September 2019 - Authentic End-of-Life Care
Authentic End-of-Life Care – A Truly Compassionate Response to Suffering
In May of this year, the Maine Legislature passed the so-called “Maine Death with Dignity Act,” legalizing physician-assisted suicide (PAS) in Maine. In numerous magisterial documents that are grounded in both faith and reason, the Catholic Church has explained its long-standing opposition to physician-assisted suicide and the closely related practice of euthanasia, basing its teaching on the necessity of respecting life from conception to natural death. The United States Conference of Catholic Bishops has published a distillation and practical application of these teachings (as presented in the Catechism of the Catholic Church) in its own “Ethical and Religious Directives for Health Care Services” (also known as “ERDS” and which are available online at USCCB.org). The ERDS present a compelling and intellectually clear argument on how one preserves the dignity of human life when dealing with end-of-life issues in a Catholic health care setting. The ERDS are also a valuable reference for any Catholic who wishes to understand the ethical parameters taught by the Church regarding health care, including end-of-life care.
Directives 60 and 61 of the ERDS define euthanasia and assisted suicide as “an act or omission that of itself or by intention causes death in order to alleviate pain and suffering.” Directive 61 goes on to state that, “Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way. Dying patients who request euthanasia [or PAS] should receive loving care, psychological and spiritual support, and appropriate remedies for pain.”
It may be a little known fact that Catholic bioethics provides the standard of care adopted by mainstream medicine in the United States on many topics, including palliative care for relief of symptoms at the end of life: “Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person’s life so long as the intent is not to hasten death.” (ERDS no. 61) (emphasis mine). This directive illustrates the latitude given to physicians in providing relief from suffering as death approaches and references the principle of double effect, a well-known principle originating in Catholic moral theology. Given the wide range of pain-relieving medications available to patients who are suffering and the sedating effects these tend to have when used to control severe pain, most physicians tend to agree that intentionally hastening death to relieve pain is unnecessary.
There has been some confusion with the language used to describe PAS under our state’s new law entitled, “Maine Death with Dignity Act.” Maine law, like similar laws in other states, has deliberately deleted the term ‘physician-assisted suicide’ from the language used in drafting statutes in order to mitigate what is otherwise considered to contain derogatory, emotionally laden overtones associated with the word ‘suicide,’ thus replacing it with phrases such as ‘death with dignity’ and ‘medical aid in dying.’ Such manipulation of language should be understood as the political and legal wordsmithing that proponents of PAS realized was necessary in order to justify the legality of the practice.
The Catholic bioethical understanding of this issue is echoed by other institutions and organizations, most notably the American Medical Association (AMA). The AMA Code of Ethics also uses the term ‘physician-assisted suicide’ to describe the practice of an individual physician knowingly prescribing lethal medications to a patient who intends to self-administer the medications to cause his or her own death. While PAS has been legalized in 10 states, along with the District of Columbia, the AMA does not endorse the practice stating, “It is understandable, though tragic, that some patients in extreme duress – such as those suffering from a terminal, painful, debilitating illness – may come to decide that death is preferable to life. However, permitting physicians to engage in assisted suicide would ultimately cause more harm than good” (AMA Code of Medical Ethics, Opinion 5.7).
What can we, as Catholics, do to discourage the practice of PAS among our relatives, friends, and communities? First, we must have a basic knowledge of what the new law means and how it contrasts with what our faith teaches. We must not be afraid to discuss the topic within our family, social, and collegial circles. We should all become more familiar with the services of palliative and hospice care in our communities and be able to ask hospice agencies what their policy is regarding the practice of PAS.
Respecting the dignity of terminally ill persons entails offering and receiving hope, acceptance, love and all the care necessary to relieve physical, social, emotional, and spiritual symptoms of distress. As Catholics, we have the tools needed to embrace authentic dignity in all stages of life. In this sense, we all have a tremendous opportunity to communicate to others, through words and deeds, the dignity of an end-of-life experience that acknowledges trust in God’s love and the limits of human power.
Laura Madigan McCown, a clinical ethicist at a Portland hospital