Euthanasia / Assisted Suicide

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Euthanasia

Euthanasia / Assaisted Suicide

"Always to Care, Never to Kill"

THE WALL STREET JOURNAL WEDNESDAY. NOVEMBER 27, 1991
Thirteen Jewish and Christian theologians, philosophers and legal scholars, under the auspices of the Ramsey Colloquium of the Institute on Religion and Public Life, have collaborated on a declaration on euthanasia. Here are excerpts:

We are grateful that the citizens of Washington state have turned back a measure that would have extended the permission to kill, but we know that this is not the end of the matter. The American people must now prepare themselves to meet similar proposals for legally sanctioned euthanasia. Toward that end we offer this explanation of why euthanasia is contrary to our faith as Jews and Christians, is based upon grave moral error, does violence to our political tradition, and undermines the integrity of the medical profession.

In relating to the sick, the suffering, the incompetent, the disabled and the dying, we must relearn the wisdom that teaches us always to care, never to kill. Although it may sometimes appear to be an act of compassion, killing is never caring. The well-organized campaign for legalized euthanasia cruelly exploits the fear of suffering and the frustration felt when we cannot restore to health those whom we love. Such fear and frustration is genuine and deeply felt, especially with respect to the aging. But to deal with suffering by eliminating those who suffer is an evasion of moral duty and a great wrong.

Deeply embedded in our moral and medical traditions is the distinction between allowing to die, on the one hand, and killing, on the other. That distinction is now under attack and must be defended with all the force available to us.

Medical treatments can be refused or withheld if they are either useless or excessively burdensome. No one should be subjected to useless treatment; no one need accept any and all lifesaving treatments, no matter how burdensome.

When we ask if a treatment is useless, the question is: "Will this treatment be useful for this patient: will it benefit the life he or she has?" When we ask if a treatment is burdensome, the question is: "Is this treatment excessively burdensome to the life of this patient?" The question is not whether this life is useless or burdensome. We can and should allow the dying to die; we must never intend the death of the living. We may reject a treatment; we must never reject a life.

Once we cross the boundary between killing and allowing to die, there will be no turning back. Current proposals would legalize euthanasia only for the terminally ill. But the logic of the argument -- and its practical consequences -- will inevitably push us further.

Arguments for euthanasia usually appeal to our supposed right of self-determination and to the desirability or relieving suffering. If a right to euthanasia is grounded in self-determination, it cannot reasonably be limited to the terminally ill. If people have a right to die, why must they wait until they are actually dying before they are permitted to exercise that right? Similarly, if the warrant for euthanasia is to relieve suffering, why should we be able to relieve the suffering only of those who are self-determining and competent to give their consent? Why not euthanasia for the suffering who can no longer speak for themselves?

Once we have transgressed and blurred the line between killing and allowing to die, it will be exceedingly difficult, in logic, law, and practice, to limit the license to kill. Once the judgment is not about the worth of specific treatments but about the worth of specific lives, our nursing homes and other institutions will present us with countless candidates for elimination who would "be better off dead."

In the face of such danger, we would direct public attention to four sources of wisdom that can teach us again always to care, never to kill.

Religious Wisdom

As Christians and Jews, we are not authorized to make comparative judgments about the worth of lives or to cut short the years that God gives to us or others.

We are to relieve suffering when we can, and to bear with those who suffer, helping them to bear their suffering, when we cannot. We are never to "solve' the problem of suffering by eliminating those who suffer. Euthanasia would inevitably tempt us to abandon those who suffer. This is especially the case when we permit ourselves to be persuaded that their lives are a burden to us or to them. We may think we care when we kill, but killing is the rejection of God's command to care and of his help in caring.

Moral Wisdom

We can, if we wish, renounce many goods or give them into the control of another. Life, however, is not. simply a "good" that we possess. Our life is our person. To treat our life as a "thing'' that we can authorize another to terminate is profoundly dehumanizing. Euthanasia, even when requested by the competent, attacks the distinctiveness and limitations of being human. Persons -- ourselves and others -- are not things to be discarded when they are no longer deemed useful.

We can give our life for another, but we cannot give ultimate authority over our life to another. To turn one's life into an object that is at the final disposition of another is to become less than human, while it places the other in a position of being more than human -- a lord of life and death, a possessor of the personhood of others.

Human community and the entirety of civilization is premised upon a relationship of moral claims and duties between persons. Personhood has no meaning apart from life. If life is a thing that can be renounced or taken at will, the moral structure of human community, understood as a community of persons, is shattered. The result is a brave new world in which killing is defined as caring, life is viewed as the enemy, and death is counted as a benefit to be bestowed.

Political Wisdom

"We hold these truths," the founders of our political community declared, and among the truths that our community has held is that the right to life is "unalienable." All human beings have an equal right to life bestowed by "Nature and Nature's God." Government is to respect that right; it does not bestow that right.

This unalienable right places a clear limit on the power of the state. Except when government exercises its duty to protect citizens against force and injustice, or when it punishes evildoers, it may not presume for itself an authority over human life. To claim that, apart from these exceptions, the state may authorize the killing even of consenting persons is to give state authority an ultimacy it has never had in our political tradition. In that tradition it is recognized that government cannot authorize the alienation of a right it did not first bestow.

Institutional Wisdom

Legalized euthanasia would inevitably require the complicity of physicians. In a time when the medical profession is subjected to increasing criticism, when many people feel vulnerable before medical technology and practice, it would be foolhardy for our society to authorize physicians to kill. Euthanasia is not the way to respond to legitimate fears about medical technology and practice. It is unconscionable that the proponents of euthanasia exploit such fears. Such fears can be met and overcome by strongly reaffirming the distinction between killing and allowing to die -- by making clear that useless and excessively burdensome treatment can be refused, while at the same time leaving no doubt that this society will neither authorize physicians to kill nor look the other way if they do.

Conclusion

This fourfold wisdom is rejected at our moral peril. By attending to these sources of wisdom, we can find our way back to an understanding of the limits of human responsibility, and of the imperative to embrace compassionately those who suffer from illness and the fears associated with the end of life. Guided by this wisdom, we will not presume to eliminate a fellow human being, nor need we fear being abandoned in our suffering The compact of rights, duties, and mutual trust that makes human community possible depends upon our continuing adherence to the precept, Always to care, never to kill.

HADLEY ARKES, Amherst College

MATTHEW BERKE, First Things magazine

MIDGE DECTER, Institute on Religion and Public Life

RABBI MARC GELLMAN, Hebrew Union College

ROBERT GEORGE, Princeton University

PASTOR PAUL HINLICKY, Lutheran Forum

RUSSELL HITTINGER, Catholic University of America

THE REV. ROBERT JENSON, St. Olaf College

GILBERT MEILAENDER, Oberlin College

FATHER RICHARD JOHN NEUHAUS, Institute on Religion and Public Life

RABBI DAVID NOVAK, University of Virginia

JAMES NUECHTERLEIN, First Things magazine

MAX STACKHOUSE, Andover Newton Theological School

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Reflections on Euthanasia and Assisted Suicide

Fr. Frank Pavone  National Director, Priests for Life

1. Do we have a "right to die?"

When people ask me about the "right to die," I respond, "Don't worry -- you won't miss out on it!"

A right is a moral claim. We do not have a claim on death; rather, death has a claim on us! Some see the "right to die" as parallel to the "right to life." In fact, however, they are opposite. The "right to life" is based on the fact that life is a gift that we do not possess as a piece of property (which we can purchase or sell or give away or destroy at will), but rather is an inviolable right. It cannot be taken away by another or by the person him/herself. The "right to die" is based, rather, on the idea of life as a "thing we possess" and may discard when it no longer meets our satisfaction. The "Right to die" philosophy says there is such a thing as a "life not worth living." For a Christian, however, life is worthy in and of itself, and not because it meets certain criteria that others or we might set.

2. What is "euthanasia?"

"Euthanasia," from the Greek words meaning "good death," is something we do or fail to do which causes, or is intended to cause, death, in order to remove a person from suffering. This is sometimes called "mercy killing."

3. What is "assisted suicide?"

This refers to an act by which one assists another in taking his or her own life. A physician, for example, who engages in "assisted suicide" would, upon the patient's request, provide the deadly drugs for the person to use.

4. What is the difference between "active" and "passive" euthanasia?

"Active" euthanasia refers to an action one takes to end a life, for example, a lethal injection. "Passive" euthanasia refers to an omission -- such as failing to intervene at a life-threatening crisis, or failing to provide nourishment.

It is important not to confuse "passive euthanasia" with the morally legitimate decision to withhold medical treatment that is not morally necessary. (The question of what is or is not morally necessary is handled below.) When we forego a treatment that we are not required to use, then even if death comes faster as a result, that withholding is not euthanasia in any form and should not be called by the name.

5. What kind of treatments and interventions, then, are morally obligatory, and which are not?

No matter how ill a patient is, we never have a right to put that person to death. Rather, we have a duty to care for and preserve life. But to what length are we required to go to preserve life? No religion or state holds that we are obliged to use every possible means to prolong life. The means we use have traditionally been classified as either "ordinary" or "extraordinary."

"Ordinary" means must always be used. This is any treatment or procedure which provides some benefit to the patient without excessive burden or hardship.

"Extraordinary" means are optional. These are measures which do present an excessive burden.

The distinction here is not between "artificial" and "natural." Many artificial treatments will be "ordinary" means in the moral sense, as long as they provide some benefit without excessive burden. It depends, of course, on the specific case in point, with all its medical details. We cannot figure out ahead of time, in other words, whether or not we ourselves or a relative want some specific treatment to be used on us "when the time comes," because we do not know in advance what our medical situation will be at that time or what treatments will be available. When the time does come, however, we must consult on the medical and moral aspects of the situation. Remember, procedures providing benefit without unreasonable hardship are obligatory; others are not. You should consult your clergyman when the situations arise.

6. Shouldn't a person be able to say that his or her pain and suffering is too much to bear, and have the right to be free of that suffering?

Our duties toward others and ourselves certainly require reasonable efforts to alleviate suffering. At the same time, it is impossible to live without suffering, and therefore it makes no sense to talk about a "right" to be completely free of it. The pro-euthanasia movement maintains that our rights include determining the time and manner of our own death. First of all, given the fact that people die unexpectedly every day of both natural and accidental causes, this philosophy is patently absurd. If, however, one simply considers the so-called right to choose death when suffering is too great, then we have to ask the question of what kind of suffering qualifies.

Who is to say, in other words, that the suffering of a teenager who has just flunked his most important class in school, lost his girlfriend, and been kicked off the football team, isn't a suffering too great for him to bear? What if he thinks it is? Do we allow him to commit suicide -- because he has the right to determine the end of his life -- or do we call a crisis hotline? The question is critical, because either people do not have the right to end their lives in any circumstance, or else they do have that right, and the circumstances don't matter.

7. What about people who are unable to communicate?

What about them? That, indeed, is the question for the pro-euthanasia forces. People who cannot communicate are people, nevertheless. This gets to the heart of the problem. A person's inability to function does not make their lives less valuable. People do not become "vegetables." Children of God never lose the Divine image in which they were made.

A key distinction that needs to be made here is between a patient who is dying and one who is not.

When one is dying, we try with all reasonable means to sustain life, and as we have noted already, some interventions are necessary and some are not. But when one is not dying, then there isn't even a question of what "treatments" to provide. There is such a thing as a useless treatment, but there is no such thing as a useless life. This is where the confusion arises. A person who cannot walk, or cannot communicate, or is not conscious (as far as we can tell), still has a right to life and to reasonable measures to sustain life.

8. Must we always provide food and fluids to a patient?

When we come back from lunch, we do not say that we just had "our latest medical treatment." Food and drink are a normal aspect of taking care of life and health, not an extraordinary intervention. As aspects of normal care, therefore, they are morally obligatory.

In the case of a person who is not dying but whose physical or mental functioning is impaired, the question often arises as to whether we should "keep them alive" by feeding them. But there is no more of a doubt about keeping that person alive than about keeping alive anyone else who is not impaired! There is no underlying cause of death in this case. To fail to feed such a person is to introduce a new cause of death, namely, starvation. This is what the current case of Terri Schindler-Schiavo in Florida is about.

In the case of somebody who is dying, food and fluids are to be provided as well. There may come a point when death is imminent and when the body no longer assimilates what it is given, despite various efforts to feed the person by alternate means. At that stage, of course, it is normal to accept the inevitability of the person's death.

9. What are some of the common myths supporting euthanasia and assisted suicide?

a. It is a myth that most terminally ill people seek suicide. "According to available data, only a small percentage of terminally ill or severely ill patients attempt or commit suicide." (p.9)

b. It is a myth that single events cause people to end their lives. "Contrary to popular opinion, suicide is not usually a reaction to an acute problem or crisis in ones life or even to a terminal illness& Instead, certain personal characteristics are associated with a higher risk of&suicide." (p.11)

c. It is a myth that requests for suicide represent a persons true desires. "Like other suicidal individuals, patients who desire suicide or an early death during a terminal illness are usually suffering from a treatable mental illness, most commonly depression." (p.13)

d. It is a myth that terminal illness has to involve unmanageable pain. "Taken together, modern pain relief techniques can alleviate pain in all but extremely rare cases." (p.40)

(Quotes are from a May 1994 study by the New York State Task Force on Life and Law entitled , When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context.)

10. How does "voluntary" euthanasia lead to non-voluntary" euthanasia?

"Right to die" proponents couch their arguments in terms of personal freedom and voluntary choice. But in fact, as soon as you say that people have a "right" to end their lives (voluntary euthanasia), you have automatically and immediately introduced non-voluntary euthanasia, that is, killing people without their having asked for it. The reason is simple: A person should not be deprived of a "right" simply because they are not able to ask for it. This is especially easy to understand when the "right" is freedom from suffering. Why should someone suffer just because he cannot vocalize his desire to die?

This also leads to involuntary euthanasia, the killing of people although they want to live. The reasoning that leads to this conclusion is that the patient is not in a position to properly evaluate what is best for him/her in the circumstances -- so we will step in and do what is best.

11. How are euthanasia and assisted suicide political issues?

The first purpose of government is to defend and protect the lives of the citizens, and both euthanasia and assisted suicide contradict that fundamental purpose. To move from the view that government has an essential duty to protect lives, to the view that it can choose to destroy (or permit the destruction) of life, is a "sea change" about which the US Catholic bishops have spoken in the following words:

"The losers in this ethical sea change will be those who are elderly, poor, disabled and politically marginalized. None of these pass the utility test; and yet, they at least have a presence. They at least have the possibility of organizing to be heard. Those who are unborn, infirm and terminally ill have no such advantage. They have no "utility," and worse, they have no voice. As we tinker with the beginning, the end and even the intimate cell structure of life, we tinker with our own identity as a free nation dedicated to the dignity of the human person. When American political life becomes an experiment on people rather than for and by them, it will no longer be worth conducting. We are arguably moving closer to that day" (1998, Living the Gospel of Life, n.4)

12. What does support for euthanasia and assisted suicide say about a candidate?

Support for any form of killing the innocent, including killing oneself, indicates that a candidate for public office believes in a different kind of government than that set up by our Founding Fathers.

Ultimately, there are only two forms of government. All of the varied governments throughout the history of the world fall into two categories. The first type acknowledges that our rights come from God and that government exists to secure those rights. The other type says that government is the source of those rights and therefore can alter, add to them, subtract from them or deny them completely.

The Declaration of Independence says that the United States is a government of the first type, acknowledging as "self-evident" that we are endowed with our basic rights, starting with the right to life, from our Creator, and that "to secure those rights, governments are instituted."

Let's make no mistake about it. One of the things we are going to decide in our national elections is which of those two types of government America will continue to be.

13. How do euthanasia and assisted suicide rank in importance among the various issues we have to consider in an election?

Euthanasia and assisted suicide are foundational issues because they attack a foundational right, the right to life. These issues, therefore, carry greater weight than issues which deal with the quality of life or with lesser rights.

The US Bishops, in Living the Gospel of Life, write, "Abortion and euthanasia have become preeminent threats to human dignity because they directly attack life itself, the most fundamental human good and the condition for all others. They are committed against those who are weakest and most defenseless, those who are genuinely 'the poorest of the poor'" (n. 5). & All direct attacks on innocent human life, such as abortion and euthanasia, strike at the house's foundation. These directly and immediately violate the human person's most fundamental right -- the right to life. Neglect of these issues is the equivalent of building our house on sand. Such attacks cannot help but lull the social conscience in ways ultimately destructive of other human rights" (n. 23)

The Holy Father says that when the right to life is denied by a state, the state itself disintegrates. He writes,

"In this way democracy, contradicting its own principles, effectively moves towards a form of totalitarianism. The State is no longer the "common home" where all can live together on the basis of principles of fundamental equality, but is transformed into a tyrant State, which arrogates to itself the right to dispose of the life of the weakest and most defenceless members, from the unborn child to the elderly, in the name of a public interest which is really nothing but the interest of one part. The appearance of the strictest respect for legality is maintained, at least when the laws permitting abortion and euthanasia are the result of a ballot in accordance with what are generally seen as the rules of democracy. Really, what we have here is only the tragic caricature of legality; the democratic ideal, which is only truly such when it acknowledges and safeguards the dignity of every human person, is betrayed in its very foundations: "How is it still possible to speak of the dignity of every human person when the killing of the weakest and most innocent is permitted? In the name of what justice is the most unjust of discriminations practised: some individuals are held to be deserving of defence and others are denied that dignity?" When this happens, the process leading to the breakdown of a genuinely human co-existence and the disintegration of the State itself has already begun.

"To claim the right to abortion, infanticide and euthanasia, and to recognize that right in law, means to attribute to human freedom a perverse and evil significance: that of an absolute power over others and against others. This is the death of true freedom" (Evangelium Vitae, 20).

14. How do advocates of euthanasia and assisted suicide manipulate language to make their position seem acceptable?

Advocates of euthanasia and assisted suicide advance their philosophy and legislative proposals by using terms such as "assist in dying," and "helping to die." This is carefully veiled language that, in a way very similar to the phrase "pro-choice," makes something which is very evil sound very good.

An example of its effectiveness is the following story.

I was stationed in a New York City parish some years ago when a ballot initiative regarding assisted suicide came up in another state. I asked the parishioners to contact any friends or relatives they had in that state, to inform them of how harmful the initiative was. A few days later, one of the parishioners told me she spoke to her daughter, who lived in the state in question, and that her daughter obtained a copy of the various initiatives that were to be voted on. She said that the one I spoke about wasn't listed.

I asked her to send me the list...And right there on the list was the ballot initiative I had spoken of. This woman and her daughter, even when they knew what they were looking for, couldn't find it, because the language was so carefully sugar-coated. The initiative spoke about giving "assistance in dying."

This kind of language blurs the critical moral distinction between giving assistance to a dying person and placing an act which brings about death.

Mother Teresa "assisted" many people "in dying" and "helped" many people "to die." She was present to them, assuring them that they would not die alone. She helped them find the courage to face death, the conviction that their dignity had not been lost, and the serenity borne of receiving love from people and from God. This is the legitimate meaning of death with dignity and of helping people to die. This, in fact, is the Gospel response to the dying members of the human family.

15. Is it acceptable to sign a "Living Will?"

Obviously, we cannot predict the future, or know in advance what form of sickness or disease we may be afflicted with in the years ahead. We do not know what treatments we will need or what will be available.

The making of a "Living Will" presupposes that we know what kind of medical treatments we will want to use or avoid in the future. It speaks about treatments before we even know the disease; it turns a future option into a present decision.

Not every medical treatment is always obligatory. But to figure out which treatments are obligatory, morally speaking, and which are only optional, one must know the medical facts of the case. These facts are then examined in the light of the moral principles involved. But to try to make that decision in advance is to act without all the necessary information. Moreover, to make that decision legally binding by means of a formal document is really putting the cart before the horse. It is not morally justified. Living Wills are both unnecessary and dangerous.

Living Wills are also unnecessary because they propose to give rights which patients and doctors already possess. People already have the right to make informed consent decisions telling their family and physicians how they want to be treated if and when they can no longer make decisions for themselves. Doctors are already free to withhold or withdraw useless procedures in terminal cases that provide no benefit to the patient. Some people fear that medical technology will be used to torture them in their final days. But it is more likely that the 'medical heroics' people fear are the very treatments that will make possible a more comfortable, less painful death.

Moreover, if the living will indicates one does not want "to be kept alive by medications" or "artificial means" what does that mean? An aspirin is "medication," is it not? Drinking through a straw is "artificial." People can construe meanings for these words which the signer of the document never intended.

16. What are the alternatives to a "Living Will?"

A safer route is to appoint a health care proxy who can speak for you in those cases where you may not be able to speak for yourself. This should be a person who shares your moral convictions, and who will be able to apply them to specific medical situations that may arise for you in the future.

Some are worried that they will have all kinds of treatment they don't want. But in the current climate, you are more at risk of the opposite, as more and more hospitals are refusing life-saving treatment to people who want it. Because of this, more and more people are signing documents, called the "Will to Live," that expressly indicate their desire for life-saving treatment, should the need arise.

17. What are some questions I should ask candidates regarding euthanasia and assisted suicide?

This issue, first of all, should be raised with candidates at all levels of government. Many of these battles are taking place at the state level.

Candidates should be asked questions like the following:

Do you believe that government should protect the lives of the sick, the dying, or the physically or mentally impaired, without judging the worth of those lives?

Do you believe that the state has the right to allow suicide, or the administration of lethal drugs?

Do you think that federally controlled drugs should be allowed for use in assisting a suicide?

Do you think that health care needs to be "rationed," or do you acknowledge that we have both the means and the duty to give all reasonable health care to citizens, without judging the merit of their lives based on their ability to function?