As Catholic Christians we speak in terms that are informed by reason, ethical dialogue, religious conviction, and profound respect for the dignity of the human person. Our awareness is shaped by thousands of years of reflection, prayer, and by our actions as Christians following Jesus. He showed most fully what it means to love, to serve, and to be present to others. His response to the suffering of others was to suffer with them, not to kill them. He accepted suffering in his life as the pathway to giving, to generosity, and to mercy. In Jesus’ life and through his actions, we are offered a supreme example of humanity.
The values of Jesus of Nazareth are the basis for our views on euthanasia and physician-assisted suicide.
In a spirit of collaboration in building a society that is more compassionate, more respectful of all human life, more just, and more generous, we have a number of issues to ponder, pray about, and discuss, for example:
- Euthanasia means killing someone - such as by a lethal injection to end his or her suffering. Physician-assisted suicide means a doctor provides the means for someone to kill oneself (proscribing a lethal dose of medication). The distinction lies in who initiates the process – the doctor or the patient.
- One of the most important principles of palliative care is to manage the pain, or illness, of patients while neither hastening death, nor prolonging the dying process. With proper palliative care, almost all requests for euthanasia would disappear.
- Euphemisms such as "medical aid in dying" or "mercy killing" or "dying with dignity" or "terminating the suffering" or "physician-assisted death" do not change the fact that allowing assisted suicide and euthanasia makes it legal to kill someone (euthanasia) or to aid in their suicide (assisted suicide).
- Physicians and other health care staff have a basic right to conscientiously object to hastening a patient’s death through assisted suicide or euthanasia and should never be forced to do so.
- Every person, at the end of life, would benefit from good palliative care, but in Alberta there are only a handful of qualified palliative care physicians and far too few palliative care and hospice beds.
- There is a huge difference between palliative sedation and euthanasia. With palliative sedation, the intent is to reduce consciousness to ease suffering. The intent of euthanasia, however, is to kill the person.
- A government advisory panel in December of 2015 and a joint committee in February 2016 recommended the widest possible access to physician-assisted suicide and euthanasia. One of the panel’s recommendation was to eventually allow terminally ill children ("mature minors") the right to ask their doctor to hasten their death.
- Doctors who are against euthanasia and who care for terminally ill children argue that virtually all pain and other symptoms can be managed to minimize suffering. If pain is not being managed well, a new doctor should be consulted. Don’t kill the patient.
- In jurisdictions where euthanasia has been legalized, the initial restrictions have eroded. Belgium, for example, now allows euthanasia for terminally ill children of any age, with the consent of parents and doctors.
- No human being dies in a social vacuum. Consider how other people will be impacted by assisted suicide and euthanasia. Consider the impact on the person who is responsible for ending someone’s life.
- Many doctors and other health professionals who want nothing to do with killing their patients may feel forced to leave the profession. Young adults considering a medical profession may choose another path if they are expected to become killers instead of healers.
- The legislation of assisted suicide could lead to the natural process of dying being recast as a process to be avoided. This could lead to pressuring patients or their families to choose a hastened death as a cost-saving measure.
- The normalization of suicide through legislation of physician-assisted suicide could significantly impact suicide prevention programs. What happens if suicide, instead of being a tragedy to avoid, becomes an acceptable option or a "responsible" choice?
- All persons deserve protection against discrimination, but especially those who are vulnerable and may not have a voice, including those living with disabilities, mental illness, or dementia. Allowing assisted suicide and euthanasia entrenches the idea that some lives are not worth living.
Let us pray:
Mary, woman of listening, open our ears; grant us to know how to listen to the word of your son Jesus among the thousands of words of this world; grant that we may listen to the reality in which we live, to every person we encounter, especially those who are poor, in need, in hardship.
Mary, woman of decision, illuminate our mind and our heart, so that we may obey, unhesitating, the word of your son Jesus; give us the courage to decide, not to let ourselves be dragged along, letting others direct our life.
Mary, woman of action, obtain that our hands and feet move "with haste" toward others, to bring them the charity and love of your son - Jesus, to bring the light of the Gospel to the world, as you did. Amen.
~Pope Francis, 2013
☩ Frederick Henry
In learning Latin, it is customary to strive for a working knowledge of basic Latin grammar, and then to read and translate classics such as Cicero's De Oratore.
"Just as some women are said to be handsomer when unadorned-this very lack of ornament becomes them-so the plain style gives pleasure when unembellished. ... All noticeable ornament, pearls as it were, will be excluded; not even curling irons will be used. All cosmetics, artificial white and red, will be rejected. Only elegance and neatness will remain. The language will be pure Latin, plain and clear; propriety will always be the chief aim."
Despite Cicero's own linguistic elegance, he encouraged speech or writing that was simple, direct, clear, brief, sincere and unambiguous. Cicero would not be pleased with our modern day over-use and misuse of euphemisms.
For reasons of politeness and civility, we sometimes use euphemism to substitute a word for another word that might offend e.g., "passed away" (died). We also might want to give a more positive view of a job, e.g., "sanitation engineer" (garbage man), or "beautician" (hair-dresser). Most of these kinds of change are not particularly problematic.
However, some are more serious in nature, e.g., "infected obstetrics" (botched abortion), "misstatement" (lie), "program misuse" (fraud), and "gaming" (gambling).
These usages of language are the opposite of "calling a spade a spade" or simply speaking the truth. They can cover up, mask, soften, smooth over important facts, and lessen responsibility. Euphemisms can be used deceptively and misleadingly to hide the truth. "Spin" is becoming a large part of modern day life and we can even hire "spin doctors" to aid us in massaging "the truth."
A classic illustration of such abuse can be seen in the Quebec government's proposed : "End-of-life care" is defined as "palliative care provided to persons at the end of their lives, including terminal palliative sedation, and medical aid in dying."
This definition changes what is meant by palliative care. The terms "terminal palliative sedation" and "medical aid in dying" are purposefully misleading. They are euphemisms for euthanasia. We need some plain speech.
Euthanasia is the intentional killing of someone, with or without his or her consent, either by act or omission. By killing the person, one seeks to eliminate all aspects of that person's life including pain, suffering or humiliation of being in need of help. The person who commits euthanasia must intend, for whatever reason, to kill the other and must cause their death.
Euthanasia is incompatible with the philosophy and goal of palliative care. Palliative care provides a dignified death by giving patients the pain management and the social, emotional and spiritual support they require to live a good death with courage. Good palliative care, through traditional spiritual care and newly developed programs and therapies, can help the dying find meaning in their pain and suffering, and enable them to deal with unfinished business in their lives.
The last days of a person's life are often times of spiritual journey and reconciliation with family, friends and God. Patients who enter a hospital or hospice expecting compassion as they live their last months, weeks or days should not have to worry about "mercy killing" based on a doctor's judgment of their quality of life. Care can never be killing.
Incorporating euthanasia into palliative care is an attempt to confuse the general public about the role of palliative care, which is to give optimum quality of life to the patient with a progressive incurable illness until natural death occurs.
The Bill creates a "right to receive palliative care." This sounds positive and it is a needed step in the right direction. However, if euthanasia is to be part of palliative care, it is anything but good.
Where does this so-called "right" come from? Is it inherent in a person? Or is it only constituted by judicial or legislative decision? What reason is to be given for such an assertion? Naming something a "right" is often the first stage in persuading society that it is time to legitimate certain behaviours, formerly viewed as unethical, and forbidden.
Furthermore, if euthanasia becomes legal, then the practice could become part of a doctor's duty.
The argument will be made that conscientious objection should take care of that, but there are increasing concerns in Alberta, and elsewhere about the protection afforded by that principle. At the same time, the doctor-patient trust relationship will be eroded, and relationships will take on a new form, unlikely to be more personal, more likely to be increasingly impersonal and technical.
A so-called "right to receive palliative care," which includes euthanasia, might soon become a "duty to die."
"Incurable serious illness," "an advanced state of irreversible decline in capacity," and "suffering from constant and unbearable physical or psychological pain" are highlighted in the Bill but we need to eliminate the pain, not the patient. Uncontrollable pain is quite rare. True compassion is all about interconnectedness with other human beings, with presence, solidarity and love: to become a partner in suffering, helping the other find meaning until death occurs naturally.
The Criminal Code defines euthanasia as a criminal act. This prohibition protects us all, especially the most vulnerable (persons with disabilities, the elderly, the very sick, the dying); we cannot give some people the right to kill others. If death can be used to solve one problem, it can be used to solve many others.
☩ Frederick Henry
One December night in 2000 as part of our supper conversation, Fr. Ian McRae shared that he visited Fr. John Weisgerber in the hospital earlier that day and that he was concerned. John was facing the prospect of yet more surgery due to his diabetes and a whole host of other medical issues, and Ian wondered out loud if John was ready to die. His wondering sparked something inside me. Was this a veiled hint or suggestion that I was supposed to do something? I decided that I'd visit John the next day.
It's important, as this story unfolds, to understand that Fr. John was a man of very few words. Sometimes you might get a "good evening" at supper and sometimes you might not. That was alright with us as we respected his space and didn't take it personally. That's just the way things were.
In any event, I visited John in the hospital and after the pleasantries and formalities were out of the way. I said to John that I wanted to review with him some moral issues so that he would be clear about his decision-making. So I eased into the subject by talking about medical assisted nutrition and hydration, rather safe ground. From there, I then got down to the main issue, namely, refusing and stopping treatment when the burdens resulting from the treatment are clearly disproportionate to the benefits hoped for or obtained.
John listened attentively, seemed to understand but didn't say anything. I thought that it was now time to move on to the even bigger issue and said: "John, are you ready to die?" Again he didn't say anything and I waited in silence for him to say something. Feeling that the silence was longer and more intense than usual, I began to question myself that I might have misread his need and the whole situation.
Then with a twinkle in his eye, he looked straight up at me and said: "I really don't know, bishop, I've never done it before!" At that point we both laughed.
Sometimes we struggle with decision regarding end of life issues, and to understand how to journey with someone to a 'happy death'.
The Catholic Health Alliance of Canada has recently published its third edition of the Health Ethics Guide and I would like to review a few of the guidelines of Catholic moral teaching.
Sickness, suffering and dying are an inevitable part of human experience and are a reminder of the limits of human existence.
Our Catholic tradition holds that we are stewards but not the owners of our lives and, hence, do not have absolute power over life. We have a duty to preserve our life and to use it for the glory of God, but this life is not our final goal and so we recognize that the duty to preserve life is not absolute. Thus we may reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome. However, suicide and euthanasia are never morally acceptable options.
Advances in science and technology are dramatically improving our ability to cure illness, ease suffering and prolong life. These advances also raise ethical questions concerning end-of-life care, particularly around life-sustaining treatment.
Reflection on the inherent dignity of human life and on the purpose and limits of medical treatment is indispensable for formulating a true moral judgment about the use of technology to maintain life. The use of life-sustaining technology is judged by Christians in the light of their understanding of the meaning of life, suffering and death.
In this way, two extremes are avoided: on the one hand, an insistence on the provision of technology that cannot bring about the goal desired or that is considered overly burdensome by the person receiving the care and, on the other hand, the forgoing of technology with the intention of causing death.
Good palliative care, that is, health care that aims to relieve suffering and improve the quality of living and dying, should be a key goal of all facilities that care for those nearing death.
Here are some of the key guidelines for care at the end of life (Health Ethics Guide 2012):
- 65. Dying persons are to be provided with care, compassion and comfort....
- 67. The physical, emotional, psychological and spiritual care that characterizes palliative care should be available to all who have a life limited illness....
- 68. A person receiving care should be given sufficient pain and symptom management .... it is important to note that these medications, if used appropriately, are effective, safe and do not hasten death. The goal is to alleviate pain and suffering while minimizing the potential side effects of medication. Such treatment does not constitute euthanasia but rather good pain management....
- 69. Palliative sedation can be morally permissible within the Catholic tradition. Patients should be kept as free of pain as possible so that they may die comfortably.
- 70. .... the wishes, values and beliefs of the person preceding care should be the primary consideration....
- 71. Persons receiving care are not obligated to seek treatment that will not accomplish the goal for which the treatment is intended or when the burdens (excessive pain, expense or other serious inconvenience) resulting from treatment are clearly disproportionate to the benefits hoped for or obtained.
- 87. Treatment decisions for the person receiving care are never to include actions or omissions that intentionally cause death (euthanasia.
☩ Frederick Henry