FAUSTO GOMEZ OP
A doctor writes: My younger brother John is suffering terribly due to a terminal brain cancer. He is asking me: “Please, let me go.” Watching him suffer so much, I am inclined to help him end his life.”
I wish to share with you dear readers some thoughts on euthanasia and assisted suicide.
MEANING OF EUTHANASIA
There are different definitions of euthanasia. Etymologically, euthanasia means “good or happy death.” From a humanist and Christian perspective, we define euthanasia as “An action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated” (Vatican Congregation for the Doctrine of Faith; cf. CCC, no. 2277). Euthanasia, or direct killing, includes then a positive act (giving an overdose of painkillers) or an omission of obligatory treatment (a failure to feed). The writer speaks of euthanasia as direct or procured euthanasia that intends the death of a suffering patient.
A helpful and important distinction of euthanasia refers to the presence or absence of freedom on the part of the suffering patient: voluntary euthanasia, when the competent patient asks for it; involuntary euthanasia, when others choose death for the patient against his will, and non-voluntary euthanasia, when the stand of the patient is not known – the case of children and those mentally disable – and surrogate decision makers or the courts impose it on him.
Objectively speaking, voluntary euthanasia (or self-killing) is suicide, while involuntary euthanasia (killing imposed on suffering patients by others) is cooperation in evil.
Connected with euthanasia is physician assisted suicide (PAS), that is, when a physician assists a gravely suffering patient by providing him with the instruments (terminal sedation with the purpose of ending his life) the patient needs to terminate his life.
IN FAVOR OF EUTHANASIA AND ASSISTED SUICIDE?
Unfortunately, the movement in favor of euthanasia is growing throughout the world, particularly in countries of the so West. The growing campaign for the legalization of euthanasia worldwide appears to be grounded on individualism (“I choose how to live and how to die,” a physically disable patient said recently); on hedonism (“suffering is useless”); on relativism (“truth is relative and morality situational”); and utilitarianism (“the terminally ill may feel or be considered by others a useless burden”).
The basic ethical principle of autonomy is generally used to defend and promote euthanasia and assisted suicide in our world. The recourse to voluntary euthanasia – we are told – is an expression of individual autonomy and as a right to a dignified death.
Some authors and terminal patients defend the “right to die.”
Who can stop the “slippery slope” that is devaluing life in our secular world? With many other men and women – promoters of the culture of life -, we try to change the tide. “Yes, together we can!”
Fortunately, there is also today a growing movement among believers and many others in favor of life and against the culture of death, including euthanasia and assisted suicide. We strongly believe in God’s Providence and grace.
AGAINST EUTHANASIA AND ASSISTED SUICIDE
In the Bible, God tells us: “Thou shall not kill” (Ex 20:13). As God’s creatures and children, we are custodians or administrators of our life under God, who is the Lord of life and death. For religious people, including Christians, human life is sacred, that is, “precious,” “holy,” “worthy of reverence.” The life of every person is sacred because he or she comes from God.
With all due respect, we affirm that euthanasia cannot be considered a dignified death, but Intentional killing, which entails a lack of true respect of human dignity and rights. It is against the fundamental right to life of every human being. Every human being has the right to life from the moment of conception to the moment of natural death.
As human beings and as Christians, we defend and promote a consistent life-ethics: human life is like a seamless garment that ought to be respected at the beginning (against abortion) and at the end (against homicide, suicide and euthanasia – also against the death penalty). Vatican II says that euthanasia is one of the “infamies” of our time, and “a grave violation of God’s law.” St. John Paul II writes: “The right to life means the right to be born and then continue to live until one’s natural end.” Pope Francis keeps repeating that euthanasia and assisted suicide are evil manifestations of a “throw away culture.”
How may we speak of the right to die? As human creatures, we all have to die; we are mortal human beings. For each one of us, there is a time to be born, a time to live, and a time to die (cf. Eccl 3:2). There can be no right to die: killing is wrong, whether one does it (suicide), or others do it (homicide, abortion), or one does it with the help of others (assisted suicide). We decry the anti-life campaign which, based on a pragmatic and immoral notion of “quality of life,” appears to view some elderly persons, the handicapped and the vulnerable members of society as useless burdens to a family, a community, a nation: “How could they not feel guilty for still being here, for costing so much, and for being so useless? That is a market mentality that leads to death” (Eric Fuchs).
Regarding the argument of the autonomy of the patient, we may ask, what kind of autonomy may a deeply suffering patient have? As has been said, how may a patient use his autonomy to end with his life – and with his autonomy? More than patient autonomy, it might be a question of paternalism or eve manipulation of the patient by those others – be scientists, bioethicists, politicians and/or healthcare professionals – or at times a family member.
The human person is not only free but also responsible, that is, he or she is autonomous and relational. His or her life is linked to others in solidarity. Every person belongs to a family, a community, a nation, the world. We remember an adult man who wanted to jump from a tenth floor of a condominium. He was using the phone. Someone shouted to him: “Remember you have a lovely daughter.” Love convinced him not to jump. Individualism? “No man is an island.”
EUTHANASIA: FALSE COMPASSION
Euthanasia is also called “mercy killing.” May helping others commit suicide be merciful? Formal cooperation in suicide cannot be considered an act of genuine but of “misplaced compassion,” or “false mercy.” True compassion is a quality of genuine love – of love of neighbor. “True compassion leads to sharing another’s pain; it does not kill the person whose suffering we cannot bear” (St. John Paul II).
Although not always, generally assisted suicide is carried out by healthcare providers, particularly nurses and doctors. Ethically speaking, Physician assisted suicide (PAS) implies immoral formal cooperation in suicide. The physicians are asked by their profession to promote life and health: they are healers! The doctors’ (and nurses) most radical duty to their patients is “primum non nocere,” that is, first of all, do not harm. Compassion, Pope Francis says, “is the soul of medicine.” When Catholic physicians, or others, are asked to assist in suicide, they ought to reject it, following their right to conscientious objection, which a universal human right – the right to follow personal conscience and/or the right to religious freedom.
Terminally ill patient John asks: “Please, let me go.” As a human being, as a Christian we are absolutely against euthanasia and assisted suicide. We are also united in compassionate and prayerful love with those who suffer, with the terminally ill patients, with John.
To the doctor we say: euthanasia is not an ethical but gravely unethical option – and un-Christian. But, indeed, we are compassionately with John and in solidarity with his family. Euthanasia – and assisted suicide – is not a moral answer to his terrible suffering from brain cancer. Certainly, there is for every human being a time to die, but not earlier through euthanasia and assisted suicide.
The doctor brother of John comments sadly: So my younger brother John continues suffering terribly! Just like that! Are there other options for him? Yes, doctor, there are. We shall continue our conversation next time.
(Published by O Clarim, Macau Catholic Weekly, May 26, 2017)
(READ) KILLING AND ALLOWING TO DIE: WHAT IS THE DIFFERENCE?
A reader asks: My cousin John is 48 years old. He is terminally ill with metastatic cancer and is suffering terribly. In this situation, what kind of “treatment” may healthcare professionals offer to John?
Doctors may have three possibilities to choose from, namely, euthanasia (or killing), dysthanasia (or prolonging dying), and orthothanasia (or allowing to die, with palliative care). A more important question is this: I any of the three possibilities ethical? treatment may John be given?
Indeed, end-of-life issues are focused today on these three main problems: killing, prolonging dying and allowing to die. On this occasion, I have been asked to consider with you the following question: What is the difference between killing and allowing to die?
On this occasion, I shall study first killing (or euthanasia), secondly prolonging dying, third allowing to die, and fourth palliative care. Let us begin our journey by reflecting on euthanasia. What is the meaning and morality of euthanasia?
In the middle of the night, a sleepy gynecology resident is called to attend Debbie, a young woman, who is dying of ovarian cancer. He is horrified by her severe distress (“It was a gallows scene,” he said later, “a cruel mockery of her youth and unfulfilled potential”). Her only words to him were: “Let’s get this over with.”1
1.1 MEANING OF EUTHANASIA
There are different definitions of euthanasia. Etymologically, euthanasia means “good or happy death.” From a humanist and Christian perspective, we define euthanasia as: “An action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated.”2 This point is substantially important: “If the aim is to bring about death, it is euthanasia, whether this is done by an omission (such as failure to feed or to cancel an order not to feed) or by a positive act.”3
Regarding euthanasia, the main distinction is between active (or direct) and passive (or indirect) euthanasia. (When we speak of euthanasia without adjectives, we understand it as real euthanasia, that is, active euthanasia.)
What is active euthanasia? It is “the directly willed inducement of death for merciful reasons;”4 the death of the suffering patient may be done by commission, a positive act (for instance, giving an overdose of painkillers), or by omission of obligatory means (e. gr., failure to feed).
What is passive euthanasia? It is allowing to die. Active euthanasia is procuring death, while passive euthanasia, or allowing to die, is “allowing death.”5 Therefore, for us there is no equivalence between active and passive euthanasia; there is really a profound moral difference.
Some authors describe passive euthanasia thus: “Passive euthanasia intends death by withholding (including withdrawing or refusing) available medical treatment or other care that clearly could enable a person to live significantly longer.”6 From a Catholic perspective, this description speaks not of passive but of active euthanasia: it is active euthanasia by omission of beneficial obligatory treatment and by even intending death.
Is “terminal sedation” passive euthanasia? In our understanding of passive euthanasia, it is not, but active euthanasia. Terminal sedation is described as “administering morphine in doses that are intended to hasten death.”
Another important distinction of euthanasia (meaning real euthanasia, that is, active, direct) refers to the presence or absence of freedom on the part of the patient. Thus, we speak of voluntary euthanasia, when the competent patient asks for it; and of involuntary euthanasia, when others choose death for the patient against his will. (There might also be non-voluntary euthanasia, that is when the stand of the patient is not known – the case of children and those like children – or presumed to be in favor of it, and surrogate decision makers or the courts impose it on him/her).
At present, euthanasia is legal in Holland and in Belgium, and in the states of Oregon and Washington, of the United States of America. There is a growing campaign for the legalization of euthanasia worldwide. This loud campaign appears to be grounded on individualism (“my life is mine”), hedonism (“suffering is useless”), relativism (“morality is plural and relative”); and utilitarianism (“the terminally ill may be useless burden”). Who can stop the “slippery slope” that is devaluing life in our secular world?
Assisted suicide is legal in Switzerland and Estonia. Assisted suicide is voluntary suicidal euthanasia (on the part of the patient) and homicidal euthanasia (on the part of the assisting person). (The case if Vincent Humbert, a 22 years-old Frenchman quadriplegic, whom his mother helped die in November 2003.)
1.2 MORALITY OF EUTHANASIA
The recourse to voluntary euthanasia is presented as an expression of individual autonomy and as a right to a dignified death; some speak even of a right to die!
The basic ethical principle of autonomy is generally used to defend and promote euthanasia in our world. But really, what kind of autonomy may a deeply suffering patient have? As has been said, how may a patient use his/her autonomy to end with his/her life – and with that autonomy? Under the appearance of patient autonomy “others” perhaps, including the social environment, persuade certain patients to end their lives. More than patient autonomy, it might be paternalism or even the manipulation of the patient by those others – be scientists, bioethicists, politicians and healthcare professionals.
Euthanasia (active, direct, intentional) is killing, one of the “infamies” of our time, and “a grave violation of the law of God.” And God said, “Thou shall not kill” (Ex 20:13). Human life is sacred, that is, “precious,” “holy,” “worthy of reverence”; all human life is sacred, and not only at a certain level of the so-called “quality of life,” which is discriminatory against the weak and vulnerable members of society.
Every human being has the right to life from the moment of conception to the moment of natural death. As human beings and as Christians, we defend and promote a consistent life ethics: human life is like a seamless garment that ought to be respected at the beginning (against abortion) and at the end (against homicide, suicide and euthanasia and also against the death penalty). In his popular book Crossing the Threshold of Hope, Pope John Paul II writes: “The right to life means the right to be born and then continue to live until one’s natural end.”7 (Does capital punishment respect this natural end? It does not!).
The right to life, however, is not an absolute right for the person, because he is a steward of life. Only God is the Lord of life and death. Objectively, therefore, not only involuntary euthanasia (others choose) is immoral; voluntary euthanasia (patient asks for it) is immoral, too. In 1985, the French Bishops wrote: “Active euthanasia, consisting in provoking directly the death of the sick person – including the laudable intention of removing his suffering – introduces us into a world where very soon it will not be possible to live.” Are we approaching this world?
How may we speak of a right to die? As human creatures, we all have to die; we are mortal human beings. As there is no “right to abortion,” there can be no right to die: killing is wrong, whether one does it (suicide), or others do it (homicide, abortion), or one does it with the help of others (assisted suicide).
Connected with voluntary euthanasia is Physician Assisted Suicide (PAS), that is, when a physician assists a gravely suffering patient by providing him/her with the instruments this patient needs to terminate his/her life. Ethically, PAS implies formal or immediate material cooperation in suicide. The fact that a physician invented the so-called “suicide machine” is really tragic; it is ironic that this machine’s name is Mercitron. (Dr. Jack Kevorkian is the physician, who once was asked: “What will happen after we die?” His answer: “We rot”). Let us face it: mercy killing (another name for euthanasia) is merciless. While respecting the conscience of those who are in favor on euthanasia – and loving them –, I add my voice to denounce the social campaign promoting euthanasia and physician-assisted suicide.
The doctors, in particular, are asked by their profession to promote life and health: they are the healers! How can patients (the whole wounded humanity) trust their doctors if they practice euthanasia or assist in suicide? The physician’s most radical duty to his/her patient is “primum non nocere,” that is, above all, do not harm. To kill is to harm. Killing cannot be considered a therapy, and, therefore, it cannot be a valid option for healthcare professionals. Cooperation in euthanasia, in killing, in suicide cannot be considered – as it is often done – an act of genuine but of “misplaced compassion,” or “false mercy.” It is “a sin that cries out to heaven for vengeance” and is “always gravely immoral.” True compassion is a quality of genuine love of neighbor. It means to be moved by the neighbor’s suffering and do something about it: “True compassion leads to sharing another’s pain; it does not kill the person whose suffering we cannot bear.”8 (On this point I disagree with Hans Jonas, who accepted the possibility of shortening, but never by a physician, the suffering –and life – of a dear one, out of “love.”)
True compassion, a quality of charity as love of neighbor, is totally opposed to assisted suicide. When physicians, or others, are asked to assist in suicide, they ought to appeal to their conscience and faith, and practice conscientious objection.
I am absolutely against euthanasia and assisted suicide, not only because I am a Christian, but also because I am a member of the human family. “Personal autonomy has as its first premise being alive and requires the responsibility of the individual, who is free in order to do good according to truth. He or she will come to affirm himself or herself, without contradiction, only in recognizing (even from a purely rational perspective) that he or she has received the gift of his or her life, of which, therefore, he or she cannot be the ‘absolute master’. To end life means in definite terms, to destroy the very roots of the freedom and the autonomy of the person.”9
I decry that anti-life campaign which appears to view some elderly persons and the handicapped as useless burdens in a family, a community, a nation: “How could they not feel guilty for still being here, for costing so much, and for being so useless? That is a market mentality that leads to death.”10 Again I ask: what kind of autonomy do patients who ask for suicide really have?
Debbie, a 20-year-old woman with ovarian cancer has asked a gynecology resident to hasten her death. Her request: “Let’s get this over with, doctor.” His answer: a lethal injection of morphine! After reading this story (fictitious it appeared) involving physician-assisted suicide, four well-known American physicians questioned: “What in the world is going on?” And they commented: “This issue touches medicine at its very moral center; if this moral center collapses, if physicians become killers or are even merely licensed to kill, the profession – and, therewith, each physician – will never again be worthy of trust and respect as healer and comforter and promoter of life in all its frailty.”11
We read in the Catechism of the Catholic Church: “Direct euthanasia consists in putting an end to the lives of handicapped, sick or dying persons. It is morally unacceptable.” It implies not only euthanasia by a positive act, but also by an act of omission: “An act of 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.”12
1 W. Gaylin, M.D., Leon R. Kass, M. D. Pellegrino, M. D., M. Siegler, M. D., “Doctors Must Not Kill,” JAMA, Vol. 259, No. 14, April 8, 1988, p. 2139.
2 Congregation for the Doctrine of Faith, Declaration on Euthanasia, Vatican City, 1980, Part II.
3 Helen Watt, Life and Death in Healthcare Ethics, London/New York: Routledge, 2000, p. 8.
4 William E. May, Human Existence, Medicine and Ethics, Chicago, Illinois: Franciscan Herald Press, 1977, p. 132.
5 Pontifical Academy for Life, Respect for the Dignity of the Dying Person, Vatican City, 2000, no. 6; in L’Osservatore Romano, 11-12 December 2000, p. 6.
6 G. P. Steward and Others, Basic Questions on Suicide and Euthanasia. Are They Ever Right? “Bioethics Series,”Manila: Christian Literature Crusade 1998, p. 24.
7 John Paul II, Crossing the Threshold of Hope, New York: Alfred A. Knopf, 1994, p. 205.
8 John Paul II, Evangelium Vitae (EV), nos. 15, 57, 66; Catechism of the Catholic Church(CCC), no. 2268.
9 Pontifical Academy for Life, Respect for the Dignity of the Dying person, l.c., no. 5.
10 Eric Fuchs, “Social Justice in Health Care,” Theology Digest, Vol. 45, No. 3, 1998, p. 217.
11 W. Gaylin, M.D., Leon R. Kass, M.D, E. D. Pellegrino, M.D., M. Siegler, M.D., ”Doctors Must Not Kill,” l.c., p. 2140.
12 CCC, no. 2277.