Death and the Organ Donor -Eastertide 2009

Death and the Organ Donor

by Nancy Valko, RN

In the early 1970s, I was a young nurse working with many trauma victims in a state-of-the-art intensive care unit and I loved it. Because of the high number of young accident victims, I was also often involved with organ donation from patients diagnosed as brain-dead. Asking shocked and grieving relatives about organ donation was the hardest part of my work.

Back then, “brain death” was a new legal and ethical concept stemming from an influential 1968 Harvard medical school committee paper titled “A Definition of Irreversible Coma”, which concluded that severely brain-injured patients who met certain criteria could be pronounced dead before the heart stops beating. Starting in the early 1970s, various state legislatures and courts acted to turn this “medical consensus” into a legally recognized standard for determining death by loss of all brain function. Patients declared “brain-dead” then could have their organs harvested while their hearts were still beating and a ventilator kept their lungs going. The brain death concept virtually created the modern transplant system because waiting to take organs until breathing and heartbeat naturally stopped usually resulted in unusable, damaged vital organs.

Like most people, I didn’t know the history of brain death back then and despite the tragic circumstances of my “brain- dead” patients, I was excited by the opportunity to participate in turning tragedy into the “gift of life”.

Over time, however, I developed some nagging concerns about the brain-death concept and I shared them with our intensive care doctors. I was told, as one doctor put it, “Nancy, greater minds than yours have already figured this all out so don’t worry about it.” It took me years to realize that this meant these doctors didn’t know the answers either.

Death and Choice
Unknown to most people, controversy about brain death has simmered for years in the bioethics community. Some well-known physicians, for example, Alan Shewmon and Paul Byrne, argue that the current brain-death standard does not reflect true death. Others, such as Dr. Ron Cranford and ethicist Robert Veatch, argue that the brain-death standard should be stretched to include so-called “persistent vegetative” patients, further expanding the pool of potential organ donors.

Last August the bioethics world was rocked by an article by Drs. Robert Truog and Franklin G. Miller in the prestigious New England Journal of Medicine that made the shocking assertion that many organ donors were not really dead at the time their vital organs were harvested.1 This Harvard doctor and this National Institutes of Health bioethicist then proposed the radical idea that doctors should drop the rule requiring that people be declared dead before vital organs are taken in favor of merely “obtaining valid informed consent for organ donation from patients or surrogates before the withdrawal of life-sustaining treatment in situations of devastating and irreversible neurologic injury”. This, in Truog’s and Miller’s opinion, would preserve the current transplant system and still be acceptable to the public because “issues related to respect for valid consent and the degree of neurologic injury may be more important to the public than concerns about whether the patient is already dead at the time organs are removed.”

Perhaps as a result of articles like this, the President’s Council on Bioethics decided to explore the determination-of- death issues involved in organ transplantation. In January 2009, the Council published “Controversies in the Determination of Death: A White Paper”.2 Many of the report’s consensus conclusions were surprising and controversial themselves.

The President’s Council on Bioethics White Paper
The President’s Council on Bioethics white paper on the determinations of death made several startling admissions, including finding that some of the most fundamental rationales for brain death were wrong. The Council, citing scientific studies and observations, admitted that the brain is apparently not the central organizing agent without which the body cannot function for more than a short period of time. Years ago, many of us questioned why some supposedly brain-dead pregnant women could be maintained on ventilators — for even up to a couple of months in some cases — in order to help their unborn children develop and survive birth. Others observed that some supposedly brain- dead children could actually grow and even sexually mature if maintained on life support. It turns out that we were right to question this allegedly settled matter.

The Council also had to admit the little-known fact that brain-death tests vary widely from institution to institution, potentially leading to people who could be declared brain-dead at one hospital but at a different hospital still be considered alive. Personally, I was disappointed that the Council’s paper did not even mention instances like the recent Zach Dunlap case, in which every supposedly definitive brain-death test was done, but a last-minute response by Zach stopped the impending organ donation and Zach even recovered.3

But in the consensus opinion of the Council members, apparently the concept of brain death is just too big to fail. Accordingly, some members of the Council proposed that the term “brain death” be replaced with the term “total brain failure”. And with the new term, these members created a new justification for harvesting the organs of people declared to have this condition. According to this redefinition, the brain is important not because it controls physiological processes, but because these processes represent “engagement with the world”.

This “engagement with the world” takes three forms: openness to the world, an ability to act on the world, and the need to do so. These abstract requirements can be met by something as basic as breathing but they are not met by physiological activities that continue in people who have allegedly lost all neurological function. This, the Council members insisted, is enough to spare breathing, brain-injured people like Terri Schiavo from a diagnosis of “total brain failure”. Ironically though, this assertion does not protect people like Terri from having vital organs removed during the time when they are initially placed on a ventilator because doctors can then use another, newer determination of death called “donation after cardiac death” or DCD (formerly known as “non-heartbeating organ donation” or NHBD).4 The Council’s white paper also addresses this type of death determination and, in the process, makes more startling admissions.

DCD/NHBD was developed in the early 1990s to promote a newer standard of determining death for the purpose of organ donation. DCD/NHBD describes a procedure in which a person is declared hopelessly brain-injured or ill but not brain-dead and, with the consent of the patient or surrogates (or potentially even a “living will”-style document), has his or her ventilator removed with the expectation that breathing and heartbeat will stop within about 1 hour. When the heartbeat and breathing stop for usually about 2 to 5 minutes, the person is declared dead and the organs are taken for transplant. If the person’s heartbeat and breathing do not stop within the allotted time, the transplant is called off and the person is left to die without further treatment.

The Council’s white paper admitted that the legal definition of irreversible cessation of heartbeat and breathing used to justify DCD/NHBD has problems. Most people would consider “irreversible” in this context to mean that the heart has lost the ability to beat. But in DCD/NHBD, “irreversible” instead means that there is a deliberate decision not to try to restart the heart when it stops and that enough time has elapsed to ensure that the heart will not resume beating on its own. However the Council had to admit the dearth of scientific evidence supporting this determination. In some cases involving babies, for instance, the heart is harvested and actually restarted in another baby.

The Council also admitted that even fully conscious but spinal-cord-injured patients have become DCD/NHBD donors when dependent on a ventilator. This sad fact is the result of virtually all withdrawal-of-treatment decisions now being considered legal and thus ethical.

The Council also noted that even though doctors are advised to take their time determining death when a natural death occurs, the interval between declaring death and starting transplantation in a DCD/NHBD patient has been as short as 75 seconds. It seems obvious that the push for a speedy declaration of death is not about new scientific information determining the moment of death but rather a desire to quickly get organs because “[t]he longer a patient removed from ventilation ‘lingers’ before expiring, the more likely are the organs destined for transplantation to be damaged by warm ischemia [lack of adequate blood flow]”.5 But even while expressing concerns, the Council still supported the DCD/NHBD concept in the end.

Despite pages discussing these DCD/NHBD issues, the Council unfortunately ignored a most crucial issue: How do doctors determine who is a “hopeless enough” patient with functioning vital organs and who will also die fast enough to get usable organs? The Council never mentioned articles like the one in the September/October 2008 issue of the Journal of Intensive Care Medicine, which stated “Donation failure [patients who don’t die fast enough to have usable organs] has been reported in at least 20% of patients enrolled in DCD”. Those authors also concluded that “There is little evidence to support that the DCD practice complies with the dead donor rule”.6

We Are All Affected
While organ donation is a worthy goal when conducted ethically, it is very dangerous when physicians and ethicists redefine terms and devise new rationales without the knowledge or input of others, especially the public. This has been happening far too often and far too long in many areas of medical ethics and the consequences are often lethal.

Opinions about medical ethics affect all of us and our loved ones. And good medical ethics decisions are the foundation of a trustworthy medical system. We are constantly exhorted to sign organ-donor cards and join state organ registries but are we getting enough accurate information to give our truly informed consent? This question is too important to just leave to the self-described experts.


Notes

1 “The Dead Donor Rule and Organ Transplantation”, R. D. Truog and F. G. Miller. New England Journal of Medicine, August 14, 2008.

2 Controversies in the Determination of Death: A White Paper by the President’s Council on Bioethics, The President’s Council on Bioethics. Washington, DC: January 2009. Available online at: www.bioethics.gov/reports/death/index.html.

3 “Was Zach Dunlap’s Recovery a Miracle?”, Nancy Valko, RN. Voices Vol. XXIII, No. 2, Pentecost 2008. Available online at www.wf-f.org/08-2-Valko.html.

4 “Non-heart beating organ donation and the vegetative state”, George Isajiw, MD and Nancy Valko, RN. March 2004. Available online at www.wf-f.org/NHBD-VatMar2004.html

5 Controversies in the Determination of Death: A White Paper by the President’s Council on Bioethics, page 82.

6 “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. September/October 2008, available online at http://jic.sagepub.com/cgi/reprint/23/5/303.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.


Enforcing the “Right to Die” The Case of Terri Schiavo

Voices Online Edition
Vol. XVIII: No. 3 – Michaelmas 2003

Enforcing the “Right to Die”
The Case of Terri Schiavo

by Nancy Valko, RN

By the time this article is published, Terri Schiavo may be dead.

Terri is not a convicted murderer. She is not terminally ill. Instead, she is a 39-year-old severely brain-injured woman whose parents and siblings, the Schindler family, have been waging a long legal battle to prevent Terri’s husband and the legal system from ending her life.1

In July, 2003, Terri was granted perhaps her last “stay of execution” by a Florida appeals court before her case is returned to Judge George Greer, a Florida judge who has previously and repeatedly ordered Terri’s tube feedings stopped. Although this will give the family’s lawyers some time to file an appeal with the Florida Supreme Court, hope is slim because that court has declined to even hear Terri’s case in the past.

The final hope to save Terri Schiavo’s life may lay with Florida Governor Jeb Bush, who has recently received thousands of petitions for him to intervene to save Terri’s life.2

 

Who is Terri Schiavo and Why Do Some People Believe She Should Die?
In 1990, 26-year-old Terri Schiavo mysteriously collapsed at home and suffered brain damage as a result of oxygen deprivation. A medical malpractice suit ensued and a trust fund was established to pay for Terri’s lifetime care. After the case was resolved, Terri’s husband, Michael, claimed that he now remembered statements his wife had made in the past about not want-ing to be kept alive in such a condition. (A former girlfriend has since disputed that claim because of statements Michael Schiavo made to her.) He petitioned a court for permission to stop her tube feedings and claimed that Terri was in a so-called “vegetative state”, despite videotape evidence of Terri, showing her smiling, responding to her mother and even apparently trying to talk.

Florida law allows food and water to be withheld if a person meets the state’s definition of “vegetative state” as “the absence of voluntary action or cognitive behavior of any kind” and “an inability to communicate or interact purposefully with the environment”. Experts for the husband claim that Terri’s visible responses are mere “reflexes” and disagree with other medical experts who have testified that Terri has at least some basic awareness and could possibly be helped with therapy.

Terri’s parents and siblings volunteered to take responsibility for Terri’s care, but Michael Schiavo has refused to relinquish guardianship or divorce Terri, despite living with and fathering a child by a girlfriend. He has also refused to allow rehabilitation services and, despite the fact that Terri is not terminally ill, had her transferred to a hospice facility three years ago.

Nevertheless, Judge Greer and the Florida courts have so far dismissed all concerns about the circumstances surrounding this case and maintain that the only issues are Terri’s disabled condition and her alleged desire to die. As a Florida probate court said in June, “we understand why a parent who had raised and nurtured a child from conception would hold out hope that some level of cognitive function remained. If Mrs. Schiavo were our own daughter, we could not but hold to such a faith. But in the end, this case is not about the aspirations that loving parents have for their children. It is about Theresa Schiavo’s right to make her own decision, independent of her parents and independent of her husband”.3

While the Schindler family endures such portrayals of themselves as being in denial over Terri’s condition — and incurs enormous legal bills fighting to save her — the courts have allowed Michael Schiavo to use the funds for Terri’s care to pay legal bills. George Felos, Mr. Schiavo’s lawyer who has been involved in several other “right to die” cases, has reportedly received more than $600,000 so far from the fund. His main medical expert was Dr. Ronald Cranford, who has testified in many “right to die” cases and who does not support even spoon-feeding for the so-called “vegetative” and people he terms “minimally conscious”.

Although Terri Schiavo’s case has received only a smattering of national media coverage, disability, pro-life, and other groups throughout the country have expressed outrage and alarm over this precedent-setting case. Terri’s case is being seen as the final dismantling of any legal safeguards to protect the mentally disabled from the deliberate starvation and dehydration that would be unthinkable for a convicted murderer or even an animal. 


The Catholic Connection
As Catholics, Terri’s parents Bob and Mary Schindler requested the help of their local bishop, Bishop Robert Lynch of the Diocese of St. Petersburg, Florida, to help save their daughter’s life.4 Instead, Bishop Lynch issued a statement that “The Catholic Church would prefer to see all parties take the safer path but it must and will refrain from characterizing the actions of anyone in this tragic moment”.5

This statement was particularly discouraging since Father Gerard Murphy, a pastor and former hospital chaplain, had already testified for Terri’s husband that withdrawing Terri’s tube feedings “would be consistent with the teaching of the Catholic church”.6

Unfortunately, there is a long history of Catholic priests and ethicists who have given similar testimony in other public “right to die” cases without rebuttal by the local bishop, despite Church documents and a 1998 statement by Pope John Paul II emphasizing that “the omission of nutrition and hydration intended to cause a patient’s death must be rejected”.7 Instead, these priests and ethicists uniformly mischaracterize people like Terri Schiavo as “gravely ill” and simple feeding tubes as “prolonging death”.

Unfortunately, these ethicists have often held prominent positions in Catholic health care and education for years. It has now become harder and harder to find a Catholic health facility that does more than provide mere lip service to principle on this crucial issue. It is telling that when Archbishop Justin Rigali of St. Louis issued a statement quoting Church teaching during the Steven Becker “right to die” case in 2000, many Catholic priests and ethicists from around the country criticized him for taking such an uninformed and “extreme” position in defense of life.8

Therefore, it is welcome news that Catholic groups are now challenging such misrepresentations in the Terri Schiavo case. Women for Faith & Family president Helen Hitchcock sent a letter to Florida Governor Jeb Bush asking him to “review Terri Schiavo’s case and to intercede on her behalf”, noting that Women for Faith & Family has filed amicus briefs in the similar Cruzan and Busalacchi cases.9 A Catholic media coalition sent a public letter to all the Florida bishops calling for them “to publicly condemn the injustice and moral evil of this deliberate act of euthanasia and to issue a plea for mercy to the Florida courts and to Governor Jeb Bush”.10 The Catholic Medical Association issued a statement that “discontinuing nutrition and hydration in this circumstance violates in its intention the distinction between ‘causing death’ and ‘allowing death'” and quotes the 1989 pastoral statement of the Bishops of Florida that states “We can never justify the withdrawal of sustenance on the basis of the quality of life of the patient”.11

The National Catholic Partnership on Disability, which includes Cardinal Francis George on its board, has highlighted the differences between Terry Wallis, a man who recently regained full consciousness after 19 years when his family refused to give up, and Terri Schiavo, whose husband is seeking to end her life. In their press release, Mary Jane Owen, executive director of the partnership, states, “those of us who live with assorted disabilities are aware that when any of us is deprived of their essential dignity and worth, each of us face that same discounting by the judgments of the culture of death”.12


A Precedent-Setting Case
The importance of saving Terri cannot be overestimated, not only for her right to live but also to apply a brake to the current “right to die” movement that seems bent on terminating people with severe brain injuries or conditions. It is no accident that people like Terri are put into hospices and cases like hers are included in “end of life” education programs for health care professionals and the public. It is no coincidence that withdrawal of treatment decisions have become the justification for the new non-heartbeating organ donation policies.13 And it is the ultimate irony that even families and patients who choose to live can now be overruled by medical futility policies being instituted at hospitals throughout the country.

Terri’s family has put up a courageous fight to save their daughter’s life and, if they finally lose, a terrible precedent will be set for coercing other families to give up fighting for their loved ones. If evidence of Terri’s responsiveness, as well as questions of possible perjury and bias, continue to be ignored by the courts, no one with a disability is ultimately safe from medical or legal discrimination.

Bob Schindler, Terri’s father, poignantly observes, “We pay great lip service in this country to disability rights, but as the degree of a person’s disability increases, the level of legal protection that person receives decreases”.

Notes
1 Schindler family’s website, www.terrisfight.org.
2 Petition to Issue a Stay in Florida Court Proceedings Regarding Theresa Schindler-Schiavo, available online at: www.terrisfight.org/Framesets/CNewsFrame.htm.
3 “Court Says Woman Has Right To Die” by Hugo Kugiya, Newsday, June 3, 2003.
4 “US Supreme Court Rules Woman Can Be Starved to Death over Parents’ Objections”, LifeSite News, 4/26/01. Available online at: www.lifesite.net/ldn/2001/apr/01042602.html.
5 “Husband Seeks to End Life of Brain-Damaged Wife” by Eve Tushnet, National Catholic Register, May 20-26, 2001.
6 Trial testimony of Father Gerard Murphy, January 24, 2000.
7 “Pope Tells American Bishops: Fight Death”, October 2, 1998. Includes full text of ad limina address delivered by Pope John Paul II in Rome to the bishops of California, Nevada, and Hawaii. Available online at www.petersnet.net/browse/553.htm.
8 See “Steven Becker and the Fight for the Soul of Catholic Health Care”, Nancy Valko, Voices Advent 2000. Available online at: www.wf-f.org/valkoadvent.html.
9 WFF’s July 21 Letter to Governor Jeb Bush concerning Terri Schiavo case. Available online at: www.wf-f.org/Bush-Schiavo.html. See text below.
10 “Catholic Media Group Calls on Florida Bishops To Defend Terri”, press release, July 23, 2003. Available online at: www.missionsun.org/faithwatch.htm.
11 Statement of the Catholic Medical Association on the case of Mrs. Terry Schiavo, by Robert J. Saxer, M.D, President of Catholic Medical Association and Steven White, M.D., President of Florida Catholic Medical Association.
12 “National Catholic Partnership on Disability Highlights Differences Between Two Neurologically Disabled Individuals”, press release July 10, 2003. Available online under Recent Headlines at: www.terrisfight.org.
13 See “Ethical Implications of Non-Heart-Beating Organ Donation”, Nancy Valko, Voices Michaelmas 2002. Available online at: www.wf-f.org/02-3-OrganDonation.html.


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

The Issue is Equality (1993)

The following is an op-ed published in the St. Louis Post-Dispatch newspaper Friday, March 19, 1993 and reprinted on LifeIssues.net on 12/01/2001

By Nancy Valko, RN
Reproduced with Permission

It happened more than 10 years ago. I was pregnant with my third child and the controversy over Baby Doe was still swirling.

Baby Doe was a newborn boy who was born with Down Syndrome and a defect in his esophagus that needed surgical correction before he could drink from a bottle. Although this operation was routine for newborns with this problem, Baby Doe’s parents refused it, and a court upheld their decision. Several parents came forward offering to adopt Baby Doe and even pay for the operation. They were rebuffed, and Baby Doe died six days later without being fed.

I was shocked. Why didn’t the court or the law protect Baby Doe from such obvious discrimination? How could the parents’ lawyer maintain that it was a “loving decision”? Did that mean that parents who make sure their disabled children receive life–saving treatment are unloving?

Four months later I gained a new understanding of the gravity of those questions when my daughter, Karen, was born with Down Syndrome and an even more serious condition than Baby Doe’s: a life–threatening heart defect. I was stunned when Karen’s doctor said that there was an operation available with an 80 to 90 percent success rate, but that he would support my husband and me “100 percent” even if we chose not to operate.

I was furious. As a nurse, I knew that such an operation would have been presented as a technological blessing, not an option, if my baby were not mentally retarded. I told the doctor that I resented such discrimination, that my daughter had rights of her own, and that if he was prejudiced against children with Down Syndrome, he could not touch her.

To the doctor’s credit, he recognized his well–intentioned mistake and promised that he would do his absolute best for my daughter. And he did.

But it frightened me that there was such a biased attitude among even good, caring doctors. Could I really trust any of those health–care providers on whom my child and I depended? I came to realize that Baby Doe’s parents “private” decision had an enormous impact on public policy and attitudes, leaving my baby at risk if I did not protect her.

Even though both Baby Doe and my Karen died several years ago (one by parental decree, one despite the best medical care), I found them often on my mind as I followed the Christine Busalacchi controversy. She, like Baby Doe and Karen, had mental disabilities, although at different points on the disability spectrum. Christine’s father, like Baby Doe’s parents, felt his child had no quality of life and went to court to prevent feeding. Mr. Busalacchi also “won” the right not by changing the law but by political and judicial acquiescence.

But the same question raised in the Baby Doe case must be raised again: Should parents have absolute power over their children’s lives or do the state and society have an obligation to ensure that everyone, disabled or able–bodied, has a right to necessary care and treatment?

We have forgotten that, before the Baby Doe case, the answer used to be obvious.

Why do we view harm to children and the elderly as an issue that the state and society must address regardless of family involvement, while maintaining that no one may even question whether a father has a right to act on his opinion that his mentally disabled daughter would be better off dead? Are mentally disabled people any less vulnerable?

The Busalacchi controversy was not about making a medical decision: Christine was neither dying nor too sick to receive food. In fact, in 1991, she was able to take most of her food by mouth before her father insisted that only the feeding tube be used.

The controversy was not about the severity of disability: There are many people who cannot smile, eat, or laugh like Christine could (even as a so–called “reflex”) who are currently receiving care and treatment. And despite the offensive and medically untestable label of “vegetative,” a recent study showed that most of the families studied were unwilling to withdraw food and water.

No, the issue is really about equality. No one should be denied care or treatment required for others just because he or she has a mental disability.

But for now, the Missouri Supreme Court and the state administration have refused to act on cases such as Busalacchi’s, allowing family choice to be the overriding issue. And, as I personally found out, it is not hard to find doctors or others who would be willing to concur with the family in death decisions.

It is families like mine who have tried to give their mentally disabled loved ones the best quality of life possible who must now watch sadly as the planned death of Christine Busalacchi is portrayed as a victory for family rights.

The disability rights movement has had great success in ensuring access to parking spots, public buildings and education for the disabled. It’s a tragedy when the disabled cannot be ensured access to something as simple as food and water.

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.