When Palliative Care Goes Horribly Wrong

As I have written before, I was almost fired for refusing to increase a morphine drip “until he stops breathing” on a patient who continued to breathe after his ventilator was removed. The doctors mistakenly presumed he had a massive stroke and thus was irreparably brain-damaged. I was told at that time that giving and increasing the morphine even though the patient showed no discomfort was merely “comfort care” that would “prevent pain.” I knew it was euthanasia.

I remembered this terrible incident when I read the April 1, 2019 Federalist magazine article “This Belgian Nurse Watched Euthanasia Turn Pain Management Into A Death Prescription”

Belgium has had legalized euthanasia for many years, including organ donation euthanasia and now even minors and psychiatric patients. But Sophie Druenne, a palliative care nurse, reached her breaking point when she had to call a doctor back to give another lethal injection when the patient didn’t die from the first injection. Sophie caught herself laughing at the absurdity of the situation at first but then realized the horror of the situation and began to question Belgium’s so-called social experiment with euthanasia.

What changed Sophie’s opinion was working in Belgium’s integrated palliative care (IPC) system. Palliative care is “medical aid that treats symptoms of a typically serious disease rather than the disease itself, which sometimes cannot be treated or not easily.” However Belgium’s euthanasia framework now includes integrated palliative care in the framework.

As the article states, palliative care used to be defined by the anti-euthanasia beliefs of its founder, Dame Cicely Saunders, a British nurse who developed holistic care for the dying in the 1940s. Dame Saunders believed that “that a patient’s request for euthanasia represented a failure to adequately care for the patient’s spiritual, emotional, and social needs.”

Although Belgium tried to reconcile Dame Cicely Saunders’ standard with its euthanasia laws, Sophie observed that the guiding intention to relieve suffering changed from “first, do no harm” to “first, relieve suffering.” This allowed euthanasia to become an “easy” solution that could effectively nullify even patient consent.

Sophie finally left Belgium to take a position in Paris at a hospital where terminally ill patients are treated with traditional palliative care

THE SITUATION IN THE US

Recently I was giving a talk on assisted suicide/euthanasia when I noticed that a woman in the audience was visibly upset. After I finished, I went over to her to ask if I said something that upset her. She responded that she was a nurse for 30 years and, when I related the story about the morphine overdose I refused to give, she said that she suddenly realized the truth of what was happening in her hospital. She started to cry while I held her hand. She was devastated just like the Belgian nurse.

Palliative care is a wonderful holistic approach to evaluating the patient’s needs beyond just the physical but it must not include causing death.

Unfortunately, a recent Delaware assisted suicide bill actually tried to define assisted suicide as a palliative care option.

Currently, hospice/palliative care is held up as a good way to combat assisted suicide. However, Compassion and Choices touts that “(a) growing number of national and state medical organizations have endorsed or adopted a neutral position regarding medical aid in dying (physician-assisted suicide) as an end-of-life option for mentally capable, terminally ill adults.”

Barbara Coombs Lee, CEO of Compassion and Choices even issued a 2017 “Call to the Palliative Care Community for a Patient-Centered Response to Medical Aid in Dying (aka physician-assisted suicide)” stating that assisted suicide actually “could improve the image and acceptance of palliative care” by taking a position of “engaged neutrality” that “indicates that it is a professional organization’s obligation to provide its members with the clinical guidelines, information, and tools they need if they choose to support their patients’ requests” for assisted suicide.” (Emphasis added)

Not surprisingly, Compassion and Choices had supported the 2016 “The Palliative Care and Hospice Education and Training Act” (reintroduced this year as H.R. 647) that would provide millions of dollars in grants or contracts to “increase the number of permanent faculty in palliative care at accredited allopathic and osteopathic medical schools, nursing schools, social work schools, and other programs, including physician assistant education programs, to promote education and research in palliative care and hospice, and to support the development of faculty careers in academic palliative medicine.” (Emphasis added)

Fortunately, a provision was added to forbid federal assistance to any health care item or service causing or assisting death such as assisted suicide. Since then, the Compassion and Choices website has been silent on the Act.

CONCLUSION

Over the years, the public has been told that assisted suicide is a humane answer to emotional and physical suffering at the end of life. But if doctors, nurses and their professional organizations come to agree with this, we all will lose the protection of truly ethical healthcare that rejects causing death as a solution. We must be able to trust that our healthcare system will give us the care we need and deserve, especially at the end of our lives.

We cannot become like Belgium.

This article was originally published at NancyValko.com.

The New Federal Conscience and Religious Freedom Division

As a nurse threatened with termination for refusing to participate in an unethical health care decision years ago, I have a special interest in conscience rights for health care professionals.

Over the past several decades, new threats to conscience rights have widened from refusing to participate in abortions to other deliberate death decisions like withdrawal of feedings from people with serious brain injuries, VSED (voluntary stopping of eating and drinking), terminal sedation and physician-assisted suicide.

Thus, I am pleased that the Trump administration recently announced the new Conscience and Religious Freedom Division in the department of Health and Human Services’ Office for Civil Rights (OCR) to enforce “federal laws that protect conscience and the free exercise of religion and prohibit coercion and discrimination in health and human services”. The division specifically mentions “issues such as abortion and assisted suicide (among others) in HHS-funded or conducted programs and activities” and includes a link to file a conscience or religious freedom complaint “if you feel a health care provider or government agency coerced or discriminated against you (or someone else) unlawfully”.

Predictably, both Compassion and Choices and Planned Parenthood immediately condemned the new department.

In a recent fundraising email, Compassion and Choices states that:

“This office (OCR) is not about freedom; it’s about denying patient autonomy. Under their proposed rules, providers are encouraged to impose their own religious beliefs on their patients and withhold vital information about treatment options from their patients — up to, and including, the option of medical aid in dying. And your federal tax dollars will be used to protect physicians who make the unconscionable decision to willfully withhold crucial information regarding their care from a patient and abandon them when they are most vulnerable.” (Emphasis added)

Planned Parenthood is just as adamant and includes other issues in their reaction:

“OCR is an important office within the HHS that’s meant to protect health care for marginalized communities, including LGBTQ people and underserved women. But the creation of the new “Conscience and Religious Freedom Division” paves the way for discrimination against people for a variety of reasons — be it their gender identity, sexual orientation, or decision to access a safe, legal abortion.” (Emphasis in original)

A SHORT RECENT HISTORY OF FEDERAL CONSCIENCE RIGHTS PROTECTIONS

In response to declining numbers of doctors willing to do abortions in the 1990s, efforts began to mainstream abortion into the health professions such as requiring abortion training for OB/GYNs, shifting training and practice into teaching hospitals and integrating abortion into regular health care.

The National Abortion Federation along with Medical Students for Choice, pushed for change and in 1995, the Accreditation Council for Graduate Medical Education ruled that OB/GYN residency programs must include abortion training or lose accreditation.

That was overturned the next year with the Coats Amendment passed by Congress but efforts to marginalize pro-life medical professionals continued, especially with newly passed physician-assisted suicide laws and well-publicized withdrawal of feeding tube cases like Terri Schiavo’s.

In 2008, the Christian Medical Association compiled a list of dozens of real-life cases of discrimination in health care, including doctors, medical students, nurses and pharmacists.

That same year, President Bush strengthened the HHS rules protecting the conscience rights of doctors and nurses to refuse to perform abortions.

In 2011, the Obama administration dismantled key provisions of the Bush administration conscience rights rules.

That same year, 12 New Jersey nurses faced firing for refusal to participate in abortion and had to rely on groups like Alliance Defending Freedom to bring a lawsuit defending their rights. They were finally vindicated in 2013.

Right now, Wisconsin is considering a physician-assisted suicide bill that states a doctor’s refusal to prescribe the lethal drugs or refer the patient to a willing doctor “constitutes unprofessional conduct”.

Obviously, conscience rights cannot depend just on litigation, conflicting state laws or professional organization positions like the American Medical Association’s or American Nurses Association’s that don’t vigorously defend conscience rights.

As explained on the Dorsey Health Care group website ,

“In January 2018, OCR announced a proposed rule to strengthen conscience-based protections for individuals and entities with objections to certain activities based on religious belief and moral convictions.”

“OCR now proposes to return much of 45 CFR part 88 to its 2008 Bush-era form, adding a requirement that certain recipients of HHS funds certify they comply with conscience protection laws and notify individuals of their rights thereunder”, enhance investigative and enforcement abilities and expands its enforcement authority to more conscience-protection laws than the 2008 or 2011 iterations. It will also “handle complaints [both formal and not], perform compliance reviews, investigate, and seek appropriate action,” including terminating funding and requiring repayment. OCR states “that a more centralized approach to enforcement of conscience protections is necessary in part due to rapidly rising complaints.” (Emphasis added) Comments on this proposed rule can be submitted by March 27, 2018.

CONCLUSION

Health care professionals with pro-life views have been under attack for decades. It’s more than just not being “politically correct”; the very existence of such health care professionals threatens the appropriation of health care by groups dedicated to promoting abortion, assisted suicide and euthanasia as civil rights.

Without strong conscience rights protections like a successful Conscience and Religious Freedom Division, they will succeed in making health care termination-friendly.

But in the end, enforcement of the most basic civil right of health care professionals to provide care for patients without being required to participate in life-destroying activities should not be determined by politics or popularity polls but by the acceptance of the universal principle of respect and protection for human life.

This article was originally published at NancyValko.com

Swedish Citizen Unmasks a Main Physician-assisted Suicide Propaganda Point

Oregon, the first US state to legalize physician-assisted suicide, is routinely promoted by advocates as having the model law for assisted suicide. Now the debate has come to Sweden.

The Swedish National Council of Medical Ethics, an advisory board to the Swedish government and parliament, published a November 20, 2017 report, “Assisted Death: A Knowledge Compilation” (an English translation is coming) “to promote a more fact-based debate on assisted dying” and states that the Council “does not take a stand on assisted dying in the report”.

However, Fabian Stahle, a Swedish private citizen who read the report, found a problem.

In his article “Oregon Health Authority Reveals Hidden Problems with the Oregon Assisted Suicide Model” , he notes that:

“As a basis for their reassurance of no slippery slope in the Oregon model, the authors of the Swedish report note that there is one question that is ‘the crucial issue’: is anyone with a non-terminal, chronic disease granted medical assisted death?” (Emphasis in original)

But Mr. Stahle notes that the report says elsewhere that the six-month limit on expected survival time applies, “if no treatment is given to slow down the course of the disease” (Emphasis in original) and thus “might complicate the the whole idea that the law only applied to the ‘untreatable’ sick where nothing could be expected to extend life beyond six months”.

So Mr. Stahle says he did his own investigation by contacting the Oregon Health Authority himself. Craig New, Research Analyst with the Oregon Health Authority replied and told him that:

“…your interpretation is correct: The question is: should the disease be allowed to take its course, absent further treatment, is the patient likely to die within six months” (Emphasis added)

Fabian Stahle went further by asking if the doctor suggests to a eligible patient a treatment that possibly could prolong life or transform a terminal illness to a chronic illness or even cure the disease but the patient refuses, would that patient still be eligible for physician-assisted suicide.

He gave the example of a patient with a chronic disease like diabetes who refuses life-sustaining medication/treatment and becomes likely to die within 6 months and asked if that person would be eligible for assisted suicide.

Oregon’s Mr. New answered yes and that if the patient does not want treatment, that would also be their choice-along with the choice for assisted suicide.

As Fabian Stahle observes, this “allows a sanctioned path to suicide, aided by a physician, for anyone with a chronic illness who is likely to die within six months if they chose to stop treatment.” (Emphasis in original)

Fabian Stahle then asked about patients with a chronic disease whose health insurance company is not willing to pay for the treatment/medication.

Oregon’s Mr. New responded that:

“I think you could also argue that even if the treatment/medication could actually cure the disease, and the patient cannot pay for the treatment, then the disease remains incurable.” (Emphasis added)

And thus the patient is considered eligible for assisted suicide under Oregon’s law. This is especially outrageous.

THE BOTTOM LINE

Unfortunately, much of the public just accepts the Compassion and Choices propaganda that physician-assisted suicide is a safe “choice” with strict regulations for terminally and incurably ill people who are going to die soon anyway. Unfortunately, a mostly sympathetic mainstream media concurs and portrays assisted suicide as a “humane” last resort for extreme cases.

But now, Fabian Stahle, a Swedish private citizen, has done what few people do today even with such a life and death issue: He actually investigated the topic and contacted the Oregon Health Authority to clarify what “terminal” and “incurable” really legally means in Oregon’s “model” law.

Of course, there are many other problems with physician-assisted laws but Mr. Stahle focused on the one cited by the Swedish National Council of Medical Ethics as ‘the crucial issue’: is anyone with a non-terminal, chronic disease granted medical assisted death?”

Mr. Stahle is right to question this. The latest Oregon report on their assisted suicide law shows a range of diseases from cancer to undefined “other illnesses” as well as 43 people whose “ingestion status” of the prescribed overdose is unknown and obviously not followed up to see if or when they died.

Having written medical news analysis articles in the past for a national newspaper, I am appalled by the routine lack of investigative interest in life or death issues like assisted suicide from today’s mainstream media. The public needs and deserves better.

I wish Fabian Stahle was eligible for a Pulitzer Prize.

This article was originally posted at NancyValko.com