Tag Archives: euthanasia

Follow Church prescription for a Catholic living will

Living wills were first introduced by the Euthanasia Society of America in 1967, and were popularized by one of its members, advice columnist Abigail Van Buren (“Dear Abby”). Given the disreputable history of the living will, Catholic patients should ensure that end-of-life documents follow Church teaching. Living wills do not become activated until patients cannot speak personally to express their desires. Health care surrogates, usually family members, need to be assigned to speak for the patients then. A Catholic living will should also address the following 5 principles, to avoid the dangers of secular end-of life documents.

1. Relieving pain. Church teaching strongly supports patients being kept as free of pain as possible. This needs to be balanced with patients’ moral and family duties as they prepare with full consciousness to meet Christ.

2. Assessing treatments as ordinary or extraordinary. Patients and their families need to be given adequate information for a clear understanding of any end-of-life treatment. Is each treatment: 1) serving as a bridge to recovery from an acute medical problem, 2) alleviating suffering from an ongoing condition, or 3) offering little hope of benefit and actually becoming burdensome? There is no obligation to accept extraordinary treatments that have significant risks which may outweigh benefits.

3. Providing food and nutrition. A written request for receiving food and water, even if by artificial means, is generally not included in a standard secular living will that views assisted nutrition and hydration as medical treatment, but the Catholic Church views assisted nutrition and hydration as normal care. Pope St. John Paul II wrote:

“The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act.”

When a terminally ill patient, however, is at the brink of death, body systems are shutting down and can no longer digest food. At this point assisted hydration and nutrition become burdensome and could be discontinued.

4. Prohibiting euthanasia. The immorality of Euthanasia and Physician-Assisted Suicide (PAS) predates Christianity, as Hippocrates prohibited this practice 2,400 years ago. The Catholic Church has always taught that these are grave violations of God’s law. In an age where PAS is being legalized, it is important to clearly state an opposition to this misguided autonomy and false mercy.

5. Requesting spiritual care. This provision asserts that a priest be notified and that the Sacraments be given. The Sacraments of Penance, Anointing of the Sick, and Viaticum are the healing Sacraments that give peace, strength, and grace in preparation for death. The Anointing of the Sick unites a person more closely to Christ’s Passion and uses suffering as a participation in His saving work.

A Catholic living will that includes these 5 principles — and a designated surrogate committed to Catholic principles to speak when the patient cannot — serves not only the patient’s own well-being, but also acts as a tool for evangelization by witnessing to the truth about human dignity, the redemptive value of suffering, and hope in eternal life. For a model Catholic end-of-life document: https://www. flacathconf.org/documents/2018/11/CDLD.pdf

Dr. PETER MORROW is the immediate past-president of the Catholic Medical Association, and practices geriatric medicine in Saint Cloud, Florida.

Seeing stealth euthanasia for what it is

Most of us are aware of the horror of abortion, of parents paying a doctor to kill their child, even if it goes by a sugar-coated name such as “choice” or “planned parenthood.” Too few are aware that at the other end of life, children, in an ironic turnabout, can pay a doctor to legally kill their own parents; the sugar-coated names for this are “hospice” or “palliative care.”

I learned this from the case of my own mother, who recently fell victim to “palliative care” and was killed at the hands of doctors and nurses, on the orders of one of her own children. She had imprudently chosen the wrong child to be her “health care proxy,” who then immediately had her physician sign a bland, one-sentence statement that she was legally incompetent. It is true that my mother was somewhat confused, particularly about time, but she recognized and cared about people, ran her own life, and knew what she wanted. Although she should not have made a major financial decision at that point, she certainly knew whether she wanted to live or die.

Unfortunately, a few months later she fell and fractured her pelvis, requiring a move to a nursing home while the bone healed. The nurses attending her were charmed by her kindness and her stories, and said that with physical therapy she should soon be able to walk again. However, her proxy decided instead that it was time for her to die. My mother was removed from medical care, and placed in hospice, or palliative care. As much as I and my mother fought for medical care, there was nothing we could do. No medical aid, including nutritional supplements or physical therapy, were to be provided – just morphine, ostensibly to relieve pain, but as later made clear, actually to hasten death.

The doctor ordered large doses of morphine at six-hour intervals, whether my mother was in pain or not. Morphine is known to depress appetite; it is used, illegally, by runway models to lose weight. When she weighed little more than 70 pounds and was losing about a pound a day, I asked that she be given a nutritional supplement, such as “Ensure.” I was told it was forbidden, under doctor’s orders. When I asked that the morphine be given only when in pain, I was told it had to be given by the clock. When I confronted the director of nursing, saying “You are allowed to give morphine to relieve pain, but not to hasten death” her reply was, point blank, “Not true – it depends on the quality of  life.” When I asked what the terminal condition was that justified her being put in hospice, the answer was “she is 96 years old and has a broken pelvis.” A broken bone is not a terminal condition. What they were saying is it was time for her to die.

Although her weight dropped to about 60 pounds, she ended up dying not of starvation, but of thirst. When she became too weak to lift a glass to her lips, the nurses were forbidden to syringe any water into her mouth – under doctor’s orders, at the behest of the proxy. My mother’s will to live kept her alive far longer than the “authorities” wished, but she eventually died after an excruciating last few weeks.

The irony is that as a young Jewish woman in Germany in the 1930s, she was slated to be exterminated at Auschwitz, but miraculously escaped from the train en route. Ironically, 75 years later she died a 60-pound skeleton, looking for all the world like an Auschwitz victim, killed not by that Holocaust but by our own Holocaust, that of our “culture of Death.”

 

ROY SCHOEMAN  is a Jewish entrant into the Catholic Church, best known for his writing and speaking on the Jewish roots of the Church, particularly in his bestseller, Salvation Is from the Jews. He has taught theology at Ave Maria University and Holy Apostles Seminary, and currently hosts a weekly radio show on Radio Maria.

When is it okay to withhold food and water?

Making decisions about assisted nutrition and hydration can be challenging. We are blessed with the gift of the Catholic Church’s clear moral teachings to guide us. While assisted suicide and euthanasia – seeking to eliminate the sufferer as a means of removing suffering – are always immoral, there are nonetheless times when there is no moral obligation for a patient to receive food and water. Here’s a quick primer on when and why.

John A. Di Camillo, Ph.D., Be.L

Food and water may be withheld when the facts of the situation prove ineffective or harmful, not when someone simply decides “it’s Grandma’s time to go.” There are several critical distinctions at play.

Most importantly, nutrition and hydration are distinct from medical treatment. This establishes a general obligation to provide food and water, even by medically assisted means, when the patient cannot take food orally. They are basic human care that every person deserves, regardless of health condition or life expectancy, and so the default action should always be to provide, with medical assistance if necessary. That said, there are three exceptions to this norm based on three additional distinctions.

First, food and water may at times be distinct from nutrition and hydration. That is, they sometimes fail to achieve their finality of nourishment and hydration. There is no duty to provide food and water by oral or by medically assisted means when the body cannot assimilate them.

Second, serious burdens associated with the effects of food and water on the body, or with the assisted means of delivering them, are morally distinct from the minor inconveniences typical of simple and safe administration. Food and water may therefore be withheld when there is moral certitude of serious harms, complications, or discomfort connected with their use, even if they are still able to nourish and hydrate.

Third, imminence of death based on a specific, identifiable cause is distinct from generally declining health or vague expectations about death. Food and water may be withheld if death is imminent, but imminent must not be confused with inevitable. For example, assisted nourishment and hydration may be withdrawn if death is expected within hours or a day due to an advancing cancer, but should not be stopped based solely on a doctor’s prognosis that the person will inevitably die “any day now.”

In sum, food and water must be provided when they actually nourish and hydrate, unless they entail a serious burden or death is imminent. It would be euthanasia to “let Dad die naturally” by withdrawing food and water when he is able to absorb them without significant harm or discomfort. It might be legitimate, however, to withdraw medically assisted nutrition and hydration if Mom is bloating from hydration her body cannot absorb, if Grandpa is experiencing serious issues with recurring infection at the surgical insertion site of a tube, or if Dad is in his final hours with a metastasized cancer.

There are various pitfalls to watch out for in applying these teachings. First, life itself, no matter the person’s health condition, can never be invoked as a “burden” to justify withholding food and water. Similarly, the fact that food and water will not enable a patient to recover from illness or regain lost function is not evidence for “futility.” Food and water can only be assessed as effective or ineffective with reference to their proper finality: nourishing and hydrating. Finally, death is inevitable for us all, but imminence is very narrowly defined and difficult to establish.

In today’s technological and bureaucratic health care context, families are bombarded with all sorts of pressures and confusion. So let us carefully reflect on these key distinctions in the Church’s moral tradition, which can equip us to defend human dignity and advance the culture of life in concrete decision-making.

JOHN A. DI CAMILLO, PH.D., BE.L., is a staff ethicist at The National Catholic Bioethics Center in Philadelphia. He earned his bioethics doctorate and licentiate degrees at the Pontifical Athenaeum Regina Apostolorum in Rome. He lives in Narvon, PA with his lovely wife Serena and their four children.

When life is regarded as ‘good’ or ‘bad’ hotel

The basic argument for voluntary euthanasia is this: the person to be killed mercifully gives free and informed consent to be killed in this way. He or she chooses death, regarding it as a benefit. In doing so, the person is simply exercising his or her autonomy. Respect for this autonomy should therefore lead others, including doctors, to confer the benefit of a merciful death on the person.

Dr. William E. May

But a doctor, even one not opposed in principle to euthanasia, would refuse to kill a patient, even if the patient begged to be killed, if he thought that the patient still had a worthwhile life to live. Thus, as the authors of a superb study prepared by a group of British Catholics rightly point out, “it is precisely the judgement that a patient no longer has a worthwhile life which will seem to justify euthanasia,” and, continuing, they affirm: “But precisely that contention is inconsistent with recognizing the continuing worth and dignity of a patient’s life.”

… We have [also] seen two principled arguments advanced to justify non-voluntary euthanasia. One claims that the individual to be killed mercifully… are no longer to be regarded as persons because they lack presently exercisable cognitive faculties, etc.

The second asserts that even if we grant that the individuals are indeed persons, their “quality of life” is so poor that life is no longer of any benefit to them and that death can be regarded as a kindly release from a burdensome and/or useless existence demeaning to human persons.

Advocates of euthanasia are in essence dualists. They regard human persons as consciously experiencing subjects, free to do as they choose, whose bodily life is merely an instrumental good, a good for persons [who are consciously experiencing subjects]. When this life becomes burdensome, it is for them no longer of value; it is rather a burden that the experiencing subject is free to set aside.

… Life is regarded as a good or bad hotel, which must not be too bad to be worth staying in.

… Dr. Leo Alexander, who took part in the Nuremberg trials after World War II, said, “… Whatever proportions these [culture-of-death war] crimes [of the Nazis] finally assumed, it became evident that they … started from small beginnings… It started with the acceptance that… there is such a thing as a life not worthy to be lived.”

Except from Catholic Bioethics and the Gift of Human Life, Third Edition, by William E. May. Published by Our Sunday Visitor (2013), www.osv.com. Used by permission.

The late DR. WILLIAM E. MAY (d. 2014) was an internationally known theologian and winner of the Paul Ramsey award for outstanding contributions to bioethics from the Center for Bioethics and Culture. He served as professor of moral theology at John Paul II Institute for Studies on Marriage and Family at the Catholic University of America.

Catechism 101

Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable.

Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded. Catechism of the Catholic Church.”

Catechism of the Catholic Church, #2277

VSED: A serious threat to the Culture of Life

Over the last several years, Right-to-Die advocates have been increasingly advocating a practice known as “VSED” — which is harmful not only to vulnerable persons, but to health care professionals and to society. If you haven’t heard of VSED yet, you soon will. You may find that VSED will affect you, your loved ones, or Catholic clinicians in ways that you did not anticipate.

John F. Brehany, Ph.D., S.T.L

Origins. VSED is an acronym for “voluntarily stopping eating and drinking,” whereby a person refuses all food and fluid and dies within days as a result. The practice was first popularized in a 1994 article in the Journal of the American Medical Association by David Eddy, MD, who described how he helped his 85-year-old mother to die a peaceful death by VSED when she tired of life (i.e., she was not suffering from a terminal illness). The article was immediately praised by the editor of JAMA as “the most important article published in the last 50 years … legal, ethical, moral and loving.”

“Right to die” advocates quickly seized on VSED as an alternative to physician-assisted suicide, which at that time was legal only in Oregon. But support has continued to grow. In 2016, a conference on VSED in Seattle, Wash., drew over 200 advocates in law, medicine, and ethics. The New York Times and The Washington Post ran articles characterizing VSED as a justifiable exercise of autonomy.

Is VSED ethical? Advocates justify VSED on several grounds — that the decision is autonomous (freely chosen by a competent person), not illegal, consistent with our rights to refuse medical and non-medical interventions, and doesn’t involve another person (such as a physician) or a lethal act (by drugs or by lethal injection). These considerations, however, do not address the ethical principles which reason and our Catholic faith have identified as essential in such a matter.

First, VSED requires a determined will to begin and sustain a pattern of behavior that will cause one’s death. This is the very nature of suicide. Second, the Church teaches, based on a moral tradition that stretches back to the Fathers of the Church, that we have an obligation to use ordinary means to conserve our lives and those of the vulnerable. In the case of health care, this means medicines and procedures which are effective and do not involve grave burdens.

Pope Pius XII formalized this moral tradition in 1957. It was confirmed by the Congregation for the Doctrine of the Faith in 1980 (Declaration on Euthanasia) and again in 2007, when the CDF ruled that providing nutrition and hydration — even assisted nutrition and hydration — should be considered in principle ordinary treatment and care of a human person.

To deliberately refuse food and fluids outside the process of dying (when the body naturally begins to shut down, the desire and need for food and fluid recedes) constitutes a failure to respect the gift of human life in our role as stewards, not owners, of our earthly lives.

Implications for others, clinicians, and society. VSED is a tragic and unethical course of action for an individual. But what does it have to do with others and society? First, death by dehydration is very painful and unpleasant. For most, it can be borne only with professional and personal support. In short, to have a “controlled, dignified death” by VSED, people need medical professionals to provide morphine and symptom management — and to refrain from providing water and food if requested, since patients sometimes call out for them in the process. Health care professionals and institutions are increasingly being asked to go along with VSED and to provide the support needed.

Beyond this unethical cooperation, however, other legal and professional challenges are looming. Recently some families have demanded that nursing homes stop feeding incompetent senile patients by hand (even when patients willingly accept food), since the patient expressed wishes in the past that they would not want life-sustaining treatment or to live “that way.” Legal experts and bioethicists are beginning to argue for a legal expectation that handfeeding be withheld based on advance directives.

We should accompany the elderly through illness and dying by providing the most basic forms of treatment and care, and we should not abandon our ethical standards — or legal and cultural protections — in the name of autonomy or for the latest trends in bioethics.

JOHN F. BREHANY, PH.D., STL, is director of institutional relations at the National Catholic Bioethics Center.

Canada goes MAD for euthanasia

When the Supreme Court of Canada overturned the country’s assisted suicide law last year, it didn’t take long for its implications to become apparent.

Archbishop J. Michael Miller, CSB

The court ruled that it was unconstitutional to deny the “right” to assisted death to persons with serious and incurable illnesses. A little more than a year later, legal medically assisted suicide arrived in Canada for adults suffering from a grievous and irremediable medical condition.

Pressure immediately mounted for the law to include youth and the mentally ill. Many euthanasia advocates want to compel physicians, nurses and other health-care workers to participate or, at the very least, provide “effective referral” to a doctor willing to provide euthanasia.

Furthermore, despite the fact that no Canadian hospital is able to provide every available medical procedure, there are demands for all hospitals (especially Catholic ones) to commit to making “medically assisted dying” available — including in palliative care wards — or lose their government funding.

In some ways, Canada has gone MAD for Medically Assisted Dying.

Palliative care doctors are now worried euthanasia will take place in the very beds where patients should be receiving compassionate care. The Canadian Medical Association, which opposes forcing doctors to participate in euthanasia against their consciences, was disappointed that conscience protection wasn’t included in the federal law. As a result, some physicians are preparing to retire, give up their practices, or move to the United States to avoid coercion.

Since healthcare delivery is a provincial responsibility in Canada, it’s now up to local conscience protection advocates to speak out. The Archdiocese of Vancouver recently wrote a letter to all the hospitals and Catholic health-care institutions in its jurisdiction, outlining why we oppose assisted suicide and asserting the right of health-care workers and institutions not to be coerced to participate. In addition to euthanasia, the letter deals with the withdrawal of treatment, as well as the requirement to provide nutrition and hydration.

Alberta’s bishops have also released a document to guide priests, deacons and pastoral workers in caring for individuals and families, focusing on spiritual and sacramental considerations in caring for individuals and families who may be considering death by these means.

Meanwhile, a regulatory patchwork has developed across Canada as provincial governments introduce varying guidelines for assisted suicide. Some, like Ontario and Nova Scotia, are more aggressive, requiring objecting physicians to at least provide “effective referral” to a doctor willing to end the patient’s life. The situation is more uncertain in other provinces like Quebec, which requires doctors to refer patients to a third party, who then refers the patient to a doctor who will help kill them.

No other country requires such a violation of conscience, and at least one lawsuit is already challenging draconian provincial requirements. The Archdiocese of Vancouver is a member of the Coalition for HealthCARE and Conscience, which is taking the College of Physicians and Surgeons of Ontario (CSPO) to court over its assisted suicide policy requiring doctors to refer patients to someone willing to provide euthanasia.

Fortunately, some provincial governments have been more restrained. In British Columbia, there is no obligation for doctors to participate, and calls to force Catholic hospitals to provide euthanasia have gone unheeded.

The code of ethics for the College of Pharmacists of British Columbia offers even more protection, stating that pharmacists are not required to provide drugs or services that are contrary to their sincerely held conscientious or religious beliefs.

We will continue to work with our partners in ministry and health care to establish guidelines that protect patients and health-care workers from abuses of the new law, since these abuses have resulted in every region around the world where such legislation has been introduced.

As more jurisdictions find themselves grappling with the euthanasia question, I urge the faithful — particularly those in the health field — to speak out and assert their rights to freedom of conscience. As we continue to minister and provide compassionate care and the sacraments to the dying, it is of critical importance that zealous euthanasia supporters don’t have the final word and thereby force healers to be complicit in killing — or to abandon health care altogether.

ARCHBISHOP J. MICHAEL MILLER is the chaplain of Legatus’ Vancouver Chapter. He is the chief shepherd of the Archdiocese of Vancouver, Canada.

Ready, set, kill

Tom Crean has been fighting greed, corruption and the Culture of Death in Canada for decades.

crean-crean

Tom Crean

A member of Legatus’ Vancouver Chapter, Crean and other pro-life activists are sounding the alarm as Canada’s parliament, responding to a Supreme Court ruling last year, is poised to legalize euthanasia and assisted suicide.

“Are we actually going to empower the state to make it legal to kill people? To make it legal for our kids to kill us? This is the point my country has gotten to,” said Crean, whose family for three generations has owned Kearney Funeral Services in Vancouver.

Death care

From his perspective in the “death care profession,” Crean said he has seen Canadian society become desensitized to, even being in denial of, death. Many now consider death to be an inconvenience when it touches their lives — even when relatives become sick or infirm, he said.

The gravity of the situation facing Canada is part of the reason why Crean has a strong interest in media education and getting the word out to citizens and members of parliament as to why they should be concerned about the latest threat to life.

crean-1“The government’s worst nightmare is an intelligent citizen, just as a corporation’s worst nightmare is an intelligent consumer,” Crean said. “We the people need to understand that to provide a future for our kids, it’s going to be in total opposition to the powers that exist, not in cooperation with them.”

In February 2015, the Supreme Court of Canada issued a 9-0 decision to remove all restrictions on state-sanctioned suicide, ruling that the previous prohibition violated the country’s Charter of Rights and Freedoms, which makes up the first portion of Canada’s Constitution.

The high court ordered parliament to pass a new law by June 5 liberalizing assisted suicide and making an accommodation for euthanasia when someone is unable to self-administer the lethal dose or injection.

In February, a special parliamentary committee delivered a report with 21 recommendations to reform the law. The report included some troubling recommendations, such as permitting euthanasia for children and those with mental illness. The report also stated that all medical professionals have a legal obligation either to provide “medical assistance in dying” or to refer a patient to someone who will help end their lives.

On April 14, Prime Minister Justin Trudeau’s government unveiled Bill C-14, legislation that would amend the country’s criminal code to permit euthanasia and assisted suicide. While considered to be more moderate than the committee report, the bill would still create a regime that critics say will pave the way for wide-open euthanasia.

Alarm bells

“At a time when our priority should be fostering a culture of love and enhancing resources for those suffering and facing death, assisted suicide leads us down a dark path,” Cardinal Thomas Collins, the archbishop of Toronto, said in a statement. He encouraged all those troubled by the prospect of assisted suicide to contact their members of parliament.

“At first sight, it may seem an attractive option, a quick and merciful escape from the suffering that can be experienced in life, but fuller reflection reveals its grim implications — not only for the individual but for our society and especially for those who are most vulnerable.”

Jim Hughes

Jim Hughes

However, that message has not gotten through the vast majority of Canadian citizens, said Jim Hughes, president of Campaign Life Coalition, Canada’s oldest and largest pro-life organization.

“Everybody I talk to says, ‘This can’t be happening here,’ but the problem is that 99% of the people are still ignorant of what all this means,” said Hughes, an At-Large member of Legatus.

Hughes, considered by many to be the father of Canada’s pro-life movement, said fighting against the Culture of Death’s advances in Canada is as like repeatedly “getting kicked in the stomach,” adding that even Supreme Court justices appointed by conservative prime ministers have turned out to be activist judges.

In 1988, the Canada’s Supreme Court effectively removed all restrictions on abortion when it struck down a 1969 law that first liberalized Canadian abortion laws. The ruling made Canada one of a small number of countries without a law restricting abortion, treating it like any other medical procedure.

Hughes said Bill C-14 is “so loosely worded, it’s ridiculous.” He said the law would open the door for widespread euthanasia and has no conscience protections for Catholic and other religiously affiliated medical facilities and physicians.

“People in the United States need to be informed on these issues before it’s too late and they’re ramming it down your throats there,” Hughes said.

Cover for murder

Alex Schadenberg

Alex Schadenberg

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, which is based in London, Ontario, said the movement to legalize euthanasia in Canada has turned the concept of mercy upside down.

“It’s now considered merciful for me to kill you,” Schadenberg said. “Compassion is a lethal injection. That is a very dangerous concept.”

Schadenberg said Bill C-14 mirrors other countries’ assisted suicide regimes in that the law lacks adequate oversight. No government representatives or neutral third parties are required to monitor whether a patient has a “serious or incurable illness” that has brought them “enduring physical or psychological suffering.”

In fact, Schadenberg said, the law even permits anyone — not just a physician or nurse practitioner — to carry out the act.

“The bill provides a perfect cover for acts of murder,” Schadenberg said. “It shows you just how bad my country is going.”

Crean has seen that trend since the late 1970s when he started building an interfaith alliance to stop a large funeral home conglomerate from acquiring Vancouver’s only public cemetery. He helped organize dozens of different churches and ethnic groups that marched on city hall and declared that their heritage was not for sale.

“And the most astonishing thing happened,” Crean said. “We won.”

In 1978, at age 21, Crean took the helm of the family business, which his grandfather, Thomas James Kearney, started more than 100 years ago. Kearney Funeral Services has since been able to operate and thrive in Greater Vancouver where large conglomerates control much of the industry.

Crean said he is committed to fighting the Culture of Death in the trenches, adding that he’s involved in initiatives to build hospice and medical facilities — and to establish a cooperative community cemetery that he said will revolutionize the death care profession.

“The great thing about a journey of faith,” Crean said, “is that you don’t always have an idea of where you’re going.”

BRIAN FRAGA is a Legatus magazine staff writer.

Learn more: kearneyfs.com
campaignlifecoalition.com
epcc.ca

Killing California

California’s pro-life community has pledged to continue its fight against the state’s new physician-assisted suicide law, which takes effect on June 9.

After falling short on a referendum campaign to overturn the law, efforts will focus mainly on education — although legislative and judicial remedies also are being considered, according to Michael Caspino, president of Legatus’ Orange Canyons Chapter and chairman of the Coalition Against Assisted Suicide.

Legal challenges

Bishop Jaime Soto, president of the California Catholic Conference, told Legatus magazine the state’s bishops would like to partner with Catholic hospitals to help people understand why the new law is a mistake. The bishops also launched a website and have been holding workshops.

“We have a lot to do — particularly in this Year of Mercy — to convey how God’s mercy helps us all to approach death and dying as good disciples of the Lord Jesus,” he explained. “It’s one thing for us as pastors to convey to Catholics the values of the Gospel given to us by the Lord Jesus. The other is to persuade Catholics of the importance of bringing those values into the public square.”

Pro-life advocates made an effort to challenge California’s End of Life Option Act — signed by Gov. Jerry Brown last October — but had just 90 days to collect 366,000 valid signatures. The effort garnered roughly 250,000 signatures.

“We may have fallen short this time,” Caspino said, “but we put a solid statement out there that we’re serious, and the bishops are serious, and we’re going to continue fighting this law.”

Among the pro-life community’s options are a ballot initiative to amend the state constitution and a legal challenge. Like the referendum, the constitutional amendment would require 366,000 valid signatures, but the coalition would have six months to collect them, Caspino said.

A potential lawsuit would challenge the manner in which the measure was approved as well as whether the state has the right under the state constitution to dictate such a regulation, he added.

Coalition support

Michael Caspino

Michael Caspino

A diverse coalition of California’s bishops and disability, senior, medical and pro-life groups have, from the outset, opposed the law which allows doctors to prescribe life-ending drugs for terminal patients with six months to live.

Megan Schirle, community partner with the Disability Rights Education & Defense Fund blasted the new law as “so flawed that they put at risk society’s most vulnerable populations.”

Among the group’s primary concerns is that the law contains no requirement for psychological evaluation, psycho-social assessment, or counseling for those seeking physician-assisted suicide. A person seeking to end his or her life because of a terminal diagnosis or prognosis could benefit from treatment, care and social support, she said, adding that many people have survived and thrived well beyond terminal diagnoses or prognoses.

“Depression, fear of becoming dependent, isolated or a burden — all these can occur following any major diagnosis — and they are all treatable,” Schirle said. Under the California law (modeled after Oregon’s Death With Dignity Act), however, “people with depression and other mental illness are neither adequately screened, nor given the care they need when they most need it.”

Marie Hilliard, director of bioethics and public policy for the National Catholic Bioethics Center, agreed. In Oregon, one of only five states allowing assisted suicide, out of 859 physician-assisted suicide deaths between 1998 and 2014, only 47 were referred for psychological evaluation.

“People will say you have to alleviate even psychological suffering,” she explained. “To kill the sufferer seems to be the remedy even before doing an evaluation to see what’s going on. When you treat pain and depression, the request [for physician-assisted suicide] goes away, so clearly what we’re seeing is the remedy to address suffering is to kill the sufferer.”

The slippery slope

Bishop Jaime Soto

Bishop Soto said people who support assisted suicide often do so out of a misconstrued perception of liberty — or out of a hesitancy to interfere or offer their own values for another’s benefit. This reluctance to share values, he said, is a misconstrued form of compassion.

“In many cases, it’s becoming a nice way of being indifferent.”

A look at countries and U.S. states that have legalized assisted-suicide laws shows the potential for massive abuse, which pro-life advocates say is taking place behind the statistics.

In 2014, 126 people reportedly died by assisted suicide in Washington State — up by 6% from 119 assisted suicide deaths in 2013 and a 43% increase from in 2012. According to the state’s annual report, doctors wrote 176 lethal prescriptions resulting in 126 assisted suicide deaths, 17 deaths from other causes, 27 deaths from an unknown cause and six people remain alive.

In the Netherlands, up to 23% of the assisted deaths are not reported. In Belgium the percentage of unreported assisted deaths is even higher. Thus, it would not be surprising if 20% of the assisted suicide deaths in Washington State are not reported.

A bill is currently under consideration in New York, but efforts to pass similar measures have failed in Connecticut, New Jersey, Massachusetts, Maryland and Colorado. Internationally, assisted suicide is legal in Switzerland, Colombia, The Netherlands, Belgium, and Canada (Quebec).

Hilliard believes that in the U.S., the Brittany Maynard case generated great sympathy for assisted-suicide initiatives. Maynard, a 29-year-old Californian with terminal brain cancer, moved to Oregon in 2014 so she could end her life under that state’s assisted-suicide law.

Assisted-suicide legislation, Hilliard said, is also fueled by contemporary society’s desire for a perfect life — and now a “perfect death” without suffering.

But assisted suicide in other countries has led to a “duty to die” and a slippery slope to more extreme measures. For example, in The Netherlands, Schirle said, doctor-assisted suicide has morphed into involuntary euthanasia for many elderly and disabled people deemed unable to give consent.

The Netherlands allows voluntary euthanasia for children over 12. Although infant euthanasia is technically illegal, charges are not filed where there is “hopeless and unbearable suffering” and, among other things, parental consent.

“In the U.S.,” Schirle said, “we already have legal rights regarding our end-of-life care —including good pain relief and palliative sedation if dying in pain. We should ensure people’s access to these before enacting a law that, while purporting to promote ‘choice’ for the individual, can potentially rob that choice from so many.”

Click on the graphs for larger images.

JUDY ROBERTS is a Legatus magazine staff writer.

Learn more: CaCatholic.org/embracing-our-dying

 

The clear and present danger of medical martyrdom

Will Catholic doctors who subscribe to the Church’s moral teaching against assisted suicide and abortion ever be forced to take human life? Until recently, such a prospect was unthinkable.

smithIf trends continue, Catholic and other sanctity-of-life-believing doctors will be forced to choose between violating the Sixth Commandment and continuing in good stead in their chosen profession. I call this threat “medical martyrdom” — a potential authoritarianism that looms darkly in the coming decade because of two fundamental mutations in the ethics of medicine.

First, doctors don’t take the Hippocratic Oath anymore and haven’t for decades. The Oath’s ethical proscriptions against participating in abortion and assisted suicide cut against the contemporary moral grain, leading medical schools to dumb it down or dispose of it altogether. Second, “patients’ rights” have become the new mantra in health care where physicians are “service providers” and patients are, in essence, consumers. As such, many among the medical intelligentsia and in bioethics believe that the competent customer is entitled to virtually any legal procedure from “service providers.”

As a consequence, Hippocratic-believing professionals are pressured to practice medicine without regard to their personal faith or conscience beliefs. This moral intolerance is slowly being imbedded into law. In the U.S., such legal controversies have mostly swirled around. Elsewhere, the force of law has — or threatens to — force doctors to be complicit in abortion and euthanasia.

The first such law was passed several years ago in Victoria, Australia, where the local law requires all doctors to perform — or be complicit in — abortion: If a patient requests a legal termination and the doctor has moral qualms, the dissenting physician is required to find a doctor on behalf of the patient known to be willing to do the deed.

Canada is heading rapidly in the same direction regarding euthanasia. Quebec legalized doctor-administered death last year and allows no conscience exemptions. When palliative care centers and hospices balked, the Minister of Health called such resistance “inappropriate and unfortunate” because doctors must “adapt to the patient,” warning darkly that euthanasia “will be offered.”

Meanwhile, Canada’s Supreme Court just legalized euthanasia for those with a diagnosable medical condition that causes “irremediable suffering,” including “psychological pain.” Recognizing that some doctors will have moral qualms about “terminating life,” the Court gave Parliament 12 months to pass enabling legislation, stating that “the rights of patients and physicians will need to be reconciled” by law or left “in the hands of physicians’ colleges.”

That doesn’t bode well for medical conscience rights. Canada’s medical associations have low regard for conscientious objectors. Saskatchewan’s College of Physicians and Surgeons recently published a draft ethics policy that would force doctors to provide “legally permissible and publicly funded health services” — which now include euthanasia as well as abortion — to “make a timely referral to another health provider who is willing and able to … provide the service.” If no other doctor can be found, the dissenting physician will have to do the deed personally, “even in circumstances where the provision of health services conflicts with physicians’ deeply held and considered moral or religious beliefs.” Meanwhile, 79% of Canadian Medical Association delegates at a recent convention voted against a motion that would have supported conscience exemptions from participating in euthanasia.

U.S. doctors cannot be forced to participate in abortion and assisted suicide (in the jurisdictions where it is legal). But these professional safeguards are generally opposed by the medical establishment — at least as they apply to abortion. The American College of Obstetricians and Gynecologists (ACOG) published an ethics-committee opinion in 2007 strikingly similar to the Saskatchewan College’s:

“Conscientious refusals should be limited if they constitute an imposition of religious and moral beliefs on patients. Physicians and other health care providers have the duty to refer patients in a timely manner to other providers if they do not feel they can in conscience provide the standard reproductive services that patients request.”

If these trends continue, 20 years from now, those who feel called to a career in health care will face an agonizing dilemma: Either participate in acts of killing or stay out of medicine. Those who stay true to their consciences will be forced into the painful sacrifice of embracing martyrdom for their faith.

WESLEY J. SMITH is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and a consultant to the Patients Rights Council. He received Legatus’ 2014 Cardinal O’Connor Pro-Life Award for his work against assisted suicide.

What does the Church say about end-of-life issues?

The Church offers solid principles regarding end-of-life issues, but it’s not always easy to apply those principles to particular situations. Let me review the principles, and then reflect on how they might apply to someone’s final days.

Fr. John Bartunek

Fr. John Bartunek

Because each of us is created in God’s image and invited to everlasting friendship with Him, human life is sacred. Therefore it’s never justified to directly will or cause the death of an innocent person. To defend sacred human life, the Church has always taught that abortion and euthanasia are morally wrong, just as wrong as any other form of murder.

Nevertheless, in this fallen world, death is inevitable. When it becomes clear that someone is dying, we do not have a moral obligation to do everything possible to extend a life as long as possible. Now, in some cases, there may be a particular reason why we would indeed want to keep someone alive. For example, take the case of a father and son who have been estranged and live on different sides of the globe. The father is facing heart failure, and doctors agree that intervention would most likely be useless, though some extreme measures may keep him alive for a few days or weeks. They may request that those extreme measures be taken so that the son has time to travel in hope of a final reconciliation. That family may decide to use aggressive treatments, whereas a family already at peace may not. Each would be justified.

Accepting the inevitable, however, does not mean abandoning a dying person or hastening their death. Therefore, if someone is dying, it would be immoral to willingly deny them the fundamental necessities that we owe to every human being: shelter, clothing, basic nutrition, and hydration. In many cases, as a person is dying, their system will no longer accept nutrition and hydration. If that’s the case, it would most often be futile and disproportionate to try and force-feed them.

In some cases, the dying process is so painful that the amount or type of palliative medicine required to relieve the pain may actually hasten the death. Nevertheless, such palliative care is acceptable (indeed, even an expression of love) if the person truly is dying.

Again, however, if the dying person wants to remain alert in order to converse with family members, for example, they may choose to forego pain relievers.

Those are the basic principles: the sacredness of human life, the inevitability of death, the moral duty to provide basic necessities, when possible, but not to provide futile or disproportionate treatments.

FR. JOHN BARTUNEK, LC, is a former professional actor who became a Catholic priest in 2003. This column is printed with permission from his book “Answers: Catholic Advice for Your Spiritual Questions” (Servant Books, 2014).

Catechism 101

Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is refusal of “overzealous” treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decision should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient whose reasonable will and legitimate interests must always be respected.

Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable.

Catechism of the Catholic Church, #2278-2279