Meaning of Suffering and Death

FAUSTO GOMEZ OP

faustogomez@yahoo.com

       Remember John, the patient with metastatic brain cancer? After discarding the option of euthanasia, which shortens life unethically, and of dysthanasia, which postpones death unduly, John has accepted orthothanasia or allowing to die, and signed a “living will.” He has also asked his elder brother physician to please continue taking care of his terrible pain, and to his daughter, not to leave him alone.

       Once in a medico-moral conference in Manila, I heard a psychiatrist say: “Ask not why a patient requests for euthanasia, but why life loses its meaning.”  Indeed, finding meaning to the end of life, and to suffering can make of euthanasia not an option.

       MEANING OF SUFFERING AND PAIN

       The word “suffering” is derived from the Latin word “sufferre” or” sub-ferre,” meaning to bear: the sufferer is a bearer of burdens. Although mainly physical in nature, pain is closely related to suffering, which is more than just bodily pain. As Eric Cassell says, pain is undergone by the body, while suffering by the person. Radically, however, the experience of pain and suffering belongs to the whole person, who is body-soul. Often, the terms pain and suffering are used interchangeably. Suffering may be physical and moral (cf. John Paul II, Salvifici Doloris).

       May suffering and pain be useful?  Do they have a positive meaning?  In the order of nature, pain and suffering especially severe and chronic are evils that attack our integrity as human beings, limit our freedom and independence, develop in many of us feelings of anger, rejection and guilt – and the fear of alienation.

       As an evil, suffering has to be avoided and fought.  As an inevitable part of our earthly life – sooner or later, an intruder into our life –, we are asked to face it humanely, that is, reasonably, responsibly, and – as much as possible – courageously.  In the order of divine grace, suffering is an evil, but it can become – when lovingly and patiently borne – an instrument of purification and salvation.

       Suffering, including physical pain, is truly mysterious: mysterium doloris. Suffering is part of the project of human life that is realized in love.  God is not indifferent to our infirmities. In fact, in his Son Jesus Christ, he shared our sufferings, and is with us when we are in pain.   Out of love Christ died for all humanity. We, Jesus’ disciples, join our sufferings to the sufferings of Christ.  The deepest meaning of the mystery of suffering is co-redemptive suffering or suffering as an act of redeeming love (Col. 1:24). How do we bear our cross – our darkness? We try to bear it with courage, patience and hope – and prayer. How do we help others carry their cross, their pains and sufferings? By relieving their suffering and accompanying them with compassion and prayer.

       COMPASSION WITH THE DYING

       True compassion with the dying – with our brother John – is not the false compassion of euthanasia that kills, but the true compassion of charity as love of neighbor, of all neighbors, especially the poor and the sick neighbor – as Jesus witnessed and taught us.

       Following Christ, the Good Samaritan – the best paradigm of the healing and caring ministry –, we all have to be at the side of those who suffer in our families and communities, and to help them bear their sufferings. We have to accompany, in particular, the terminally and incurable ill.  In his play Caligula, Albert Camus put these words in the mouth of Scipio:  “Caligula often told me that the only mistake one makes in life is causing suffering to others.” We have to be at the side of the terminally ill in a nonjudgmental, non-paternalistic, but understanding, respectful and prayerful attitude.

       The terminally ill patients need not only pain relief, but also empathetic solidarity; need not philosophical or theological explanations but compassion. In general, health care professionals try to free patients from pain, while significant others – immediate family, friends, the pastoral team and also the healthcare team – provide support and protection, security – and “a warm heart.”

       Another important point to underline: those serving the terminally ill, in particular believers in Jesus, realize that the sick evangelize them, too, by silently inviting them to reflect on the gifts of health and relationships, on God, on our own sufferings, on the finitude of life, and on their loving union with the Crucified and Risen Lord.

       How do we help others to die? We help them to die peacefully by praying with them and their families, by being with them, by accompanying them. While we ask the Lord to help us face our own death with courage, we ask him to help us face the death of our loved ones and our neighbors with compassion, with sympathetic solidarity. The Lord is particularly present in those who suffer. When we visit patients like John, we believe that Jesus is present in them. Jesus keeps telling us: “I was sick and you visited me” (Mt 25:36).

       THE REALITY OF DEATH

       Death is inescapable, inevitable, and utterly undeniable:  “Man’s days are like those of the grass, like a flower of the fields it blooms; the wind sweeps over him and he is gone, and his place knows him no more (Ps 103:15-16).

       Pain and suffering are travelling companions on our journey of life. They appear as veiled or clear warnings of the reality of death. As the Catechism of the Catholic Church puts it, Illness “can make us glimpse death” (CCC, 1500).

       As Christians, we are asked not only to accept our death but also to help others accept theirs. Physicians, and other healthcare givers, are asked by their profession – and by their faith – to help the terminally ill and dying accept their death at the proper time.  To be able to do this responsibly, they must have accepted the reality of death not as a failure of medicine (except when there is a gross negligence), but as a natural end of earthly human life.

       For Christians, death is also a very important and difficult reality, but not the ultimate reality. The ultimate reality is eternal life with God: “Where might the human being seek the answer to dramatic questions such as pain, the suffering of the innocent and death, if not in the light streaming from the mystery of Christ’s Passion, Death and Resurrection?” (John Paul II). “I am not dying. I am entering life” (Saint Therese of the Child Jesus). “If you are an apostle, you will not die. You will change of house and nothing more” (St. Josemaría Escrivá).

       Objective ethical guidelines and answers are not hard, but personal decisions at the end of life are often extremely difficult. The bishops of Illinois advice: “We must not let some of the ambiguities of end-of-life decision making lead us, on one hand to a neurotic fear that we will incur Christ’s judgment for not acting with sufficient care and, on the other hand, to choose reckless or misguided care for our loved ones. In consulting with legitimate Church teaching, our conscience can be formed so that decisions made even in emotionally laden situations are moral, compassionate and appropriate.”

       On earth we are pilgrims, co-travelers on the way to the Father’s house: we are citizens of heaven. Our life is God’s gift which we must treasure from womb to tomb. Our faith, God’s unmerited gift, is hopeful. Our love – God’s love – makes of our life a faithful and hopeful journey to heaven. Certainly, love is stronger than death.

       At the end of his earthly life, John is suffering with continuing pains. He has signed his “living will.” His brother physician is helping him diminish his pains by prescribing the appropriate painkillers. His daughter, family and friends are giving him “a warm heart” so that he does not suffer from loneliness, from feeling alone, which would mean social death. They all, with the members of his parish are praying with and for him. John has asked for the Anointing of the Sick and Holy Communion. He is calm and at peace within and without. He is ready to go.

       “You, dear Lord, have made us for yourself, and our hearts are restless until they rest in you” (St. Augustine). May God bless us all!

(Published by O Clarim, June 23, p. 10)

 

The two Articles about “the end of life”

Article 1: PROLONGING LIFE OR POSTPONING DEATH?

FAUSTO GOMEZ OP

faustogomezb@yahoo.com

                John is 48 years old. He is terminally ill with brain cancer – and suffering terribly. His older brother who is a physician has accepted, and convinced John, that euthanasia is unethical and unchristian. Now the only daughter of John cannot accept his approaching death, and wants to continue treatment by all means available. Out of love for her, her father has consented to start aggressive treatment. Now the physician asks: May I give to my brother all the medical means available to keep him alive?

                The doctor is asking for what is called dysthanasia.  Is dysthanasia ethical and Christian?

                MEANING OF DYSTHANASIA

               What is dysthanasia? Etymologically, dysthanasia means faulty, imperfect death.  It may be defined as the medical process through which the moment of death is postponed by all means available.  Dysthanasia is the undue prolongation of life – of dying -, the postponement of death.

                The fundamental ethical distinction to apply in the case of the terminally ill is the distinction between ordinary and extraordinary means of treatment. In the words of the National Conference of American Bishops (USA), ordinary or proportionate means “are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.” On the other hand, extraordinary or disproportionate means refer to “those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive expense on the family or the community.” This important distinction should be applied fairly and not in a discriminatory manner – in a different way for rich and poor, for men or women, for children and the elderly, for the able and the differently able.

               Another important and enlightening distinction on the case refers to the kind of treatment, which can be beneficial, useless or doubtful. If the treatment is beneficial it must be generally given, except when it is too burdensome for the patient or the family. Useless treatment is futile treatment, which is not really beneficial but futile. When the doctor is not sure if it is beneficial or useless, the treatment is called doubtful treatment.

                 MORALITY OF DYSTHANASIA

                Human life must be protected and dutifully prolonged.  From a humanist and Christian perspective, human beings are obliged to take care of and prolong their lives through ordinary, proportionate, beneficial means. It is our duty to care for our life and try to be healthy. For believers in God, the use of beneficial treatment is connected with the principle of stewardship, which states that we are stewards of our life which belongs to God, our creator, who is the Lord of life and death.

                 When the medical treatment is doubtful or uncertain, the “best-interest of the patient” principle seems to demand providing treatment, which has a potential benefit – to health and life.

                When the treatment is futile, or too burdensome, it is not obligatory to use it, but generally optional. However, it appears more humane and Christian not to try a useless therapy. Indeed, if it is truly useless, why should it be used at all? The poet Jorge Manrique wrote: Que querer hombre vivir / cuando Dios quiere que muera / es locura (“For man to want to live when God wants him to die is madness”). Therefore, death should not be caused, neither should it be absurdly delayed (Spanish Episcopal Conference). St. John Paul II said: “Both the artificial extension of human life and the hastening of death, although they stem from different principles, conceal the same assumption: the conviction that life and death are realities entrusted to human beings to be disposed of at will.”

               When facilities are scarce, when the poor do not have primary health care, may we squander funds and resources by providing futile high-tech procedures? The use of extraordinary means is at most optional and, at times, it may be obligatory not to use them. In some cases – or more than some -, it may also be against social justice: medical resources are limited and ought to be used rationally and ethically by those who really need them.  Furthermore, very often the use of extraordinary means entails for the patient, who is hooked to machines and heavily intubated with multiple tubes, an incredible isolation from his or her loved one.

               Dysthanasia is generally unethical because it is not the due prolongation of life, but the undue postponement of death, which usually ends up in an “undignified death,” after an abusive use of extraordinary means of treatment, provoked by the technological imperative. The doctor is obliged to treat, but not to over-treat.

               Another basic question: Who decides to use or not use disproportionate means of treatment? When possible, the patient gives informed consent: the patient gives free and responsible consent after knowing and understanding his medical facts, treatments available to him and their consequences). When not possible, proper surrogates (the closest relative or the family representative) provide proxy or substitute consent, which must respect the principle of the best interest of the patient.

               THERE IS A TIME TO LIVE AND A TIME TO DIE

               The daughter of John is really asking for the undue prolongation of life, for the continuation of artificial life for her dear father. Life has a beginning and an end for all humans. There is a time to live. Last medical report: John’s terminal cancer of the brain has metastasized to other parts of his body. The daughter is asking for the postponement of his death through useless and futile means of treatment. For each one of us, there is a time to die (Ecl3:2), neither earlier through euthanasia, nor later through dysthanasia.

               Another major point! Objectively speaking, the ethical principles are clear and neat – and helpful. The problem is we are speaking of subjects, of persons, of a concrete persons, of John who has a loving daughter, and a brother who is a doctor. We cannot leave John with cold bioethical principles and their application to his case. Against his pains, doctors give painkillers. Against his loneliness, the daughter and the “significant “others” offer love, solidarity and compassion. Accompaniment and love will also aid John’s daughter. Praying with him and for him is a fraternal Christian duty.

               We add a final significant point: our humanity and our faith urge us to defend life. We respect people with different stands on the matter.

             The elder brother of John, the physician should not provide his younger brother John with extraordinary means of treatment. What else can he do for John? In our next conversation we hope to share with you, dear reader, some more thoughts on this sensitive matter. Until then take it easy, be compassionate – and smell the flowers on your way!

(Published by O Clarim, June 2, 2017)

 

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Article 2: ORTHOTHANASIA OR ALLOWING TO DIE

FAUSTO GOMEZ OP

faustogomezb@yahoo.com

               Our friend John is dying of metastatic terminal brain cancer. His elder brother, a physician is helping him face, as a human being and as a Christian, his complicated situation. After rejecting the options of euthanasia and dysthanasia as unethical, the doctor offers his brother John the option of orthothanasia, or allowing to or letting him die.

               Is orthothanasia, or allowing to die ethical?

 

               MEANING OF ORTHOTHANASIA

               The word orthothanasia was used for the first time in the 1950s. It means correct dying, or allowing to die or letting die.   

               It is vital to note the difference between allowing death to occur and intending death to happen. While in euthanasia the death of the patient is directly intended and caused, in allowing to die his death is directly caused by a grave pathology: the morphine administered to the patient in pain directly causes the relief of his pain and indirectly and unintendedly may perhaps advance his death, which is merely foreseen and tolerated.

               Let us underline that in the case of letting die, what is directly intended is the relief of the acute pain of the patient. In allowing to or letting die, therefore, death is neither directly caused nor intended or postponed. It merely happens. It is an event, part of the temporal life of every human being. Hence, allowing to die is anti-euthanasia, which unethically anticipates death, and anti-dysthanasia, which unduly postpones it.

                 ALLOWING TO DIE: POSSIBILITIES

                 Allowing to die includes, in particular, three possibilities.

                First possibility: when the treatment to prolong life is useless or futile for the patient, and therefore ought not to be given. We remember the world of the poet: For man to want to live when God wants him to die is madness.

               Second possibility for letting die: when the prolongation of life or the postponement of death is unduly burdensome in the first place for the patient – also for the family. On this point, the Catechism of the Catholic Church summarizes the traditional teaching of the magisterium: “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted” (CCC, 2278).

                Third possibility for allowing to die: when the patient needs painkillers or medical sedation, which does not intend the death of the patient. These painkillers directly mitigate suffering and indirectly may shorten life.  Physicians and significant others are committed to relieve pain and suffering, which is their professional commitment, or moral duty limited only by the prohibition against direct killing. Summing up the traditional teaching of the Church, the Catechism states: “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” (CCC, 2279).

                 Related to the option of allowing to or letting die, we usually face, among others, three objections: one objection refers to doubtful treatment, another to the real meaning of death with dignity, and the third to patients in persistent vegetative state (PVS).

                How about a doubtful treatment? If treatment is beneficial to the patient and not unduly burdensome, it ought to be given: we are to administer our life well. If treatment is truly useless, generally it should not be given.  Moreover, if the treatment is doubtful or uncertain, the “best-interest of the patient” principle suggests providing treatment for it might have a potential benefit: in doubt, it is good to be on the side of life.

                “DEATH WITH DIGNITY”

                Another objection is: How may we understand ‘death with dignity’? It is often understood wrongly as “death without pain,” as if those who die with pain cannot have a death with dignity. The word dignity is often – as someone put it – “high-jacked” by those who favor euthanasia. For believers and others, to die with dignity means respect for the dying, preparing for death and accepting it when it comes. The saintly Pope John Paul II says that the elderly – and all human beings – have “the right to a worthy life and to a worthy death.” Palliative or comfort, or hospice are is a way to a worthy death, or a death with true dignity.

                Death with dignity then is an ambiguous expression that may mean two opposite things. One meaning is the justification of killing – of euthanasia and assisted suicide – based upon the unethical principle of absolute personal autonomy. A second meaning is this:  “letting die in peace” or allowing to die, which is ethical.  Death with dignity means for the Christian a good and dignified death that respects the principles of stewardship (God is the Lord of Life and Death), of solidarity (we are members of the human family and God’s family), and the principle of respect for all persons, beginning with the respect due to our own person, dignity and rights, including the basic right to life, which ends with a dignified death. Palliative care helps achieve a death with dignity that is, a death that comes after achieving peace with God, with ourselves, loved ones, and neighbors.

                The final objection we wish to face: How about patients in deeply comatose or a persistent vegetative state (PVS)? What kind of treatment should they be given? The main problem here is reliable and true diagnosis: How certain may we be of the diagnosis?  Certainly, these permanently comatose patients have to be given beneficial and not too aggressive or undue burdensome treatment. Food and drink should always be given. These are not medical treatment, but a human need of every person. The basic teaching of the Church is well formulated by the American Bishops (USA) in their significant Ethical and Religious Directives for Catholic Health Care Services: “There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.”

              A final radical question: Is there any equivalence between killing and allowing to die? There is, indeed, no equivalence at all but profound difference between killing and allowing to die: while killing is intrinsically and objectively evil, allowing to die is the moral option that respects life and considers death as inevitable part of human life.

             Most probably our patient John is soon to die of metastatic brain cancer. So far three options were presented to him: assisted suicide, prolonging dying with useless aggressive treatment, and allowing him to die with dignity. From a humanist and Christian perspective, the ethical possibility is the third, which is allowing or letting him to die. (In parenthesis: When we are in doubt regarding the application of the ethical guidelines at the end of our own life and the life of our loved ones, we ask those who may know better than us. However, we decide on our own cases; others advise but should not decide for us)

                Our dear patient John is asking his brother physician: “Please, let me die in peace, but remove or at least decrease substantially my terrible pains.” John is asking for comfort or palliative care. What is the meaning and implications of palliative care? We shall try to answer this question in our next conversation with our dear readers.  Many thanks for walking with us.

(Published by O Clarim, June 9, 2017)

Dominic of Guzmán

José Luis de Miguel, OP

jldemiguelf@gmail.com

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Dominic of Guzmán

“He arrived as fire.

He left as light”

  Io-Ann Ianotti, O.P.

     Dominic was a sensitive person, attentive to the aspirations and distresses of his contemporaries, for whom he was ready to relinquish his most precious possessions – his books, for example – and turn them into gift, a gift of life.

     His heart was as the large altar where God’s mercy and the miseries of his sons and daughters had a daily appointment. Deeply human and brotherly, left us as legacy and task, a great sense of admiration and defense of the dignity of the person, of all persons, and an attitude of intense Evangelical compassion for those most in need.

     Free man, he bequeathed to his brethren the indelible mark of his inner freedom, fruit of the action of the Spirit of Jesus. Free to dream, free to fly,  free to serve. Centuries before the cry of “liberté, fraternité, et égalité” was launched to the air, Dominic with his brothers and sisters lived already in democracy, without adjectives, as their normal way of life.

     He knew how to harmonize, eminently, and in an almost instinctive way, a great fidelity to the will of God with a lucid analysis of the reality of his time, including the reality of his beloved Church, without, nevertheless, closing his eyes of Prophet, which pierced deeply where lights and shadows nest. As a Prophet, he knew well how to look deep and far, and how to interpret the signs of the times.

     Sharp observer of life, had, in addition, a clairvoyant vision of the future, ahead of history, and the knowledge to provide answers to the most pressing questions that concerned his contemporaries. These answers did not come to him by art of magic, but by a firm and constant dedication to study, as a means to help other people to know more about God, the mysteries of his love, and the project of his Kingdom.

     Profound seeker of truth (the truth of God, the truth of the world and the truth of the others, brothers and sisters), after the manner of his Master Jesus, he came to love it, as our Brother Yves Marie Congar says, “as one loves a dear friend”.

     Dominic was, above all, a deep lover of the Word of God, which he sought to listen, study, teach, and share. To the Word of God he devoted, in a particular way, his life. That has been his most precious legacy for all of us, his brothers and sisters of the Dominican Family. Legacy that has become today a real concern, challenge and task for us his sisters and brothers: how to follow Dominic’s original inspiration, re-reading it at the light of the Gospel and the challenges of contemporary society, with its countless lights and joys, with its shadows and pains. And be pilgrims, like him, leaving behind the wake in flames of hope, and the desire to embrace, the friendly face that invites us go to him…, smiling.

     In the message dated on July 15, 2016, sent by Pope Francis to the Order of Preachers, on the occasion of our General Chapter of Bologna,

     “The Holy Father hopes that all who follow the charisma of Saint Dominic, tireless apostle of grace and forgiveness, compassion for the poor and staunch defender of truth, rediscover the urgency of solidarity, love and forgiveness, and are testimonies of mercy, professed and incarnated in their lives, and indicative of the closeness and tenderness of God for today’s society”.