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Life Issues Connector
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Phone (513) 729-3600 · Fax (513) 729-3636 · E-Mail LifeIssues@aol.com
President & Publisher………………..J.C. Willke, M.D.
Major Court Decision Near
by J.C. Willke, MD
The Roe vs. Wade of euthanasia may be coming soon. Major oral arguments on two appellate court decisions were heard in January. The 9th Circuit U.S. Court of Appeals in California and the 2nd Circuit U.S. Court of Appeals in New York had both handed down decisions that would have legalized euthanasia in all 50 states with very few restrictions. These had been appealed to the U.S. Supreme Court which heard the cases in January. A decision will be handed down before the end of this term in June.
In both cases, the wording used to legalize or not to legalize was “physician-assisted suicide”. But few in the pro-life movement, or in the various medical, nursing and other allied professions, thought it would stop at that. Pro-lifers saw it as a giant step, literally off of a cliff, that would in fairly short time authorize the actual killing of patients by physicians. The 9th Circuit Court decision, particularly, used wording that could easily be used to authorize direct euthanasia in later court decisions.
At issue was a law passed in the State of Washington forbidding assisted suicide. This had been struck down by a radical feminist judge whose decision read like it had been written by the American Civil Liberties Union. It stretched the Constitution to unbelievable lengths and in effect would have created a right to euthanasia in the U.S. Constitution. This lower court decision had been demolished by a three-judge panel in the 9th Circuit Court in a decision containing the famous phrase, “Unless we see the federal judiciary as a floating constitutional convention…” Unfortunately, in an en banc decision of 11 judges of the same court, the lower court decision was reinstated. Judge Rinehart who wrote this decision patterned it after Roe vs. Wade. In thinly veiled language, he moved well beyond a conscious request by a patient for aid by the physician in suicide. His decision all but justified the lethal dose to be given by someone else without the patient’s consent, for social reasons.
The Second Circuit Court arrived at the same end-point but by a different rationale. They pointed to the fact that a patient may voluntarily refuse to accept a treatment, even if that refusal will allow death to occur. These judges said that they saw no essential difference between voluntarily refusing treatment and the very specific, positive intervention of giving, or helping to give, a fatal dose of a drug to a patient.
The pro-life movement was not caught unprepared. As James Bopp of the National Legal Center for the Medically Dependent & Disabled stated, “We’ve been preparing for this one for over ten years.” One might say that this particular office in Indianapolis had been set up to ultimately cope with just this threat. Out of that office has been coming the intellectual law journal entitled Issues In Law & Medicine. Out of that office also, under the capable management of Mr. Tom Marzen and Daniel Avila, has come a succession of supportive papers, research and otherwise, that have gone worldwide. These gentlemen have testified before lawmakers and have helped to write laws against assisted suicide. They were not the only group, of course, as several other well known legal defense funds have been active during this time also. When, however, this threat materialized one year ago, the Indianapolis office called all of them together and coordinated the defense. Ultimately, over 40 Amicus Curiae briefs were submitted to the court. These briefs meticulously covered almost every possible angle of this case. They were a powerful and, it would seem, effective influence pleading the pro-life case before the court.
The American Medical Association (AMA) filed an amicus brief in the 9th Circuit case and was joined by 40 other national medical nursing and care-giving organizations. It incorporates powerful and convincing arguments against assisted suicide. To mention several: The pain of most terminally ill patients can be controlled throughout the dying process, and the risk of such medication hastening death is minimal. Most requests for suicide are because of fear of pain to come, of loss of dignity, of dependency and becoming a burden. And all of this is complicated by the most significant factor of all — clinical depression, which is usually treatable.
Another amicus brief by the National Hospice Organization notes that the two decisions “fail to appreciate that the final stages of life present opportunities for meaningful experiences that could be lost without the state’s protection of life and prevention of assisted suicide, even among the terminally ill. Moreover, many terminally ill seek assisted suicide, not because they cannot be cured but rather because they cannot bear the pain and depression that often accompany terminal illnesses. These factors can almost always be ameliorated.” … When such patients “are given proper palliative and supportive care, the desire for assisted suicide generally disappears.”
The amicus brief of the American Geriatrics Society added a very important consideration. It said, “Life just before death can be especially precious and important. When supported and comfortable, dying persons ordinarily accomplish important tasks such as saying farewells, disposing of property, completing life projects and enjoying their remaining days.”
Detailed in a number of the amicus briefs was the Dutch experience. Over a decade ago a judge allowed the direct euthanasia of a patient in Holland. Subsequent decisions broadened and codified that permission. After some years, the judge-made law in Holland allowed a doctor to give a lethal injection under the following conditions. (1) A voluntary request by a patient of sound mind, (2) That request being made on repeated occasions, (3) Witnesses, (4) Several doctors agreeing, (5) The patient being in uncontrolled pain, (6) The patient being in terminal condition, (7) Force majeure, a Dutch term stating that there was no other answer. Many of you have undoubtedly read that all of these qualifications exist to prevent abuses. In fact, with no exception, they are all ignored in many cases.
Your author is president of the International Right to Life Federation. I have visited Holland almost annually over the last decade and three times in the last two years. As a physician, I have spoken to other doctors, specifically to small, private groups exploring how this issue is handled. Some patients are directly killed, some without their knowledge or consent. Many patients have necessary treatment withdrawn to bring about their demise. In many, many cases a dose of morphine is quietly, slowly increased until the patient expires. 135,000 people are buried in Holland every year. Reliable estimates state that over 20,000 are either directly killed by lethal injection, or directly helped on their way by increasing doses as above by doctors, and that as many as half of them without their knowledge or consent.
One example may suffice. A pro-life colleague had admitted a cancer case to a hospital, and by Friday had a definite diagnosis of metastatic cancer. She was not in pain, and the decision to be made the first of the week was – what type of chemotherapy and treatment could be used to keep her comfortable and prolong her life? He left on a weekend holiday. On Monday, making hospital rounds, he found another patient in her bed. Inquiring of the resident doctor as to where his patient had been moved, the answer was, “Oh, well she had a metastatic cancer. Hers was incurable.” — “Yes, but” — “Well, we needed the bed.”
Australia has been through a very wrenching experience this past year. Their Northern Territory narrowly passed a law authorizing direct euthanasia. In the ensuing fallout, most of the other state legislatures rejected such a bill. Finally the national parliament, which can override a territorial law, debated this at length, and both Houses voted to cancel the law. In Australia, all medical groups unanimously opposed the law, as did all but a tiny number of churches.
Everyone knows of Dr. (now Mr., as he lost his license) Kevorkian and of his obsession with assisting the suicide (or direct killing?) of patients. He was tried twice for homicide. In both cases the jury acquitted him. His saga continues.
On the West Coast we have seen initiative referenda in California, Oregon and Washington, which in each case turned down euthanasia initiatives. Finally, Oregon passed a law permitting euthanasia (“assisted suicide”) by a 1% margin. This law has been enjoined pending a full review by the federal appellate court.
Recently Life Issues Institute called a leadership meeting in Washington, DC on this issue. Attendees came from Holland and England, and much valuable information was exchanged.
This was followed by an excellent legal seminar at Catholic University Columbus School of Law, in Washington, DC. And what will the Supreme Court do? There seems to be a near-unanimous opinion of pro-life attorneys who were there, and who reported at these meetings, that the court will not find a new right to “assisted suicide” in the Constitution. If not, then what? It is hoped that the court will simply say no. It could go further and rule that it would be unconstitutional to allow “assisted suicide”. It could back away and qualify with a “no, but”. We must wait and see. The most likely result will be that the court will not find a right in the federal Constitution but that it will recognize a state’s right to legislate. In this case, laws at state level, and initiative referenda at state level would then be governing, unless the state constitution were to be interpreted otherwise.
This issue will stay in suspended animation until the U.S. Supreme Court decision which will come down before the end of June. Then what? Let us predict, in the states that do not have a law forbidding assisted suicide, such laws will be proposed and vigorously pursued. Definite plans are being made in the State of Oregon to resubmit the issue in an initiative referendum to the voters of that state in November 1997. It was through this method that their law was passed allowing “assisted suicide”. With a Supreme Court decision behind them (they hope), and a much more educated electorate, along with no other major issues to compete with it for public attention on the ballot, Oregon pro-lifers will hope to reverse that awful decision and re-establish the right-to-life in Oregon.
The Pro-Life Response? It is of the utmost importance that a saturation education campaign proceed at the grass roots level. Here are some recommended resources:
Seduced By Death, an excellent new book by Herbert Hendin, MD – W. W. Norton & Co. He provides an extraordinarily detailed analysis of the Dutch situation and draws conclusions.
Dying Well, by Ira Byock, MD – Riverhead Books. Dr. Byock shares real-life stories of his dying patients. His extensive experience, both personal and professional, provide a thorough insight into hospice and palliative care. The only negative is his approval of removing food and water.
Euthanasia: When the Doctor Kills the Patient – Hayes Pub. This brochure is a thorough summary of the issue by J. C. Willke, MD.
The Battle for Life, by The Christian Medical & Dental Society, is a euthanasia packet including an outlined presentation, public service radio announcements, and a 15 -minute video.
The German Euthanasia Program by Fredrick Wertham – Hayes Pub. Co. This is a chilling description of the Nazi Experience.
Life Issues Today with Dr. J. C. Willke
Why Preach Against Abortion?
In the previous issue of Connector we ran a lead article entitled Why Clinton Got the Catholic Vote. After its publication, our office was inundated with phone calls, faxes and letters, overwhelmingly approving of the article. Only one critical letter was received in the first full month after publication.
In the time since, during Dr. Willke’s travels, several pastors offered their reason for not preaching against abortion from the pulpit. The reason offered may be quite widespread. It certainly reflects a genuine concern and poses a question that must be answered. Let’s consider two examples of this concern.
“I am quite aware through my counseling that there are a number of women in our congregation who have had abortions. Most are handling this problem and continuing to function as good wives, mothers and women in a community. They know that abortion is wrong. Now you suggest that I preach on abortion. If I do, what would the content of my preaching be? Well, certainly I would include a recital of the medical facts that confirm that this is a baby from the very beginning. It would involve pointing out that abortion was killing this developing baby. I would certainly speak to God’s goodness and his forgiveness. But I would also have to be clear about the fact that this is a very serious sin.
“Many of these women carry a considerable burden of guilt. If I preach about this, it will be rubbing in the sin that they committed. It will raise an issue that they are trying to forget, and blow upon the smoldering coals of their guilt feelings. It might even cause an emotional upset to the point of one of them breaking down, crying and making a spectacle of herself that would be profoundly embarrassing to her. In spite of my speaking of God’s forgiveness, it might even drive her from the congregation. I believe, in all Christian charity, we should let sleeping dogs lie and not needlessly torment such a woman.”
Another example might be this:
A group of parents has asked us to speak to a general assembly of a religious senior high school. This might be girls alone or co-educational. The Principal asks if we intend to use slides, i.e., pictures of developing babies and pictures of aborted babies. Our answer is in the affirmative. The teacher’s decision, then, is to not invite us to give that general session. The explanation is much like the one above. The Principal says, “You see, Doctor, we know there are girls in the class who have had abortions. Now if you come and lecture on this, you’re going to explain to them the fact that this truly was a baby that she had killed. And you say that you would actually show us some pictures of those dead babies. You realize that this would lay a very real guilt trip on some of these girls. It’s even possible that one or another of them might break down and cry, become hysterical, or run from the assembly. I don’t think that any of us teachers want to be responsible for such an outburst or for such emotional trauma inflicted on one of our students. You know we are pro-life, but I think it is unwise for you to give such an address to our girls.”
Fifteen years ago, a common answer to these situations was “Yes, we don’t deny that this could happen, and it would be emotionally upsetting, of course. But for every one girl who has to be managed after such an emotional upset, we’re probably going to prevent a half-dozen other girls from getting an abortion in the first place. We think the price of upsetting one is worth it if we save six others.” Sometimes that argument worked. Often it did not.
Today, however, we have the answer to both of the above situations and others like them. We now know in depth the dynamics of Post-Abortion Syndrome. We know that, in both situations, even if, and particularly if, we caused an emotional distress or outbreak from one or more post-abortion women in the audience, we would be doing, not a disservice, but a profound favor to those women. Here’s why.
The hallmarks of Post-Abortion Syndrome are repression and denial. It is well known that she suppresses the memory and guilt of that abortion. We know now that, for some at least, and for varying lengths of time, they’re quite successful in suppressing and denying the guilt and emotional upset resultant from an abortion. But this only lasts so long. We know that the suppressed emotional trauma of an abortion festers and eats away at the very core of that woman’s being. We know how it breaks through — flashbacks, anniversary reactions, sexual problems, nightmares, resort to alcohol and/or drugs, depression, etc. We know that many women, using this psychological defense mechanism, merely postpone to a later year these repressed problems, but that sooner or later the symptomatology breaks through. Sometimes it will be in a very disabling way, ultimately leading some even to suicide.
The answer is to stop the denial and repression, and admit to herself that she was a party to the killing of her own offspring. To do this, she must be in a supportive environment with sympathetic shoulders to lean on, confide in and pray with. She cannot handle this alone. We know today that the very best thing for her emotional health is to cease the repression and denial, admit the problem, cope with it, grieve over it, pray over it and work it through. That high school girl who is only beginning long years of repression and denial is not well served by continuing to hide this. Nor is the woman in church. We would do both a great favor to break open that shell, start her crying, because now she is in a supportive environment. Now most of the damage may not yet have been done, and she is open to healing.
We should lecture in that high school because it would be good for one or more of those post-aborted girls to come to one of her teachers crying. For now they can be helped.
In the congregation above, the same is true. That pastor must offer this counseling in his preaching. The biggest favor he can do for a post-aborted woman in his congregation is to crack that shell and to get her to come for the counseling and the compassionate help that she so desperately needs. (For details bout helping such a woman, see the March 1996 Connector. Write us if you need a copy.)
It seems clear that the reason why some clergy do not preach about abortion is compassionate but misguided. Truly informed sympathy for a post-aborted woman today should lead them to very deliberately preach on this subject. In all charity, but in all truth, we should explain to the priest or pastor that it is not really being kind to that woman at all to let her stay within the repressed and denial situation she’s in. The kindest thing he can do for her is to break that shell by his preaching.
Needless to say, vast numbers of others in those congregations would warmly appreciate dynamic preaching of the church’s position on abortion. In that preaching, always understand that that priest or pastor should emphasize God’s forgiveness. He should begin with the theme of let us love them both. That should be repeated within preaching, and it should be restated at the end of that preaching. We’re here to save babies’ lives, but we’re also here to love and help women in these troubled circumstances.&127;
National Anti-Euthanasia Effort by AMA
The American Medical Association (AMA) has long been known for its consistent pro-abortion stand. As a result, the pro-life movement has often been directly at odds with this powerful and influential organization of America’s doctors.
As the issue of euthanasia, particularly doctor-assisted suicide, has come to the forefront, the AMA has taken a very strong position on this controversial subject. This time the AMA has taken a firm stand for life. They filed an amicus brief in the 9th Circuit case regarding doctor-assisted suicide. In this brief, the AMA stated, “There is, in short, compelling evidence of the need to ensure that all patients have access to quality palliative care, but not of any need for physician-assisted suicide….” The AMA is keenly aware that doctors perform a crucial act of healing and saving life. Accepting a dual role of taking life, while at the same time protecting life, would undermine their credibility and the sacred trust that exists between a patient and doctor.
Thus the AMA has recently announced the implementation of the Institute for Ethics. The goal of this entity within the AMA will be to educate 10% of its member doctors (estimated to be 20,000) on hospice and palliative care. Further, they believe that providing responsible alternative treatment to ending life will all but eliminate the quest for euthanasia.
This aggressive new project will be headed by Linda Emanuel, Professor of Bioethics at Harvard. The two-year pilot program is funded by a 2-million-dollar grant from the Robert Wood Johnson Foundation. Ironically, this foundation is also well known for aggressive pro-abortion funding. However, in addition to assisting the Institute for Ethics, it has also funded other hospice and palliative care efforts.
Serving as a senior consultant on the project is Carlos F. Gomez, MD, Ph.D. Dr. Gomez, a native of Havana, Cuba, is currently Assistant Professor of Medicine at the University of Virginia School of Medicine. His major role with the Institute will be as a spokesman and public speaker. He will also advise Professor Emanuel and others on its organization and future plans. This new position will require Dr. Gomez to commute weekly to Chicago from Charlottesville, Virginia, forcing him to juggle existing responsibilities of teaching, treating patients and caring for his family.
“It sort of surprised me how strong a stand the AMA took on euthanasia. I don’t believe they want to be recognized as executioners,” said Dr. Gomez. He feels that assisted suicide is particularly ill-timed with health care reform taking place and cost-cutting a major issue. “To throw this in at this time is absolutely insane,” he said.
According to Gomez, ignorance and fear is driving the euthanasia debate. Their goal is to educate more doctors to alternatives to doctor-assisted suicide. This will be done by conducting regional meetings for doctors around the nation. During these meetings Dr. Gomez and others will provide intensive training in pain control, compassionate care and alleviation of fears. It is their hope that the educated doctors will in turn enlighten their colleagues and communities regarding effective palliative care.
The AMA is aware of many of its physicians shortcomings regarding pain and palliative care. In its amicus brief the AMA stated, “The delivery of [adequate pain relief] is ‘grossly inadequate’ today, and efforts to make such care universally available have not yet succeeded.” Dr. Gomez added, “We now have lots of documented evidence that an aggressive drug regimen can effectively protect dying patients from pain. Doctors won’t have any trouble prescribing medication if they are careful and document their actions.”
Regarding how their efforts will directly affect patients, Gomez said, “Anything we can do to educate doctors to the needs of patients is good. We will teach them to discuss pain control and alternative treatments with their patients. During the dying process, a doctor should be encouraging and bolstering his patients. We hope to have a very direct impact on patients’ lives.” Gomez speculated that the next five or six years will tell if they are successful.
The AMA has watched, with great interest, doctor-assisted suicide in The Netherlands expand to include euthanasia even without a patient’s knowledge or consent. Doctors in The Netherlands often resort to euthanasia when it appears that their efforts to cure the patient have been unsuccessful. The AMA does not want to see a repeat of this situation in America. Holland has shown that once the doctor has accepted the fact that he can end life, no amount of rules or regulations will protect the public.
It was only natural that the AMA would recruit the participation of Dr. Gomez. He received a four-year Robert Wood Johnson Generalist Scholars Award in 1994 to develop a palliative care curriculum and teaching service for medical students at the University of Virginia. He has authored a book, Regulating Death: Euthanasia and the Case of The Netherlands, and co-authored with Dr. Steven Miles, Protocols for the Use of Life-Sustaining Treatments. In addition he has extensive bedside experience treating dying patients.
Gomez and others feel that educating 20,000 doctors in two years is an “ambitious but doable” undertaking. They are convinced that when patients are offered a reasonable alternative, they will reject euthanasia. “The other side is preying on fear and anxiety,” said Dr. Gomez. “When you attack that fear directly, you take the steam out of the other side’s arguments.”
The program is expected to be up and running in six to eight months. It will take that amount of time to train the needed speakers and get things organized. It is too early to tell if the Institute will be involved in sponsoring and promoting anti-euthanasia legislation on the state or national level. However, the Institute for Ethics plans to set the tone for the AMA whenever it speaks on this issue — a powerful and influential voice in America’s medical communities.&127;
Breast Cancer — Danish Study
The New England Journal of Medicine recently published a Danish abortion study by Melbye et al. The lead author told the Wall Street Journal: “I think this settles it definitely. There is no overall increased risk of breast cancer for the average woman who has an abortion.” In an accompanying editorial an official of the National Cancer Institute stated, “The clear central finding is that there is no overall risk.” The pro-abortion media picked up this description of the study and headlined it across this nation and the world. It was exactly what they wanted to hear, and they swallowed these comments without any attempt to evaluate whether or not they were valid.
We now have an exhaustive study of this research article by the man who is probably the most qualified judge of the validity of such studies in the world, Dr. Joel Brind. Let’s mention a few obvious problems.
Of the 1.5 million women studied, 1.2 million had neither any exposure to induced abortion nor have developed breast cancer.
Of the 281,000 women who did have an induced abortion, most are still too young to have developed breast cancer, and some are still teenagers.
Of the 10,000 women who have developed breast cancer, most are too old to have their abortion histories on record, as the Danish Registry only goes back to 1973, about when abortion was legalized. At that time the oldest women were already 38 years old.
Of the 1,338 women who had abortions and did develop breast cancer, 81% had their abortion recorded at age 30 or over, and 54% at age 35 or over. As we know, by far, most abortions are done on younger women. The women younger than 30 years who developed breast cancer are only listed as having breast cancer without any record of having had abortions. Other equally important data is omitted or de-emphasized. There were a few women who had abortions as teenagers who had already developed breast cancer, and they had a 29% increased risk, but they were too few in number to be statistically significant.
The study did demonstrate a statistically significant trend of a 3% risk increase for each additional week of gestation before abortion. This rose to an 89% increased risk for abortions after 18 weeks. Interestingly, this finding in the study was not mentioned in the study’s “conclusions”.
Much data was missing from the paper, particularly the effect of other independent variables.
Previous studies confirming a relationship between abortion and breast cancer are attacked or misrepresented.
There is an egregious distortion of the age distribution of abortion clients.
The author falsely misrepresents other medical studies, saying that his “result” is very much in line with the results of previous retrospective cohort studies. Actually, three of the four such studies he cites are entirely irrelevant. Two of these concern only miscarriages, and the third almost entirely so while not presenting any data relating specifically to induced abortion.
The author attacks the Brind meta-analysis, which was published last fall, as unreliable due to “response bias”. Such criticism has been thoroughly discredited in a number of major studies. He criticizes Brind’s meta-analysis as being from 30 studies, when in fact it analyzed the entire world literature of more than twice that number.
All of the above may become a bit confusing. Truly this is a field where those without in-depth expertise in statistical medical analyses should tread very lightly. Brind has such expertise and rather thoroughly demolishes the Melbye study as being essentially invalid and drawing invalid conclusions. For those of you who want more specific detail, Dr. Brind’s tightly reasoned critique is available for $5.00 through Americans United for Life, 343 S. Dearborn St., Suite 1804, Chicago, IL 60604. Phone (312) 786-9494.&127;
A Message From Chris Smith to Bill Clinton
Congressman Chris Smith (R)NJ, wrote this open letter to President Bill Clinton and read it at the March for Life on January 22.
“A generation of kids–both here and abroad–are at risk because of you. For four long years you have waged a relentless war on defenseless unborn children–and millions have been butchered on your watch. Only a determined bipartisan majority in Congress checked your obsession with promoting abortion.
“You tried, Mr. President, to compel taxpayers to pay for and expand abortion on demand as part of your ill-fated national health care bill. You’ve tried to repeal the Hyde Amendment. Failing that, you sought to weaken it. By pushing the so-called Freedom of Choice Act, you tried to repeal modest state laws that require waiting periods and informed consent.
“You, Mr. President, have authorized the use of human embryos as “guinea pigs” in scientific experiments. You’ve made felons out of peaceful and sincere pro-lifers who pray outside abortion clinics and engage in non-violent civil disobedience–a staple of the civil rights movement. You’ve greased the skids at the FDA for a new baby poison – RU 486. The French abortion pill doesn’t heal or eradicate disease–it kills infants.
“And you, Mr. President, have pushed an international right to abortion, both overtly and covertly, at UN conferences and as a key component of US foreign policy. You’ve demanded that taxpayers provide hundreds of millions of dollars each year to the death peddlers overseas like Planned Parenthood, who undermine and seek the repeal of pro-life laws in other countries. Your Administration demands that countries accept population control policies before they are given desperately needed food and medicines.
“Your nominations to your cabinet and the courts, including the Supreme Court, have all been litmus-tested pro-abortionists.
“And last year, you vetoed the partial-birth abortion ban using bogus science and deceitful logic. As things stand today, you are the Abortion President–and unless you change course, your legacy will be Bill Clinton, Abortion President.
“Mr. President, the Scripture admonishes us to pray for those in authority, and we will be faithful to that. While we pray and sincerely hope that you and Mr. Gore will have a change of heart, be certain of this: Out of love and compassion for the disenfranchised and the weak, pro-life Americans will bear the burden of this struggle until we re-establish the right to life.
“Safeguarding children and their mothers from the cruelty of abortion is the human rights cause of our time. Pro-lifers, Mr.