What Do You Need To Know About Euthanasia?

As the calls for the legalisation of euthanasia are getting louder, Catholics must understand what is at stake, and how to respond. Over two articles, MELESE SHULA tells us how.

While our country and many other societies consider the possibility of legalising assisted suicide and euthanasia, Catholics cannot remain silent on the sidelines.

As Catholics we must take part in the discussion and suggest responses inspired by our deepest values and convictions.

But first, we have to understand what is meant by euthanasia and assisted suicide. This article and the second part next week will look closely at the issues involved.

What is euthanasia?

Euthanasia is the deliberate killing of someone by action or omission, with or without that person’s consent, for compassionate reasons.

The person who commits euthanasia must, therefore, intend to kill the person and must cause the death. A lethal injection would be an example of such an action. Withholding medically-indicated treatment would be an example of an omission.

Euthanasia does not include:

• Respecting a person’s refusal of treatment or request to discontinue treatment;
• Letting someone die naturally by withholding or withdrawing medical treatment when its burdens outweigh its benefits;
• Giving drugs to relieve pain and suffering, even if a foreseen but unintended effect is to shorten life.

What is assisted suicide?

In assisted suicide, a third person provides the means for the person to kill him or herself, for example by providing pills.

The Catholic position

According to Catholic teaching, euthanasia is unacceptable both at the level of principle and because of the consequences of any relaxation in the law.

The principles are the intrinsic value and sanctity of human life and the relational or interdependent quality of human life which imposes a sense of mutual responsibility.

Although a legal distinction is made between euthanasia and assisted suicide, there is no ethical difference. The moral responsibility is the same whether the third party provides the pills or administers an injection.

Catholics believe that life is a gift of God’s love and goodness.  We do not have absolute dominion over the gift of life; we are stewards, not owners of life.

Consequently, the time and circumstances of our birth and death are not ours to choose. Death is an inevitable part of life and a transition to eternal life. Life is also relational, a gift from others in that we remain recipients and givers of life.

Human life is the ultimate basis for all of our relationships.

The consequences of legal euthanasia/assisted suicide

The frail, poor, elderly and others who are vulnerable would be at the mercy of third parties who could exercise pressure on them to see an earlier death as an option.

They could even feel compelled to ask for a premature death if it is available. This danger would only increase as health resources decrease.

The role of the physician and the patient’s trust in the physician would be undermined. Palliative care would be marginalised.

If assisted suicide or euthanasia were permitted for the terminally ill on the basis of their suffering, their autonomy and their individual self-determination over life itself, how could it be denied to those who are depressed, infirm, frail or suffering for other reasons?

Legitimating euthanasia or assisted suicide, which allows one person to kill another, would diminish respect for human life. It would also erode the basic trust that human life will be protected —a trust that is essential to the functioning of any society.

What are our obligations to the dying person?

Persons who are dying should be provided with care, compassion and comfort, including:

• Appropriate medical care;
• Pain and symptom management (palliative care);
• Social, emotional, spiritual and religious support;
• Full information about their condition;
• The opportunity for discussion with health care personnel and religious, if desired;
• Full disclosure to any family member or any person authorised by the dying person to receive information; and
• A degree of privacy that ensures death with dignity and peace.

What is palliative care?

The World Health Organisation’ defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”.

In essence palliative care:

• Provides relief from pain and other distressing symptoms, affirms life and regards dying as a normal process;
• Intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of patient care;
• Uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated will enhance quality of life, and may also positively influence the course of illness;
• Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

In the application of this definition of palliative care, one may deduce, there might be a drastic reduction in the number of people who would opt for euthanasia.

It is prudent to consider palliative care in children as they too are not immune to life-threatening illnesses.

Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.

It begins when illness is diagnosed (an important fact, contrary to popular misconception), and continues regardless of whether or not a child receives treatment directed at the disease which is offered by the diagnosing health care team.

Health providers must evaluate and alleviate a child’s physical, psychological, and social distress. Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources.

It can be successfully implemented even if resources are limited. This is vital because it assures the inclusion, into palliative care, of people in poor and/or rural areas.

It’s imperative, therefore, that all people who have been diagnosed with a life-threatening illness should be referred for and or offered proper palliative care. This must be done from the date of diagnosis and at any point thereafter.

With impeccable application of the principles of palliative care we could be close to eradicating the supposed need for euthanasia and potentially encountering advocacy for euthanasia in rare and really exceptional circumstances.

Poor palliative care can cause euthanasia

The decision to consider and the intention to carry out euthanasia or assisted suicide is most commonly the result of unbearable suffering and or the failure to alleviate symptoms and relieve suffering which are associated with that particular illness.

Often the distress one experiences after being diagnosed with a life-threatening illness involves emotional, mental and spiritual concerns and the physical effects are considered in the latter stages of the illness.

Unfortunately health care workers, in general, place more emphasis on the physical wellbeing and the relief of physical symptoms. This means that the spiritual, mental and emotional concerns are relegated to the periphery of management.

What obligation do we have regarding treatment?

Competent persons receiving care, and proxies of persons who are not competent, are to seek those measures that offer a reasonable hope of benefit and that can be obtained and used without excessive pain, expense or other serious inconvenience.

Persons receiving care are not obliged to seek treatment when it is of no benefit, or when the burdens resulting from treatment are clearly disproportionate to the benefits hoped for or obtained.

The difference between euthanasia and withdrawing treatment

In the withdrawal or withholding of extraordinary or disproportionate treatment, the intention is not to cause death but to allow the person to die naturally; in euthanasia the intention is to cause death — the patient does not die naturally but before his or her time.

When disproportionate treatment is withdrawn or withheld, the cause of death is the underlying disease or condition. In euthanasia, on the other hand, the cause of death is the lethal injection, pill or other means used.

There is a great difference between allowing someone to die and causing someone to die. Intention is the key element in distinguishing between euthanasia and other end-of-life decisions.

Isn’t euthanasia a victimless crime?

Where, we may be asked (or be tempted to ask ourselves), is the harm to society with euthanasia and assisted suicide?

Legalising euthanasia and assisted suicide is not a private matter because changing the law is a very public process. The act of euthanasia or assisted suicide also involves third parties such as physicians, pharmacists, family and friends. In other words, it requires the law to sanction it and third parties to carry it out.

Such a law would obviously jeopardise the role of the medical profession, which is to safeguard life, and would seriously undermine the trust that must exist between patient and doctor.

The legal prohibition of killing is foundational; it protects everyone equally and is essential to the basic trust of living together in community. Public acceptance of this act could dull our consciences to the gravity of taking human life. Euthanasia and assisted suicide, therefore, have a public dimension.

How to Respond to Suffering from Illness

Melese Tumato Shula is a pastoral care officer at Catholic Healthcare Association of South Africa (Cathca) in Johannesburg. In next week’s issue he will look at issues such as Living Wills and how a Christian response outweighs the call for euthanasia and assisted suicide.