Right-to-die law faces skepticism in nation’s capital: ‘It’s really aimed at old black people’

The Washington Post
October 17, 2016

The D.C. Council is poised to approve legislation making the District the nation’s sixth jurisdiction to allow doctors to prescribe lethal drugs to terminally ill residents, adding momentum to a practice that had long been controversial but is gaining acceptance among elected leaders, the medical community and the public.

A majority of D.C. Council members say they plan to vote for the bill when it comes before them Tuesday.

But chances for enactment are unclear. The council will have to vote on the bill twice more by the end of the year. Mayor Muriel E. Bowser (D) has not indicated whether she will sign the legislation, although her health director has testified against it, saying it violates the Hippocratic oath. It is not certain that proponents have enough votes for an override. And Congress could also strike down the legislation; a spokeswoman for House Speaker Paul D. Ryan (R-Wis.) did not answer requests for comment.

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Although the law has been enacted in a handful of states with a mostly white population, it faces particular opposition in the nation’s capital, home to a large African American community. In national surveys, African Americans have consistently stood against assisted suicide.

Critics say the notion of doctors hastening death for terminally ill patients runs counter to religious teachings about the sanctity of life.

Among them is Pamela Wandix, a 59-year-old African American woman with esophageal cancer who lives east of the Anacostia River. She saw her sister die of bone cancer last year and has buried nine other siblings. Death is often on her mind.

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“I watch hundreds of people come and go at the oncologist’s office,” said Wandix, who has undergone chemotherapy. “They are not trying to give up. They want to live. We believe in God. That’s not even a question. I’m fighting for my life, and my God is going to show me how.”

 

Many in the black community distrust the health-care system and fear that racism in life will translate into discrimination in death, said Patricia King, a Georgetown Law School professor who has written about the racial dynamics of assisted death.

“Historically, African Americans have not had a lot of control over their bodies, and I don’t think offering them assisted suicide is going to make them feel more autonomous,” King said.

Some worry that blacks, who tend to have less access to treatment and preventive care, may think that ending their lives early is their best option when given a terminal diagnosis.

Rev. Eugene Rivers III, a black minister from Boston with a national reputation for his work against urban violence, is helping a group of opponents called No DC Suicide. Rivers has called the legislation “back end eugenics” aimed at eliminating poor blacks. No DC Suicide is endorsed by organizations including the Arc, the advocacy group for people with disabilities, the Jewish Community Relations Council of Greater Washington and the D.C. Catholic Conference.

Some African American residents have said the legislation reminds them of the Tuskegee experiments, in which hundreds of black men with syphilis in Alabama unwittingly participated in a 40-year federal study of the disease’s long-term effect. The men were told they were being given “free health care” and were being treated for the disorder, when in fact they were not.

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This is a non-scientific user poll. Results are not statistically valid and cannot be assumed to reflect the views of Washington Post users as a group or the general population.

“They are afraid that somebody is going to take advantage of them the way they have been taken advantage of in the past,” said Omega Silva, the black D.C. physician working with Compassion and Choices, a national advocacy group trying to pass the legislation. “We have to assure them they are in control of everything.”

African Americans, who make up nearly half of the population in the District, have been the group most consistently opposed to the practice.

In 2013, the Pew Research Center found 65 percent of African Americans and Latinos nationwide opposed aid-in-dying, compared with 42 percent of whites. Although D.C. polling isn’t available, a Washington Post survey last year found that four in 10 black Marylanders supported similar legislation, about 20 percentage points lower than the state overall.

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Right-to-die measures were first passed in Oregon, followed by Washington state and Vermont. The practice was authorized by court ruling in Montana and it also was cleared in June in California, despite protests from Latino lawmakers and Catholics. Voters in Colorado will be asked to approve a right-to-die referendum next month, and lawmakers in Michigan are set to discuss it in January. The American Medical Association, which has formally opposed such measures since 1993, has said it will consider taking a “neutral” position in 2017.

Some in the District are counting on the council to pass the law.

“Medical aid-in-dying is not suicide — it’s the cancer that’s killing me,” said Mary Klein, a supporter and 68-year old resident of the Crestwood neighborhood whose ovarian cancer has metastasized. “I would like the option because I am dying, and I’m so close to death’s doors and I’ve done everything possible to extend my life. . . . I would like the option of a peaceful and dignified death.”

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Klein has endured surgery that split open her abdomen, weekly hospital trips and chemotherapy with side effects that left her feeling like she was “struck by a hurricane.”

“I don’t believe it’s compassionate to say to someone who only has a very short time left to live that they need to suffer intolerable pain,” she said.

Lawmakers from the District’s most heavily African American wards are split on the bill. Council member LaRuby May (D-Ward 8) supports the measure but Council member Yvette M. Alexander (D-Ward 7) says voters, not the council, should decide the matter through referendum.

[‘Act of kindness’ Medical aid-in-dying legislation advances in the District ]

The full council is expected to approve legislation that would allow doctors to prescribe lethal drugs to patients who are mentally sound and have less than six months to live.

[D.C. Council members hear impassioned testimony for and against assisted death ]

That is likely to put the council’s relatively young, progressive members at odds with the city’s older black residents, said Barbara Morgan, a longtime Ward 7 resident.

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With “smart” technology, cities will be able to address infrastructure challenges, food and water shortages, and constrained budgets.

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“I guess I’m from the old school. We just don’t believe in taking your own life,” said Morgan, 83. “If you want to go to heaven, you live right. It is a known fact if you commit suicide, you won’t.”

Activists on both sides of the issue say African Americans are apprehensive about discussing options in the face of terminal illness.

“End of life is not a discussion in my community that people want to have. Period,” said Donna Smith, an African American organizer for Compassion and Choices. “It’s almost as if talking about it will hasten it.”

Compassion and Choices has been trying to sway black residents in the District by enlisting volunteers in all eight wards to hold house parties to discuss the legislation and by recruiting Silva, a black physician, and James Jones, a bioethicist, to assure that no one would be coerced into an early death.

At one outreach event Monday at the predominantly black Faith United Church of Christ in the Michigan Park neighborhood, only three congregants showed up.

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Across the country, some of the most high-profile representatives of the right-to-die movement have been white, including the terminally ill California woman Brittany Maynard who publicized her decision to end her life on widely viewed YouTube videos and in national media appearances.

Most of the demonstrators at a recent rally outside the D.C. Council building for the “Death with Dignity” legislation were white.

“They are not people who look me,” said Leona Redmond, a 64-year-old longtime District community activist who has been organizing other African American seniors against the legislation.

She’s concerned that low-income black senior citizens may be steered to an early death. When she hears politicians discussing end-of-life care, she fears they are mainly concerned with reducing government health-care costs. And she notes that African Americans are less likely to be able to afford expensive treatment when faced with a terminal prognosis.

“Because of Jim Crow laws . . . we didn’t have the opportunity to have the same jobs to have the same insurance, the same retirement benefits,” said Redmond, who lives in senior citizen housing in the Northeast Washington neighborhood of Fort Lincoln. “It’s really aimed at old black people. It really is.”

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Aid-in-dying advocates say fears about coercion haven’t been realized in states that have the laws.

In fact, just one African American has chosen to exercise the provisions of the law in Oregon, which became the first state in the country with such a law in 1997.

Similar legislation has failed in at least 20 other states in recent years — including Maryland, where it encountered opposition from the state’s large black and Catholic communities.

Right-to-die advocates say passage in the District, especially after their California victory last year, would help break a key racial barrier in their national campaign.

“We need to show that this just isn’t a ‘white’ issue,” said Smith, the Compassion and Choices organizer. “This issue is for everyone whose facing unbearable suffering at the end of life.”

Emily Guskin contributed to this report.

https://www.washingtonpost.com/local/dc-politics/right-to-die-law-faces-skepticism-in-us-capital-its-really-aimed-at-old-black-people/2016/10/17/8abf6334-8ff6-11e6-a6a3-d50061aa9fae_story.html?hpid=hp_local-news_dcsuicide-545pm%3Ahomepage%2Fstory

We at Peace and Freedom have witnessed doctors telling loved ones to “let go of their Dad/husband/wife” only to find out later that the medical establishment just didn’t want to be bothered with the difficult fight for life that many choose…. New immigrants to America who are old are often singled out for early death…. with medical professionals using “right to die” as an option….

Related:

Worrying claim: Professor Patrick Pullicino said doctors had turned the use of a controversial ¿death pathway¿ into the equivalent of euthanasia of the elderly

Worrying claim: In Britain, Professor Patrick Pullicino said doctors had turned the use of a controversial ‘death pathway’ into the equivalent of euthanasia of the elderly

The Catholic Church’s Teaching on Euthanasia

ISSUE: What is euthanasia? Why does the Church forbid its practice?

RESPONSE: The glossary in the Catechism of the Catholic Church defines euthanasia as “an act or omission which, of itself or by intention, causes the death of handicapped, sick, or dying persons—sometimes with an attempt to justify the act as a means of eliminating suffering.”

Euthanasia is a form of murder and thus is prohibited by the Fifth Commandment. It is a grave offense against the dignity of the human person and also against God, the Author of human life. While motives and circumstances can mitigate one’s culpability, they do not change the nature of this murderous act, which must be forbidden (Catechism, no. 2277).

The Church affirms the right to life of all persons, from conception to natural death. The Church encourages those with terminal illness to unite their sufferings with those of Jesus Christ, for the sake of His body, the Church (cf. Col. 1:24). The Church also encourages caregivers and family members to treat sick or handicapped persons with “special respect” (Catechism, no. 2276).

DISCUSSION: Death is part of the human condition. While everyone is well aware of this reality, the presence of terminal or severe illness requires us to look more closely at this reality. As we approach death, we confront our own beliefs about the meaning of life, the value of suffering, and the prospect of life after death. In other words, the experience of our own mortality is a pivotal moment in our pilgrimage of faith (cf. Catechism, no. 1501). How we approach death is of utmost importance to the individual and to society. Further, the way we treat those in need, the least of our brethren (cf. Mt. 25:31-46), speaks volumes about who we are as a people.

In his encyclical letter on the “Gospel of Life” (Evangelium Vitae, “EV”), Pope John Paul II identifies several cultural factors that have contributed to the spread of euthanasia. He says that in today’s society we are increasingly unable to face and accept suffering, so we are increasingly tempted to eliminate it at the root by hastening the moment of death (cf. EV, no. 15). This points to the “crisis of faith” in the West, where the physical evil of suffering is considered to be “the epitome of evil, to be eliminated at all costs” (ibid.). The Pope points out several other factors, including modern man’s desire to control life and death and an assessment of human value based on medical costs, self-sufficiency, and societal “burden.”

We saw in the 20th century how Planned Parenthood and the little-known radical views of its founder, Margaret Sanger, subtly imposed its contraceptive, anti-natalist, racist, and eugenic agenda on the world. The result has been that conduct once considered unspeakably evil—the killing of unborn or even partially born children—is not only accepted but enshrined as an inalienable right. Less people, however, are aware that a similar effort is well under way to legitimize the killing of our elderly and sick citizens.

Palliative care - file picture

Credit: AMELIE-BENOIST / BSIP/SPL

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In 1938, Dr. Foster Kennedy, president of the Euthanasia Society of America (ESA), announced his organization’s support of legislation to legalize the killing of “defective” or “incurable” human beings—with or without their consent. Back then, such legislation was utterly intolerable to most people, so the ESA took a more strategic, incremental approach, employing deceptive language such as “death with dignity” and building upon the utilitarianism (“quality of life”) and radical autonomy (“right to choose”) championed by secular society and, unfortunately, the U.S. Supreme Court. Many now see euthanasia as a topic of political discussion, not an abomination.

God’s Timeless and Timely Word

It would not be realistic to expect Sacred Scripture to address contemporary issues regarding care for the dying. Even so, the biblical message—amplified by Church Tradition and definitively expounded by the Magisterium—is firmly and unequivocally on the side of life. Some relevant biblical themes include:

The value and dignity of human life.

The Bible begins with the creation narrative, which provides that man has been specially created in the image and likeness of God (cf. Gen. 1:26-27). The rest of the Bible is the story of God’s fatherly plan to draw all people to Himself. This plan culminates in the Incarnation of Christ. By becoming one like us, God amazingly demonstrates His solidarity with the human family and affirms the value and dignity of human life. Pope John Paul II connects the dots for us, telling us that a rejection of human life is really a rejection of Christ (EV, no. 104).

Prohibition of murder.

The Fifth Commandment expressly forbids taking another’s life (cf. Ex. 20:13). Jesus not only affirms the necessity of this commandment for eternal life (cf. Mt. 19:16-22), but actually tightens its requirements (cf. Mt. 5:21-26). He also roots the commandment in the positive requirement to love one’s neighbor “as one’s self” (cf. Mt. 22:34-40). This positive command presupposes a legitimate love of self that would exclude the rejection of the fundamental gift of life.

Respect for advanced age.

Throughout Scripture, old age is characterized by dignity and surrounded with reverence. Just one example of the dignity of the elderly can be found in the story of Eleazar, who accepted torture and martyrdom rather than violate God’s law. His heroic action is described as “worthy of his years and the dignity of his old age” (2 Mac. 6:23).

Jesus’ love for the sick.

The Gospels are replete with accounts of Jesus tending to the needs of the sick, handicapped, and dying. Jesus healed the sick and instructed His disciples to do the same (cf. Mt. 10:8). Caring for the sick has always been considered a “corporal work of mercy,” based on Our Lord’s own words in Matthew 25. And in the parable of the Good Samaritan (cf. Lk. 10:29-39), we see the Christian’s obligation to tend to the needs of our “neighbor” despite any perceived inconvenience or cultural bias.

Earthly life is not an absolute.

Scripture says we weren’t created simply for this life but for eternity (cf. Wis. 2:23). We are advised to be concerned most of all about threats to our eternal souls (cf. Mt. 10:28), realizing that while our “outer self” is wasting away, our “inner self” is being renewed each day (cf. 2 Cor. 4:12-5:1).

Trust God in life and death.

Life is a gift from God, and whether we live or die is in His hands (cf. Ps. 16:15). The just man is depicted not as seeking deliverance from the burdens of old age, but as putting his trust in God’s loving providence. The Bible does not teach a mere fatalism or resignation, but elicits faith in God and trust in His mercy and promises.

Salvific value of suffering.

Through dying on the Cross for us, Jesus Christ reveals the life-giving value of suffering. Christ’s sacrifice redeemed the whole world, but in appropriating this redemption for ourselves, we are instructed to follow Jesus’ example and carry our own crosses, laying down our lives for others. All our thoughts, words, and actions, but particularly our sufferings, have salvific value when united with Christ’s sacrifice.

Here we have to understand the distinction between martyrdom, which involves accepting suffering and even death out of love for Christ, and suicide, which involves seeking death for its own sake, i.e., rejecting the good of human life. St. Jerome, a 4th-century Doctor of the Church, expressed the distinction this way: “It is not ours to lay hold of death; but we freely accept it when it is inflicted by others.”

For 2,000 years, the Church’s Tradition has consistently taught the absolute and unchanging value of the commandment, “Thou shall not kill.” Pope John Paul II cites the Didache, the most ancient non-biblical Christian writing, which condemns crimes against human life as being part of the “way of death” that Christians must reject (EV, no. 54).

St. Augustine, writing in the fifth century, made several statements that support the Church’s constant teaching on euthanasia, such as his assertion “that no man should put an end to this life to obtain that better life we look for after death, for those who die by their own hand have no better life after death” (City of God, I, 26).

Magisterial Pronouncements

The Catholic Church has firmly and explicitly confirmed its condemnation of euthanasia in recent decades. Notably, at the Second Vatican Council (1962-65), the universal Church taught:

The varieties of crime are numerous: all offenses against life itself, such as murder, genocide, abortion, euthanasia, and willful suicide . . . are criminal: they poison civilization, and they debase the perpetrators more than the victims and militate against the honor of the Creator (Gaudium et Spes, no. 27, emphasis added).

Even more recently, in response to what he calls the “culture of death,” Pope John Paul II definitively reiterated the Church’s perennial teaching:

In harmony with the Magisterium of my predecessors and in communion with the bishops of the Catholic Church, I confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. This doctrine is based upon the natural law and upon the written Word of God, is transmitted by the Church’s Tradition, and taught by the ordinary and universal Magisterium (EV, no. 65).

Guilt by Association?

The patient who requests euthanasia in effect commits suicide, which the Church has always considered a “gravely evil choice” (ibid., no. 66). While suicide in all its forms is an objective violation of the Fifth Commandment, we must recognize that psychological disturbances, anguish, or grave fear of hardship, suffering, or torture can diminish the responsibility of the person who commits suicide (Catechism, no 2282). We cannot know the eternal fate of such a person: “We should not despair of the eternal salvation of persons who have taken their own lives. By ways known to him alone, God can provide the opportunity for salutary repentance. The Church prays for persons who have taken their own lives” (Catechism, no. 2283).

Then there is the physician and others who help to bring about the patient’s death, including those who provide lethal drugs or other means of enabling a patient to commit the form of euthanasia commonly known as “assisted suicide.” All those who knowingly and willingly perform or assist in carrying out the act of terminating the patient’s life have committed murder (cf. Catechism, no. 2277). While there may be mitigating factors in a particular case, especially when it comes to family members who are coping with a loved one’s catastrophic illness, the act nonetheless is seriously wrong, even when the patient requests it. “True ‘compassion’ leads to sharing another’s pain; it does not kill the person whose suffering we cannot bear” (EV, no. 66).

Finally, there are those public officials who pass laws legalizing euthanasia in their jurisdiction. A law that tolerates—or even requires—the killing of the innocent is unjust, non-binding, and brings about the obligation to oppose it by means of conscientious objection (ibid., no. 73). The fact that civil laws allow an evil or that there is a diversity of views on the subject does not alter this requirement, which the Holy Father summarizes:

In the case of an intrinsically unjust law, such as a law permitting abortion or euthanasia, it is therefore never licit to obey it, or to take part in a propaganda campaign in favor of such a law, or vote for it (ibid.).

The Problem of Pain

In discussing the topic of euthanasia, some further distinctions need to be made. First, the Church recognizes the legitimacy of palliative care, which involves making suffering more bearable in the final stage of illness and ensuring that the patient is supported and accompanied throughout his or her ordeal (cf. EV, no. 65).

Surely, Christians are called to find in their suffering and pain a unique opportunity to participate in Our Lord’s Passion. Excessive pain, however, brings the prospect of draining a patient’s moral resources, interfering with his spiritual well-being, and even tempting him to consider euthanasia. Therefore, the patient’s request for pain relief should be respected; those who cannot express their wishes can generally be assured to want such relief.[1]

In treating some serious illnesses such as cancer or AIDS, the doses of narcotics needed to effect adequate pain management can bring about a foreseeable risk of shortening the patient’s life. Pope Pius XII taught in a 1957 address that it is permitted to relieve pain with narcotics, even when the result is decreased consciousness and a shortening of life, “if no other means exist, and if, in the given circumstances, this does not prevent the carrying out of other religious and moral duties.”

The Church has subsequently reaffirmed the moral liceity of authentic palliative care, so long as the medicines are not taken or prescribed with the intention of bringing about the patient’s death. The Catechism calls palliative care a special form of charity which should be encouraged (no. 2279).

It Is Finished

A second issue arises as to what measures must be taken to preserve life. Patients, family members, and health care providers are not morally obligated to pursue every possible avenue of extending human life. Instead, “it needs to be determined whether the means of available treatment are objectively proportionate to the prospects for improvement” (EV, no. 65).

The Church has distinguished between “extraordinary” and “ordinary” care, with only the latter being morally obligatory:

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 (Catechism, no. 2278).

Even when death is considered imminent, patients by virtue of their human dignity should continue to receive “ordinary” care. The Charter for Health Care Workers (Pontifical Council for Pastoral Assistance for Health Care Workers, 1995) says that such care includes nursing care, hygiene, and palliative care. It also involves nutrition and hydration, orally or with artificial assistance (i.e., a feeding tube), if this will support the patient’s life without imposing serious burdens on the patient.

Allowing the patient to die a natural death with dignity is not euthanasia. While it is not permissible and indeed reprehensible to cause a patient’s death through starvation or dehydration, in the case of a patient in the final stages of the dying process, where providing him with food or water would cause greater hardship than relief, those tending to the patient may forego such care (cf. National Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, no. 58).

In both the case of palliative care and the case of foregoing “over-zealous” treatment, the goal is not to terminate the life of the patient, but on the contrary to treat the patient with dignity and respect. The patient’s death is accepted without being willed or deliberately accelerated. And in both cases we see the principle of double effect in action. Some forms of treatment may have two effects, one good (e.g. pain relief) and one evil (shortening of patient’s life). In appropriate circumstances, the treatment may be provided because of the intended good effect, despite the possibility of the foreseeable but unintended bad effect (cf. Catechism, no. 1737). The pivotal issue is what one is trying to accomplish through a given medical decision. If the intention is to kill or shorten the patient’s life, then it is not morally justifiable.

Christian Beatitude

Our Lord says, “Blessed are those who mourn, they shall be comforted” (Mt. 5:4). Modern man tends to resist mourning, to resist embracing the reality of human suffering and death, opting instead for a cosmetic, shallow, and ultimately disposable existence. Our Lord does not say that He will take away our temporal pain and anguish, but He does promise to “comfort” us, which literally means that He will be strong with us, through the power of His Holy Spirit.

He also tells us that when we care for the sick, the marginalized, and the dying, we are truly caring for Him, such that the late Mother Teresa would often say that she was serving the “hidden Jesus” in the poorest of the poor in Calcutta.

We affirm the Gospel of Life, and in particular the value and dignity of the elderly and ill in our midst, when we tend to their physical, psychological, and spiritual needs. This could involve just sitting with them, offering them reassurance, or making the sacraments available to them—particularly Confession and Anointing of the Sick, the underappreciated “Sacraments of Healing”—as well as the Eucharist, which is called “viaticum” when received in anticipation of passing over to eternal life (cf. Catechism, no. 1517). Thus by our actions as well as by our words, we must be ambassadors of God’s mercy and compassion to those who are dying.

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Recommended Reading:

Holy Bible (Catholic edition)

Catechism of the Catholic Church

Vatican II Documents

Pope John Paul II, Evangelium Vitae

Sacred Congregation for the Doctrine of the Faith, Declaration on Euthanasia

Russell Shaw, ed., Our Sunday Visitor’s Encyclopedia of Catholic Doctrine

William Brennan, Dehumanizing the Vulnerable

 

Other Available FAITH FACTS:

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From Eternal Word Television (EWTN)

The court-ordered starvation and dehydration of Terri Schiavo in 2005 raised a number of issues—moral, legal and constitutional, about the right to life and the so-called right to die. Most coverage of the case focused on the question of her guardian’s right to decide according to her alleged wishes and the due process of the judicial proceedings. However, at base the question was a moral, not a legal, one: under what conditions, if any, may a patient, a guardian, medical personnel or civil authorities, withhold or withdraw nutrition and hydration?

Catholic Teaching on Extraordinary Means

The natural law and the Fifth Commandment1 requires that all ordinary means be used to preserve life, such as food, water, exercise, and medical care. Since the middle ages, however, Catholic theologians have recognized that human beings are not morally obligated to undergo every possible medical treatment to save their lives. Treatments that are unduly burdensome or sorrowful to a particular patient, such as amputation, or beyond the economic means of the person, or which only prolong the suffering of a dying person, are morallyextraordinary, meaning they are not morally obligatory in a particular case. Medical means may be medicallyordinary, but yet morally extraordinary.

The many advances in medicine during recent decades has greatly complicated the decision whether to undergo or forego medical treatment,  since medicine can now save many people who would simply have been allowed to die in the past. Further, having saved them, many people continue to live for long periods in comatose or semi-conscious states, unable to live without technological assistance of one kind or another. The following Questions and Answers will address some of the complexities of this issue.

Q. When may medical therapies, procedures, equipment and the like be withheld or withdrawn from a patient.

A. The Catechism of the Catholic Church states,

2278. 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. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.

The key principle in this statement is that one does not will to cause death. When a person has an underlying terminal disease, or their heart, or some other organ, cannot work without mechanical assistance, or a therapy being proposed is dangerous, or has little chance of success, then not using that machine or that therapy results in the person dying from the disease or organ failure they already have. The omission allows nature to takes its course. It does not directly kill the person, even though it may contribute to the person dying earlier than if aggressive treatment had been done.

Q. Does this also apply to artificially provided nutrition and hydration?

A. Yes, when the moral conditions noted above are met. We must, therefore, ask the question “will the withdrawal of nutrition and hydration allow the person to die, or kill the person?” When it will allow a person to die from an underlying condition, rather than unnecessarily prolonging their suffering, it may be removed. So, for example, in the last hours, even days, of a cancer patient’s life, or if a sick person’s body is no longer able to process food and water, there is no moral obligation to provide nutrition and hydration. The patient will die of their disease or their organ failure before starvation or dehydration could kill them.

However, when the withdrawal of nutrition and hydration is intended to kill the person, or will be the immediate and direct cause of doing so, quite apart from any disease or failure of their bodies, then to withdraw food and water would be an act of euthanasia, a grave sin against the natural law and the law of God.

Q. What about the case of Terri Schiavo?

A. In Terri’s case, while there was some disagreement as to her exact medical condition, she was not dying. Indeed, when the other artificial means were withdrawn she continued to live, so that the withdrawal of her food and water directly caused her death. This was a violation of the natural law and the law of God.

Q. You mention the natural law, what is it?

A. The natural law is morality which reason can determine from the nature of man, without the assistance of God’s revelation. An example is the right to life. Almost all human societies throughout history, both religious and non-religious, have recognized that it is wrong to kill an innocent person. This is a conclusion which reason can easily come to, since all human beings  have an inborn desire to live. From this natural law principle we can easily see that any action that directly and intentionally kills an innocent person is an unjust taking of a human life. Therefore, withdrawing food and and water from anyone who is not about to die and who can still tolerate it, has no other reasonable name than murder.

Q. What does the Church say about this?

A. The Pope addressed this issue in an address to a group of physicians who were in Rome in March 2004 precisely to discuss it.

I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.

The obligation to provide the “normal care due to the sick in such cases” (1) includes, in fact, the use of nutrition and hydration (2). The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.

In this regard, I recall what I wrote in the Encyclical Evangelium Vitaemaking it clear that “by euthanasia in the true and proper sense must be understood an action or omission which by its very nature and intention brings about death, with the purpose of eliminating all pain”; such an act is always “a serious violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person” (n. 65).  [Pope John Paul II, To the Congress on Life-Sustaining Treatments and Vegetative State, 20 March 2004)

(1) Congregation for the Doctrine of the Faith, Iura et Bona, p. IV

(2) cf. Pontifical Council “Cor Unum”, Dans le Cadre, 2, 4, 4; Pontifical Council for Pastoral Assistance to Health Care Workers,Charter of Health Care Workers, n. 120

In this address the Holy Father draws the following significant conclusions:

1. Food and water are natural means of sustaining life, not medical acts, even if delivered artificially.

2. Nutrition and hydration are ordinary and proportionate means of care.

3. Food and water are morally obligatory unless or until they cannot achieve their finality, which is providing nutrition and hydrating and alleviating suffering.

4. The length of time they are, or will be, used is not grounds for withholding or withdrawing artificially delivered nutrition and hydration.

5. If the result of withholding or withdrawing nutrition and hydration is death by starvation and dehydration, as opposed to an undying disease or dysfunction, it is gravely immorally.

In summary, nutrition and hydration, like bathing and changing the patient’s position to avoid bedsores, is ordinary care that is owed to the patient. This is true even if it is delivered artificially, as when a baby is bottle-fed or a sick person is tube-fed. Nutrition and hydration may only be discontinued when they cannot achieve their natural purposes, such as when the body can no longer process them, or, when during the death process they would only prolong the person’s suffering. If such a case the patient dies of the underlying disease. On the other hand, if starvation and dehydration is the foreseeable cause of death, to withhold or withdrawn nutrition and hydration is gravely immoral.

Q. What can a person do to ensure that their wishes and their religious beliefs are respected by their family, medical personnel and the courts?

A. The best way is by means of an Advance Directive which states the patients wishes with respect to aggressive medical treatment. There are two basic kinds, a Living Will by itself or an Advance Directive with a Durable Power of Attorney (or Proxy) for Health Care Decisions. The merits of each are as follows:

1. Living Will. By this document a person decides completely in advance whether they want to be kept alive by technology. It is a “yes” or “no” statement, which then places the matter in the hands of the medical community. Many Catholic bishops and moralists consider this an unsatisfactory approach, as it does not provide for unforeseen circumstances. Despite the enthusiasm of the media, many medical professionals, and sadly even some Catholic institutions, Living Wills are NOT the way to go!

2. Advance Directive with a Durable Power of Attorney or Health Care Proxy. These documents give to a friend or family member the authority to make health care decisions according to one’s mind as expressed in an Advance Directive. By appointing an agent, or giving someone durable power of attorney, the patient allows for unforeseen circumstances. By stating in an  Advance Directive that one wants Catholic teaching adhered to, one can ensure that neither the agent or the medical institution will disregard that teaching. Together they ensure that a trusted person, rather than strangers, will make circumstantially appropriate decisions, in keeping with the Faith.

The following sample forms are provided through the courtesy of theNational Catholic Bioethics Center.

Health Care Proxy               Advance Directive

Adobe 4 or higher is need to read and print these forms.

https://www.ewtn.com/morals/end-of-life.htm

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