By Nancy Valko, RN, ALNC
I wanted to be a nurse since I was 5. I was drawn to nursing not only because I wanted to help people but also because medical ethics standards were so high, especially in contrast to some of the corrupt business practices that I saw.
I graduated from a Catholic nursing school in 1969 and spent the next 50 years working mostly in intensive care but also in home health and hospice, oncology (cancer), kidney dialysis, volunteer work, and on ethics committees.
I first noticed the change in medical ethics when the US Supreme Court’s Roe v. Wade decision in 1973 legalized abortion for the first three months of pregnancy. I was working in intensive care at the time and found that my fellow medical professionals who supported the abortion decision angrily rebuked those of us who were shocked that the first rule of medical ethics we were taught—First, Do No Harm—was eroding.
Then in 1982, my doctor husband and I were shocked by the Baby Doe case where the parents received a judge’s approval to let their newborn son with Down syndrome die instead of repairing an easily correctable hole between the tube that leads from the throat to the stomach and the tube that leads from the throat to the windpipe and lungs. While lawyers were appealing his case and many parents (including my husband and me) wanted to adopt Baby Doe, the newborn starved and dehydrated to death without the desperately needed surgical repair.
My husband asked “What has happened to medical ethics??” but we both knew the answer: Babies with Down syndrome are often unwanted and aborted.
Five months after Baby Doe died, our third child Karen was born with Down syndrome and a reparable heart defect, but the heart doctor gave us a choice to “let” our baby die without surgery. We refused, but my former trust in the medical system was shattered.
After I suddenly became a single parent in 1988, I had to return to a paid nursing job to support my three children but found a drastically different medical ethics system.
I found that during the 1970s, medical ethics began to evolve into the newer “bioethics,” even in Catholic hospitals.
This new bioethics has essentially four principles:
1. Respect for autonomy (the patient’s right to choose or refuse treatment)
2. Beneficence (the intent of doing good for the patient)
3. Non-maleficence (not causing harm)
4. Justice (“fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation”) Emphasis added.
Unfortunately, those principles are malleable and then used to justify actions and laws that would have been unthinkable when I graduated from nursing school. That bioethics mindset changed not only medical and nursing education but also the principles that informed our work.
Even the Hippocratic Oath, the oldest and most widely known treatise on medical ethics that forbade actions such as abortion and euthanasia that medical students routinely took upon graduation, has now been revised or dropped at many medical schools.
SOME MEDICAL ETHICS DIVISIONS THAT CAN COST YOUR OR A LOVED ONE’S LIFE
The American Medical Association, the American Congress of Obstetricians and Gynecologists, and the American Nurses Association and other healthcare organizations that used to condemn abortion are now supporting “abortion rights.”
Abortion on demand and taxpayer-funded has now been deemed a “civil right” by Planned Parenthood and many Democratic politicians throughout pregnancy to birth and even beyond. Alternatives to abortion such as free pregnancy tests, counseling, ultrasounds, maternity and baby clothes, diapers, car seats, bassinets, etc. are not options at Planned Parenthood but rather at nonprofit crisis pregnancy centers.
As a parent of an unwed teenage daughter, I support these services and give thanks for my now 22-year-old granddaughter.
In the early 1970s when I was a young ICU nurse, none of us medical professionals had even heard of a “living will.” There was a universal presumption for life, and “quality of life” was something to be improved, not judged.
Nevertheless, sick people could and did refuse treatment and even check themselves out of the hospital against medical advice. When patients appeared to be dying, they or their families could agree to a “do not resuscitate” (DNR) order. Treatments could be ethically refused when such measures were considered medically futile or excessively burdensome for the patient. But one thing we didn’t do was offer to withhold or withdraw medical care like tube or even spoon feedings to cause or hasten a patient’s death. And it was unthinkable that medical professionals could assist even a dying patient’s suicide.
Unknown to us, all this began to change after Louis Kutner, a Chicago lawyer, wrote a 1969 article in the Indiana Law Journal titled “Due Process of Euthanasia: The Living Will, A Proposal.” (emphasis added).
By 1970, The Euthanasia Society of America (later renamed the Society for the Right to Die) distributed 60,000 living wills. In 1976, California passed the nation’s first “living will” law and in 1990, the US Congress passed the Patient Self-Determination Act that requires information to be given to patients about their rights under state laws governing advance directives (commonly called “living wills), including the right to accept or refuse medical or surgical treatments.
Now, 8 states and the District of Columbia have assisted suicide laws, and Compassion & Choices, the largest advocacy group for medically assisted suicide, is using the COVID-19 pandemic to push for telehealth (the provision of healthcare remotely by means of telecommunications) for medically assisted suicide.
In my nursing school 50 years ago, we were taught medical ethics, and one example used was the case of a newborn with Down syndrome who needed life-saving surgery but whose parents refused, choosing to let him die. We were told that the law would protect such children from medical discrimination—even by the parents.
Now we have cases like Charlie Gard and Simon Crosier and others whose parents chose life for their babies with disabilities but were thwarted by doctors and courts.
When I started working in an ICU in 1971, I had questions about the brain death diagnosis for organ harvesting but was told not to worry because there were strict rules.
However, and over subsequent years, I discovered that the rules for organ donation have been changing from brain death to other criteria, including severe brain injury. There have even been proposals for “presumed consent” state laws where people would have to register an “opt-out” or be automatically presumed to consent to organ donation.
I do not have an organ donor card nor encourage others to sign one. Instead, I once offered to give a friend one of my kidneys as a living donor. Although I was not able to donate then, my family knows that I am willing to donate tissues like corneas, bone, etc. that can be ethically donated after natural death and will only agree to that donation.
Doctors and nurses used to be protected when asserting their conscience rights when refusing to deliberately hastening or causing a patient’s death.
Now, even that protection—which protects both patients and medical professionals—is under attack.
I discovered this personally several years ago when I was almost fired for refusing to increase a morphine drip “until he stops breathing” on a patient who didn’t stop breathing after his ventilator was removed.
The bottom line is that everyone must remain vigilant when they or a loved one becomes seriously ill, regardless of the hospital or institution. It is also important not to be afraid to ask questions.
There are also non-denominational, nonprofit groups like the National Association of Pro-life Nurses, the Healthcare Advocacy and Leadership Organization, and state and national pro-life organizations that have much useful information and resources for patients, families, and the public.
The bottom line is that what we don’t know—or allowed to know—can indeed hurt us. We need to demand transparency and the highest ethical standards (from information) from our doctors and healthcare system before they can earn our trust.
And without a change in laws, policies, and attitudes promoting deliberate death as an answer to human suffering, those of us medical professionals who believe we should never cause or hasten anyone’s death may become an endangered species—as well as our medically vulnerable patients.
This article has been reprinted with permission and can be found at nancyvalko.com/2020/09/21/think-the-political-and-cultural-divisions-in-our-country-are-bad-the-divisions-in-medical-ethics-could-cost-your-or-a-loved-ones-life.