2014: Should a Pro-Life Person Become a Nurse?

This article was written for Voices magazine in 2014.

Recently I received an email from a nurse friend asking if I could reply to a letter from a student nurse. Unfortunately, this student nurse’s concerns are common, and I’ve often wondered how many wonderful pro-life people have been intimidated from pursing a medical career because of such concerns and so many media outlets’ bias against the pro-life movement.

Because of the urgency, at first I replied to this student with suggestions about specialties that had few if any ethical conflicts, such as same-day surgery clinics and pro-life doctors’ offices.
But then I realized that this reply missed the real issue: Is it worth it to become a pro-life nurse? So I sent this student my revised reply.

Letter and Reply

The following is this anonymous student nurse’s letter and my reply:

I am a nursing student with big questions. I am 100% pro-life — anti-abortion in ALL cases, anti-birth control, anti-euthanasia, anti-sex change, and the like. Is there any hope for me in the culture of death nursing field? I’ve emailed a few right-to-life folks.  They tell me that there is a desperate need for pro-life nurses. I would agree, but, from the anti-life demeanor of some bloggers, becoming a nurse seems akin to being thrown to the lions. So, my question: what area of nursing can I move into that does not demand that I do things that I absolutely will not do?

Some nurses say that a nurse must take care of all patients and their every medical need and that a nurse could become “dis-barred” if they dare refuse to care for someone. I don’t want to sacrifice any more of my family’s time by finishing this degree if I end up getting fired everywhere I go or having to hire a lawyer to defend my pro-life, God-given conscience! I have a family to support financially. I am very, very concerned. I have to pay for this fall’s classes by the end of the month or else I’m out of the program.

Do you have any advice for me? Am I being too over the top about the whole thing? I don’t know what the “real” nursing world is like.

My reply:

I’ve been a pro-life nurse for 45 years working in hospice, intensive care, general medicine/surgery, oncology, dialysis, and home health, along with some other jobs both paid and volunteer. I never wanted to be anything but a nurse.

I’ve just retired this month from hospital nursing but not from nursing itself. I’ve taken courses to become a legal nurse consultant mostly to become a more effective pro-life advocate.

I have never regretted becoming a nurse.

When I started in the 1960s, all medical professionals were on the same page except for oral contraceptive pills, which were just being developed. Back then, the focus was entirely on helping patients. I went to my first job interview not even knowing what I would be paid or what benefits were available. I just wanted to help relieve suffering.
When I started as a registered nurse in 1969, the camaraderie was amazing. We were all so dedicated and willing to do anything to help. We were inspired by TV medical shows like Medical Center, Marcus Welby, MD, and others that portrayed medicine as a vocation and even ministry. And we lived it.

When the American Academy of Obstetricians and Gynecologists (now the American Congress of Obstetricians and Gynecologists) in 1965 quietly changed the definition of the beginning of life from fertilization to implantation in the uterus, things began to change rapidly. This was done to allow contraception to become not only legal but also promoted as a beneficial development.

By 1973 when Roe v. Wade made abortion legal, I was a 23- year-old intensive care unit nurse and the decision was a shock to all of us. A few doctors and nurses thought it might be okay since we all thought abortions were only done in very early pregnancies. Besides, the abortion promoters told us that women would go for help more readily instead of to “back alley” abortionists. We were told that with such help, more women would have the support to have their babies.

However, abortion was soon promoted as a positive good and a women’s right issue. The traditional ethic that was the bedrock of our medical professions — of never harming or causing the death of our patients — was undermined.

But I was unaware of all this (the facts about abortion and contraception) when I left nursing temporarily in 1976 to raise my children. However, I was still a nurse and the volunteer opportunities were a way that I could still be involved. This was one of the happiest times of my life and I knew I was still a nurse.

However, in 1982 I learned firsthand how awful things had become when my baby Karen was born with Down syndrome and a critical heart defect. At the same time there was a national case involving a baby with Down syndrome who had an easily treated problem with his esophagus but the parents — on the advice of their OB/GYN — refused the routine surgery because they said their son would be better off dead. The baby died of starvation and dehydration about two weeks later. I was very upset and wondered what had happened to medical ethics during the time I was away from hospital nursing.

When my Karen was born, I came face to face with what is rightly called the culture of death when I was offered — even encouraged by some — to refuse surgery for my daughter and just let her die. As I told her cardiologist, “When exactly do her constitutional rights kick in? She’s not even a ‘fetus,’ for God’s sake!”

The cardiologist immediately backtracked and said he would do everything to save my daughter’s life. I knew he was a good man but I could never completely trust him again. What frightened me the most was that he and so many of the doctors and nurses involved with Karen had been seduced into a “better dead than disabled” mentality. I finally realized how much medical and nursing education had changed and a lot of that was due to the deterioration of ethics starting with contraception. Young doctors and nurses were no longer being taught sanctity of life but rather quality of life.

My daughter Karen finally made me a committed pro-life advocate.

Eventually I saw even utilitarian economics become a growing part of medical ethics. That’s why we have such issues as in vitro fertilization, assisted suicide/euthanasia, and organ donation problems.

I went back into hospital nursing in 1989 when I suddenly became a single mom and the sole support of three children. However, things had changed radically. Nurses were being laid off and I found that my volunteer pro-life work was frowned upon by many.

However, I didn’t give up, and instead of talking about pro-life topics, I set my sights on being the best nurse possible. It worked.

As time went on I got on ethics committees where I could make a difference by talking about cases from a traditional ethics/natural law perspective, which is really the basis of pro-life health care. My fellow nurses eventually decided I was a good nurse even if I didn’t agree that abortion should be legal. I was even able to help a fellow nurse who was considering abortion get more information and she eventually had a healthy baby — and her first girl.

I was also able to advocate for my chronically ill, terminally ill, elderly, and disabled patients. Sometimes it worked, sometimes it didn’t, but I knew that at least I tried and I saw some minds and hearts changed in the process.

Only once was I threatened with firing in a situation where I could not “opt out” but I knew my rights. This is where groups like California Nurses for Ethical Standards (ethicalnurses.org)  and the National Association of Pro Life Nurses (nursesforlife. org, where I am a spokesperson) can help. In that case, not only was I not fired but my stand helped a whole floor of other nurses say no — in unison — to a doctor who ordered something unethical.

So my point is not that is easy to be a pro-life nurse. My point is that it is a privilege and a mission to be a pro-life nurse!

I ended my reply by giving this student my email address and home phone number.

Conclusion

The culture of death is big and intimidating but I believe that the vast majority of doctors and nurses do want to give the best care to their patients. Sadly, between groups promoting death issues like abortion and euthanasia with the help of a sympathetic and biased media and the deteriorating ethical standards taught in many medical and nursing schools, many doctors and nurses are unaware that there is a better philosophy of health care. Too many think that legal automatically means ethical. We need to help educate them, not just with words but with truly excellent and patient-safe health care.

The situation will continue to be difficult because culture of death supporters know that if enough doctors and nurses refuse to participate in their agenda, their movement is dead. Long ago, I resolved never to become angry or criticize people for their views but I also resolved to be steadfast on the front lines of the battle between killing and caring. Although the episode of my attempted firing could have ended differently and I actually did not expect the positive outcome, I was willing to lose my job rather than participate in a deliberate death decision.

Conscience rights are crucial, especially in today’s world. We need strong conscience rights on all life issues enshrined in law and in practice to protect ethical health care providers and their patients.

In the end and despite the occasional difficulties, I can attest personally that it has all been worth it and that I am truly blessed to be a pro-life nurse.

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.


National Catholic Register 1996: Anencephaly Newest Frontier in Prenatal-Testing, Abortion Battle

Anencephaly Newest Frontier in Prenatal-Testing, Abortion Battle

Sunday, Nov 10, 1996 2:00 PM Comment

EVERY YEAR in the United States, approximately 800 babies are born with a birth defect known as anencephaly. It is a condition where, early in pregnancy, an error in development occurs which prevents the top portion of the brain and skull from forming correctly. Such babies have only a brain stem in place of the entire brain and lack part of the skull. Despite the severity of the defect, about half of such babies are born alive. However, almost all die shortly after birth, with only a rare few living months or years.

In years past, anencephaly was not detected until birth. However, with the advent of routine ultrasound and a newer blood test for the mother called AFP screening, the condition can often be detected during pregnancy.

Although abortion for unborn babies with terminal illness or disabilities has long been condemned by the Catholic Church, in the past few years some ethicists have developed a rationale by which pregnancies involving babies with anencephaly could be terminated by inducing labor as soon as the diagnosis is made.

Such terminations are called “early inductions of labor”rather than abortions by proponents, as anencephaly is usually not discovered until midway through the pregnancy. As justification, these ethicists have cited the possibility of difficulties during labor and delivery, the emotional trauma of the parents, and the apparent absence of mental development in babies who have the fatal condition. Reports of such terminations occurring at Catholic hospitals have prompted anger in the pro-life movement and calls for reexamination of the issue by other ethicists and doctors.

In an ironic twist, at the same time these ethicists were proposing ending anencephalic pregnancies prematurely, the Council for Ethical and Judicial Affairs of the American Medical Association (AMA) proposed the continuation of such pregnancies at the parents’ discretion so that the babies’ organs could be harvested shortly after birth and before death. Earlier this year, the council reluctantly withdrew its proposal after strong opposition from AMA members, legal experts, pro-lifers, and parents of infants with anencephaly. These critics argued that taking organs before death should remain legally and ethically forbidden.

Moral Principles

In a definitive statement issued Sept. 16, 1996 and titled “Moral Principles Concerning Infants with Anencephaly,”the National Conference of Catholic Bishops (NCCB) Committee on Doctrine condemns both practices. The NCCB statement reaffirms the Church’s position that “it can never be morally justified directly to cause the death of an innocent person no matter the age or condition of that person.”

Specifically, the Committee on Doctrine states: “The fact that the life of a child suffering from anencephaly will probably be brief cannot excuse direct causing death before ‘viability'(the ability of a baby to live outside the womb) or gravely endangering the child’s life after ‘viability’ as a result of the complications of prematurity.”

As the statement points out, while it is permitted to treat a life-threatening pathology of the mother even when this has the unintended side-effect of causing the death of her child, “[a]nencehpaly is not a pathology of the mother, but of the child, and terminating her pregnancy cannot be a treatment of a pathology she does not have.”

Because the child has an ultimately fatal condition, the statement says that babies with anencephaly “should be given the comfort and palliative care appropriate to all the dying” but that “extraordinary means to prolong life”can be foregone.

The statement also recognizes that while a wish to help other children by donating organs from babies with anencephaly is commendable, “this may never be permitted before the donor child is certainly dead.”

In the August 1996 issue of the Linacre Quarterly, Father Kevin O’Rourke, director of the Center for Health Care Ethics at St. Louis University, reversed his previously held opinion that premature delivery for unborn babies with anencephaly was justified. He now states that “because intervention in the pregnancy of an anencephalic infant results in a direct killing of an innocent human being, the only suitable, ethical opinion seems to be to allow the pregnancy to go to term, …”thus concurring with the NCCB Committee on Doctrine’s conclusions.

Prenatal Testing and Anencephaly

With the advent of prenatal testing, particularly AFP or “triple screen”testing of the mother’s blood, more and more parents are faced with the possibility of learning before birth that their baby has anencephaly or other birth defects. In 1994, the American College of Obstetricians and Gynecologists officially recommended that a “triple screen”test of the mother’s blood be offered to pregnant patients of all ages.

This implies a legal mandate to practicing physicians who cannot afford the liability of not offering such a test after a national recommendation has been made. This has resulted in “triple screen”testing becoming a common routine during pregnancy.

The “triple screen”test is done around 16-18 weeks into pregnancy when levels of certain substances produced by the baby can be detected in the mother’s blood. An abnormally high result suggests such conditions as anencephaly or spina bifida (an opening in the spine). An abnormally low result primarily suggests Down’s syndrome.

However, the rate of false-positive results is quite high and the vast majority of women with abnormal test results will be carrying perfectly healthy babies. Further testing is supposed to be recommended when an abnormal result is obtained, but there have been reports of mothers being offered the option of abortion after only the initial test.

Routine “triple screen”testing remains controversial. The anxiety engendered in pregnant women by abnormal but usually false-positive test results, the financial cost of testing all pregnant women as well as the costs of retests, and the implicit support for aborting so-called “defective” infants have spawned criticism of this policy. Supporters of the policy point to the potential cost savings of abortion over the costs of caring for infants with severe birth defects and the parents’ right to know all information currently available as justifying the policy.

As the 1987 Congregation for the Doctrine of the Faith’s document Donum Vitae makes clear, the Church’s position is that prenatal testing which does not pose disproportionate risks to the unborn child or mother is permitted if the intention is not to abort but rather to safeguard or heal the child.

Nancy Valko, R.N., is based in St. Louis, Mo.

2009 Mercatornet: Have death panels already arrived?

Have death panels already arrived?

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

Nancy Valko | Nov 12 2009 | comment

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

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

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

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

Ethics and health care reform

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

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

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

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

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

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

Common sense and ethics

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2006 Voices: The “Secret of Life”

Voices Online Edition Vol. XXI No. 4
Christmas 2006 – Epiphany 2007

The “Secret of Life”

by Nancy Valko, RN

The first thing I noticed about my elderly patient was her radiant smile. Most of my patients are groggy or anxious after even a routine surgery but this tiny lady was fully awake and entirely comfortable even after her major surgery.

As the night went on, Esther* (*all names of former patients have been changed for privacy) continued to do well, even better than most of my younger patients with the same surgery.

I was impressed but it was the story she had to tell that made her truly unforgettable.

When she was a young woman, Esther was delighted to find out that she and her husband were finally expecting a child. The pregnancy progressed uneventfully until delivery. It was only then that it was discovered that her baby was growing outside her womb. Not many babies survive in those circumstances even today, but Esther’s baby was born a healthy little boy. Even though Esther lost her reproductive organs in the process, she felt blessed by her one “miracle child”, Ethan.

The little boy grew, both in size and character and he was a great comfort to her when she lost her husband.

Then the war came. Esther was terrified when Ethan volunteered for the army. She talked to his recruiter and emphasized that Ethan was all she had. The recruiter promised her that Ethan would be stationed far away from the active fighting.

Unfortunately, death still found Ethan. He died in an apartment fire while saving a baby. Esther’s grief was mixed with pride in her son.

I asked Esther how she coped after suffering such a devastating loss and shared how I too had lost a precious child. She turned the question back on me. I blurted out that I both prayed a lot and laughed a lot, I said. “Exactly!” Esther exclaimed. “That’s the secret of life!”

I’ve thought a lot about Esther since then and how these two “secrets of life” work in my own life but I’ve come to the conclusion that there is a third “secret” that is just as important as the other two.

PRAY A LOT

The importance of prayer cannot be overestimated but I know from experience how hard prayer can be at times.

Personally, my transition from being a stay-at-home mom to a working mom as a result of divorce was frequently overwhelming. In the middle of this, my mother developed Alzheimer’s and, soon after, terminal cancer. Going through a painful divorce, dealing with a lack of consistent childcare, working at multiple jobs, and dealing with chronic exhaustion often left me too drained to formally pray. I tried to offer up all these problems and I did ask friends to pray when I just couldn’t. This did help a bit but it was my friend Marcia who had the best suggestion: pray the rosary daily. At first, I couldn’t imagine adding dozens of prayers at a time when I had trouble even getting through one prayer but I decided to try Marcia’s suggestion anyway.

Initially, I dozed off by the first Joyful Mystery but I rationalized that at least the rosary was proving to be a good sleeping pill.

Slowly but surely, I found ways to incorporate the rosary into my life while driving, walking or doing housework. Soon I began feeling calmer, more hopeful and, best of all, closer to my role model Mary. The repetition of the Hail Mary became a kind of soothing and calming mantra.

In the end, the storm of disasters ended but I still try to say the rosary daily. I now actually feel deprived if I miss saying the rosary, even for one day. And I now realize how truly blessed I’ve been, even during the toughest times.

LAUGH A LOT


After my daughter Karen died, I started working with other bereaved parents who had lost a child with a disability.

Lana was one of those parents. She had lost a little boy with Down Syndrome by sudden death and she was devastated. We talked almost daily but, despite keeping her job and family together, she felt she wasn’t handling her loss well enough.

Lana was surprised when I asked her if she had laughed since her son’s death. Almost apologetically, she revealed that she had laughed at a TV show just the night before.

Laughter, I told her, was the first sign of healing. Eventually Lana came to understand that she didn’t have to hold on to the pain to hold on to the memories of her beloved child. She finally reached the stage where her son’s life instead of his death became her most important memory and she was finally able to allow herself to laugh and enjoy her life.

Over the years, I have come to appreciate the power of even the smallest moments of humor we can find in the middle of tough times. Such humor renews our spirit and perspective.

For example, the first Christmas after my ex-husband left had the potential to be very sad. However, one day during Advent, a group of people from our parish came with a Christmas tree and gifts for all of us. I was touched and a little embarrassed but I noticed that my 10-year-old son was watching with horror on his little face. He knew that our parish did this for the inner city families every year and he whispered, “Mom, are we poor?” I smiled, put my arms around him and said, “Steve, we are very rich in love.”

“Oh, no!” he exclaimed. “That means we’re really poor!”

That comment made all of us crack up with laughter and, more importantly, lifted the pall that had settled over our little family. We had a really good Christmas that year and my son’s comment became a running family joke.

THE THIRD SECRET: FORGIVE


The last “secret of life” is by far the hardest but it is indispensable for a happy life.

“I’ll never forgive him! He ruined my life.” One of my children found it especially hard to live a different kind of life after her father left. She understood that her father had an especially severe mental illness but that fact wasn’t very comforting to her. She was still hurting from her father’s absence.

I encouraged her to pray for her father but she found that impossible unless, as the Bible says, it is like “heaping hot coals” on an enemy’s head. I told her that, as I learned the slow way, forgiveness is a decision — not a feeling. The feeling of forgiveness may come later but at least in the beginning, it is the decision to forgive that is critical.

Even if someone doesn’t mean to hurt us, words and actions can still cause excruciating pain. It is the power of the forgiveness decision that is able to give us at least some relief from the pain and keep us from spreading bitterness.

Forgiveness becomes harder but even more important when the person we have to forgive is ourself.

I learned this firsthand when I was a new nurse caring for a teenage drunk driver. After more than a few beers, Sam swerved into a car containing a young couple and their two children. The wife was dead instantly but our ICU received all the other victims. We were heartbroken when we couldn’t save the children and their father was hanging on by just a thread.

So it was hard not to be outraged when Sam, the 17-year-old drunk driver, was demanding and even abusive to the staff while we treated his more minor injuries. He was going to recover but the young father probably wouldn’t.

Sam was assigned to me and, sure enough, he continued his appalling behavior. I set limits on his nastiness but I still tried to care for him with as much compassion as I could muster. Surprisingly, near the end of my shift, Sam broke down and sobbed, “Why don’t you hate me? I hate myself!”

It turned out that Sam wanted to be punished and his actions were designed to push people away. We talked for a long time about how his self-destruction from guilt would only add more tragedy to an already tragic situation.

Sam had to learn to forgive himself to be able to turn his life around and allow some good to result.

Bad things do happen to good people. Sometimes the bad things happen as a result of sin or avoidable mistakes and sometimes the bad things happen despite all precautions and good intentions.

The important thing to remember is that God is always on our side and that it is not so much what happens to us but rather how we deal with our experiences that can make the difference between being a survivor who thrives or just being a victim.

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.

**Women for Faith & Family operates solely on your generous donations!

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

PERMISSION GUIDELINES

2003 Voices: Are Pro-Life Healthcare Providers Becoming an Endangered Species?

Voices Online Edition
Medicine and Morality
Vol. XVIII: No. 2 – Pentecost 2003
VOCATIONS ISSUE

Are Pro-Life Healthcare Providers Becoming an Endangered Species?
by Nancy Valko, RN

At the urging of Planned Parenthood, the Nevada state Assembly approved an amendment in April to stop pharmacists with religious objections from refusing to fill prescriptions for any drug, including abortifacient contraceptives and the so-called “morning after” pill.1 New York City hospitals now require abortion training for all their OB/GYN resident doctors unless they invoke a narrowly written conscience clause.2,3 The Oregon Nursing Association has issued guidelines for assisted suicide that prohibit nurses from making “unwarranted, judgmental comments or actions” to patients, families or other colleagues when patients decide to kill themselves with doctor-prescribed lethal overdoses.4

Slowly but surely, more and more pro-life doctors, nurses and other healthcare professionals are getting the message that they and their views are unwelcome in today’s health care system. But these public items tell only a small part of the story. Intimidation, harassment and coercion are becoming increasingly common as pro-life health care providers try to advocate for both their patients and their professional ethics.

For example, a nurse was threatened with firing after she refused to follow a doctor’s verbal order to increase an intravenous morphine drip “until he stops breathing” on a patient who continued to survive despite having a ventilator removed. An OB/GYN physician was told by other doctors that they would no longer refer patients to him if he continued to sign an annual pro-life ad. Three California nurses were suspended after they reported a doctor who later admitted giving a lethal injection to a child. An insurance company executive speaking on ethics committees at a conference recommended that such committees avoid appointing “family values” members.

Unfortunately, these reprehensible acts are not confined to just secular health care institutions.

A dedicated nurse who cared for elderly nuns in a Catholic facility for over a decade was told she could resign when she objected to the slow starvation and dehydration deaths of two of her beloved nuns. Several doctors and nurses working at Catholic hospitals have personally told me about similar incidents, including other supposedly prohibited actions such as sterilizations, referrals to Planned Parenthood and even some abortions. Amazingly, hospital administrators often told them that these procedures were ethically allowed according to some prominent Catholic ethicists.

Years ago when I was the co-chair of the St. Louis Archdiocesan Pro-Life Committee, I was asked by the late Archbishop May why I didn’t work as a nurse at a Catholic institution. He was shocked when I told him that I felt safer at a secular institution that at least understood the implications of conscience rights rather than at a Catholic institution, which could try to talk me out of them.

I wasn’t kidding.

THE SLIPPERY SLOPE
Before the invention of the Pill and the legalization of abortion, medical ethics principles were relatively simple, unambiguous and, with few exceptions, followed by doctors and nurses. The Hippocratic oath prohibiting abortion and euthanasia was a mainstay of medical education.

However, the beginnings of a drastic change started with the furor over the invention of the Pill and accelerated when the American College of Obstetricians and Gynecologists (ACOG) allowed the redefinition of conception from fertilization to the later implantation of the embryo into a woman’s uterus, thus blurring the distinction between contraception and abortion by ignoring scientific fact.5

The American Medical Association (AMA) softened its long-standing opposition to abortion as state laws on abortion were being relaxed in the 1960s and 1970s. After the 1973 Roe v. Wade decision, the AMA declared abortion to be an ethical healthcare procedure and now opposes almost any restrictions on abortion practice.

With legality rather than principle becoming a deciding factor in medical ethics, the standard of the Hippocratic oath had to be revised and now it is rarely used at all. Both the prohibition of abortion and euthanasia in the oath as well as the sacred commitment of the doctor to the individual patient were seen as obstacles to a more “enlightened” and modern healthcare system. Healthcare is now seen by many as an important part of societal reform to a more “inclusive” and less “judgmental” culture.

Thus, it is not surprising that pro-life health care providers are now portrayed as divisive to their professions and even a threat to patients’ rights when they refuse to conform to the Culture of Death.

When the infamous Roe v. Wade decision on abortion was handed down, it was assumed that healthcare providers would not be forced to participate in abortion. However, the reality of legalizing abortion soon led many states to pass conscience rights legislation on abortion to protect doctors and nurses who object. Unfortunately, this still has not adequately protected doctors and nurses from intimidation, harassment or from obstacles to career advancement because they do not provide what is now called “full service” on “reproductive rights”.

Many pro-life healthcare providers thought they would be safe if they chose a specialty other than OB/GYN or labor and delivery. But with the court decisions and laws legalizing the withdrawal of basic medical treatment, the acceptance of terminal sedation as comfort care, the legalization of assisted suicide in Oregon and the push for such laws in other states, etc., there is now almost no area of medicine where a pro-life healthcare provider can avoid ethical dilemmas.

And instead of unity, the medical professions have now become virtual war zones with many ethical doctors and nurses reluctant to even express their views or reveal that they are pro-life. Unfortunately, the healthcare professions, which rely on universal standards to protect both their members and the public, cannot long be trusted when their members can have diametrically opposed views on life and death. Coexistence of such disparate views ultimately becomes impossible because, as the Bible says, a man cannot serve two masters and must eventually choose one over the other. Thus, conscience rights help but they are not enough.

CONCLUSION
Pro-life healthcare providers are becoming a thin, white-coat line trying to protect both their patients and the public from an ever-expanding Culture of Death. And without such people of principle, there is no possibility of maintaining a pro-life movement.

With the current “politically correct” view that people should not judge the actions of others and the rise of moral relativism in all areas of personal ethics, far too many people are being intimidated into silence or despair. But we must remember that we are called to be persistent and that the ultimate success is God’s.

And there are already glimmers of hope. For example, the efforts of disability, pro-life and other organizations have so far helped to defeat efforts to legalize Oregon-style assisted suicide in other states. The courage of Jill Stanek, the nurse who exposed the scandal of neglecting newborn abortion survivors to death in her hospital and was finally fired, has led to President Bush signing the Born-Alive Infant Protection Act this year. The incident of the nurse who refused to increase a morphine drip to euthanize a patient opened many eyes among her colleagues and recently an entire division of nurses refused to follow a doctor’s order to use morphine to terminally sedate a patient-and the doctor backed down.

The reform of medical ethics has to come from both inside the medical profession and from the public. It is only when the highest standards are insisted upon that the ongoing corruption of the healthcare professions can be stopped and trust restored.

But first we must all accept the fact that evil never limits itself and always seeks to expand. Now is the time to make truly ethical healthcare the norm and stop the Culture of Death. Otherwise, we all can become an endangered species.

NOTES:
1 Ed Vogel, “Assembly Voice Vote: Pharmacists told to heed doctors’ Rx”. Las Vegas Review-Journal, April 4, 2003. Available online at: http://www.reviewjournal.com/lvrj_home/2003/Apr-04-Fri-2003/news/21036565.html
2 “New York City Begins Abortion Training for All OB/GYN Residents Starting Next Month; Supporters Want Program Duplicated Nationwide”, Kaiser Daily Reproductive Report. June 11, 2002, Available online at:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=11634 – broken link
3 Michelle Malkin, “Forcing doctors to kill”. Townhall.Com, June 7, 2002. Available online at: http://www.townhall.com/columnists/michellemalkin/mm20020607.shtml broken link 6/27/2005
4 “ONA Provides Guidance on Nurses’ Dilemma”. The Oregon Nurses Association Position Paper on the Death with Dignity Act. Available online at: http://www.oregonrn.org/services-whitepapers-0001.php broken link 6/27/2005

5 Eugene F. Diamond, M.D., “Word wars”. Physician (a Focus on the Family publication), November/December 1992. Available online at: http://www.lifeadvocate.com/mar_97/wars.html – broken link

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.

**Women for Faith & Family operates solely on your generous donations!

WFF is a registered 501(c)(3) non-profit organization. Donations are tax deductible.
Voices copyright © 1999-Present Women for Faith & Family. All rights reserved