Explain Church’s teaching on life, death

When "60 Minutes" recently broadcast a videotape featuring Dr. Jack Kevorkian killing a man who had Lou Gehrig’s disease, it led to a flurry of discussion on physician-assisted suicide and euthanasia.

Dr. Kevorkian himself told "60 Minutes" that his actions "could never be considered a crime in any society which deems itself enlightened," and the widow of Tom Youk, Dr. Kevorkian’s victim, stated that "a person should be in control of their own life and death."

In response, The Evangelist spoke to several Catholic experts on life issues, asking for their reactions to common arguments made by advocates of euthanasia and assisted suicide. They are:

1. Kathleen Gallagher, associate director of the New York State Catholic Conference, the public policy arm of the state’s bishops;
2. Gail Quinn, executive director of the U.S. bishops’ secretariat for pro-life activities; and
3. Dr. Nancy Knudsen, physician spokesperson for Carondelet Health System and the Daughters of Charity National Health System on end-of-life care.

Q    Here are some common arguments in favor of Dr. Kevorkian’s position. Let me begin with this: "Isn’t it merciful not to have people suffer?"

Mrs. Gallagher: True mercy and compassion is demonstrated by helping people escape extreme pain and suffering without resorting to death as the only way out. The movement toward assisted suicide reflects such a negative philosophy of life — that dignity comes from one’s abilities and what one does, and the absence of pain and suffering. The Catholic perspective is so positive: that human life has intrinsic value and dignity, regardless of one’s ability or level of discomfort. There’s a reason we’re called human "beings," and not human "doings."

Ms. Quinn: Yes, it’s merciful. But you do not have to kill people to keep them from suffering. We do need better pain management in this country.

Dr. Knudsen: In whose definition are people suffering? Is their suffering related to pain, their emotional situation, spiritual problems? You need to get to the root of their suffering. Assisted suicide is not the answer to suffering. If your hand is hurting, you don’t chop it off. You find out why it’s hurting and treat the problem.

Q    "By coming out against physician-assisted suicide, isn’t the Church saying that people should suffer?"

Mrs. Gallagher: The Christian tradition rejects the underlying assumption of assisted suicide, namely that suffering has no meaning. Christians recognize and cherish the redemptive possibilities of suffering. True "death with dignity" is accomplished through submission to God’s will in the face of impending death, not through the hopelessness of suicide. That being said, the Church is certainly not saying that terminally ill persons must suffer unbearable pain. It is morally appropriate to ease suffering through pain relief medications.

Ms. Quinn: No, not at all. The Church is saying that God gives life and God takes life. We ought not to insert ourselves into that. The Church is second to none in the services it offers [i.e. Catholic hospitals, AIDS clinics, hospice care].

Dr. Knudsen: No. There have been plenty of studies using palliative or hospice care to look at the crux of what the person’s problem is. Once you find that, the request for assisted suicide goes away. The Church’s position is that you are embracing life — and you are not promoting suffering.

Q    "My father/mother/grandparent suffered so terribly before he or she died; if I’d had that option for them, I would have taken it."

Mrs. Gallagher: If one is expressing a desire to have taken the option of assisted suicide for a loved one such as a grandparent, then that pretty well debunks the myth of assisted suicide being a "personal," "private," and completely autonomous decision, doesn’t it? If we are tempted to suggest the option for a loved one, the question to ask ourselves is, "Just whose suffering are we trying to alleviate?" There is a great quote in Pope John Paul II’s Gospel of Life: "True compassion leads to sharing another’s pain; it does not kill the person whose suffering we cannot bear."

Ms. Quinn: I’m sorry that an individual person would feel that way. I hope they would see the value in someone’s life right to the very end. Sometimes, we’re blind to that. It’s also almost unheard of [for a person to suffer terribly with so many pain medications available].

Dr. Knudsen: There are plenty of medications or treatment interventions that get to the crux of the person’s suffering. If you have a person who’s suffering, it is extremely rare not to be able to alleviate that pain. You can put a person at rest and in comfort by treating those symptoms. You need staff trained in knowing how to administer those medications. When a person’s pain is out of proportion [to their medical condition], you look at the emotional situation. Even spiritually, a person’s faith and relationship with God plays a huge role in the amount of suffering the person has. The answer is not to provide assisted suicide; it’s to train medical professionals to administer these pain medications.

Q    "It’s a matter of personal choice. I have control over other aspects of my body; why not this one?"

Mrs. Gallagher: The irony here is that people who attempt suicide don’t have control at all! Most probably don’t want to die; they want something else: their girlfriend back, a steady job, their depression to end, their suffering lessened. In many cases, what they need is a listening ear, compassion and care, painkillers, love, a game of checkers. They feel abandoned and isolated, and they’re reaching out for help.

Research shows that between 90 and 100 percent of those committing suicide, including the elderly and terminally ill, are suffering from psychiatric illness. When assisted suicide becomes a legally permissible option, will treatable mental illness be ignored? Lethal doses of medication sure would be the least costly method of treatment.

Ms. Quinn: It’s not just your body you’re talking about. We choose to do wrong in many areas of our lives, but we seem to have reached the point where the strongest value held out to people is "choice." But there are some things that are totally incompatible with morality, with God.

Dr. Knudsen: I believe none of us actually choose the time we die. I believe there is a plan set by God. It’s all part of what we on earth are meant to do. Perhaps, in our dying, we resolve a certain relationship, so we don’t die ’til that relationship is healed. God knows what we need to do. I don’t think it’s our right to choose that, as individuals or as physicians. We rob those individuals of a certain message, goal or mission they have yet to perform. None of us has the authority to do that, any more than we had a choice over when we were born.

Q    "This is a private decision and the Church shouldn’t interfere."

Mrs. Gallagher: The Catholic Church’s opposition to assisted suicide is not an attempt to force its faith down the throat of a pluralistic society. Nor is it a teaching "for Catholics only," any more than the Church’s opposition to child abuse, racism or abortion applies solely to Catholics. Legalizing any one of them further decays reverence for life and lessens the value and dignity of every one of us. This isn’t about the so-called "right to die." It’s about right and wrong. Active euthanasia and assisted suicide are wrong in that they deliberately and actively destroy life by inducing death before its natural time.

Ms. Quinn: There’s nothing private about it. [In the case of Dr. Kevorkian and Mr. Youk], it’s a decision made by a man who’s terribly sick as an effort to make it a public debate. We’re social beings. Just because I’m doing it doesn’t make it a private act. We’re part of a community. It has an enormous impact on the culture we live in, the type of people we are. It’s a coarsening of society, little by little. What we watched on "60 Minutes" was a very sanitized death. It doesn’t shock people.

Dr. Knudsen: I don’t think it’s a private decision — and the Church needs to protect the rights of those who have no one to speak for them, [such as] persons with certain disabilities. The Church has the right because you’re emphasizing life. Part of its work is to assure people have the continued right of life.

Q    Let me continue with the pro-Kevorkian arguments: "If it were me, I wouldn’t want to be a burden to my family."

Mrs. Gallagher: The real beauty of the Church’s teaching on end-of-life decision-making is that it encourages families to weigh all the burdens against all the benefits in each individual case, not just selfishly single out one particular perceived burden above all others. So, for example, persons are urged to consider whether a specific treatment may be painful or dangerous, whether it will offer hope for recovery, whether it will impose on the patient and family considerable hardships. All of these things must be carefully weighed when making decisions about whether to accept or forgo extraordinary treatments. It’s really a very rich and helpful teaching in guiding our judgments, but perhaps not widely known or understood.

Ms. Quinn: Nobody wants to be a burden. There’s an increase in suicides among the elderly — the people left behind are burdened tremendously from the person’s decision to do that.

Dr. Knudsen: Anybody who has ever had any experience with a loved one knows that when they allow you to give back, when you are able to care for them, it’s their gift to you. I tell patients, "You took care of them as children; let them take care of you." It’s a wonderful experience. They’re not a burden. [The caregivers] find an emotional satisfaction in that they can show how much they love them.

Q    "The Church is against abortion because it harms another life. Some people argue that assisted suicide doesn’t hurt anyone but the person doing it. Why do you care if it doesn’t hurt you?"

Mrs. Gallagher: Assisted suicide hurts everyone in the human community; we’re all connected. Once it is legalized for the terminally ill, other classes of people will follow: those who are not so ill, those who are a burden, those who do not voluntarily seek death. We all have a significant interest in protecting vulnerable patients because we could be next!

Our laws have traditionally recognized limits on personal, private behavior, e.g. laws against bigamy, narcotics possession, gambling, prostitution. These are correct and necessary because the law is our collective moral judgment about how society should be ordered and how to achieve the common good.

Ms. Quinn: The Church opposes abortion because it purposely destroys a human life. Human life at the beginning, at the end — there’s no difference.

Dr. Knudsen: It’s the premise of life and who has the right to take it away. We don’t have that authority.

Q    "Maybe there are pain medications to help people who are in pain, but what about the people who want to die because they’re paralyzed or have Alzheimer’s? There’s nothing you can do for them. How can you deny them the right to die?"

Mrs. Gallagher: The question really highlights the danger of the "slippery slope." Derek Humphrey, the founder of the Hemlock Society who wrote the book "Final Exit," argues for lawful physician aid-in-dying for the terminally ill, the not-so-ill, babies with Down Syndrome, quadriplegics etc. He believes the entire population should have the option of assisted suicide, "because we’re all really terminally ill." To him, pain is not so much physical, but emotional. To him, people who have lost pride, dignity and "quality of life" have unbearable pain, too.

Ms. Quinn: Deny them what? death? not being here any more? Would you go the same route with a teenager who just broke up with her boyfriend? We say, "My God, no — she’s just a girl. She’s going to get over this." Well, we have to help people deal with the situations they’re in life. We all have limitations, some much more severe than others. But we all have to help each other live, not push each other into the next world.

Dr. Knudsen: With people who are paralyzed, the suffering they have is social and emotional. But there still is some measure of worth to that person. They are valued. People who have Alzheimer’s still have some purpose with their life. They are still important people. People who take care of Alzheimer’s patients — it doesn’t have to be an unpleasant interaction. It can still have meaning and worth to the person taking care of them.

Q    "If people know they’re terminally ill and they’re going to die anyway, why not let them die when they’re still ‘themselves’?"

Mrs. Gallagher: The point is that it’s not necessary to help them die. In most cases, their pain can be relieved. The tragedy is that expertise in pain management is often not available to patients and the patient care delivery system is seriously deficient in regard to care of the terminally ill. But I think we’re making some headway in this department.

Ms. Quinn: The Church doesn’t say, "At all costs, keep people alive by any means whatsoever." Sometimes, you let people die. When medicine can’t cure, it can care. But that’s worlds apart from saying, "Since I’m not going to get better, [I should die now]."

Dr. Knudsen: Back to the thing of that person’s mission: I think there’s still some work they do on earth in their dying process.

Q    "It happens every day: Doctors give a little too much morphine to a patient who then dies. Isn’t that the same thing Kevorkian did?"

Mrs. Gallagher: Arson, robbery, child abuse and murder happen every day, too. That doesn’t make them morally acceptable.

Ms. Quinn: The difference is the intention. You can put someone on pain medication, and maybe they need a great deal of it. Mistakes are made all over the world. Is [the doctor] purposely hastening death? It COULD shorten someone’s life. If you change that to "would," the intention is to kill the person. It’s very different. We’re all going to die. In the meantime, as a society, we ought to be very careful to never cross that line.

Dr. Knudsen: The difference is the intent. You read ethically about the "double effect": Our intent is to alleviate suffering, not to hasten death. I don’t think there’s any way to prove people are intentionally overdoing with pain medication. Your intent is to alleviate suffering. At [a meeting I attended], they asked, "Who of you would rather die in a car accident, and who would rather die a terminal death?" The majority of us physicians raised our hands for a terminal death. Physician-assisted suicide is stark, technical.