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 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.

2014 Voices: Brain Death and Catholic Teaching

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

Brain Death and Catholic Teaching

by Nancy Valko, RN ALNC

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

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

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


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

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

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

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

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

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

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


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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

4 Ibid

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

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

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

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

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


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

11 Ibid.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

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

2013 Voices: When children die, where is God?

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

When children die, where is God?

by Nancy Valko, RN

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

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

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


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

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

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

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

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


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

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

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

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

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

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


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

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

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

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

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

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

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

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


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

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

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

2012 Voices: Special Needs, Special Gifts

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

Special Needs, Special Gifts

by Nancy Valko, RN

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

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

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

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

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

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

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

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

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

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


I didn’t have a plan for this.

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

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

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

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

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

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

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

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

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

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


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

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

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

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

2011 Voices: The Trouble with “free” birth control

Voices Online Edition
Vol. XXVI, No. 3
Michaelmas 2011

The Trouble with “free” birth control

by Nancy Valko, RN

Entirely too often, we Catholics and other people of faith find ourselves on the defensive when it comes to controversial issues such as abortion, embryonic stem cell research, same-sex marriage, etc. We can forget that Catholicism is based on natural moral law and the innate sense of right and wrong written in every rational heart. It’s not surprising, then, when objective facts and consequences support what the Church teaches. The issue of “free” birth control is a case in point. Even without the strong moral, psychological and spiritual arguments against “free” birth control, the facts speak for themselves.

This past August, I was asked to participate in a radio debate with Paula Gianino, the local head of Planned Parenthood, on the topic of the new Obama administration mandate forcing health care insurance programs to provide “free” contraception to women starting next year as part of the Affordable Health Care for America Act.1 Although the topic was limited to drugs like the Pill in this debate, the new “preventative services” mandate would also cover such things as the potentially abortifacient “morning after” pills, surgical sterilization, “well woman” visits, domestic violence screening, sexually transmitted infection counseling, breast feeding support and supplies, and more.

The host was Charlie Brennan, a locally well-known critic of conservative values, but even he challenged Ms. Gianino when she stated that 99% of women had or were using artificial birth control and that most health insurance companies cover some of the cost. Why then, he asked, should taxpayers be paying the co-pays for these drugs since women were obviously already getting them? And wouldn’t health care insurance costs rise?

Ms. Gianino responded that although Planned Parenthood didn’t charge some poor women for their contraceptives, many other women coming to Planned Parenthood struggled with their copays, especially in this economy. Knowing that Planned Parenthood already receives more than $300 million annually in tax-funded support, I asked why Planned Parenthood didn’t have a foundation to cover the copays for these allegedly cash-strapped women like the pro-life movement that supports women in crisis pregnancies without charge.

I also pointed out that this mandate was an economic boon for Planned Parenthood, especially since so many states are trying to defund the organization because of its recent scandals and its involvement with abortion. In addition, this mandate for “free” birth control would further Planned Parenthood’s ultimate goal to remove any restrictions on abortion, taxpayer-funded or not. In many people’s eyes, the term “legal” means acceptable but “free” means good.

When Ms. Gianino repeated the old Planned Parenthood argument that contraceptives are truly preventative in reducing unplanned pregnancies and abortions, I quoted from the May 2011 report of the Guttmacher Institute (the former research arm of Planned Parenthood, which now claims it is independent — guttmacher.org/pubs/fb_induced_abortion.html) online that stated “Fifty-four percent of women who have abortions had used a contraceptive method (usually the condom or the pill) during the month they became pregnant” and that of the other 46% of women who had abortions while not using contraceptives, the cost of contraceptives was not even mentioned as a factor.2

Other points I was able to raise during the 30-minute debate and telephone call-in show included:

• Fertility is not a disease, and powerful hormones are not vitamins. It is sadly ironic that health-conscious women are choosing hormone-free food for themselves and their families but don’t think twice about ingesting potent hormones to “treat” their own fertility.

• There are serious health risks to women including life-threatening blood clots that, as a nurse, I have seen at least twice with teenagers.

• Why isn’t Natural Family Planning — which is drug-free, low-cost and enormously effective in both postponing and achieving pregnancy — included in this allegedly non-political mandate?

• How do you answer the man who questioned the fairness of “free” birth control by pointing out that his heart pills are truly preventative but not free?

• Forcing health insurance companies to cover “free” birth control demonstrates one of the biggest problems with the proposed Affordable Care Act: mandates developed by unaccountable, unelected bureaucrats without congressional oversight or public input.

• There are even serious environmental concerns about contraceptives passing into the water supply despite filtration techniques,3 and that affects all of us.


Most people are unaware of the multitude of risks and consequences — physical, psychological and spiritual — of artificial birth control. The media has to take a large share of the blame because it influences not only the general public but also government and research entities.

It has become obvious that the mainstream media is overwhelmingly liberal, especially on social issues. Therefore, for most mainstream journalists, the perceived need for artificial birth control is unquestioned and even defended as a right. Even when recalls or studies show serious problems with a birth control drug or device, the media reacts with reassurances about overall safety rather than concern. Contrast this with the constant headlines of alarm over preliminary studies of other drugs, supplements or even standard food products. The result is that most of the public is left in the dark when it comes to artificial birth control.

For example, have you ever read an article about the World Health Organization classification of the birth control pill as a class-I carcinogen (cancer-causing agent), the same category that includes cigarettes?4

Did you know that oral contraceptives have been specifically linked to breast cancer5 and can cause loss of bone density in young women?6 And how many doctors inform women that the Pill can cause depression7 and, most ironic of all, loss of libido (sexual interest)?8

The list of potential complications is lengthy.

Also ignored is the fact that the widespread use and promotion of the birth control pill and condoms still has not resulted in a spectacular decline of either abortions or unplanned pregnancies. However, this same widespread use and promotion of birth control has indeed led to the glorification of abortion, the corruption of sexual morality, and more single mothers.

Instead, we see the media tout the birth control pill as the greatest invention of the 20th century and the major source of empowerment for women. The Pill is hailed as safe for almost all women or girls and even beneficial for conditions like acne.

But the problem is not only with the media. When was the last time you heard a homily on artificial birth control? Will you hear a sermon now on how “free” birth control threatens conscience rights and religious freedom? Why do some conservative and even pro-life groups often avoid the topic of birth control?

And how many more times will we find ourselves standing by a coffin instead of a crib as fewer and fewer of our young people are having more than one child or any at all? When did we start counting babies as carbon footprints instead of blessings? What will it take for us to wake up to the dangers?

I must admit that I was one of the willingly uneducated for several years. The nagging of my conscience that I was not truly in union with the Catholic Church by using the Pill never went away despite the assurance of a priest that my husband and I had “good reasons” to use it.

It wasn’t until my third child, Karen, was born with problems that I was forced to re-evaluate my relationship with God and stop making excuses. I started by reading Humanae Vitae, Pope Paul VI’s beautiful encyclical on marriage, children and birth control. I joined a Natural Family Planning group at my parish. I researched Planned Parenthood and the history of birth control. In other words, I finally started truly thinking and questioning the conventional wisdom about artificial birth control.

I have been richly rewarded by this knowledge, and I hope you are or will be.

The culture of life encompasses many issues leading to one goal: respect for every human life. None of these issues can be ignored. Artificial contraception was crucial for the legalization of abortion. To reverse this, we must understand that we, our children, and our society deserve better than the sterilizations, drugs, and devices that produce and sustain this contraceptive mentality.

1 CBS St. Louis, KMOX radio. Charlie Brennan Show. August 2, 2011. Online at: stlouis.cbslocal.com/2011/08/02/charlie-brennan-tuesday-august-2nd/

2 “Facts on Induced Abortion in the United States”. Guttmacher Institute, May 2011. Online at: guttmacher.org/pubs/fb_induced_abortion.html

3 “Contracepting the environment – Birth-control poisoning of streams leave U.S. environmentalists mum” by Wayne Laugesen. National Catholic Register, July 11, 2007. Online at: catholic.org/national/ national_story.php?id=24681

4 “Learn about Cancer”. American Cancer Society. Online at: cancer. org/Cancer/CancerCauses/OtherCarcinogens/GeneralInformationaboutCarcinogens/known-and-probable-human-carcinogens

5 “The Pill and Breast Cancer Risk: Is Anyone Listening?” by Timothy P. Collins, MD. Ethics and Medics. The National Catholic Bioethics Center. Online: http://www.truegate.org/news/view_news.php?id=5029

6 “Study: Low-Dose Birth Control Pills Decrease Bone Density in Young Women” by Thaddeus Baklinsi. LifeSiteNews, January 21, 2010. Online at: lifesitenews.com/news/archive/ldn/2010/jan/10012103

7 “Birth Control Pill and Depression”. all-on-depression.com. Online at: all-on-depression-help.com/birth-control-pill-and-depression.html

8 Birth Control Pill May Permanently Reduce Sex Drive Study Finds”. LifeSiteNews.com, May 26, 2005. Online: https://www.lifesitenews.com/news/birth-control-pill-may-permanently-reduce-sex-drive-study-finds

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: Saving Catholic Health Care Ethics

Voices Online Edition
Vol. XXVI, No. 1
Eastertide 2011

Saving Catholic Health Care Ethics
by Nancy Valko, RN

More than a decade ago I was approached by a non-Catholic nurse I’ll call Melissa, who wanted to talk about an abortion that continued to haunt her. A young pregnant mother discovered she had breast cancer and was counseled to get an immediate abortion and then start chemotherapy and radiation. Melissa, a pro-life nurse herself, was reassured by the Catholic oncologist that this was a necessary and ethical abortion to save the mother’s life. The mother reluctantly agreed but Melissa said that the abortion itself seemed to take a terrible toll on the young mother. The young mom died of breast cancer not long after the abortion. Melissa felt that somehow the abortion was wrong despite the doctor’s reassurances. Knowing I was Catholic and involved in ethics, she wanted to know my opinion.

As a non-Catholic, Melissa did not fully understand the Catholic Church’s prohibition against direct abortion. As a nurse, she also did not know that studies were showing that not only did abortion show no benefit in the survival of these mothers, the survival rates were often better for the mothers who did not have an abortion.1 Now, even the National Cancer Institute says “Because ending the pregnancy is not likely to improve the mother’s chance of survival, it is not usually a treatment option.”2 Melissa’s instincts were right. So was the Catholic Church.

This tragic situation came back to me recently when I read about Bishop Thomas Olmsted of Phoenix and his actions following an abortion at one of his diocese’s Catholic hospitals.


In November 2009, Sister Margaret McBride and the ethics committee at St. Joseph’s Hospital and Medical Center in Phoenix gave doctors permission to perform an abortion. The mother involved had pulmonary hypertension in the 11th week of pregnancy and the hospital continues to insist that the abortion was necessary to save the mother’s life.3 Bishop Olmsted found out about the abortion. After months of discussion with the hospital and its parent company, Catholic HealthCare West, about not just this abortion but what the bishop determined to be a pattern of behavior that violated Catholic ethical directives for health care, Bishop Olmsted revoked the Catholic status of the hospital in December 2010.

The criticism of Bishop Olmsted was immediate and harsh. Sister Carol Keehan, head of the Catholic Health Association, issued a strong statement supporting the abortion and the hospital.4 Marquette University professor and theologian M. Therese Lysaught denied that the termination was even a direct abortion.5 The American Civil Liberties Union, citing the Phoenix abortion case, complained to federal health officials that “… no hospital — religious or otherwise — should be prohibited from saving women’s lives and from following federal law.”6

News media and pundits across the country criticized Bishop Olmsted’s decision. Unfortunately ignored was the US Conference of Catholic Bishops’ statement explaining the principles involved in the Phoenix abortion case.7 (See the complete statement on page 14 of this issue.)

While the criticism from secular sources is not unexpected, it is the criticism from Catholic sources that arguably causes the most damage and confusion for Catholics and non-Catholics alike. The real-world consequences of such criticism of religious freedom, traditional ethics and conscience rights are already happening.


That some Catholic ethicists, theologians or entities would defy a bishop on Catholic principles should come as no surprise to anyone familiar with some of the long battles waged in Catholic ethics circles. For decades, Catholic ethicists and theologians have taken opposing stands over such issues as early induction abortions on babies with anencephaly, contraception, sterilizations, tube feedings for the so-called vegetative, etc. Even pronouncements from the Vatican or the USCCB have not dissuaded some Catholic sources from insisting that they are right.

As Ann Hendershott wrote in The Wall Street Journal in December 2010, “Many theologians, like Prof. Nicholas Healy of St. John’s University in New York, write that theologians comprise ‘an alternative magisterium’ to the teaching authority of the bishops. And in cases like the one at St. Joseph’s, the alternative magisterium often trumps the true Magisterium of the Church. Catholic colleges and hospital administrators now ‘shop’ for theologians who will support their decisions.”8

Bishop Robert F. Vasa, who revoked the Catholic status of St. Charles Medical Center in the Diocese of Baker, Oregon, in February 2010 because of its insistence on performing sterilizations, has cautioned that “if a bishop trustingly accepts that Catholic hospitals in his jurisdiction are following the [ethical] directives in accord with his proper interpretation of those directives, he may be surprised to learn this may not be the case.”9

When I graduated from a Catholic nursing school in 1969, abortion was illegal and universally abhorred. There was no such thing as “emergency contraception”. Withholding or withdrawing tube feedings from people with severe brain injuries or dementia was unthinkable. Pulling ventilators from non-brain-dead patients in order to harvest their organs when their hearts stopped would have been considered an atrocity. Conscience rights for health care providers were intrinsic and considered a protection for patients, not debated or undermined. The list of current ethical problems goes on and on.

Now we have a society well along in the process of embracing all this and more as progress. Unfortunately, we also now have some influential Catholic theologians, ethicists and entities like the Catholic Health Association finding ways to support many of these so-called “progressive” changes in health care ethics.

I purposely chose a Catholic nursing education because I knew it was the best and, like most people, I totally trusted Catholic health care institutions. Now, however, I often get calls or e-mails from Catholic patients, relatives and even doctors and nurses who are confused and upset with the treatment and ethics they encountered in a Catholic hospital. Too often I even hear the refrain “But I though they were pro-life!”

I applaud bishops like Bishops Vasa and Olmsted in taking strong but unpopular actions to ensure authentic Catholic ethics in any health care institution calling itself Catholic. In an era where hospitals are competing for patients, Catholic hospitals can stand up and actually shine by offering both the best technology and the best principles. Trust is not only an indispensable component of good health care but also a potent marketing tool that can appeal to both Catholics and non-Catholics alike in this uncertain health care environment.

It is up to all of us, whether as health care providers or the public, to demand the very best in Catholic health care before it is too late.


1 “Abortion Typically Unnecessary When Cancer Strikes a Pregnant Mother” by Steven Ertelt. LifeNews. 12/09/07 online at: lifenews.com/2007/12/09/nat-3522/.

2 “Breast Cancer Treatment and Pregnancy”, National Cancer Institute, US National Institutes of Health: cancer.gov/cancertopics/pdq/treatment/breast-cancer-and-pregnancy/Patient/page3#Keypoint17.

3 St. Joseph’s Statement to Bishop Announcement. Online: stjosephs-phx.org/Who_We_Are/Press_Center/211990.

4 Catholic Health Association Statement Regarding St. Joseph’s Hospital and Medical Center in Phoenix. December 22, 2010. Online: chausa.org/newsdetail.aspx?id=2147488971.

5 “No direct abortion at Phoenix hospital, theologian says” by Jerry Filteau. National Catholic Reporter, December 23, 2010. Online: ncronline.org/news/no-direct-abortion-phoenix-hospital-theologian-says.

6 “Abortion fight at Catholic hospital pushes ACLU to seek federal help” by Rob Stein. Washington Post, December 22, 2010. Online: washingtonpost.com/wp-dyn/content/article/2010/12/22/AR2010122206219.html.

7 “The Distinction between Direct Abortion and Legitimate Medical Procedures”. United States Conference of Catholic Bishops Committee on Doctrine. June 23, 2010. Online: http://www.usccb.org/about/doctrine/publications/upload/direct-abortion-statement2010-06-23.pdf

8 “Catholic Hospitals vs. the Bishops” by Anne Hendershott. Wall Street Journal, December 31, 2010. Online: online.wsj.com/article/SB10001424052970203731004576046443911321586.html.

9 “Phoenix hospital’s break with bishop a troubling sign, health care experts say” Catholic Anchor, January 6, 2011. Online: http://issuu.com/the_anchor/docs/01.14.11

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.