs. The Good Samaritan did not ask whether the man lying on the road had health insurance. The Hippocratic Oath established a sacred covenant between doctor and patient, not health care rationing protocols. I strongly disagree with ethicists who contend that new technologies and economics demand new ethics.

I am tired of hearing some of my medical colleagues talk about patients who “need to die”. I am saddened to hear many of my elderly, frail patients fret about being an emotional and financial burden on their families. I am outraged when I read editorials arguing that those of us who refuse to participate in abortion or premature death should find another line of work.

I recently attended a 40th anniversary nursing school reunion. We remarked on how much has changed. Some things are better — uniforms, equipment and technologies, for example. But some things are worse, especially ethics.

People are often surprised that even back in the late 1960s, we had do-not-resuscitate orders and spoke to families about forgoing aggressive medical treatment when patients seemed to be on the terminal trajectory to death.

But, unlike today, we did not immediately ask them whether we could withdraw food, water and antibiotics to get the death over with as soon as possible. Back then, we were often surprised and humbled when some patients recovered. Today, too many patients don’t even get a chance. Doctors and nurses are too quick to give up hope.

Back then, ethics was easily understood. We didn’t ever cause or hasten death. We protected our patients’ privacy and rights. We were prohibited from lying or covering up mistakes. We assumed that everyone had “quality of life”; our mission was to improve it, not judge it.

Medical treatment was withdrawn when it became futile or excessively burdensome for the patient — not for society. Food and water was never referred to as “artificial” even when it was delivered through a tube. Doctor and nurses knew that removing food and water from a non-dying person was as much euthanasia as a lethal injection.

“Vegetable” was a pejorative term that was never used in front of patients or their families. And suicide was a tragedy to be prevented, not an alleged constitutional right to be assisted by doctor and nurses.

Today we have ethics committees developing futility guidelines to overrule patients and/or their families even when they want treatment continued. We have three states with legal assisted suicide. We have even non-brain dead organ donation policies (called non-heartbeating organ donation or donation after cardiac death). Some ethicists even argue that we should drop the dead donor rule.

We see living wills and other advance directives with check-offs for even basic medical care and for incapacitated conditions like being unable to regularly recognize relatives. We are willing to sacrifice living human beings at the earliest stages of development to fund research for cures for conditions like Parkinson’s rather than promote research on ethical and effective adult stem cell therapies.

We are inspired by the Special Olympics but support abortion for birth defects. We now talk about a newborn child as another carbon footprint instead of as a blessing and sacred responsibility.

I could go on and on but I think you get the idea.

Death panels are not the overwrought fantasy of right-wing nut cases. Real “death panels” are already at work. They have been created by apathy, misplaced sympathy, a skewed view of tolerance and an inordinate fear of a less than perfect life. Death panels? In the famous words of the comic strip character Pogo, “We have met the enemy and he is us.”

Nancy Valko is president of Missouri Nurses for Life and a spokeswoman for the National Association of Pro-life Nurses.


2012 Ethics and Medics: Is Catholic Ethics a “House Divided”?

In the May 2012, Ethics and Medics, a publication of the National Catholic Bioethics Center (NCBC), published my article Is Catholic Ethics a “House Divided?”:

There is no question that traditional Catholic healthcare ethics is under fire, especially in the media. From nightly crime and medical dramas to the standard news stories of the day, Catholic ethics is routinely portrayed as cruelly rigid, inscrutable, or even outright dangerous to public health.
A case in point is the December 4, 2011, lead story for the CBS Sunday Morning show. The story, titled “The Catholic Church: A House Divided?,”focused on the 2010 decision of Bishop Thomas Olmstead of Phoenix, Arizona, to remove the Catholic status of St.
Joseph’s Hospital and Medical Center in Phoenix, because of an abortion performed there on an eleven-week-old unborn child whose mother was ill with life-threatening pulmonary hypertension.The chief medical officer at St. Joseph’s Hospital stated in an interview that the abortion was medically necessary to save the mother’s life. Adding fuel to the media fire, the CBS show reported that Bishop Olmstead excommunicated Sister Margaret Mary McBride, RSM, administrator and member of the ethics committee at St. Joseph’s Hospital for approving the abortion.
The story portrayed the issue as one where abortion was the only medical solution. But was this true? CBS suggested that Sr. McBride, and American women religious in general, were being punished by a dogmatic and out-of-touch Catholic hierarchy. Again, was this true?  And what exactly were the details surrounding the excommunication of Sr. McBride? Was it, as the CBS show implied, an arbitrary exercise of power?
The Untold Story

The real story behind the St. Joseph’s Hospital abortion tragedy and its consequences is much more complicated than that depicted by the CBS show. Unfortunately, the average Catholic is unlikely to encounter clear and thoughtful explanations of the Church’s governing principles in cases such as this, especially if he or she depends primarily on the media for information. Thus it is not surprising that Catholic patients and families who are suddenly faced with ethical dilemmas find themselves confused and troubled by differing opinions about what is the best course of action, even at Catholic hospitals. This is a grave problem that I have seen often during my forty-two years as a nurse.

In the case of the abortion at St. Joseph’s Hospital, not surprisingly, given media hostility toward the Catholic Church, quite a lot of information was left out of the CBS Sunday Morning report, that is, facts that would have
been helpful to future patients and families who will face similar decisions. Too often, Catholics find themselves on the defensive because they do not know the actual teaching of their own moral tradition. The Church’s prohibition against direct abortion makes both moral and practical
sense because it is rooted in natural moral law and in scientific fact.
In the case at St. Joseph’s Hospital, the Church’s prohibition against direct abortion was not a hard-hearted dogma designed to force the death of a mother, but rather it was a commitment to both lives involved. There is an enormous difference between terminating the life of an unborn child (a direct abortion) and treating a serious or even life-threatening condition of the mother that may lead to the unfortunate but foreseeable death of the unborn. The classic example of a pregnant woman with uterine cancer, where the diseased organ must be removed along with the unborn child, is justifiable under the principle of double effect. The object of the act is the removal of an unhealthy organ. The death of the child is foreseen but not intended.
In the case at St. Joseph’s Hospital, there was no diseased organ to be removed, and the child, of course, was healthy. Although women with pulmonary hypertension are advised to avoid pregnancy because the risk of pregnancy-related death is substantial (reported to be 30 to 50 percent 1), tremendous advances have been made in treating pulmonary hypertension in pregnant and nonpregnant patients. In addition, although the media
rarely report it, abortion poses physical and emotional risks to even a healthy mother in the first trimester of pregnancy. Bishop Olmstead determined that the hospital’s medical staff and ethics committee had decided to perform an abortion rather than treat the woman’s disease.2
The CBS program ignored these facts. The other major controversy presented in the report was whether Bishop Olmstead had overstepped his bounds by revoking the Catholic status of the hospital and by  excommunicating Sr.McBride. Were these actions a sudden and rash decision of an authoritarian monarch, as most secular media and
even some Catholic critics claimed? Hardly. There was along and complex history behind these events, a history that continues to show itself in Catholic Healthcare West’s recent decision to abandon its Catholic identity.
As Bishop Olmstead made clear in his December 2010 statement, he spent months discussing with officials of the hospital and Catholic Healthcare West not just this abortion but what the bishop determined to be a pattern of behavior that violated the Ethical and Religious Directives for Catholic Health Care Services, the governing document for Catholic health care institutions.
According to Bishop Olmstead’s, this behavior included administering contraceptives, contraceptive counseling, voluntary sterilizations, and abortions in cases of rape, incest, and even for the benefit of the mental health of the mother—a dubious medical claim. Bishop Olmstead expressed his reluctance to remove the Catholic status of the hospital and stated that “the Catholic faithful are free to seek care or to offer care at St. Joseph’s Hospital, but I cannot guarantee that the care provided will be in full accord with the teachings of the Church.”3
Bishop Olmstead said that he had had discussions for years with Catholic Healthcare West, the parent company of St. Joseph’s Hospital, about resolving violations of the Ethical and Religious Directives but that CHW had refused to comply. Those directives recognize a bishop’s essential responsibility over Catholic health care institutions:“As teacher, the diocesan bishop ensures the moral and religious identity of the health care ministry in whatever setting it is carried out in the diocese.”4
The CBS Sunday Morning show criticized Bishop Olmstead for excommunicating Sr. McBride, but in fact he privately informed her that she had incurred an excommunication latae sententiae, that is, that it happened automatically at the procurement of the completed abortion. Canon 1398 states, “a person who procures a completed abortion incurs a latae sententiae excommunication.” Of course, there are extenuating circumstances, such as intention or coercion, that could mitigate the penalty of excommunication, but this is far from the liberal feminist cause célèbre that the CBS Sunday Morning show would have its viewers believe.
A Deeper Problem
As troubling as is the media criticism and lack of depth, it is the confusion spread by Catholic sources that is arguably the most damaging, for Catholics and non-Catholics alike. The United States Conference of Catholic Bishops issued a thoughtful statement on the case, ignored, of course, by the media.5 But it was also ignored by prominent Catholic organizations and theologians.
The Catholic Health Association, claiming to include more than six hundred hospitals and 1,400 long-term care and other health facilities in all fifty states, issued a strong statement in support of the abortion and of the hospital.6 Marquette University professor and theologian M. Therese Lysaught, hired by St. Joseph’s Hospital to provide an “independent” analysis, denied that the termination was a direct abortion.7 Such events lead many devout Catholics to scratch their heads. They wonder whom they can trust when it comes to making health care decisions in the light of Catholic teaching.
The real-world consequences of such division within the Church are frightening. The American Civil Liberties Union, citing the abortion case at St. Joseph’s Hospital,already complained to federal health officials that “no hospital—religious or otherwise—should be prohibited from saving women’s lives and from following federal law.”8 The Obama administration’s February 2011 revision of a federal protection of conscience rights regulation has left both health care professionals and institutions vulnerable to litigation and coercion.
A consistent ethical standard of care is crucial for protecting patients as well as Catholic health care itself. Reliability builds trust, an indispensable component of good health care that appeals to both Catholics and non-
Catholics alike in this uncertain health care environment. At a time when hospitals are competing for patients,Catholic hospitals can stand out by offering both the best technology and the best standard of ethics.
Bishop Olmstead’s difficult decision to revoke the Catholic status of St. Joseph’s Hospital exposed the problem of Catholic institutions and ethicists who ignore or reinterpret many of the clear and definitive principles of the Ethical and Religious Directives to justify certain practices. Generations have gratefully entrusted their confidence, respect, and donations to Catholic health care institutions in order to build up the wonderful system of care that we have. Catholic institutions must now prove themselves worthy of that trust.
Nancy Valko, RN, is a contributing editor for Voices, president
of Missouri Nurses for Life, and a spokesman for the National
Association of Pro-Life Nurses.
Scientific Leadership Council, “Birth Control and Hormonal Thera-
py in Pulmonary Arterial Hypertension,” Consensus statement,
Thomas J. Olmsted, “St. Joseph’s Hospital No Longer Catholic:
Statement of Bishop Thomas J. Olmsted,” December 21, 2010,
Ibid., 3.
U.S. Conference of Catholic Bishops,
Ethical and Religious Directives
for Catholic Health Care Services,
5th ed. (Washington, DC: USCCB,
2009), General Introduction.
USCCB Committee on Doctrine, “The Distinction between Direct
Abortion and Legitimate Medical Procedures,” June 23, 2010.
Catholic Health Association, “Catholic Health Association State
-ment regarding St. Joseph’s Hospital and Medical Center in
Phoenix,” December 22, 2010, http://chausa.org/newsdetail.
Jerry Filteau, “No Direct Abortion at Phoenix Hospital, Theologian
Says,”National Catholic Reporter, December 23, 2010, ncronline.
Rob Stein, “Abortion Fight at Catholic Hospital Pushes ACLU
to Seek Federal Help,”Washington Post, December 22, 2010,


1996 National Catholic Register: A Compassionate Response

A Compassionate Response

 Sunday, Nov 10, 1996 1:00 PM Comment

In 1992, David and Anne Andis had a little girl with anencephaly whom they named Emma. Although an ultrasound showed the possibility of anencephaly only 10 weeks into the pregnancy, David and Anne, who are not Catholic, made the decision not to abort but found little support or information on dealing with their family’s crisis.

Although Emma lived only five days after birth, the Andises found that being able to know and love Emma during her short life was a meaningful and healing experience for them and their family. In response to their situation, they helped to start the Anencephaly Support Foundation to help other parents, families, and friends deal with the physical and emotional challenges of having (and losing) a baby with anencephaly. They now give such practical tips as the best kind of bottle to use if the baby can suckle and how to care for the skull defect as well as linking parents with other parents who have had children with anencephaly.

David and Anne are also spearheading an effort to establish a national birth defects registry and federal funding to study the causes of birth defects, hoping this information will lead to some answers and help prevent future babies from dying. Currently, low levels of the vitamin folic acid has been linked to the incidence of anencephaly but further research is considered warranted.

The Andises maintain an Internet site and also recently produced a videotape called The Anencephalic: A Suitable Donor? which deals with the controversial subject of using anencephalic infants as organ donors before death.

The Anecephaly Support Foundation can be reached by the Internet address http://www.asfhelp.com or by the toll-free phone number 1-888-206-7526.

Nancy Valko

1996 Catholic Ethicists Draw Scrutiny-Prolifers worry about abuses at Church-sponsored health-care institutions


by Nancy Valko
National Catholic Register
April 28, 1996. p. 1

A woman who finds out that her unborn baby has a severe brain abnormality has the pregnancy terminated in the second trimester. A hospital goes to court for permission to remove a feeding tube from a brain-injured, homeless man.

Cases like these are so commonplace today that they barely raise an eyebrow. But they have rarely involved Catholic institutions. However, in a trend that worries the pro-life movement, some Church-supported health care institutions and Catholic ethicists have begun to challenge Church practice and teaching.

Abortion and Anencephaly

In a 1993 article, “Anencephaly and the Management of Pregnancy”, Sr. Jean deBlois, CSJ, senior associate for clinical ethics at The Catholic Health Association, cites anencephaly, a condition in which an unborn baby is missing major portions of the brain and skull, as a case where “the pregnancy may be terminated at any time”. Although Sr. deBlois admits that “there is no life-threatening maternal pathology”, she cites the possibility of difficulties during labor and delivery, the “emotional trauma” of the diagnosis on parents, and the lack of mental development in the baby as justification for “inducing labor to end the pregnancy”. Emplying the principles of proportionality and double effect, she reasons that “the resulting fetal death is indirect” and thus not a directly intended abortion. Sr. deBlois further states that because “human life involves more than simply biologic life” and infants with anencephaly lack “psychologic, social, and creative capacities”, such babies “can never acquire the quality of viability, properly understood” — despite the traditional definition of viability as the ability to live outside the womb. Thus, she says, the termination of pregnancy is allowable at any point in pregnancy.

The article was later included in the 1994 book A Primer for Health Care Ethics — Essays for a Pluralistic Society (deBlois, O’Rourke, and Norris) and there have been reports of such “terminations” being proposed and even occurring in Catholic hospitals, raising strong objections from both prolife and medical groups.

Dr. T. Murphy Goodwin, assistant professor of maternal-fetal medicine at the University of Southern California, writing in the March 1996 issue of Ethics and Medics, notes that “Even in Catholic institutions, early induction has been proposed as a humane option with the reasoning that the proportionate benefit to the fetus of living a few more weeks is outweighed by almost any burden on the mother and the family.” But, he counters, “there is rarely any physical risk to the mother of carrying through an anencephalic gestation compared to early induction (of labor)” “Early induction before viability ,” Dr. Goodwin wrote, “hastens the death of the child for the purpose of ending the parents’ grief.”

Dr. William Burke, a neurologist and associate professor of neurology at St. Louis University, concurs with Dr. Goodwin’s opinion and told the Register that “the diagnosis of anencephaly cannot be made with absolute certainty prior to birth and, even after birth, errors in diagnosis have been described in (medical) literature”. He also strongly objected to Sr. deBlois’ new definition of viability and says that “anencephalic infants have the same intrinsic value as any other human being, normal or disabled”. Dr. Burke said he was “outraged” when other doctors told him that such abortions had already occurred at a Catholic hospital.

Mary Kay Culp, president of Missouri Right to Life, says “I worry that arguments like Sr. deBlois’ will be used to undermine our efforts to protect the lives of all unborn babies with disabilities. This article gives tacit support to many pro-abortion arguments and I am deeply disturbed that this is coming from a Catholic source.”

Archbishop Justin Rigali of St. Louis, writing in the June 2, 1995 edition of the St. Louis Review, underlined the “extreme importance (of) is the witness of the Catholic health care community of the Archdiocese in not cooperating in any abortion of anencephalic fetuses or in the donation of the infants’ organs before they’re dead.”

Nutrition and Hydration: Agressive Care?

Prolifers were also stunned when the Jan. 21, 1996 edition of the St. Louis Post-Dispatch reported that St. Anthony’s Medical Center was going to court to ask permission to remove the feeding tube from Lucio Bretana, a 44-year-old homeless man, who sustained severe head injuries following a beating and had been a patient at the Catholic institution for six months. Because Mr. Bretana could not speak for himself and no relatives were found, a court-appointed guardian and lawyer, Robert Weis, was appointed. Mr. Weis opposed the removal of Mr. Bretana’s feeding tube based on Missouri law requiring “clear and convincing” evidence of a prior decision by a person that he or she would want food and water withdrawn in such a situation. The court ultimately agreed and Mr. Bretana was transferred to a non-Catholic long-term health facility where he is today.

After the court hearing, Thomas Hooyman, Ph.d., the Catholic ethicist for St. Anthony’s, said that the hospital “was comfortable” with the court’s decision despite his support of the petition for removal of food and water. Dr. Hooyman further stated that such a case showed the importance of having an advance directive which would allow removal of tube feedings.

Dr. Karen Pentella, chairperson of the Medical Ethics Committee of Christian Hospital Northeast/Northwest, criticized the court decision to continue feedings. In her letter to the editor of the St. Louis Post-Dispatch, she maintained that “Each human being has a right, and perhaps even a obligation, to die when life no longer has any quality or meaning.”

For pro-lifers, this calls to mind the similar Nancy Cruan case, which figured prominently in both recent federal circuit court decisions that favored a right to physician-assisted suicide. As the Ninth Circuit Court stated last month, “When Nancy Cruzan’s nutrition and hydration tube was removed, she did not die of an underlying disease. Rather, she was allowed to starve to death. In fact, Ms. Cruzan was not even terminally ill at the time, but had a life expectancy of 30 years… (t)he removal of her gastrostomy tube, which was clearly the precipitating cause of her death, is not considered to be the legal cause only because a judicial judgment has been made that removing the feeding tube is permissible.”

Fr. Kevin O’Rourke, director of the Center for Health Care Ethics in St. Louis, who supported the Cruzan parents’ efforts to remove their daughter’s feeding tube, has argued that removing feeding tubes in such a case is not intended to cause death but that death “may be anticipated”. He stated that the ethical standard of withdrawing care or treatment that is futile or burdensome is met in the Cruzan case because food and water would not restore Nancy Cruzan to “some degree of cognitive-affective function” and that “the Cruzan family is burdened by the condition of Nancy”. He further cited “persistent vegetative state (as) a psychic burden for a person”.

In a 1991 interview with Our Sunday Visitor magazine, Fr. O’Rourke said that the moral imperative to spoon-feed or provide food and water by tube would arise “if there is medical evidence that the injury is reversible — that she would be able to know, love, relate to people” and that the treatment would have a clear benefit for the patient. Fr. O’Rourke was referring to Christine Busalacchi, another young woman said to be in a “vegetative state”, but who was being retrained to eat by mouth. Fr. O’Rourke later testified in her court case that removal of her feeding tube was consistent with Catholic teaching. She died in March, 1993 after her feeding tube was removed.

More recently, in a March 1996 essay in the Center for Health Care Ethics’ newsletter, Father Patrick Norris, OP discussed the case of Michael Martin, a Michigan man who was severely brain-injured after a car-train accident, but who is conscious and able to “nod, smile and grip with his right hand”. The Michigan Supreme Court recently refused to allow Mr. Martin’s wife to order his feeding tube removed. Fr. Norris criticized the court’s decision because, he maintained, the court ignored “the best interests of the patient”. He theorizes that “the reluctance to discontinue treatment often originates from the emotional reluctance to remove artificial nutrition and hydration from a conscious patient, even though the removal of nutrition and hydration need not cause pain nor suffering during the dying process if proper care is given (e.g., proper mouth care)”. He also worries that “sentencing patients to medical limbo has already helped to generate calls for euthanasia.”

Thomas Marzen, J.D. and Dan Avila, J.D., of the National Legal Center for the Medically Dependent and Disabled, wrote in the University of Detroit Mercy Law Review, “the wordless language of Mr. Martin — conveyed by gesture and affect rather than by noun and verb — attests just as eloquently to the indomitable will to live.”


Food and Water: Some Excerpts From Catholic Sources

1. “By euthanasia is understood an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated. Euthanasia’s terms of reference, therefore, are to be found in the intention of the will and in the methods used.” Declaration on Euthanasia. Prepared by the Sacred Congregation for the Doctrine of the Faith. May 5, 1980.

2. “Negative judgments about the ‘quality of life’ of unconscious or otherwise disabled patients have led some in our society to propose withholding nourishment precisely in order to end these patients’ lives. Society must take special care to protect against such discrimination. Laws dealing with medical treatment may have to take account of exceptional circumstances, when even means for providing nourishment may become too ineffective or burdensome to be obligatory. But such laws must establish clear safeguards against intentionally hastening the deaths of vulnerable patients by starvation or dehydration.” Statement on Uniform Right of the Terminally Ill Act. NCCB Committee for Pro-Life Activities. June, 1986.

3. “(I)t is our considered judgment that while legitimate Catholic moral debate continues, decisions about these (persistent vegetative state) patients should be guided by a presumption in favor of medically assisted nutrition and hydration… Such measures must not be withdrawn in order to cause death, but they may be withdrawn if they offer no reasonable hope of sustaining life or pose excessive risks or burdens”. “Nutrition and Hydration: Moral and Pastoral Reflections” U.S. bishops’ Pro-Life Committee. 1992.

4. “Some state Catholic conferences, individual bishops and the NCCB Committee on Pro-Life Activities have addressed the moral issues concerning medically assisted hydration and nutrition… These statements agree that hydration and nutrition are not morally obligatory either when they bring no comfort to a person who is imminently dying or when they cannot be assimilated by a person’s body. The NCCB Committee on Pro-life Activities report, in addition, points out the necessary distinctions between questions already resolved by the magisterium and those requiring further reflection, as, for example, the morality of withdrawing medically assisted hydration and nutrition from a person who is in the condition which is recognized by physicians as the ‘persistent vegetative state’… There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.” Ethical and Religious Directives for Catholic Health Care Services, U.S.Bishops meeting. 1994.

5. “The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him: their undue suspension could be real and properly so-called euthanasia.” Charter for Health Care Workers by the Pontifical Council for Assistance to Health Care Workers. Approved by the Congregation for the Doctrine of the Faith. Published 1995.

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.



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.


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.


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.


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!

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.

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