Voices 2009: A Nurse’s View of Ethics and Health Care Legislation

A Nurse’s View of Ethics and Health Care Legislation -Michaelmas 2009

As a nurse for 40 years, I have long been very concerned about the direction our health system has been taking. Now, I am becoming truly frightened by the significant changes that government’s proposed health care reform would cause.

I’ve read much of HR 32001, the 1000+-page proposed health care reform bill currently being pushed by the Obama administration and I agree with the critics who worry about potential taxpayer-funded abortion, rationing of care and promotion of the “right to die”. Like them, I am also concerned about a massive governmental overhaul of our health care at an exorbitant financial as well as moral cost.

Much of the bill’s language is murky legalese that is hard to understand. Much of the language is vague enough to allow all sorts of interpretations — and consequences. Worse yet, efforts to insert limits on such issues as taxpayer-funded abortion-on- demand so far have been rebuffed — or concealed in various ways. Government officials who advocate the proposed health- care-reform legislation are furiously trying to allay the fears of the increasing number of citizens who oppose the bill — but we have only to look at the statements and philosophy of the people supporting this bill to recognize potential dangers. Here are some examples:

— Compassion and Choices (the newest name for the pro-euthanasia Hemlock Society) 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 (section 1233 of House Bill 3200).”2

— On abortion, President Barack Obama not only said “I remain committed to protecting a woman’s right to choose” on the January 22, 2009 anniversary of Roe v. Wade, but he also moved to rescind the recently strengthened federal conscience-rights protections for doctors and nurses who object to participating in abortion.

— On rationing: Dr. Ezekiel Emanuel, President Obama’s health care advisor, wrote in the January 2009 issue of the British medical journal Lancet about using a “complete lives system” to allocate “scarce medical interventions”. He wrote that “When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.”3 Dr. Emanuel wrote a 2005 article on the Terri Schiavo case, bemoaning the low percentage of people signing “living wills” and other advance directives and stated, “Cases such as these also introduce economic issues, as the costs of keeping people alive — especially in the ICU — are substantial.”4

End-of-Life Issues a Major Concern

Just recently, a judge in Montana, acting alone, declared assisted suicide legal, making Montana the third state with legalized assisted suicide.5 Last year, cancer patient Barbara Wagner received a letter from the state-run Oregon Health Plan that denied coverage for an expensive drug for her recurrent lung cancer, but agreed to cover drugs for assisted suicide as “palliative” or comfort care that would cost around $50.6 This past July, a New York nurse sued her hospital after she allegedly was pressured into participating in a late-term abortion.7

Around the country there are instances where judges refuse to allow the implementation of state laws mandating parental notification, women’s right to know information and abortion clinic safety regulations.

Unfortunately, those of us who try to be ethical health-care professionals cannot turn to the mainstream national organizations like the American Medical Association (AMA) and the American Nurses Association (ANA) for help. I’ve been particularly alarmed that the ANA, like Planned Parenthood, is so vocal in its support of the newly proposed health-care-reform legislation.

Like most nurses, I do not belong to the ANA. Though I was formerly a member of ANA, and tried to work for change, I withdrew my membership when the ANA opposed the ban on partial- birth abortion. Since then, the ANA has also opposed strengthened conscience clause protections8 and supported the “right to die” in the Terri Schiavo case.9

As a nurse, I believe that not participating in abortion is a moral and natural imperative, not a “choice”. And also as a nurse, I’ve seen the effects of the “right-to-die” movement on health-care providers and their education over the years. Personally, I have become sick of hearing that this or that patient “needs to die” when the patient or family chooses not to withdraw basic care or treatment. Unfortunately, there are a lot of medical people and prominent ethicists who don’t really believe in free choice when it comes to the “right to die” and who actually do think some patients are a drain on the health care system and society. Not surprisingly, many of them also support direct euthanasia.

President Obama said in an April interview, “The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.”10

The present context of the moral and ethical issues makes it particularly worrisome for the proposed health-care-reform legislation’s plan to mandate “end-of-life counseling”.

Mounting concern about what is really involved in the administration’s health care reform proposals has met with unexpected resistance. It’s been amazing to watch the throngs of people of all ages making their voices heard at town hall meetings. I’ve been especially impressed by the older citizens. It seems that seniors who may once have told their children that they didn’t want to ever be a burden have now awakened to the realization that soon government-appointed ethicists may decide when a person is “too burdensome” to be allowed to live.

Some of the criticism of HR 3200 now seems to be finding its mark. Dr. Emmanuel, who at first maintained that critics were taking quotes from his writings out of context, now says that his views have “evolved”, and that he no longer supports health care rationing.11 And Iowa Senator Chuck Grassley now says, regarding the upcoming Senate version of health care reform, “We dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly.”12

These are hopeful developments — much, much more is necessary. The architects of what is now often termed “Obamacare” are still determined to win passage of a comprehensive health- care bill, and pro-abortion groups demand unlimited abortion coverage. Politicians’ continued reassurances are most often mere repackaging of bad ideas. Influential ethicists who support abortion and the “right to die” can be expected to resist opposition as vigorously as ever.

Good Health-Care Reform

Of course, we must continue to be serious about making health care better, especially when it comes to the moral and ethical foundation of our health-care system. It can be done.

A few years ago, I was privileged to serve on a Catholic Medical Association task force on health-care reform. Many great ideas, such as health-savings accounts, ways to help the uninsured poor, and better conscience-rights protections, were developed and published in a 2004 report entitled “Health Care in America: A Catholic Proposal for Renewal”.13 Some of these ideas already have support in Congress.

In early August, the National Association of Pro-life Nurses (NAPN), of which I am a member, issued a statement of guiding principles necessary for any ethical health care reform (see sidebar).14

Many of our bishops have been addressing these crucial issues, as well. The US Conference of Catholic Bishops has a Health Care Reform web section to provide information, action alerts, statistics, statements and other resources (www.usccb.org/ healthcare/).

As I write this in August 2009, the future of HR 3200 and the government’s proposed reform of health care in general are still in dispute, as voting was delayed until after the August recess of the US Congress. The proposal may well be changed before a vote is taken. What is indisputable is that all citizens need to be informed and especially to be heard on this crucial issue that affects all of us.


Position Statement on Health Care Legislation of the National Association of Pro-life Nurses

Because proposed health-care legislation affects those of us in the nursing profession directly, the National Association of Pro-life Nurses issues the following guidelines to be included in any approved proposal.

• The bill must not include any mandate for abortion

• Abortion funding prohibitions must be included to reflect long-standing bans in place

• State laws regulating abortion must be upheld

• There must be protection of the conscience rights of health care workers, and

• Any plan adopted must include full prenatal and delivery care for all pregnancies.

In addition, we are opposed to mandating end-of-life consultation for anyone regardless of age or condition because of the message it sends that they are no longer of value to society. Such consults place pressure on the individual or guardian to opt for requests for measures to end their lives.

We believe those lives and ALL lives are valuable and to be respected and cared for to the best of our abilities. Care must be provided for any human being in need of care regardless of disability or level of function or dependence on others in accordance with the 1999 Supreme Court decision in the Olmstead v. L. C. Decision.

Adopted by the Board of Directors
August 3, 2009


On 25 Years of Women for Faith & Family

Twenty-five years ago, militant feminism seemed to be taking over our culture, and WFF started as a small beacon of light for Catholic women struggling to live their faith in an increasingly callous and dispiriting society. Today we are growing in numbers, stronger and better able to bring God’s message of hope and love to all through an organization of dedicated and devout women.

Congratulations to Women for Faith & Family for 25 great years! I am both proud and humbly inspired to be part of the WFF family!


Notes

1 H.R. 3200 – America’s Affordable Health Choices Act of 2009, available online at: www.opencongress.org/bill/111-h3200/text or www.govtrack.us/congress/bill.xpd?bill=h111-3200.

2 “Anti-Choice Extremists Mislead On End-Of-Life Conversation Provision in Health Care Reform”. Compassion and Choices. Monday, July 27, 2009. Online: compassionandchoices.org/blog/?p=445.

3 “Principles for allocation of scarce medical interventions” by Govind Persad BS, Alan Werthheimer PhD, Ezekiel J Emanuel MD, The Lancet, Volume 373, Issue 9661, Pages 423-431, January 31, 2009. Available online: www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60137-9/fulltext.

4 “The Prognosis for Changes in End-Of-Life Care after the Schiavo Case” by Lindsay A. Hampson and Ezekiel J. Emanuel. Health Affairs, 24, no. 4 (2005): 972-975. Online: content.healthaffairs.org/cgi/content/full/24/4/972.

5 “Montana judge rejects stay of physician-assisted suicide ruling” by Kevin B. O’Reilly. AMNews. January 29, 2009. Online: www.ama-assn.org/amednews/2009/01/26/prsd0129.htm.

6 “Death Drugs Cause Uproar in Oregon: Terminally Ill Denied Drugs for Life, But Can Opt for Suicide”, by Susan Donaldson James. ABC News. August 6, 2008. Online: abcnews.go.com/Health/story?id=5517492&page=1.

7 “Nurse ‘Forced’ to Help Abort — Faith Objector Sues Mt. Sinai” by Kathianne Boniello. New York Post. July 26, 2009. Available online: www.nypost.com/seven/07262009/news/regionalnews/nurse_forced_to_help_abort_181426.htm.

8 “Bush-Era Provider Conscience Act Rules Under Scrutiny” by Cathryn Domrose. August 3, 2009. Nurse.com. Available online: news.nurse.com/article/20090803/NATIONAL01/108030001/-1/frontpage

9 American Nurses Association Statement on the Terri Schiavo Case. American Nurses Association. March 23, 2005. Available online: nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2005/pr03238523.aspx.

10 “Obama Says Grandmother’s Hip Replacement Raises Cost Questions” by Hans Nichols. April 29, 2009. Bloomberg Press. Available online at: www.bloomberg.com/apps/news?pid=20601070&sid=aGrKbfWkzTqc.

11 “Palin target renounces care rationing” by Jon Ward. Washington Times. August 14, 2009. Online: www.washtimes.com/news/2009/aug/14/white-house-adviser-backs-off-rationing/print/.

12 “Grassley: End-of-life care concerns, other concerns in House health care legislation”. Press release by Senator Chuck Grassley of Iowa, August 13, 2009. Online: grassley.senate.gov/news/Article.cfm?customel_dataPageID_1502=22465.

13 “Health Care in America: A Catholic Proposal for Renewal”. Statement of the Catholic Medical Association. September 2004. Available online at: http://www.cathmed.org/assets/files/CMA%20Healthcare%20Task%20Force%20Statement%209.04%20Website.pdf

14 Position Statement of the National Association of Pro-life Nurses on Health Care Legislation. August 3, 2009. Available online at: www.nursesforlife.org/napnstatement.pdf.


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.

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1996: NO BLANK BULLETS

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.

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.

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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.

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

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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

2011 Voices: The Dark Heart of Euthanasia: Selling Death

Voices Online Edition
Vol. XXVI, No. 2
Pentecost 2011

Bioethics Watch

The Dark Heart of Euthanasia: Selling Death

by Nancy Valko, RN

“Eleanor” (not her real name) was larger than life even when she became ill with cancer in her 50s. Spirited and feisty with a wicked sense of humor, Eleanor regaled us doctors and nurses with her tales about her event-filled life. But as her cancer treatments failed to cure her, Eleanor’s mood darkened and she told us of her plans to commit suicide either with a doctor like Jack Kevorkian or by her own hand. She was insistent that she die before she became mentally diminished or physically dependent on others.

We worked with Eleanor by treatment and especially by addressing her fears and the ramifications of a suicide decision. We were elated when Eleanor changed not only her mind but also her attitude. Once she decided against suicide, she embraced life fully and with gusto. She eventually died comfortably and naturally.

However, when Eleanor initially changed her mind about suicide, her friends tracked me down on the oncology unit where I worked to complain that we doctors and nurses were unjustly “interfering with her right to die”. Instead of being happy or relieved for Eleanor, these friends were instead outraged that we took the usual measures we would take with anyone to prevent a suicide.

At first I thought this incident was an aberration but over the years since Eleanor, I’ve seen this disturbing enthusiasm for “choosing” death go mainstream, especially with the help of the media. What was initially sold to the public by the euthanasia movement as a “living will” to choose to forgo extraordinary means when death was inevitable (a choice that was already available ethically) has now evolved into a demand for medically assisted death. This has led to a change in attitudes not only among the public but also in law and medicine.

Exploiting the natural fear of suffering most people have has led to a growing acceptance of the premise that it is noble to choose death instead of becoming a burden on family members or a drain on society. But many — if not most — people are unaware that the “right to die” issue has gone far beyond just the stereotype of the terminally ill person in unbearable pain.

SUICIDE KITS AND BILLBOARDS

For example, a 91-year-old California woman started a business selling “suicide kits” by mail for $60 each. When a 29-year- old depressed but physically healthy Oregon man recently killed himself using this kit, the elderly woman defended herself by claiming that she was providing a valuable service while noting that her business is growing rapidly. Just as appalling was the response to this young man’s suicide from Faye Girsh, president of the pro-assisted-suicide Hemlock Society of San Diego, who said “If I were his mother, I’d be very upset, but I don’t think I’d be very upset because somebody provided a peaceful means to end his life.”1

This callous disregard of even actual or potential suicide victims and their families is unfortunately not isolated.

In another example, the Final Exit Network erected a billboard in San Francisco that simply says “My life, My death, My choice”, and gives the web site for the group. Final Exit Network said that the billboard was intended to “provoke discussion about the ‘right to die’” even as suicide-prevention experts pointed out that the billboard could lead other suicidal people to take their lives.2 Nevertheless, Final Exit Network has continued its billboard campaign for assisted suicide to places like Boston, stating that it believes that, like civil rights, the right to die will become the “ultimate right of the 21st century”.3

It should also be noted that members of the Final Exit Network have been present (their terminology) at approximately 130 deaths of people they claim were suffering from “intractable and irreversible disease”. Although it received scant media attention, eight of their members are now facing charges related to assisted suicide, including cases in Georgia and Arizona.

Outrage or apathy?

Now, following the template of abortion, the “right to die” is being mostly protected from bad publicity or even serious discussion beyond sound bites. There is a constant drumbeat of newspaper editorials, TV medical and crime dramas, award-winning movies like “You Don’t Know Jack” (about Dr. Kevorkian), etc., that are sympathetic to the “right to die” movement. Opposing arguments are routinely dismissed as cruel ignorance or extreme religious ideology. This has had a profound impact on society.

Polls are showing increasing support for assisted suicide.4 Two more states have joined Oregon in legalizing assisted suicide with similar laws being proposed in many other states. Relatives or friends who claim that out of compassion they helped a loved one die now often escape criminal charges or prison time even in states with laws against assisted suicide. Books like Imperfect Endings tout the acceptance of even a non-terminally ill relative’s decision to die as a wonderful act of love and respect.5 Oregon, the first state to legalize assisted suicide in the 1990s, now finds itself with a suicide rate 35% above the national average.6

Conscience rights for doctors, nurses and pharmacists are especially at risk because without medical participation, the euthanasia movement falls apart. Thus, euthanasia activists like Barbara Coombs Lee, one of the architects of Oregon’s assisted suicide law, claim that strong conscience-right protections encourage “workers to exercise their idiosyncratic convictions at the expense of patient care”.7 Do we really want only health care providers who are comfortable with ending life?

At its dark heart, the euthanasia movement is primarily about a selfish insistence on avoiding suffering no matter what the consequences to others or to society. It is accomplishing its goal by trying to intimidate everyone — health care professionals, grieving relatives, the unsuspecting public — into accepting their lethal agenda.

Will we respond with apathy or outrage?

Notes:

1 “Local senior’s ‘suicide kit’ business ignites controversy” by Richard Allyn. KFMB TV Channel 8, San Diego, California, March 26, 2011. Online at: cbs8.com/Global/story.asp?S=14326023

2 “Suicide-Prevention Experts Decry Ad” by Katherine Miezkowski. The Bay Citizen, June 22, 2010. Online at baycitizen.org/health/story/suicide-prevention-experts-decry/print/

3 “Billboard Advertises ‘Right To Die’”, TheBostonChannel.com. March 21, 2011. Online at: thebostonchannel.com/news/27269931/ detail.html

4 “Large Majorities Support Doctor Assisted Suicide for Terminally Ill Patients in Great Pain”, Harris Interactive, January 25, 2011. Online at: http://www.prnewswire.com/news-releases/large-majorities-support-doctor-assisted-suicide-for-terminally-ill-patients-in-great-pain-114540239.html

5 “A Mother’s Decision to Die” by Paula Span. New York Times. March 1, 2010. Online at: newoldage.blogs.nytimes.com/2010/03/01/a-mothers-decision-to-die/?pagemode=print

6 “Report: Oregon has higher suicide rate than national average”, Gazette Times, September 9, 2010. Online at: gazettetimes.com/news/local/article_dc63d760-bc6c-11df-9593-001cc4c002e0.html

7 “New HHS ‘Conscience’ Rule Jeopardizes End-of-Life Pain Care” by Barbara Coombs Lee. Huffington Post blog. Online at huffingtonpost.com/barbara-coombs-lee/new-hhs-conscience-rule-j_b_155934.html

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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.

2010 Voices: Suicide — Prevention or Assistance?

Voices Online Edition
Vol. XXV, No. 2
Pentecost 2010
Bioethics Watch
Suicide — Prevention or Assistance?

by Nancy Valko

Early this year people across the United States were shocked by the news that three Cornell University students committed suicide within the span of a few days. Many news stories searched for reasons for such sad and senseless deaths. What had gone wrong? Could these troubled students have been helped? How?

Coincidentally, at about the same time as the Cornell tragedies, news stories reported on the first anniversary of Washington State’s law legalizing physician-assisted suicide. The New York Times reported on March 4, 2010, that 36 people had died as a direct result of the new law.

Suicide is a death like no other. It complicates the grieving process for everyone involved and can even increase the risk of suicide for surviving family and friends. I know this both professionally as a nurse and personally as a mother. Last October, my much loved 30-year-old daughter, Marie, died by suicide using a “textbook Final Exit” technique, according to the medical examiner. However, Marie was not terminally ill or disabled but rather under treatment for substance abuse and mental health issues. Tragically, like so many young people, she was all too familiar with web sites supporting suicide and assisted suicide.

Suicide is a critical problem in our society and affects virtually every age group. More than 33,000 people die by suicide in the US every year, and authorities estimate that there are hundreds of thousands of suicide attempts annually. The National Institute of Mental health cites “exposure to the suicidal behavior of others, such as family members, peers or media figures” as a risk factor for suicide.

If trying to prevent such deaths seems obvious to most of us, there are people want to assist in making it happen. Assisted suicide was first presented to the public in Oregon in the 1990s as a last resort for unrelieved pain in the terminally ill. Since then, however, Oregon’s yearly reports show that the 40 to 60 assisted suicide deaths reported each year are overwhelmingly motivated by a perceived loss in quality of life rather than pain.

Despite a unanimous 1997 US Supreme Court decision finding no constitutional right to assisted suicide, supporters continue to campaign relentlessly to legalize assisted suicide in every state. Unfortunately, such efforts have found support not only in state courts but also in the popular culture.

Now we have three states — Oregon, Washington and Montana — with legalized assisted suicide, and relentless efforts by groups like Compassion and Choices (formerly known as the Hemlock Society) to pass assisted suicide laws in other states. Assisted suicide is defended by these groups as a rational and even altruistic decision when a person is suffering and feels he or she no longer wants to live. Unfortunately, this message is also filtering down to the people in our society who are most at risk for suicide, like my daughter.

As a nurse with 40 years experience, I know how to control pain and other symptoms in dying people and I will do anything for any of my patients — except kill them or help them kill themselves. I have also cared for suicidal people and I know the very real psychic and other pain that drives them to consider suicide. But I also know that suicide prevention and treatment does save lives.

Assisted suicide supporters may not want to admit it, but legalizing the participation of a medical professional or anyone else in suicide is not the admirable exercise of an alleged right but rather a dangerous demand for total control of death. Such control has terrible consequences not only for suicidal people and their families but also for the most basic medical ethics that protect all of us.

I would never have helped my daughter Marie kill herself under any circumstances. I would have continued fighting for her life. I wouldn’t have been holding her hand and supposedly respecting her decision to end her suffering as assisted suicide supporters suggest. That kind of so-called tolerance is really lethal despair and abandonment. “No” is a powerful and even lifesaving word. Marie, like everyone else, deserved a natural lifespan and the help to live it as well as possible until the end.

With so many suicide deaths and attempts yearly in the United States, we cannot recognize suicide as a tragedy to be prevented if possible while simultaneously glorifying assisted suicide as a courageous decision. Our most vulnerable people — young, old, dying, disabled, etc. — are listening and watching our response to the argument that some lives are not worth living.

One thing is very clear: we must not discriminate as to who is worth saving when it comes to suicide prevention and treatment. We must oppose all forms of suicide promotion including assisted suicide.

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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.

2009 Voices: War Against Conscience Rights

Voices Online Edition
Vol. XXIV, No. 2
Pentecost 2009

Women for Faith & Family
Celebrating 25 years of service to the Church
1984-2009

Bioethics Watch:
War Against Conscience Rights

by Nancy Valko, RN

First they came for the Communists but I was not a Communist so I did not speak out. Then they came for the Socialists and Trade Unionists but I was not one of them, so I did not speak out. Then they came for the Jews but I was not Jewish so I did not speak out. And when they came for me, there was no one left to speak for me.
— Pastor Martin Niemöller
Lutheran theologian and pastor who opposed the Nazis

In December 2008, the Bush administration announced stronger protections for health care providers’ conscience rights, protecting them from workplace discrimination. In February 2009, the Obama administration quietly started the process of overturning those conscience protections.1

These actions did not occur in a vacuum.

The stage was set several years ago, when a concerted effort was started by abortion supporters to force pharmacists to supply Plan B (the “morning after pill”) without a prescription — despite some pharmacists’ moral objections to this drug, which can cause an abortion shortly after conception (according to the manufacturers’ own description of Plan B’s actions).

Just like the initial roundup of communists in Pastor Niemöller’s quote, there were few public objections — except, of course, from the pro-life community. Some states have gone even further in coercing consciences by advocating laws that would force Catholic hospitals to supply Plan B to rape victims, even though the hospitals object.

But the agenda was always larger than just the pharmacists and Plan B.

This was made clear when the Bush administration announced strengthening conscience-rights protections for medical professionals. The reaction from abortion supporters and the mainstream media was immediate: For example, a December 24, 2008 editorial in the St. Louis Post-Dispatch baldly stated, “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.”2 (emphasis added) But if the conscience-rights line cannot be drawn at the easily understandable, scientific fact of abortion, what happens when the discussion turns to euthanasia and the whole area of end-of-life care?

Barbara Coombs Lee, one of the euthanasia supporters behind Oregon’s law legalizing assisted suicide, exposed the radical agenda behind the war on conscience rights when she wrote in January 2009 “Now comes a federal rule encouraging workers to exercise their idiosyncratic convictions at the expense of patient care. Employees who, for example, might exalt suffering, or disapprove of discontinuing feeding tubes or respiratory support have license under this rule to refuse to deliver or support any treatment or procedure.”3 Apparently Lee also believes that health-care providers who refuse to participate in life-ending decisions because of their moral convictions should choose another profession.

And the proposed destruction of conscience rights for health-care providers is not a peculiarly American issue. For example, in a January speech to a group in Ireland, UK ethicist Baroness Mary Warnock called doctors who refuse to cooperate in assisted suicide “genuinely wicked”.4

But by eliminating conscience rights for health-care providers who adhere to traditional medical ethics, we will effectively eliminate future as well as present ethical health-care providers from the health-care system. Right now, massive health-care changes are looming. And with a health-care system solely populated with doctors and nurses who are comfortable with ending life at any age, will medical ethics devolve even further into mere issues of legality and economics rather than principles and respect for human lives?

Thus, Pastor Niemöller’s wisdom about the consequences of silence comes to its logical end with this campaign to end conscience rights: First they came for the pharmacists, then the nurses, then the doctors. And in the end, without this thin white line of ethical caregivers who refuse to deliberately end lives, there is nothing standing in the way of a conscienceless healthcare system terminating any of us at any age and with any unfortunate condition.

Neither patients nor health-care professionals can expect mercy in a culture of death unless we all speak up.
Notes:
1 “Health Workers’ ‘Conscience’ Rule Set to Be Voided” by Rob Stein. Washington Post, February 28, 2009. Available online at www.washingtonpost.com/wp-dyn/content/article/2009/02/27/AR2009022701104_pf.html.

2 “An Unconscionable Conscience Rule” St. Louis Post-Dispatch editorial, December 24, 2008. Available online at: www.stltoday.com/blogzone/the-platform/published-editorials/2008/12/an-unconscionable-conscience-rule/.

3 “New HHS ‘Conscience’ Rule Jeopardizes End-of-Life Pain Care” by Barbara Coombs Lee. Huffington Post blog. Available online at www.huffingtonpost.com/barbara-coombs-lee/new-hhs-conscience-rule-j_b_155934.html.

4 “Doctors Who Refuse Assisted Suicide ‘Genuinely Wicked’ says UK Bioethics ‘Philosopher Queen’” by Hilary White. Lifesite News, January 7, 2009. Available online at http://www.freerepublic.com/tag/baronesswarnock/index?tab=articles
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.