The Role of Nurses When Patients Decide to End Their Lives

Some hospitals and hospices have policies that forbid nurses to be part of the process or even to discuss end-of-life options.

New York Times

Emilie Le Beau Lucchesi

When Ben Wald, 75, was dying of cancer in 2012, he wanted to use Oregon’s Death with Dignity Act to receive a prescription for a lethal medication that would end his life. His hospice nurse, Linda, was part of the discussion and provided both information and support, said his wife, Pam Wald, of Kings Valley, Ore.

His colon cancer had spread to his lungs, and his weight dropped from 180 to 118 pounds. He struggled to speak or eat.

When he was ready to end his life, the couple wanted Linda with them, but the hospice organization she worked for did not allow it, Mrs. Wald said. The organization allowed other hospice workers, such as social workers and massage therapists, to be present, but not the doctors or nurses it employed. . . [Full text]

Physician-Assisted Suicide and the Perils of Empirical Ethical Research

JAMA Netw Open. 2019;2(8):e198628. doi:10.1001/jamanetworkopen.2019.8628

Daniel P. Sulmasy

Al Rabadi et al1 compare statistics on physician-assisted suicide (PAS) available from public databases for the states of Washington and Oregon and find similar profiles and trends, which is unsurprising given the similarity of the laws and demographic characteristics of these states. Among the unanswered questions are what such a study can contribute to medical ethics (about PAS or any other ethical controversy) and what the limits are of such work.

Cautions

First, it should be noted that the medical literature is, in general, favorably disposed toward the empirical and the new. Although this predilection is often advantageous for scientific progress, it introduces a problematic bias when applied to ethical questions. The appeal of the study by Al Rabadi et al1 is that it is empirical, and by comparing data from 2 states for the first time, it can be considered novel. Because there are new reports each year and the practice of PAS is legal in only a few states, descriptive reports about PAS are published frequently. This means, however, that articles defending the ethical status quo (ie, against PAS) tend to be shut out of the medical literature because they are not reporting anything new and, therefore, cannot have any data. The result is an impression of growing acceptance of PAS, but it really represents an artifact of a scientific bias. . . . [Full text]

19 State Attorneys General Declare Opposition to HHS’ Proposed Conscientious Objection Rule

New York Law Journal

Kristen Rasmu

A U.S. Department of Health and Human Services proposed rule that would more vigorously protect health care providers’ ability to deny coverage in certain circumstances because of moral or religious beliefs should be withdrawn, according to a coalition of state attorneys general.

The proposed rule would strengthen the enforcement of existing regulations that allow providers to invoke conscientious objections as a basis for refusing to provide care that involves certain medical issues, including abortion, sterilization, assisted suicide and others. It also would allow individual providers to object to informing patients about their medical options or referring them to providers of those options. . . [Full Text]

Prevailing culture hard on religious liberty

Policy hits conscience; believers often classified as bigots

Catholic Sentinel

Ed Langlois

Oregon tends to lead the pack in causes favored by some wings of the political left — legal abortion, assisted suicide, gay marriage, recreational marijuana.

Some fear that next on the progressive docket could be tax exemption for churches and the right of church agencies to operate according to their ancient beliefs, especially in the dignity of life and marriage.

‘Striking change’

“There has been a striking change just in the last 10 or even just five years,” says Bishop Liam Cary of the Diocese of Baker in central and eastern Oregon.

Bishop Cary cites demographics. Among the fastest-growing groups in Oregon is the population without religious affiliation. That means they have no personal interest in protecting religious freedom. In their minds, personal choice trumps religious liberty, the bishop says.

Also new is the government’s willingness to use policy to try to force people to act against conscience. . . [Full text]

    

Dying Dutch: Euthanasia Spreads Across Europe

Newsweek

Winston Ross

In one of the last photographs my family took of my grandmother, she looks as if she’s been in a fistfight. Jean Bass Tinsley is lying in a hospital bed in Athens, Georgia, wearing a turquoise button-up shirt and staring blankly at the camera. A bandage obscures her fractured skull, along with the bridge of her bloodied nose. She is 91 years old.

My grandmother essentially did this to herself. In June 2013, she fell out of her wheelchair headfirst, after ignoring her caregivers’ warnings not to get out of bed without help. Earlier that year, she’d broken both of her hips, in separate falls. Before that, her pelvis-all while trying to do what for most of her life she’d managed just fine on her own: walk.

In her last year, dementia crept into my grandmother’s mind. The staff at her long-term-care facility plotted ways to protect her from herself. It’s against the law in Georgia to restrain patients in such facilities, so they lowered her bed to the floor and put a pad down next to it. They even installed an alarm that went off if she left her mattress. My grandmother disabled the alarm, moved the pad and freed herself, repeatedly. In the end, she was both too weak and too strong. [Full text]

 

Embargo on lethal drug stops executions and assisted suicides in US

 Bioedge

Michael Cook

A shortage of a lethal drug is stopping both executions and assisted suicide in the United States. The supply of Nembutal, the drug of choice for executing prisoners in many American states and for assisted suicide in Oregon and Washington state, has dried up because its European manufacturer, the Danish company Lundbeck, refuses to supply it for use in executions. This has had an unintended consequence: patients in Oregon who want physician-assisted suicide cannot get it.

In a recent, widely-reported execution, the state of Oklahoma tried a three-drug cocktail as a substitute for Nembutal (also called pentobarbital or sodium thiopental) last month, but the prisoner, Clayton Lockett, appeared to die in great pain. So patients in Oregon are not going to be using that. A second-best drug, secobarbital, costs between US$1,500 and $2,300-more than five times pentobarbital and it is still hard to obtain.

The botched execution has dismayed lobbyists for assisted suicide because it suggests that a satisfactory substitute for Nembutal will be hard to find. According to the Wilamette Week, an Oregon newspaper, “Advocates would like to expand the policy across the country, and their concerns about bad publicity hampering that rollout appear to account for their reluctance to discuss Oregon’s shortage.”

The assisted suicide lobby, therefore, has turned to other solutions. Compassion & Choices (the rebranded Hemlock Society) has asked the Oregon Board of Pharmacy to allow a pharmacy to manufacture the drug from raw materials.

“Providing this service is important to Oregonians, and I’m very concerned about what appears to be a complete lack of availability of the drug we’ve historically used,” State Senator Elizabeth Steiner Hayward (who is also a doctor who dispenses assisted suicide prescriptions) told Wilamette Week. “What I’ve been told by the pharmacists is the drug is completely unavailable, and we should not prescribe it.”

The irony that one group lobbying against death is frustrating the work of another group lobbying for death was not lost on bioethics gadfly Wesley J. Smith. “It seems to me that if the drugs are wrong to use in lawful executions, they are also wrong to prescribe to people who want to kill themselves. Death-causing is death-causing, and that ain’t medicine,” he wrote in the National Review.

There are other ironies. It is widely acknowledged that it is against medical ethics for doctors to participate in executions. However, Oregon is one of the few states that mandates physician participation in an execution. And anticipating objections by a doctor’s colleagues, it has banned sanctions against him (or her) for participating in an execution.


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‘Wrongful birth’ award in Oregon

Parents of a child with Down Syndrome have been awarded  $2.9 million (U.S.) damages on the grounds that they would have aborted her had the condition been diagnosed during pregnancy.  The award is based on the estimated extra lifetime costs of caring for someone with Down syndrome. [ABC News]

Pro-life nurse reaches settlement agreement with Oregon health department over request for religious accommodation, abortion

Rutherford Institute Attorneys, Health Department Agree on Resolution to Implement New Policies

Salem, Ore.— Attorneys for The Rutherford Institute have reached a mutually agreeable resolution with the Marion County Health Department on behalf of Janice Turner, a public health nurse who lost her job with the health department due to her deeply held religious belief that life begins at conception. The settlement agreement provides for the enactment of two new policies.  The first policy guarantees that all clients who receive emergency contraception, a.k.a. “the morning after pill,” will be informed in easily understandable terms that it functions by preventing the implantation of a fertilized ovum if conception has already occurred. The second policy, a general statement of employees’ rights to religious belief and expression within the workplace, prevents discrimination based upon religious or moral beliefs regarding abortion or contraception and requires the health department to accommodate those beliefs.  Patterned after existing Conscience Clause legislation, this policy ensures that employees who refuse to accept job duties that contradict their religious or moral beliefs regarding abortion or contraception can do so without fear of being fired, demoted, transferred or disciplined.

Turner, who worked for the Health Department from 1990 until July 2001, had early on in her employment expressed her religious opposition to abortion and requested accommodation from having to discuss or promote abortion procedures with her patients. According to Turner, her initial supervisor accommodated her religious beliefs and allowed her to refer those patients wanting to receive emergency contraception or information about abortion to another nurse. However, in 1995, a new supervisor was appointed to the Women’s Clinic who declared herself to be pro-choice and allegedly acted in a manner intolerant of other viewpoints. According to Turner, this new supervisor stated her expectation that everyone on staff discuss emergency contraception with patients as “a method of contraception that will prevent a pregnancy” and discouraged the nurses from referencing it as a possible abortifacient.  Turner claims that her supervisor continually reiterated her distaste for Turner’s pro-life views regarding emergency contraception and repeatedly told her that she “was not a complete nurse.”  During Turner’s final evaluation, the supervisor warned Turner that her position could be cut in the department budget, and if Turner wanted another position in the department, she would have to be willing to dispense emergency contraception. Attorneys for The Rutherford Institute filed a complaint in Janice Turner’s behalf last year in U.S. District Court.

“This is a timely issue which brings to light the importance of protecting health care workers’ rights, especially those who have sincerely held religious beliefs regarding abortion,” stated John W. Whitehead, president of The Rutherford Institute.  “It is also heartening to see that women, some of whom may have religious beliefs against taking an abortifacient, will be given complete information regarding the effect of the morning-after pill on a possibly fertilized ovum and its medical implications.”

The Rutherford Institute is an international, nonprofit civil liberties organization committed to defending constitutional and human rights.

Nisha N. Mohammed Ph: (434) 978-3888, ext. 604;
Pager: 800-946-4646, Pin #: 1478257
Email: Nisha N. Mohammed

No equal opportunities for nurse With pro-life views

Oregon, USA

 John W. Whitehead

According to a federal lawsuit filed by Janice, when the new supervisor-one intolerant of pro-life viewpoints-was assigned to the Women’s Clinic, Janice’s treatment on the job began to change. Indeed, not only were Janice’s religious views no longer accommodated, she was also harassed.  Attorneys for The Rutherford Institute reached a mutually agreeable resolution in Feb. 2003 with the Marion County Health Department on behalf of Janice Turner. As part of the settlement agreement, a new policy was enacted preventing discrimination of employees based upon religious or moral beliefs regarding abortion or contraception and requiring the health department to accommodate those beliefs. [Full text]

No Equal Opportunities for Nurse With Pro-Life Views

NEWS RELEASE

Rutherford Institute

Salem, OR–January 30, 2002–Attorneys for The Rutherford Institute filed suit yesterday on behalf of Janice Turner, a public health nurse who lost her job with the Marion County Health Department due to her deeply held religious belief that life begins at conception. The complaint, filed in U.S. District Court for the District of Oregon, charges that Turner’s supervisor at the Women’s Clinic harassed and retaliated against her for her pro-life views and refused to accommodate her religious objections to discussing or promoting abortion procedures with her patients.

Turner, a public health nurse with the Health Department from 1990 until July 2001, had early on in her employment expressed her religious opposition to abortion and requested accommodation from having to discuss or promote abortion procedures with her patients.

According to Turner, her initial supervisor accommodated her religious beliefs and allowed her to refer those patients wanting to receive emergency contraception, a.k.a. “the morning after pill,” or information about abortion to another nurse.

As a result of Turner’s personal commitment to providing quality health care to those in need, she also worked as a Maternity Case Manager, making house calls to women undergoing high-risk pregnancies and educating them on how to have a healthy pregnancy. However, in 1995, a new supervisor was appointed to the Women’s Clinic who declared herself to be pro-choice and allegedly acted in a manner intolerant of other viewpoints.

According to Turner, this new supervisor stated her expectation that everyone on staff discuss emergency contraception, or “the morning after pill,” with patients as “a method of contraception that will prevent a pregnancy,” and discouraged the nurses from discussing it as a possible abortifacient. Turner claims that her supervisor continually reiterated her distaste for Turner’s pro-life views regarding emergency contraception and repeatedly told her that she “was not a complete nurse.” During Turner’s final evaluation, the supervisor informed her that budget cuts would soon be forthcoming. She then warned Turner that her position could be cut in the department budget, and if Turner wanted another position in the department, she would have to be willing to dispense emergency contraception. Shortly thereafter, Turner was notified that her position was to be cut.

Among the allegations detailed in the complaint filed by Institute attorneys are charges that Turner was discriminated against for her religious beliefs, a violation of Title VII, the Hill/Burton Conscience Act and Oregon’s conscience clause.

“It is unconscionable for anyone to force their beliefs on another person, especially forcing a pro-abortion message on a person who believes that life begins at conception,” stated John Whitehead, president of The Rutherford Institute. “What makes it even worse is that this was being done by an employer who was fully aware that she is in control of that person’s livelihood.”


The Rutherford Institute is an international, nonprofit civil liberties organization committed to defending constitutional and human rights.
THE RUTHERFORD INSTITUTE
Charlottesville, Virginia.
General inquiries: tristaff@rutherford.org
Press Contacts: Nisha N. Mohammed Ph: (434) 978-3888, Pager: 800-946-4646, Pin #: 1478257