Euthanasia – Disthanasia – Benemortasia (CCC 2276-2279)
Consider the following case studies:
1. An elderly lady, Doris, has been on kidney dialysis for ten years. Her health is failing generally. Some months ago she had to be hospitalised. She is tired and worn out. She wonders about asking to discontinue the dialysis. She has made her peace with God and feels ready to die, but she is worried whether discontinuing dialysis treatment would be equivalent to committing suicide. What advice can you give her?
2. A baby, Jennifer, is born with Down's Syndrome and intestinal blockage (duodenal atresia). A simple operation will allow her to survive. Otherwise she will die if nature is left to take its course. Is the doctor right to refuse surgery? A recent editorial in the British Medical Journal urges upon paediatricians the desirability of sedating the baby in such a case. What would be the moral course of action?
3. John is dying of lung cancer. He is in intense pain. He says he is a Catholic, but he does not want to see the priest – God's never done anything for him, he says, why should he bother now? He is given narcotics to control the pain level. Should he be given such drugs even when they may slightly shorten his lifespan? Should he be given painkillers to the level of rendering him unconscious and painfree? Should he be quickly put out of his misery?
4. Bertha is 90 years old, living in a geriatric hospital. She can no longer take food by mouth. She suffers severe senile dementia. She is being fed by an intravenous drip and a naso-gastric tube. She is also suffering from gangrene, diabetes, arteriosclerotic heart disease and urinary tract infection. She is confined to bed, but not diagnosed as terminally ill. She keeps pulling out the feeding tubes because they annoy her. What should the nurses do?
Now I want to define the three main terms in this discussion and to apply them to these four practical cases:
EUTHANASIA – “An act or omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated.” (JB) It is often called 'mercy-killing'. Groups like EXIT campaign to legalise voluntary euthanasia. Some of their supporters have stated publicly, that once public opinion has accepted voluntary euthanasia, 'it should be possible to move on further'.
The euthanasiast might advocate that Doris (case 1) could be treated by passive euthanasia (ceasing dialysis), perhaps combined with more active measures (a lethal dose of diamorphine). Baby Jennifer (case 2) is a candidate for 'passive euthanasia' – the omission of a life-saving operation – She will not last long when sedated to avoid distress and deprived of nutrition, as per the instructions of the BMJ editor. In cases 3 and 4, John and Bertha, with their relatives' agreement, “should be helped to die with dignity” to avoid any further 'useless' suffering.
These main postulates of the euthanasiast position are taken from the writings of Kohl and Fletcher:
DISTHANASIA is the medical prolongation of life at all costs. It is based on the idea that life is all that we have, so every possible means should be preserved to maintain it. The treatment of Josip Broz Tito, ruler of Yugoslavia, was a textbook case of disthanasia. He was kept artificially alive for about eight months while the Party chiefs, afraid to let him die, jostled for power in the succession stakes.
The disthanasiast would insist that Doris (1) must continue her dialysis, Jennifer (2) is operated on, John (3) is only allowed low and ineffective doses of pain-killer which will not shorten his lifespan, and the nurses must make every effort to keep Bertha (4) alive.
BENEMORTASIA – a term from the Latin, meaning 'good death', bona mors, coined by the theologian Dyck. An alternative is ORTHOTHANASIA (a correct death). This aims to avoid the unnecessary and fruitless prolongation of the dying process. Yet it respects the sanctity of life: 'Thou shalt not kill'. In line with Judaeo-Christian tradition, it maintains that it is absolutely forbidden to kill directly an innocent human being. This is the ethically correct via media.
It would advocate: (1) Doris is not obliged to continue extraordinary means of treatment (dialysis), if this seems right with her own conscience, between her and God. (2) Jennifer must not be refused an ordinary routine operation. We must not discriminate against the handicapped, effectively condemning them to death because of the way we perceive their 'quality of life'.
(3) John is given a pain-killer and cared for whilst dying. It is important to preserve his consciousness as long as possible in the hope of spiritual healing and reconciliation. Treatments with narcotics is allowable, to reduce unbearable pain, whether they slightly shorten or lengthen his lifespan. (4) is difficult. The nurses should just do the best they can. Artificial nutrition and hydration should not be withdrawn unless they become impossible, because they are a part of basic medical care. While one may pray for the Lord to take someone quickly, we are not permitted to hasten deliberately anyone's death in any way. It would seem acceptable not to try and resuscitate if she were to have a heart attack, for instance.
The B.M.A. in June 1999, judged artificial hydration and nutrition as medical treatment, which could therefore be withdrawn for stroke victims and others with little chance of recovery. This decision may open the way to a starvation death for many seriously ill patients.
In this debate there are three human values involved: a) prolonging life; b) lessening suffering; c) preserving freedom and consciousness. We need to maintain the correct balance. The euthanasiast regards (b) as all-important. The disthanasiast wants (a) at all costs. We need an ethic which provides the right balance between all three, whilst observing fundamental moral laws. The benemortasia ethic tries to balance these three values, and respects the sanctity of life.
Classical Catholic moral theology has long taught that we must use ordinary means to sustain life, but we are not obliged to use extraordinary means.
There has been much discussion as to what constitutes ordinary treatment, and what is extraordinary, a discussion complicated by further advances in medical technology. By extraordinary means one intends heart-lung machines, complex and difficult operations, etc. Ordinary means include basic antibiotics, simple operations, etc. The problem is that what is ordinary and what is extraordinary changes with time and place. A blood transfusion in the 1930's was extraordinary, but ordinary procedure by the 1960's. Haemodialysis was extraordinary in the 1960's, but might be considered normal today. Moreover, one cannot draw up a watertight list of ordinary/extraordinary treatments. They must be considered relative to a patient's overall condition: an elderly person, after a number of operations, may just not wish to face yet another surgical intervention.
There is an old saying which states broadly what we are advocating, so long as it is not interpreted in a cynical manner: 'Thou shalt not kill, but need not strive, officiously to keep alive'. Here read 'officiously' in the sense of 'by extraordinary means.'
Pause for thought:
Traditionally a sharp distinctlon is drawn between 'causing death' and 'allowing to die'. Some ethicists would deny the distlnctlon, and they would pose problems such as this: there are two terminally ill comatose patients. One is on a respirator. If the machine were turned off he would die within 20 minutes. The other is not on a respirator, but is expected to die within about a week. But if he is given a lethal injection, he will die in 20 minutes, the same as the first. If the first case is allowable (turning off the respirator), why not the second? What do you think? – think about it before going on.
The answer is that in the first case, one is allowing someone to die. In the second case, one is performing a direct killing. As Christians we must hold to the truth that 'the disposal of life is the prerogative of the God who gives life'
There have recently been discussions over the withdrawal of food and water to hasten death. Food and water would qualify as ordinary means, or better, as basic human care: food, shelter, warmth, clothing. No-one can survive without these. Basic care and sustenance should always be given if at all possible. If it becomes physically impossible to feed a patient, even by nasal or intravenous drip, well, at least everything possible has been done for them. But deliberately starving the sick to death is not an acceptable moral option.
The ethos of benemortasia maintains that life as such always retains some value, whatever form it takes. The dying or handicapped person is always worth caring for. Human life, even in extremis, geriatric and senile, is still worthy of respect and reverence. As we said before, to write off a life as not worth living is to usurp the place of God. Even in suffering and senility there can be a purpose.
...
This is precisely why my husband says to spotlight the point that this is indeed an execution.