Tag Archives: John Brehany

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.

CRISPR: A new challenge to the Culture of Life?

The journal Science named “CRISPR” the “breakthrough of the year” for 2015. What is CRISPR, and what challenges could it pose to building a Culture of Life?

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

“CRISPR” is an acronym for a new biotech tool scientists developed in 2012-2013 by harnessing two features that Strep bacteria use to fight viruses: first, an ability to reliably identify specific strands of DNA, and second, an ability to use enzymes to cut such strands at precise points. CRISPR is the most powerful gene editing tool yet, theoretically able to accurately identify, cut, and replace more than one gene at a time in DNA — including human DNA.

Over 30 years ago, in developing ethical and procedural proposals to begin genetic engineering, scientists distinguished between using genetic engineering for therapy and for enhancing human traits. An additional distinction was drawn between inducing genetic changes in individuals (somatic cell) and creating genetic changes that could be passed down to future generations (germ line). Somatic cell gene therapy was widely embraced in principle — including by Pope St. John Paul II in 1983 — while germ line genetic engineering was outlawed by a number of countries and taken off the table in the United States.

Yet few human diseases have been successfully treated with somatic cell gene therapy, in part due to the challenge of delivering replacement genes with precision. Scientists tried everything from disabled retroviruses to “gene guns” shooting gold particles coated with DNA. Now CRISPR appears to overcome this hurdle — well enough, some argue, to safely introduce changes into the human germ line.

Indeed, CRISPR hit the headlines in early 2015 when Chinese researchers tested it on human embryos. While many in the scientific community greeted news of this unethical experiment with angst and even outrage, influential scientists, journals, and bioethicists called for additional research and discussion.

Last December, the National Academies of Science of the U.S., the U.K., and China held a summit about CRISPR in Washington, D.C. Their closing statement favored use of CRISPR in somatic cell therapies and research into human germ line applications, but stopped short of endorsing clinical applications to the human germ line — for the time being. Meanwhile, CRISPR’s impact is being felt outside of laboratories and conferences. I met late last fall with a financial analyst who told me that CRISPR was the hot new topic at venture capital meetings.

Catholics are called to be leaven, salt, and light in a fallen world. Catholics can and should be leaders in the ethical debate and the scientific development of CRISPR. If indeed practical (reliability and safety) obstacles to significant genetic engineering are soon to be overcome, it’s more important than ever to be clear on issues of principle.

Some issues of principle are clear. The potential abuse of technology does not rule out legitimate use — and there are clear ethical and practical uses of CRISPR. For example, it can be used to quickly create lab animals to study diseases, to control rather than change genes (for example, to “turn on” some genes to grow heart muscles after a heart attack), and to enhance the effectiveness of ethical stem-cell therapies.

Some moral harms are clearly and widely rejected. Eugenics is almost universally condemned, as is employing technology to exacerbate social disparities. And Catholics should faithfully apply John Paul II’s clear teachings regarding respect for the dignity of every human life (including at the embryonic stage) in research and treatment.

However, some ethical issues raised by CRISPR have not yet been comprehensively examined or defined by the Church. What if gene editing or control can be used to promote human health in new or better ways, for example, by replacing vaccines in providing immunity? Questions like these require new and careful discernment.

Finally, Catholics need to bring an enhanced level of prudence to respond to the enhanced powers this new technology provides. There is no doubt that CRISPR will fuel substantial personal and cultural temptations. It’s being celebrated as a scientific game-changer. Some scientists will be tempted to fight against limits on their work, and ordinary people will be tempted to use technology to meet deeply felt human needs or to advance their children with the continuous growth of the reproductive technology industry.

Catholics need to be aware of what CRISPR is and how it can affect science and society. We should encourage greater regulation of research, particularly research on human embryos. We should also renew our efforts to form students in the Church’s moral vision of the human person, science and society.

JOHN F. BREHANY, PH.D., S.T.L. is the National Catholic Bioethics Center’s director of institutional relations.

ObamaCare five years later

JOHN BREHANY writes that Catholic business leaders are still burdened by ObamaCare . . .

John F. Brehany

John Brehany

by John Brehany

The Patient Protection and Affordable Care Act (aka ObamaCare) is five years old. Legatus members should continue to learn about and respond to this flawed legislation.

Where do we stand at this point? It’s hard to say. The Administration has not provided regular and reliable data about implementation. And the Galen Institute has identified 49 significant changes in ObamaCare (30 by unilateral executive action) since 2010. Most have involved delays or waivers of mandates, deadlines and fees. Another significant change — providing federal subsidies in states without insurance exchanges — is under review by the Supreme Court.

After these caveats, it’s clear that there has been some progress in providing access to health insurance. In 2014, a total of 14 million people obtained new access to health insurance (5.8 million bought health insurance and 8.7 million were added to Medicaid). The net increase, however, was closer to 10 million due to millions losing their employment or private insurance. Significantly, only half of those buying insurance at Healthcare.gov were uninsured, and only one-third of those eligible for subsidies signed up. This lack of participation should be concerning. In 2014, health insurance premiums increased an average of 49% despite President Obama’s pledge that families would see an average $2,500 reduction in annual health insurance premiums. For now these increases are being masked by subsidies.

What will we be facing? The real impact of ObamaCare will be felt in the next few years. First, the employer mandate is set to be enforced in 2016. Employers have already cut employee hours and reduced benefits, and this trend is likely to continue. The disruption in employment-based health insurance could be greater than that in the individual market in 2013. Second, the full costs of ObamaCare will become more apparent in 2017. The Administration has been tapping a $25 billion reinsurance fund to backstop health insurance companies’ losses, allowing them to keep premiums artificially low. After this fund expires at the end of 2016 and insurance companies gain claims experience with the newly insured — who are older, sicker, and poorer than originally projected — on Healthcare.gov, costs almost certainly will be much higher.

What should we do? Catholics and Catholic business leaders in particular should play a key role in proposing and enacting substantive changes to the current law as soon as the window for action opens — after a new president takes office. The Catechism teaches: “It’s not the role of the pastors of the Church to intervene directly in the political structuring and organization of social life. This task is part of the vocation of the lay faithful, acting on their own initiative with their fellow citizens” (#2442).

While being cognizant of key data and of the rules for effective political discourse, Catholic business leaders should make a compelling and comprehensive moral case for substantial changes in ObamaCare that will achieve authentic health care reform and protect essential human goods. I suggest there are at least three indispensable components of this moral case.

First, a moral case should be built on the foundation of Catholic social teachings, especially the principles of social justice and subsidiarity. We respect social justice (CCC #1928) when we ensure that the vulnerable and marginalized have access to adequate health insurance and health care. We respect the principle of subsidiarity (CCC #1883) when we ensure that decisions about health insurance and health care are made at the lowest, most local level.

Second, a moral case should be built on the dignity of the human person and on respect for fundamental human goods — above all, respect for the right to life, of conscience, and of religious freedom. ObamaCare’s sloppily written legislative language undermines longstanding protections for these rights in federal and state law. And the HHS mandate has been imposed with disregard for the religious beliefs of millions.

Third, a moral case can and should build on the strengths of the American social tradition. These strengths go beyond broad human freedom and decentralized governance to include high levels of generosity across the population. America is the most generous nation on earth. Philanthropy has been essential to building the finest and most advanced health care institutions. Legislation and taxes are necessary to protect human rights and the common good. Yet, where the welfare state is strongest, generosity of philanthropy dedicated to serving those in need is the weakest. Sound political and economic measures for health care reform should be supplemented by encouraging philanthropy.

JOHN BREHANY is the director of institutional relations at the National Catholic Bioethics Center.