With an Assembly committee's May 31 passage of AB 374, the bill that would legalize assisted suicide in California, the following article was prepared by Fathers Richard Benson and Gerald Coleman --- both moral theologians --- to assist all Catholics in answering questions about this issue.
1: What is the difference between the Teresa Schiavo case and Assisted Suicide?
Teresa Schiavo did not have any written directives, e.g., a Durable Power of Attorney for Health Care, to direct someone of her choice to make medical decisions if she became incapacitated. Her husband made the decision to withdraw life-support (nutrition and hydration), thus causing her death.
In physician-assisted suicide, after certain legal requirements are handled, terminally ill patients make a request requiring a doctor to give them a lethal prescription. Patients actually kill themselves with the doctor's help. Teresa Schiavo did not request such "assistance," nor could she make such a request due to her persistent vegetative state.
2. What is ethical and licit to request in a living will?
Everyone should have a "durable power of attorney for health care." While "living will" is a popular term, it is not equivalent to an "advance directive," which is a document appointing a person to make health care decisions if he/she is unable to do so. Copies of this document should be given to a person's doctor, family and perhaps close friends.
A Catholic should complete an advance directive in such a way that (a) palliative care is requested toward the end of life and (b) no treatment should be administered if it is deemed medically ineffective, because treatment that only prolongs the dying process is considered extraordinary and is no longer required.
3. How can a person be sure that his/her surrogate (designated decision-maker) and family will respect one's wishes when the time comes to die?
A "durable power of attorney for healthcare" binds the treating physician to follow the directions and intentions of the person who executed the document. In Catholic teaching, the patient is the primary person who makes health care decisions. The surrogate named in the "durable power of attorney" is also bound to follow the reasonable wishes of the person - just as the physician is.
4. Can a Catholic ask for a "Do not resuscitate" (DNR) order?
Yes. If one has stopped breathing and resuscitation to restore breathing would only prolong the dying process, it is morally permissible not to resuscitate and to allow death to come.
5. What is the "principle of double effect"?
Basically, the "principle of double effect" defines the conditions necessary to allow a person to perform an action, not evil in itself, when it is known beforehand that the action will have both the good effect intended and an unavoidable evil effect. The principle is often traced to Thomas Aquinas' discussion of self-defense (ST II-II, q. 64, a. 7).
The four conditions are classically stated as:
a) The action itself must be good or at least morally indifferent.
b) The good effect must not be produced as a result of the evil effect.
c) The evil effect is not intended.
d) There must be a proportionately serious reason for tolerating the evil effect.
This principle is cited by the Church in defending the use of pain medication for terminal patients even when the medication may itself shorten the life of the patient.
6. What pain control is available? How much may one morally use?
The principle of double effect outlined above is used by the Magisterium to make it clear that terminal patients have a right to any pain medication (including narcotics) necessary to address their condition.
In "Euthanasia," a document authored by Cardinal Ratzinger (CDF, 1980), he quotes a statement by Pope Pius XII: "Is the removal of pain and consciousness by means of narcotics…permitted to both doctor and patient even at the approach of death and if one foresees that the use of narcotics will shorten life? Yes, provided that no other means exist…"
In another section of the same document he states: "…in the case of many sick people, human and Christian prudence urges the use of such medications as may alleviate or eliminate suffering, even though they cause secondary effects… In the case of persons who are unable to express themselves, it may legitimately be presumed that they want to take painkillers and have them administered according to the advice of the doctors."
It is clear that church teaching allows terminal patients to be kept as comfortable and pain free as modern pain medication can provide even if there are undesirable secondary effects from the medications. The church does not demand that patients endure heroic and unnecessary pain.
7. What is "extraordinary care"? What are the moral implications?
Extraordinary care is disproportionate care in which the burdens of that care clearly outweigh the benefits. Extraordinary or disproportionate means are those that in the patient's judgment do not offer a reasonable hope of benefit or would entail an excessive burden, or impose excessive expense on the family or community. Extraordinary care is an option for the patient. In and of itself it is neither immoral to refuse or to accept extraordinary care.
8. What are some stories we can tell?
The story of Emilio Gonzales, a 17-month-old being treated at Children's Hospital in Austin, Texas, may serve as a valuable example of the sensitivity and compassion necessary for the pastoral minister in addressing issues of end-of-life care.
Emilio, who had been on a respirator since December 2006, died on May 20, 2007. He was believed to have Leigh's disease, a terminal illness which destroys brain functions. His mother had fought in court to continue his medical care while doctors, saying there was no hope of recovery, sought to remove him from what they considered extraordinary care that they believed was in actuality providing no medical benefit and simply prolonging the dying process of a terminal patient.
Bishop Gregory Aymond of Austin responded: "Numerous physicians have stated that Emilio's condition is irreversible and will result in his death. There is also great concern that continued extraordinary treatment will only result in greater pain for Emilio without curing or improving the condition from which he suffers.
"Based on this information and a review of the case by ethicists, moving to a 'comfort care' plan for Emilio would be morally acceptable. Emilio would continue to receive food, water, pain medication and other 'ordinary' treatment to provide as much comfort as can be given by a loving and vigilant team."
The complete statement by Bishop Aymond on Emilio Gonzales can be found in Origins, May 3, 2007, Vol. 36, No. 46. p. 763. Vincentian Father Richard Benson is Academic Dean and professor of Moral Theology at St. John's Seminary, Camarillo. Sulpician Father Gerald D. Coleman is the vice president of Corporate Ethics for the Daughters of Charity Health System. |