“Choosing Life for the Dying” Talk for 20th Annual Cardinal O’Connor Conference on Life
“Choosing Life for the Dying”
Talk for 20th Annual Cardinal O’Connor Conference on Life Georgetown University
Might I begin by congratulating the organisers of this twentieth annual Cardinal O’Connor Conference on Life here at Georgetown, the largest collegiate pro-life conference in America and very possibly in the world. This is a great achievement!
My talk today will begin with two stories, then examine five questions that are crucial to the euthanasia and physician-assisted suicide (hereafter ‘euthanasia’) debate, and finally draw some conclusions. I hope along the way to offer you some arguments
you might use in your circles when pressing the case for choosing life for the dying.
First, two stories of two brothers
The 2014 film The Water Diviner, starring and directed by my fellow-Australian Russell Crowe, was inspired by the true story of an Australian farmer who travelled to Turkey after World War I to discover the fate of his three sons, who had all been soldiers in
the Australian forces and were all reported missing in action at Gallipoli. A spoiler alert for those who haven’t seen the film: towards the end, Joshua Connor (played by Russell Crowe) finds his eldest son, Arthur, still alive. Art tells his father how his youngest brother Henry died: after being shot by the Turks, he bled out painfully for hours, until Art shot him at his brother’s request. Art’s anguish since killing his brother is evident in the film, but the film portrays his act of euthanasia sympathetically.
A parallel story from the next World War is of two more Australian brothers, Stan and Thomas (‘Butch’) Bisset. They grew up playing rugby together – a type of football popular in Australia – and they enlisted together, fighting side by side on the Kokoda Track in New Guinea in 1942. There Butch was severely wounded by Japanese machine gun fire. The platoon doctor could do no more for him than give him morphine; so Stan held his brother Butch in his arms for six hours until he died. They “sat, laughing, crying and remembering the good times of their childhood, the trouble they got up to as kids, and the times they played rugby together.”
Butch faded in and out of consciousness, and Stan shared one last song with his brother Butch as he breathed his last.1 These are examples of two different ‘brotherly’ responses to human suffering and dying, both motivated by mercy, and both
likely to gain our sympathy. The first says that in the end it’s better to kill someone than let them suffer, better to fulfil their request for such ‘mercy’ than to resist it; the second deals with suffering differently, never killing the suffering person but giving
them every reasonable assistance. The euthanasia debate puts to two approaches in stark contrast.
Question 1: What is a life worth?
Many advocates of euthanasia, such as another fellow-Australian, the controversial philosopher Peter Singer, are of the view that some lives are so wretched, and personal autonomy or choice so important, that this justifies an exception to our general rule
against killing. Opinion polls tell us that many people agree and so the ‘physician assisted suicide’ movement is growing around the world. On the other hand, many people are uneasy with the idea of doctors killing some patients, or assisting them to kill themselves, and so most countries by far have not gone down this path. Stories like that of the Bisset brothers do not deny the reality of physical, psychological, and spiritual suffering, but they insist that these things do not diminish the intrinsic value or dignity of a human life; they do not deny the importance of personal freedom, but they deny that all choices are equally responsible. This position seems to ask a lot more of people, both those who are suffering and those who are caring for them.
So how are we to think these things through? One answer might be that since God is the author of life and entrusts life to us to care for as stewards, we must never usurp God’s place by infringing his command not to kill. In my book Catholic Bioethics
for a New Millennium I examine traditional Christian opposition to suicide and euthanasia and argue that it is solidly biblically based. Some will answer that I don’t believe in your god or his rules, and that you Christians allow warfare anyway and some even favour capital punishment. In our discussion time we could return to the
claim that Christians and other pro-lifers are hypocritical when it comes to the moral absolute against killing. But at this point let me say that the view that human beings are special, their dignity inalienable, their lives inviolable, is no monopoly of Christians or even of religious believers: it is common to the legal systems of most nations, international human rights instruments, the pre- Christian Hippocratic Oath, the post-Christian World Medical Association Oath, the Code of Ethics of the Medical Associations of most civilised nations, and so on. You don’t have to be particularly
religious to insist on the dignity of every human being and the norm against killing.
Why is it that we save drowning people, staff hospital emergency wards, found families, congratulate new parents, give birthday cards, run ambulances and firetrucks, and do many things that take the high value of human life for granted? Before saving or celebrating with them, why don’t we ask what those people are
doing with their lives, how useful they are to others, how enjoyable they are finding life themselves? It’s because we understand that human life is valuable in itself: in this respect whether you are rich and powerful or live rough in a cardboard box under a bridge, you have something in common. Human beings matter just as humans and are worthy of enormous respect. Intentionally killing human beings says something very
Of course, to say no health professional should ever intentionally kill a patient is not the same as saying we must always extend life by every possible means: we have to take into account how burdensome those means are, how risky, how effective, and so
on. But it does mean that amongst the reasonable ways health professionals may deal with their patients to relieve suffering, killing them is not one. And it means that all of us, even the most able physicians, must have the humility to recognise that sometimes there’s nothing more ethically and practically to be done than standing by and investing ourselves in someone’s care.
Question 2: Is euthanasia merciful?
Many will respond that while human life is to be valued highly, we should also, where reasonable, be doing what we can to minimize pain and suffering. I entirely agree – as long as we hold onto the ‘where reasonable’ bit. The compassionate desire to relieve
suffering has driven the Catholic Church to being the oldest and largest healthcare provider in the world, and motivates many people of other faiths or none to invest their time and treasure into projects of one kind or another. Even were you were agnostic on the question of whether killing is ever permitted, you surely wouldn’t reach for your pistol or syringe of poison as your knee-jerk response: you’d want first to ensure that every person who could benefit from pain management and other palliative and pastoral care had access to it. And the fact is, many people don’t
have access to appropriate palliative care, even in affluent societies like the U.S. and Australia, let alone in the rest of the world.2
No one should pretend dying is easy or caring well for the dying is easy. Palliative care professionals do their best and today their best is very good. Most pain can be anticipated and blocked even before it begins: we don’t have to wait until people are begging for relief. In really difficult cases, patients might have to be rendered unconscious for long periods of time, woken only for brief periods with their loved ones and carers. On the same logic, drugs, nutrition and hydration should be provided while ever they can achieve their proper goal. But when these can no longer be
absorbed, or no longer effective, or provides no comfort, they are rightly withheld.
For the dying the focus changes from extending life to keeping the patient as comfortable as possible for the time they have left. And in my experience that time can be very precious for all concerned. No one need fear that giving high but appropriate doses of pain relief or withholding too-burdensome treatments is unethical or
illegal: it is sound practice, even if, like the rest of healthcare, it has its risks and is morally complicated.
All this is well understood in the palliative care world. In the end it is the logic of “I am my brother’s keeper” in answer to Cain’s cynical question (Gen 4:9) implying he and we are not. It does not require changes to law or practice. But it does require greater
resourcing, if palliative care is to be available to all who might benefit, and better education of the community, even perhaps of physicians, about end-of-life care. The compassion-driven logic of palliative care means we don’t need to give some people a ‘license to kill’. Indeed, we should never tell sick people by our laws and practices that we think they would be better off dead, or that we would be better off if they were dead. Nor should we ever tell health professionals by our laws and policies that we think they would be better professionals if they killed some of their patients. This would only reduce our determination to provide the care people need and people’s willingness to ask for help.
Furthermore, if compassionately relieving suffering is what euthanasia is all about, we have to be honest with ourselves about where that leads. If the suffering of some people is to be resolved by killing them or assisting them to kill themselves why
not the chronically but not terminally ill, the mentally but not physically ill, those unable to consent because they are unconscious, too disabled or infants? Why restrict this mercy to dying consenting adults?
Question 3: Is euthanasia a matter of choice.
Of course, relieving suffering isn’t the only reason people support euthanasia. Many argue for it on the basis of choice or autonomy, the view that people should be able to decide for themselves when they don’t want to live anymore. Once again, we might ask: what is the rationale for excluding the chronically ill, mentally ill, or those simply tired of life, from such choice? Choice is choice, after all…
But we don’t normally think of autonomy as absolute. If a drug addict asks us for money for a fix, we will rightly resist that request: there are better ways to help. Some choices contradict fundamental moral principles, and should not be valorised just
because they are freely chosen. Furthermore, human flourishing occurs in the context of relationships – friendships, marriage, family, education, workplace – and that means whether we live or die is never a merely private matter. What we decide effects many
others; just ask anyone who has had a suicide of a loved one in their circle. And what others decide about us, how they regard and treat us, also affects us.
Indeed, I am convinced that euthanasia regimes actually reduce people’s autonomy. They embed the social expectation that certain people will elect death: people whose autonomy is already reduced by pain, fear, depression; people who feel they are of
little worth or too great a burden on others; people pressured overtly or subtly to hurry up and get out of the way; people the community now judges no longer warrant protection by our homicide laws. Having classed the frail, elderly and disabled as
expendable, the community is likely to do less for them, leaving them feeling even more worthless. Ironically, in name of choice, people’s freedom is narrowed and their lives – the premise of autonomy – put at risk.
Question 4: What sense can we make of suffering
The great Jewish Rabbi Abraham Heschel once said: “The man who has not suffered, what can he possibly know, anyway?”3 Another great thinker, the Peanuts cartoon figure Charlie Brown, once wondered aloud why his baseball team never won. This
sparks a debate amongst his team-mates. Linus quotes the Book of Job to the effect that “Man is born to trouble”; Lucy responds with a feminist critique. She then suggests that people suffer because they deserve it. Schroder interjects that suffering can have a positive, maturing effect, which Lucy dismisses out of hand. The debate about suffering goes on… Eventually Charlie says: “I don’t have a ball team, I have a theological seminary!” Jokes aside, the idea that suffering has many dimensions and
plays its part in every life is an important one.
Pregnancy and child birth, physical sickness, injury and ageing, depression and mental illness, loneliness, grief, unfulfilled desire, dying: these are inevitable in any life. A life without suffering is a life without feeling. And a life without feeling would be a life
without fellow-feeling or compassion. It would be a life without growth, because it’s a life without pruning. Though it is difficult to talk about, Charlie Brown’s mate Schroder is right to think that good can come from enduring suffering well when it can’t be
Question 5: Why not go down the euthanasia path and see?
Till recently it’s been a defining aspect of our healthcare professions that they never kill or harm their patients. International and national codes of medical and nursing ethics all forbid euthanasia. Do we want our health 4 professionals assessing who should live and who should die? Do we want them to be gradually desensitised to harming and killing? Do we want medical students trained in giving lethal doses? Normalizing euthanasia would be a revolution in medical and nursing practice. We entrust ourselves to health professionals when we are very vulnerable in the expectation that they will keep to the long agreed healthcare ethic of save-heal-care, never kill-harm-abandon. But euthanasia and physician-assisted suicide undermines that trust and abandons that ethic.
Whatever of the ethics of health professionals, till now it’s been a defining aspect of our law that human rights are universal and all human life is protected. But legal euthanasia would introduce into law two classes of citizens: those whose lives are inviolable (most of us) and those whose lives can be taken (the terminally ill, the
disabled, and others). The prohibition on killing is a cornerstone of law and social relationships, and protects each one of us impartially and equally. It should not 5 be compromised in law.
Who dies in a euthanasia culture? Mostly the sick, the frail, the handicapped and the depressed. No wonder advocates for the elderly and disabled tend to oppose euthanasia. As one put it, “We’re scared enough now; we’ll be terrified if euthanasia
becomes state-sanctioned.”6 Euthanasia is sold to the community for extreme cases, but its logic soon extends, as we have seen, from the terminally ill with unrelievable pain, to the chronically ill, mentally ill, those with ‘existential’ despair; from competent, informed, consenting adults only, to the incompetent, unconscious, children: from those who judge their own lives too burdensome for themselves to those judged too burdensome on others. “Putting Granny out of her misery” easily becomes putting Granny our of our misery.
Bracket creep is built into the very logic of euthanasia. Once we start deciding that death is in the best interests of some people, then of course there’ll be others in the queue (= line). That’s exactly what’s happened in Holland and Belgium. The Dutch
introduced voluntary euthanasia for adults in the 1980s and 90s, but by the 2,000s it allowed non-voluntary euthanasia for newborns; what was supposed to be for 7 the extreme cases of unrelievable suffering, is now the standard way of dying for 5,000
people in the Netherlands every year. The Belgian Parliament legalised euthanasia in 2002 with an ‘R’ rating – for adults only: a decade later it got a ‘G’ rating for children.8 The New Yorker reports instances of euthanasia in the Netherlands and Belgium
for people not with terminal illnesses but with autism, anorexia, chronic-fatigue or depression; one was a woman who didn’t want to live in a nursing home, another feared losing sight, and a third was dissatisfied with a sex-change operation.9 Several were just “tired of life.” No wonder so many expert committees and Parliamentary inquiries have concluded that it is impossible to restrict euthanasia to voluntary euthanasia, and that it’s bound to be abused.10
On Christmas Eve 2015 God gave me the sort of Christmas present only saints can call a grace: the sudden onset of Guillain- Barré Syndrome meant that in 24 hours I went from being more or less normal to completely paralysed from the neck down. I
might have died and I spent the next five months in hospital. During a long Paschaltide, I found myself beside Christ on the cross, completely disabled in hands and feet, racked at times with pain, and wondering what it all could mean. But unlike my Lord and so many others, I was to recover in this life, due to great healthcare and physiotherapy, as well as God’s grace mediated by the prayers and support of so many. It was a time of trial but also I hope of some learning and other spiritual fruit.
One thing I experienced first-hand was the paradox of the human body unresponsive to the human spirit. I knew the grief and frustration, the challenge to patience, courage and hope. I knew the humiliation of baby-like dependency. I came to understand
first-hand the temptations and vulnerability of our frail, elderly, and disabled brothers and sisters. But I also witnessed the triumph of human spirits in the care people received, in the determination of some to conquer their disability or at least accommodate it and get on with their lives, and in the camaraderie amongst the patients as we shared our limitations and frustrations, tried to keep each other’s spirits up, and pushed each other to maintain the struggle.
After myself suffering a terribly debilitating and potentially lethal sickness, I became more convinced that a euthanasia regime will leave those who suffer suffering more and those with few options even less free. The challenge for this generation is to help each other find meaning in the face of suffering, compassion that does the hard caring even when it’s exhausting, and a richer sense of responsibility beyond the culture of choice.
- Australian Institute of Public Welfare, Palliative Care Services in Australia 2018
- Pope John Paul II wrote beautifully and from experience about how suffering endured in right spirit can be redemptive for self and others, e.g. Salvifici Doloris: Apostolic Letter on the Christian Meaning of Human Suffering (1994). In answer to a question asked by a priest at a meeting with the clergy of the Diocese of Belluno-Feltre and Teviso, Pope Benedict XVI said “that there can be no love without suffering”. Pope Francis has continued this theme in a number of addresses, such as during his morning meditation at Domus Sanctae Marthae, ‘Contemplating Jesus, Meek and Suffering”, 12 September 2013; “The Risk of Giving Mercy”, 5 June 2017
- Resolution on Euthanasia adopted by 53rd WMA General Assembly Washington DC (Oct 2002) endorsed by ANZ Society of Palliative Medicine Position Statement on Practice of Euthanasia & Assisted Suicide (2013): “The World Medical Association reaffirms its strong belief that euthanasia is in conflict with basic ethical principles of medical practice…”. This was reiterated in 2017: “The WMA and its national member medical associations, which include the Australian Medical Association, have strongly reiterated their long-standing opposition to physician assisted suicide and euthanasia on the basis that they constitute the unethical practice of medicine.” ~ https://www.wma.net/news-post/world-medical-association-reiterates-strong-opposition-to-physician- assisted-suicide-and-to-australian-bill/
- VE in Quebec, Belgium, Luxembourg & Holland; PAS in Switzerland, Oregon, Washington, Vermont, Montana & New Mexico.
- Cf. Ryan T Anderson, “Physician-assisted suicide betrays human dignity and violates equality before the law,” Heritage Foundation Issue Brief, 4405 (11 May 2015)
- Cf. Eduard Verhagen & Pieter J. J. Sauer, “The Groningen Protocol – Euthanasia in Severely Ill Newborns”, The New England Journal of Medicine, Vol. 352, (2005), pp. 959-962
- Now Dutch paediatricians are pushing for the same: Eva Elizabeth Bolt, Eva Quirien Flens, H. Roeline Willemijn Pasman, Dick Willems, & Bregje Dorien Onwuteaka-Phillipsen, “Physician-Assisted Dying for Children is Conceivable for most Dutch Paediatricians, Irrespective of the Patient’s Age or Competence to Decide”, Acta Paediatrica, Vol. 106, No. 4 (April 2017), pp. 668-675. Luc Bovens, “Child Euthanasia: Should We Just not Talk About It?”, Journal of Medical Ethics, Vol. 41, No. 8 (August, 2015), pp. 630-634; Rita L. Marker, “Kids and Euthanasia”, Human Life Review, Vol. 26, No. 1 (2000), pp. 30-45
- Rachel Aviv, “The death treatment,” New Yorker 22 June 2015: http://www.newyorker.com/magazine/2015/06/22/the-death- treatment. In one case a doctor approved the euthanasia of a 25-year-old woman whose borderline personality disorder caused her existential angst: the doctor said “it was impossible for her to have a goal in this life”.
- Grant Gillet, A Report on Euthanasia for the NZMA (2017)’ House of Lords Select Committee on Medical Ethics, Report (1994); House of Lords Select Committee on Assisted Dying for the Terminally Ill, Report (2005); Health & Sport Committee (Parliament of Scotland), Report on the Assisted Suicide (Scotland) Bill (2015); Social Development Committee (Parliament of South Australia), Report of the Inquiry into the Euthanasia Voluntary Euthanasia Bill 1996 (1999); Community Development Committee (Parliament of Tasmania), Report on the Need for Legislation on Voluntary Euthanasia (1998); Joint Standing Committee on Community Development (Parliament of Tasmania), Report On The Dying With Dignity Bill 2009 (2009); Senate Legal and Constitutional Legislation Committee (Parliament of Australia), Euthanasia Law Bill 1996 (1997); Senate Legal and Constitutional Legislation Committee of the Australian Parliament, Report on the Rights of the Terminally Ill (Euthanasia Laws Repeal) Bill 2008 (2008); New York State Task Force on Life and the Law, When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context (1994); Canadian Special Senate Select Committee on Euthanasia and Assisted Suicide, Of Life and Death (1995).