Is Euthanasia Ever Lawful?
Euthanasia may be defined as “the act by which someone deliberately terminates the life a patient, even at the behest of the patient or of the family if the individual is not able to make known his will in the matter.”
It remains to judge the morality of this action. Let me state at once that euthanasia is nothing else than homicide. Moreover, if it is “voluntary” on the part of the patient, it is also suicide, which, according to St. Thomas, is the worst form of homicide (Summa Theologica, I-II, q. 73, a. 9, ad 2).
There is in euthanasia, therefore, egregious malice, an especially unreasonable act, an act of singular gravity against divine law.
Let us briefly examine the reasons for the exceptional gravity of the sin of euthanasia in its two elements, homicide and suicide.
Homicide is the most serious sin of injustice that can be committed against one’s neighbor since it deprives him of the greatest good he possesses and to which he has an absolute right: life. It is an explicit violation of the Fifth Commandment: “Thou shalt not kill.” An individual, even at the express request of the “victim,” and even with a general authorization granted by public law, may not take away the life of another, because it belongs only to God, and He alone may give it or take it.
What adds to the particularly odious and abject character of this specific act is the condition of the victim. In effect, euthanasia is only envisaged by a vulnerable person, diminished by sickness, made miserable by mental distress, sorrow, pain and suffering, often by age—circumstances which render him more or less dependent on others. The element of incurable suffering has been seen as an aspect of euthanasia since its reappearance in the Utopia of Thomas More, and it is also a fundamental element of contemporary legislation. So it is in the name of false compassion and faced with the ineffectiveness of medical care that the solution of killing the suffering person is proposed. That solution eliminates a problem that is perceived to be too hard to deal with or to face up to or to take on: the patient, difficult, and possibly long-term care of a sick, dying, or incapacitated person in a condition of helplessness. To be quit of the problem, for compassion’s sake to be sure, many now want to do away with a person whom one has a duty to help, support, and love.
The existence of palliative care has shown that the central problem lies here. The disintegration of society, in particular with the breakdown between generations, individualism, and selfishness, no longer prepare people to deal with their kindred in the often terrible moments leading up to death. The mystery of redemption having disappeared from the horizon, suffering, whether it be one’s own or another’s, does not make sense: euthanasia comes to mind unbidden. That this is the fundamental reason is proven by the results of palliative care: sick people who are properly nursed, supported, and loved, even in an end-of-life situation, do not think of asking anyone to cut their days short. Oncologist Professor Lucien Israel, in his book La vie jusqu’au bout (Plon, 1993), explains that he only received two requests for euthanasia from his patients during his years of medical practice, which were withdrawn once they were given more attentive care. Nor should the doctor’s feeling of inadequacy before a seemingly desperate situation be left out. This feeling can lead him to accept euthanasia as a solution. Finally, it costs money to occupy a hospital bed. When a life “is no longer worth leading,” it ought to make room for another.
The particular malice of suicide must also be considered in addition to the homicide if the euthanasia is “voluntary,” that is to say, requested by the patient even if he is under some pressure. (If the request comes from his entourage, then it is purely and simply a case of homicide). Saint Thomas (ST, II-II, q. 64, a. 5) gives three reasons to explain the particular malice of suicide:
“First, because everything naturally loves itself, the result being that everything naturally keeps itself in being, and resists corruptions so far as it can. Wherefore suicide is contrary to the inclination of nature, and to charity whereby every man should love himself. Hence suicide is always a mortal sin, as being contrary to the natural law and to charity.” As the holy Doctor astutely observes (ST, II-II, q. 126, a. 1), it is out of an exaggerated self-love that one commits suicide. “Wherefore even those that slay themselves do so from love of their own flesh, which they desire to free from present stress.”
Other People Need Us!
“Secondly,” St. Thomas continues, “because every part, as such, belongs to the whole. Now every man is part of the community, and so, as such, he belongs to the community. Hence by killing himself he injures the community, as the Philosopher declares” (Ethics, v, 11). This profound reason is no longer understood nowadays. Euthanasia wounds the various societies to which the person belongs: nation, city, family. It is precisely the unbridled individualism and dissolution of society which results, so well described by the Thomist philosopher Marcel De Corte, that makes this wound incomprehensible. A member of a family, even if, and especially if, he is plunged in grievous suffering, irrevocably belongs to the whole; he even possesses an eminent function in it: to increase the love and devotedness of his kin. When our Lord said, “You will have the poor with you always,” He meant not only those who lack their daily bread, but also the children, the elderly, the sick and the infirm, all of whom, in certain respects, are the “poor” whom we should look after as Christ Himself. Euthanasia evinces, and causes, the dehumanization which, after having gone after the unborn child, seeks to destroy in men’s hearts filial piety and love of the “poor.” And there is undoubtedly no more important cement for society, in the natural order, than filial piety.
Suicide and the Death Penalty
Cardinal John De Lugo, S.J. (1583-1660), has some interesting considerations on the subject (Disputationum de justitia et jure, Venice, 1751, I x, i). He begins his reflections with the truth that God alone may dispose of human life, for He is its sole master. Man is certainly master of his acts, he possesses a certain dominion, a particular capacity which makes him the subject of rights. But he has no dominion over his own existence, which has been given him by God, nor over any other man besides. That is why both homicide and suicide are forbidden. The objection of the death penalty then arises. De Lugo responds that society was founded by God and that, according to the words of the Apostle, “There is no power but from God” (Rom. 13:1). He adds that the authorities have a responsibility to punish transgressors. So doing, they are not arrogating to themselves a right that belongs to God alone, but they cut away a member who threatens the common good for which they are responsible. State authority acts, thus, like a minister of God, as, moreover, St. Paul teaches (Rom. 13:4). That is why the death penalty does not violate the Fifth Commandment of God: “Thou shalt not kill.” The State is not arrogating to itself a right that belongs only to God, but it serves the will of God by preserving the society He has founded.
As regards the end-of-life question, De Lugo makes an important distinction. He says one must not confuse the intention to shorten one’s life with permission to expose oneself to the danger of shortening it. The first is always unlawful because it amounts to bringing about death prematurely. The second may be lawful for a proportionate reason. Someone may take a risk by caring for those stricken with a contagious deadly disease.
Euthanasia is inherently vitiated: No authority may decide to authorize a doctor to dispose of the life of one of his patients, even at the individual’s request, for the patient may not dispose of that which he does not possess, nor is it lawful for the authority to authorize a doctor to dispose of a life except in the case of the death penalty. How odious it would be, moreover, to employ a doctor as executioner.
De Lugo finally adds interesting considerations which he was the first to formulate, even if they have become commonplace. He insists that one must not confuse the non-usage of a remedy to treat a terminal illness with an action that positively induces death. The second course is always unlawful, but the first may frequently be lawful. He explains: “The omission of such means is not the equivalent of killing oneself, but of allowing death to occur and of relying upon the ordinary means by which men commonly live....One cannot say that such a one, who is not bound to maintain his life by all means, commits suicide, but that he dies from the sickness or infirmity of his nature.”
How Far Do We Have to Go?
This topic naturally leads to an important end-of-life question caused by the development of new therapies and advances in medical technology: the well-known distinction between ordinary and extraordinary means, which was already discussed by De Lugo in the 17th century, and elucidated by Pope Pius XII in his speech to a congress of anesthesiologists, “Medical and Moral Problems in the Practice of Resuscitation,” November 24, 1957. In the address, the pope begins by reiterating the basis of our duty to preserve our health: “Natural reason and Christian morality say that man (and whoever is responsible for taking care of his brother) has the right and the duty, in case of grave illness, to take the measures necessary to conserve life and health. This duty, which he has towards himself, to God, and even to the human community, and most often towards specific persons, flows from well-ordered charity, from submission to the Creator, from social justice and even from strict justice, as well as from filial piety.”
This duty having been admirably summarized and set before our eyes, he adds the following clarification: “But usually the obligation is limited to the use of ordinary means (according to the circumstances of person, place, era, and culture), that is to say, means which impose no extraordinary burden on either oneself or another.” Herewith the well-known distinction is introduced, and the reason for justifying it immediately follows: “A more severe obligation would be too heavy for most men, and would render the acquisition of more important higher goods too difficult. Life, health, all temporal activity, are, after all, subordinate to spiritual ends. Moreover, it is not forbidden to do more than the strictly necessary to conserve life and health, on the condition that higher duties are not neglected.”
It seems worthwhile, and even imperative, that we comprehend the words of the venerable pope, because they have been subjected to many regrettable interpretations, and, moreover, they so carefully delimit the subject that they enable us to successfully reject the fraudulent attempts of the partisans of euthanasia to bypass public sentiment and lawmakers.
The question that is posed is the following: Just how far is one obliged to go in making use of currently available treatments? The answer is simple in its formulation: man is obliged to make use of the ordinary means for conserving his health, but he may avail himself of extraordinary means. However, the question still arises: how can one tell whether a means is ordinary or extraordinary?
In order to grasp the distinction, we must first understand that the terms ordinary and extraordinary are taken from the domain of ethics and do not intrinsically denote the nature of the care. They are not definitively attached to any particular treatment in every situation, as the notions “slightly probable,” “probable,” and “most probable” are associated by moral theologians with certain opinions once and for all. Such an attribution would be the negation of the virtue of prudence. On the contrary, one must always remember that a decision about health care is a decision based on this virtue, which must take into account the facts pertaining to a particular case in a unique situation. Therefore it is not possible to categorize treatments as ordinary or extraordinary ahead of time. For example, putting someone on a respirator may be either one or the other. A patient with Guillain-Barré syndrome may experience paralysis of the respiratory system for a relatively short period and be exposed to death for its duration. Therefore putting the patient on the respirator would be to employ ordinary means; in other words, one is obliged to make use of this means. A patient in the final stages of lung cancer and experiencing suffocation is not obliged to be put on a respirator, and the means would be judged extraordinary.
This having been stated, it is necessary to make a further distinction, clearly addressed by Pope Pius XII in his speech, between the objective and subjective aspects of a case. In strictly analogous circumstances, a means will be judged, and will in fact be, ordinary for one, but not for another from a purely subjective standpoint for very diverse reasons, which can indeed be, for some persons, quite unreasonable. But medicine treats persons, whose will must be respected within the normal bounds of morality. Let’s take, for instance, a concrete case: blood transfusion. Even if a lamentable scandal has discredited this practice indirectly, it nonetheless remains the case that in most medical situations in developed countries, it may be considered ordinary. But it is rejected by Jehovah’s Witnesses for subjective reasons. One could also mention vaccination and injections, but these are usually for preventive care, except for rabies, in which case injections are the only kind of treatment available. It is easy to multiply the examples of instances where, from a subjective point of view, treatments have been rejected which had otherwise been judged ordinary.
Consult a Good Doctor
Before speaking about objective considerations, we should remember that when seeking to decide a difficult matter in a given domain, we normally consult a specialist endowed with prudence and competent in his field. Aristotle, intending to explore certain ethical notions, examines current opinions, but he carefully distinguishes between those of sages and of the multitude, the former being the only ones of value. If we need to examine a legal question, we consult a lawyer; if it’s about construction, an architect. Thus, for the matter under discussion, a doctor is the wise and prudent consultant. This doesn’t mean that every doctor is wise and prudent—which is true of the practitioners of any field of human endeavor—but that a doctor is the best person to judge the matter. This reminder seems apropos. It should be added that a good number of doctors competent and prudent in their specialties can be found. After all, we put our health in the hands of persons whose competence we trust.
That being said, how does the doctor himself assess the ordinariness or extraordinariness of the treatment being recommended in a particular case? Obviously we cannot replace medical experience with a few suggestions, but the doctor’s assessment is based on objective elements. A number of these factors have been listed [specify: page no. or sidebar].
It should be added that this judgment may vary, as Pope Pius XII pertinently pointed out, “according to the circumstances of person, place, era, and culture.” This means that a means which may be considered ordinary here and now, in a given situation—for example in an industrialized country with a highly developed health care system—might be considered extraordinary in similar circumstances elsewhere on the planet. Treatments that have been developed and perfected, according to the different standpoints just discussed, will in most cases be considered ordinary, excepting, of course, particular subjective circumstances that would modify this judgment.
One other question remains to be discussed, which constitutes the Trojan horse of the advocates of euthanasia: the alimentation and hydration of patients who can no longer feed themselves. The importance of this question is such that we address it separately [see p. ##].
Effective resistance to the euthanasia mentality being spread by propaganda and legislative initiatives, some already successfully, necessitates knowledge of Catholic doctrine about the end of life and the snares that are being disseminated by mass media to transform the convictions of entire populations and attack the divine law in order to extirpate it from the hearts of men. Let us not passively accept the euthanasia of our minds nor the diabolical rejection of divine law.
Here are a few objective elements that help clarify whether a treatment is ordinary or extraordinary.
- The degree of complexity. E.g., the difference in complexity between a routine appendectomy and cardiac surgery on a newborn.
- Risk. A life-threatening treatment is considered extraordinary.
- Cost. This may vary substantially from one country or continent to another. Insurance coverage may vary considerably, and associated costs may be taken into consideration.
- Feasibility. Whether care can be given at home or requires periods of hospitalization.
- Expected outcome. What benefit will the patient receive? This may be weighed against other factors, such as risk, painfulness, and cost, as well as the patient’s state.
- Duration. This is a factor when prospective treatment may be long and perhaps painful. Kidney dialysis, for instance, is a standard treatment with few risks, reasonable cost, doable at home, but rather painful in the long term. Some may weary of it, realizing that cessation means imminent death.
- The physical and moral state of the patient. There is no point in subjecting someone to a painful treatment for modest relief whose weakened condition allows us to think that death is not far off.
Nutrition and Hydration
The question of the alimentation and hydration of patients who cannot feed themselves is still a hot topic today. First, it must be emphasized that food and water are not medical treatments per se, even if a doctor may have to intervene in order to nourish an incapacitated patient, for everyone is bound to nourish himself in order to conserve his life and health. Most of the time, if medical assistance is required, it involves basic interventions like a gastric feeding tube or intravenous infusion. A number of doctors refuse to call these treatments. Nevertheless, since they belong to the order of means, the distinction made by Pius XII between ordinary and extraordinary may be applied.
There may be cases in which an individual is not obliged to make use of these means; for example, an elderly person who is gently declining and cannot eat anymore. It is often inconvenient to insert a gastric tube, nor medically necessary to avail of oneself intravenous feeding. This is generally only done if the patient is suffering from dehydration. On August 1, 2007, the Congregation for the Doctrine of the Faith gave a response to questions raised on this subject:
“First question: Is the administration of food and water (whether by natural or artificial means) to a patient in a ‘vegetative state’ morally obligatory except when they cannot be assimilated by the patient’s body or cannot be administered to the patient without causing significant physical discomfort?
“Response: Yes. The administration of food and water even by artificial means is in principle an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which and for as long as it is shown to accomplish its proper finality which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.
“Second question: When nutrition and hydration are being supplied by artificial means to a patient in a ‘permanent vegetative state,’ may they be discontinued when competent physicians judge with moral certainty that the patient will never recover consciousness?
“Response: No. A patient in a ‘permanent vegetative state’ is a person with fundamental human dignity and must therefore receive ordinary and proportionate care which includes in principle the administration of water and food even by artificial means.”
These responses seem just and appropriate.