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About Medicine & Morality

MAY 2000
BIOETHICS WATCH

By Nancy Valko, RN

Topics in this issue:

Abortionists
Abortion
Euthanasia
Family Planning
Stem Cells and Fetal Tissue

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ABORTIONISTS

A Decision Between a Woman and Her Doctor?

Under new Rhode Island Department of Health rules, mid-level health professionals such as nurse practitioners, physician assistants and midwives will be allowed to perform abortion procedures, making Rhode Island one of just five states to allow mid-level health professionals to perform some types of abortions.

The new Rhode Island rules now also allow abortions after 18 weeks to be performed in doctors offices and clinics rather than in hospitals.

Rhode Island has the 5th highest rate of abortions in the nation. (Source: "State Revises Abortion Rules" by Ariel Sabar, Providence Journal, 12/28/99)

Comment: Everyone is familiar with the Roe v. Wade rhetoric of abortion as a decision between a woman and her doctor, yet 5 states have quietly moved to allow non-physicians to perform abortions legally. One of those states was Montana, where a state law mandating that abortions only be performed by a doctor was overturned in court last year.

Unnoticed by most people, pro-abortion groups like the American Nurses Association now refer to abortion as a decision between a woman and her health care provider. The reason for this is that the number of abortionists is declining as todays abortionists are getting older and retiring or leaving the abortion industry altogether and younger doctors are not flocking to work in abortion clinics. Therefore, to keep the abortion industry alive, rules are being changed. Note also that in RI, the decision to allow non-physician abortions was not made by the state legislature, but rather by the state health department. -- NV

Abortionists Facing Charges
Although it rarely makes national news, several abortionists have been facing disciplinary action from medical boards or even criminal charges in recent months. These are the most recent cases usually reported only in the local media.

• Joseph Durante, who operates abortion clinics in Riverside and San Bernadino counties in California, was already on medical probation, and now faces medical board allegation regarding his care of a woman whose uterus was perforated in an abortion.
  
  Durante did not perform the abortion, but in followup care, it was charged that he did not properly evaluate the patient or send her to a hospital. He is also charged with keeping outdated medications and did not have a valid federal permit for keeping controlled substances at one of his clinics.
  
  Durante had been on probation in 1996 for gross negligence after he misdiagnosed the age of an unborn child he was trying to abort. His medical license was later suspended for two months for lying in the earlier case, He is now facing a range of penalties including revocation of his license.(Source: Press-Enterprise, 5/12/2000)
  
• Abortionist Dr. Bruce Steir pleaded guilty to involuntary manslaughter for what prosecutors called "gross negligence" and lack of "due caution" in his care of a 27-year-old patient who bled to death due to a perforated uterus. Dr. Steir was facing 2nd degree murder charges in the case. (Source: Los Angeles Times, 4/6/2000)
  
• Dr. Stephen Pack, 44, was charged with assault and criminal possession of a weapon in a bizarre syringe attack on a pregnant nurse with whom he reportedly had an affair. The 31-year-old woman suffered five stab wounds to the leg and one to the buttocks in the attack outside Montefiore Hospital in the Bronx on Friday. She was admitted to the hospital in stable condition.
  
  According to a complaint filed by the Bronx district attorney's office, one witness, who did not give her name, said that Pack shouted "I'm giving you an abortion!'' as he struggled with the woman and forced her to the ground near the hospital's parking garage He was arrested minutes later.
  
  Hospital employees told investigators that Pack and the nurse had been romantically involved for more than a year, and that he believed she was six weeks pregnant.
  
  Pack is married and the syringe attack apparently was his attempt to abort the 6- to 8-week-old unborn child by injecting the woman with a fluid, believed to be methotrexate, a drug used to induce labor or an abortion, the complaint said. Andrew Rubin, Pack's attorney, said Pack had been "showing certain symptoms of depression'' recently. (Source: Associated Press, New York Times; April 15, 2000)
  
• Dr. Allan Zarkin was charged with assault when he carved his initials into a mother after performing a C-section to deliver her baby but later received probation in the incident. He had been fired from a New York hospital after the incident and went to work as the medical director of a New York abortion clinic.
  
  After the carving incident, Zarkin excused his actions as due to an Alzheimers-type brain disorder. The abortion clinic operator said that she knew of his medical problem when she hired him but not about the carving.
  
  As a result of this incident, the abortion clinic was investigated and soon shut down for numerous health violations. (Source: New York Times. Series of articles from 2/1/2000-5/26/2000)

ABORTION

• Mother Sues Doctors for Malpractice after Healthy Son is Born
  A mother in Arizona who was suing her doctors for malpractice and asking $180,000 dollars in damages after they failed to detect her pregnancy in time for an abortion has lost her case.
  
  Ruth Ann Burns argued that her son, Nicholas, now aged two and healthy, had become a financial burden on her and her boyfriend. She claimed that by the time the pregnancy was confirmed it was too late for an abortion, but defense attorneys argued that she knew how to obtain a second trimester abortion herself because she had done so before in 1995. Her first abortion was in 1993. (Source: The Arizona Republic, 5/15/2000)

Comment: The right to abortion is considered so sacred by some that it trumps even a born child's right to feel loved and wanted. Child experts often talk about psychological child abuse. How would these experts characterize this court case where the parents publicly regret not aborting this little boy? Hopefully, this child will receive help and not be permanently damaged by his parents' actions. - NV

 

• A 26-Year-Old Woman Seeking an Abortion, One Year Later
  In a September 22, 1999 article in the Journal of the American Medical Association, Dr. David Grimes, a clinical professor in the Department of Obstetrics and Gynecology at the University of North Carolina, presented the real-life case of a typical woman seeking abortion for some of the most common reasons-financial problems, the stigma of unwed motherhood, etc.
  
  Dr. Grimes went on to extol the virtues of legalized abortion for women, touting its safety and minimal emotional impact.
  
  However, this follow-up article revealed a different picture one year later. It turns out that Ms. B broke up with her boyfriend but continued to see him occasionally, used the prescribed artificial contraception sporadically, and finally became pregnant again and was planning a repeat abortion. (Source: Journal of the American Medical Association, Vol. 283 No. 20, May 24/31, 2000)

Comment: It is significant that the patient herself was not reachable to speak for herself in this followup article. Rather than an "empowering choice", abortion does not make the average woman feel proud and satisfied.

The "noncompliance" with birth control, the pending repeat abortion, the relationship breakup, etc. are not surprising to those who have studied post-abortion trauma and dramatically refute the first article's conclusion which maintained "that psychological sequelae following abortion tend to be minor and that most women feel relieved, as Ms. B did". Obviously, the initial relief was fleeting and it's hard to defend this woman's most obvious current problems as "minor" or as a final solution to her previous crisis pregnancy.

It turns out that this abortion "success story" was a total failure and shows what pro-lifers have long maintained: abortion hurts women as well as the unborn babies.

Some abortion supporters have suggested that pro-life health care providers -- particularly OB/GYNs and religiously-affiliated hospitals -- provide "second-rate" care because they are biased and do not include all options like abortion. This article shows how promoting abortion is the real substandard level of care. -- NV

• Missouri: Opposition to Partial Birth Abortion Law, Part 1
  In a bizarre criticism of Missouri's Infants Protection Act outlawing partial birth abortion, a lawyer for University Hospital and Clinics in Columbia, Missouri said that four terminally ill infants were kept on life support against their parents' wishes for up to 2 1/2 weeks because the law defines infant as a baby up to 30 days old.
  
  Despite the language of the law, the protestations from the law's author that the statute only applied to abortion and the fact that the law is currently on hold due to the current court challenge, the hospital's lawyer maintains that doctors who remove a baby less than 30 days old from life support could be charged with murder.
  
  Dr. John Pardolos, a neonatal specialist, stated, "Here the families were grieving because of deciding to lose their child, and they can't do it because a group of legislators told them they can't for the first 30 days of life. It converted the grieving process into more of a hatred in some cases. Hatred of the political system." (Source: St. Louis Post-Dispatch: "Hospital Kept 4 Babies on Life Support Against Parents' Wishes" 5/21/2000)

Comment: It's interesting that no other hospital or lawyer in Missouri had the same interpretation of the law and that the lawyer waited until the last baby died after 2 1/2 weeks to go to the media about this. Yet, the lawyer continues to maintain that his position is the correct one and that any distress to the families is due to the law -- not his legal advice.

The war over banning partial birth abortion has been particularly contentious in Missouri where pro-abortion Governor Mel Carnahan vetoed legislation twice before the Missouri legislature finally voted to override the veto. -- NV

• Missouri: Opposition to Partial Birth Abortion Law, Part 2
  In graphic testimony, Dr. Robert Crist, Planned Parenthood's chief abortionist in St. Louis, described how he performs abortions in an attempt to have Missouri's Infants Protection Act ruled unconstitutional. He cited how a first-trimester baby can be suctioned out whole with its little heart visibly beating and how he sometimes uses a twisting action to dismember the baby for removal in a late-term abortion. He maintained that the definition of partial birth abortion could also apply to these other abortion procedures. (Source: St. Louis Post-Dispatch: 5/25/ 2000 and 5/26/2000)

Comment: One unintended consequence of opposing a partial birth abortion ban was that the abortionist had to describe what he does in an abortion -- and it's not a pretty picture. A description of amputation surgery would not be as stomach-turning.

It's always easier to defend abortion in the abstract without getting into the gory details. It would be interesting if women considering abortion were allowed to read a description of the abortion "procedure" using this abortionist's own testimony. For example, it should be a little disconcerting for anyone to find out that a first-trimester so-called "clump of cells" could be extracted whole with his or her little heart "visibly beating" or that the unborn baby's arm could be twisted off to dismember him or her in later-term abortion, not to mention the brain suctioning in the partial birth abortion technique.

Several years ago, I was often asked if I wished I had had an abortion with my daughter who had Down Syndrome and who later died of complications of pneumonia. For awhile, I considered that question an opportunity to inform the questioner about the latest advances in helping people with Down Syndrome.

But one day, I responded differently. I asked the questioner if she knew how an abortion was performed. Like most people, she said no. In just a few minutes, I described a first trimester suction abortion, a second-trimester D&E (this was years before the partial birth abortion technique was developed), and a third trimester hysterotomy. She gasped, "Oh, no, you couldn't do that to your baby!"

"Exactly", I told her. The truly important question wasn't how "defective" or even just unwanted my baby would be. The real question was whether I would be willing to have her killed and in such a horrible manner.

The answer was easy. -- NV

EUTHANASIA

• The March 21, 2000 issue of the medical journal Annals of Internal Medicine contained a series of articles on assisted suicide. Most of the articles are papers presented at the Assisted Suicide Consensus Panel as a part of the Finding Common Ground Project of the University of Pennsylvania Center for Bioethics.
  
  Instead of discussing whether or not assisted suicide should be legalized, these participants agreed to discuss only how assisted suicide could be regulated.
  
  One of the articles, Death with Dignity: A Case Study by Walter J. Kade (a pseudonym for the real doctor), tells how an Oregon doctor assisted the suicide of a 29 year-old woman who had non-Hodgkin lymphoma, a type of cancer.
  
  He begins by saying: "I voted twice against legislative measures in Oregon that would allow physician-assisted suicide. Within months after the Death with Dignity Act became law, I received a call from the parents of a patient of mine requesting that I assist their daughter in her suicide. (Source: "Death with Dignity: A Case Study" by Walter J. Kade, MD, 3/21/2000.)

Comment: Note that the parents, not the patient, made the initial contact with the doctor. Patients seeking assisted suicide usually cite fear of being a burden rather than pain as the reason they want to die. Family support for assisted suicide can be a subtle form of coercion in these instances.

This article is also typical of an emerging genre in medical journals over the last several years: A "courageous" but anonymous doctor defends his termination of a similarly anonymous patient he deeply cared about. This article, like the others, involves a doctor with a natural distaste for causing death but who is confronted by a heroic patient who challenges his ideals. After a period of angst, the physician complies with the death request, but suffers during the process. Later, frequent ruminations about the event result in a new wisdom about the terrible injustice of hard and fast rules about killing.

The obvious purpose of these articles is to convince other doctors and nurses that assisted suicide and euthanasia are necessary medical options and that current laws against killing the sick should be changed. -- NV

 

• Kevorkian Honored at Ceremony at Harvard
  
  In April, Jack Kevorkian, the notorious unemployed pathologist serving a second-degree murder sentence for giving a lethal injection to Thomas Youk, was given the Gleitsman Foundations Citizen Activist Award in ceremonies at Harvard University. Kevorkian shared the $100,000 award with fellow honoree Bryan Stevenson, a crusader against the death penalty.
  
  Gleitsman Foundation president Alan Gleitsman called Kevorkian a selfless believer in death with dignity who sacrificed his medical license and now his own freedom toward that cause. Accepting the award in his absence was his victim's wife -- Melody Youk.
  
  Jack Kevorkian has had a long history of helping people to die and escaped punishment despite several trials. He was finally convicted after videotaping himself giving Thomas Youk, a man with ALS (Lou Gehrig's disease), a lethal injection and persuading CBS's 60 Minutes television show to play the tape on national TV.
  Among the judges on the Gleitsman Foundation board choosing Kevorkian for the award were actor Ted Danson, abortion activist Gloria Steinum and Mothers Against Drunk Driving founder Candace Lightner. (Source: Detroit Free Press, 4/8/2000)

Comment: It is ironic that Kevorkian, who has long also promoted lethal experimentation and organ harvesting on death row inmates should share this award with a crusader against the death penalty.
It is outrageous that Kevorkian, who craved the spotlight and boasted that no one would be able to stop him from perfoming his lethal services until his final trial, is called a selfless believer by people who should know better. -- NV

 

• Over 2,200 Dutch Euthanasia Cases Reported in 1999
  
  Holland, which has had a long history of tolerating euthanasia, is now considering formally legalizing the practice. Dutch regional euthanasia review committees said in an annual report that they had received 2,216 notifications of euthanasia and assisted suicide from doctors for the last calendar year.
  
  By law, Dutch doctors are supposed to report all euthanasia deaths, but the latest data from the Dutch Voluntary Euthanasia Society showed 3,600 deaths in 1995 from euthanasia or assisted suicide. The society believes its figures are the most accurate available since they include deaths not reported to the coroner, which account for around 59 percent of cases. (Source: Reuters news service. 5/10/2000.)

Comment: Note the estimated percentage of cases NOT reported to the government. -- NV

 

FAMILY PLANNING

• Pro-Life Groups in Argentina Respond to Reproductive Health Legislation

Buenos Aires, Argentina -- More than 60 pro-life organizations that promote respect for human life in Argentina have published a declaration about a series of so-called "reproductive health" bills being considered by the National Congress, the Legislature of the City of Buenos Aires, and the Provincial Legislatures.

They warn that in the language of international organizations, "reproductive health" "always includes abortion through surgical or chemical means, and attempts against the liberty and rights of families and individual persons."

"Therefore, should a law on 'reproductive health' or 'responsible procreation' be required, it must:

"1. Respect the first of human rights: the right to life of the unborn, from the first instant of conception.

"2. Respect the inalienable rights of parents to impart sexual education to their children.

"3. Guarantee integral care for the mother and unborn child during the pregnancy and birth; for the mother after the birth, for the newborn child during the first year of life.

"4. Guarantee health agents the right to conscientious objection, that is, not to indicate contraceptive methods with probable abortive effects, if this is against their ethical convictions.

"5. Guarantee the right to information, calling for information in simple, comprehensible language on the mechanisms of action and secondary effects of contraceptive methods and their probable or possible anti-implantation, in other words, abortive effects.

"6. Respect for the ethical, cultural and religious ideas of the family in the prevention of sexually transmitted sicknesses.

"7. Respect for justice and equity in the allocation of funds, such as in the area of health, where people have needs that are as urgent, or more urgent, than the reproductive."

(Item is quoted in its entirety from the Pro-Life Infonet News. Source: Zenit News Agency, 5/25/2000)

 

• The Pill Turns 40
  Many articles celebrating the invention of the birth control pill 40 years ago have appeared in many news articles. The St. Louis Post-Dispatch, however, contained this excerpt on the history of the Pill and the Catholic Church:
  
  A co-inventor of the pill was Dr. John Rock, an ardent Catholic with five children and 19 grandchildren who reportedly attended 7 a.m. Mass at St. Mary's Church in Brookline, Mass., nearly every day of his adult life.
  
  Rock believed the pill was a natural method of birth control, in keeping with the Catholic doctrine outlawing artificial methods. The Church-approved rhythm method of birth control works by limiting sex to the safe period created by the release of a class of hormones known as progestin during a woman's monthly cycle.
  
  "The pill works by using progestin in a tablet form to extend the safe period for sex to the entire month.
  
  "Rock, who started the country's first rhythm clinic for educating Catholic couples in natural contraception, believed the pill carried the same moral implications as the rhythm method.
  
  "But in 1968, Pope Paul VI outlawed oral contraceptives and all other artificial methods of birth control in his encyclical Humanae Vitae. The pill is approved for Catholics for medical purposes, as long as its primary purpose is not contraception.
  
  "Gerard Magill, a Jesuit priest who is director of the Center for Health Care Ethics at St. Louis University, said it is well known in the church that a large percentage of Catholics take the pill...."
  
  The article also quoted Planned Parenthood as applauding the progress in allowing teens to get the pill confidentially without parental knowledge and ended with a call for laws mandating insurance coverage for contraception. (Source: "The Pill turns the Big 40", by Deborah Peterson. St. Louis Post-Dispatch, 5/21/2000)

Comment: The real point of this article occurs at the end: "free" contraceptives for all.

But one problem with this is that virtually all contraceptive devices are an abortifacient at least some of the time. For example, one of the recognzied actions of the Pill is that it can make the uterine lining inhospitable to the new embryo, thus causing an early abortion without the woman even knowing conception had occurred. How often this happens is unknown, but most women using the Pill have never been told this (see next item).

So-called "emergency contraception" is acknowledged to cause this action if conception has occurred but because pregnancy has been redefined to mean implantation of the embryo in the womb, abortion supporters deny this is an early abortion. Ditto the intrauterine device, Depo-Provera, etc.

This is quite different from the ovulatory suppression action that Dr. John Rock thought his Pill produced. And, of course, he never foresaw the societal impact of his invention. Pope Paul VI and Humanae Vitae did.

What is also disturbing in the article is the endorsement of "confidentiality" (read "secrecy") for teens obtaining the Pill and other devices. Personally, I am horrified that my 14 year-old daughter, who is just starting to develop, can get powerful hormones without my knowledge. Some of the known complications of the Pill are blood clots and depression. This would be devastating to her but shrugged off by the people who would give her the Pill.

Lastly, the "everybody does it, including Catholics" justification for the Pill and other contraceptive devices shows the need for more education -- not public funding. --NV

 

• The Pill and Informed Consent
  In a recent article in the medical journal Archives of Family Medicine, two doctors make the case that failing to disclose the abortifacient possibilities of the birth control pill violates the right of a woman to know all the facts before agreeing to take the Pill.
  
  They conclude that "Since there is evidence to support the existence of postfertilization effects (early abortion. -- NV) and because it is impossible to know in advance which patients would find the potential for this effect objectionable, we believe that the lack of information regarding postfertilization effects in patient information materials about OCs (oral contraceptives) represents a potential failure to provide complete informed consent. Furthermore, if this mechanism of an OC violates the moral requirements of a woman, then failure to disclose this information seriously jeopardizes her autonomy. If information about the mechanism of an OC is deliberately withheld or misstated, then an unethical deception occurs. Failure to disclose information that might lead a patient to choose a different method of treatment is generally considered to be unethical.Therefore, it seems clear to us that failure to inform patients of a possible postfertilization mechanism of an OC is a failure to provide informed consent." (Source: "Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent", by Walter L. Larimore, MD; Joseph B. Stanford, MD, Archives of Family Medicine: Vol. 9 No. 2, February 2000)
  
  

STEM CELLS, FETAL TISSUE

• Adult Cell -- not Stem Cells or Fetal Cells -- Show Progress in Diabetes
  In a New York Times article in May, Canadian researchers report that transplants of insulin-producing cells have freed eight patients with a severe form of diabetes from insulin injections.
  
  The Times reports that "Two to 14 months after being transplanted in a simple procedure resembling a transfusion at the University of Alberta in Edmonton, the cells are still working in all eight patients, half of whom were treated almost a year ago." (Source: "Cell Transplants Offer Hope for Severe Cases of Diabetes", by Denise Grady, New York Times, 5/27/2000)

Comment: Despite actors Christopher Reeve's and Michael J. Fox's testimony on stem cells and embryo research, using embryos and aborted fetal tissue that "would be thrown out, anyway" is not necessary for medical progress in treating diseases. While opposition to ethics of using such tissue does not depend on current or potential alternatives, there would be less incentive to do research using ethically acceptable sources of tissue if we just accepted the use of aborted babies and surplus embryos and allowed taxpayer money to flow to National Institutes of Health [NIH] researchers and others. It's a "dirty little secret" in research that money flows most easily to trendy research areas rather than to the best research.

Following is the response from Richard Doerflinger of the National Council of Catholic Bishops Pro-Life Committee on this latest diabetes research breakthrough:

"The cells are from dead adult donors. They're not stem cells, but mature islet cells. There was some interest in getting such cells from fetal tissue after abortions back in the late 1980s and early 1990s, but researchers found that the cells were too immature to produce much insulin and the fetal organs were too small. In these new successful transplants they needed two donor pancreases for each patient. Key to the advance was a new immunosuppressant drug with fewer side-effects. This is the second indication in recent weeks that embryonic stem cells are unnecessary to medical progress toward curing diabetes.

In the March 2000 issue of Nature Medicine, University of Florida researchers reported that they had reversed insulin-dependent diabetes in mice using adult pancreatic stem cells.

'The next step is take this into humans', one of them said." (Reuters, Feb. 28--Rich Doerflinger)

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