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Ministering to euthanasia patients

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Euthanasia and assisted suicide are now legal in all Australian States. In each State, however, there are conditions and restrictions. Advocates for euthanasia are currently calling for a review of some of these restrictions.

There has been, for instance, a call that advice on euthanasia and assisted suicide should be available via telehealth.  It should not be restricted to a personal face-to-face interview with a doctor.  It is argued that regional patients in particular are disadvantaged by the current restrictions. Although a recent Federal Court judgement (Justice Abraham: 30 November, 2023) rejected such a submission, it is inevitable that a variation of the original submission will be drafted and re-submitted in the near future.

There is also lobbying that doctors and health care professionals should be permitted to initiate discussions on euthanasia with patients rather than being restricted only to answering patient-initiated enquiries.

It is not surprising, then, that the Australian Catholic Bishops Conference should have responded to these further attempts to make euthanasia more accessible, firstly, by restating the Church’s strong opposition to euthanasia and all forms of assisted suicide, and, then, addressing some of the emerging issues that may arise specifically for Catholics in this end-of-life context.

The bishops’ document: To Witness and Accompany with Christian Hope, (27 November, 2023), draws directly on a previous Vatican Letter, Samaritanus Bonus (14 July, 2020), which in turn draws on the Encyclical Letters of Pope John Paul II Veritatis Splendor (6 August, 1993), and Evangelium Vitae (25 March, 1995). The Australian bishops also acknowledge as a source parallel documents drafted by the New Zealand Catholic Bishops Conference.

The Vatican Letter, Samaritanus Bonus, begins by rehearsing the traditional Catholic arguments against euthanasia and assisted suicide, in specific, the dignity and inviolability of human life and the adverse social effects of compromising this basic human value.  It then goes on to distinguish euthanasia from what is morally permissible, namely, foregoing needlessly aggressive and futile treatments in the terminal stages of life. It insists, however, that basic nutrition, hydration, nursing and health care must always be maintained unless their administration, too, becomes unduly burdensome.

The Letter then adverts to the specific case of infants born disabled with severely limited life prospects. Even though their situation is irredeemably parlous, this does not disqualify them from being treated under the same principles already outlined for terminally ill adults. This very specific section of the Letter dealing with disabled infants with limited life prospects is particularly pertinent in view of the number of cases that have recently been brought to the attention of the Vatican.

 

'Even though the Catholic priest or chaplain is unable to administer the sacraments of Penance, Viaticum and Anointing of the Sick to a terminal patient who has definitively committed themselves to euthanasia, this does not mean that the Church has abandoned, or  ‘wiped its hands of’ such patients. The priest or chaplain is strongly exhorted to accompany these patients right up to the time that the lethal dose is administered.'

 

There is a parallel section, too, insisting that the general principles apply also to those in a vegetative state and in a state of minimal consciousness, while recognizing, of course, that what constitutes overly aggressive or futile treatments in such situations is both specific to the patient and variable in view of their condition.

Samaritanus Bonus then openly canvasses the use of strong analgesics to combat pain. Even though the use of such analgesics may result in terminal unconsciousness, it is permissible provided that the intention is to alleviate pain and any resultant hastening of death, while possibly foreseen, is not intended.  Indeed, the administration of such analgesics, as with palliative care in general, may extend, rather than hasten, death.

The importance of family and hospice support, the rights of health care workers and the respect that must be accorded to their conscientious objections to euthanasia and assisted suicide, the importance of palliative care as an alternative to euthanasia – all these are treated extensively within the parameters of the Catholic tradition in the Vatican Letter.

It is in the section of Samaritanus Bonus which addresses the traditional pastoral accompaniment that the Catholic Church provides for the terminally ill – the sacraments of Penance, Eucharist (Viaticum) and Anointing of the Sick – that the Vatican Letter intersects most significantly with the parallel section of the Australian Bishops’ document.  What is to be done where a terminally ill Catholic patient requests access to the sacraments when at the same time their clear and definitive intention is to embark on euthanasia and assisted suicide?

The Vatican Letter does address this issue in its penultimate section.  It deals with the situation sympathetically, admitting that the decision to postpone absolution and to refuse Viaticum does not necessarily ‘imply a judgment on the imputability of guilt, since personal responsibility could be diminished or non-existent’.  It counsels ongoing accompaniment for such terminally ill patients despite their ‘misguided’ conscience.  It is only if such accompaniment could be construed as support for euthanasia that such assistance should be moderated or even withdrawn – but only as a last resort.  A Catholic priest or chaplain, however, should not be present at the bedside when the lethal dose is taken or injected.

The Australian Catholic Bishops’ document develops this sympathetic response in greater detail in the final section of its statement. Once again, the stress is on ongoing accompaniment.  The priest or chaplain will recognize that, despite their best efforts to appreciate the Church’s teaching, a patient may, in good if misguided conscience, still choose euthanasia:

 

‘It is possible that, despite a patient’s best efforts to make the Church’s teaching their own, and the best efforts of the priest or other carers to explain that teaching and to provide personal support and understanding, a patient remains convinced that deliberately ending their life is a good thing for them to do. If such a person is ‘in good faith’, then he or she will experience a conflict between their own personal judgment and the teachings of the Church to which they give allegiance.’

 

The bishops’ document recognizes that this personal judgment to embark on euthanasia may arise from a variety of causes: ‘They might be focused on such thoughts as ‘I cannot go on living this way’ or ‘ I cannot ask my family to keep supporting me’’, or there is ‘…mistaken reasoning that is based on deep unresolved psychological factors (fears, obsessions, compulsions, etc.) which limit the patient’s freedom and insight into the good.’

Whatever the source of this reasoning and the consequence that the patients is not permitted to access the sacraments of Penance, Viaticum and Anointing of the Sick, the priest or chaplain is exhorted to remain close to the patient, not only in the hope that there may be a change of heart, but also because such a choice for euthanasia does not necessarily imply a negative judgment about the patient’s guilt.  Even further, the Australian document invokes Pope Francis’ recent response to the doubt put to him by the five Cardinals prior to the Synod on Synodality: ‘…it should be clear that all the conditions that are usually attached to confession are generally not applicable when a person is in a situation of agony or has very limited mental or psychological capacities.’ (2 October, 2023).

Further again, even though the priest or chaplain must withdraw when the lethal dose is about to be taken or injected, as he/she withdraws he/she should assure the patient that ‘he will pray for them and that, if requested, he will return to pray the Prayers for the Dead.’  A final note suggests that a Catholic funeral is not to be denied for such a patient.

There is, then, a strong pastoral, non-judgmental theme that animates the Australian Bishops’ document.  It recognizes that even ‘good’ Catholics may be attracted to euthanasia, particularly if they are confronted with the prospect of an extended and pain-filled terminal phase. In this vulnerable condition it may seem to them that they can choose euthanasia ‘in good conscience’. To this degree both Samaritanus Bonus and the Australian bishops acknowledge that moral responsibility may be diminished or even absolved.

Even though the Catholic priest or chaplain is unable to administer the sacraments of Penance, Viaticum and Anointing of the Sick to a terminal patient who has definitively committed themselves to euthanasia, this does not mean that the Church has abandoned, or  ‘wiped its hands of’ such patients. The priest or chaplain is strongly exhorted to accompany these patients right up to the time that the lethal dose is administered. He/she should return to recite Prayers for the Dead after death has supervened.

Nor should a Catholic funeral de denied for such patients, provided, of course, that this is not construed as acceptance of euthanasia. As the document concludes: the patient whose life has ended through euthanasia continues to be a son or daughter of the Heavenly Father, a brother or sister in Christ and a loved member of the Church who ought to be kept in our prayers seeking, through God’s infinite mercy, the repose of their soul.

 

 

 


Bill Uren, SJ, AO, is a Scholar-in-residence at Newman College at the University of Melbourne. A former Provincial Superior of the Australian and New Zealand Jesuits, he has lectured in moral philosophy and bioethics in universities in Melbourne, Brisbane and Perth and has served on the Australian Health Ethics Committee and many clinical and human research ethics committees in universities, hospitals and research centres.

Main image: Getty images

Topic tags: Bill Uren, Euthanasia, VAD, assisted dying

 

 

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After spending some 35 years of my life treating some of the sickest patients the medical profession has to deal with, viz, those with end stage kidney failure who will die within 3-4 weeks without either artificial kidney machine treatment or a kidney transplant, I never experienced a single request from a patient to help him/her die. I did, however, experience such requests from relatives who were looking to their own comfort or inheritance rather than to the allegedly beloved patient. The human being in my experience clings desperately to life in the face of daunting illness and those who prefer to die if such do exist are almost certainly outside the usual human mould. The management of such patients is far more likely to demand good psychiatric care than legalised murder. I often wonder who the executioners will be. Will they be paid by government like the hangmen of yesteryear or will they charge a private fee to the remaining family members.

 


John Frawley | 31 January 2024  
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Being very fortunate (or blessed), I have very limited experience of pain, in others or in myself. I obey the Catholic Church's position on euthanasia because it is the moral and not prudential position of the institution
commissioned by Christ to represent him until his return. However, as Faith is not divorced from Reason, the truth of the Church's position must also be supportable by fact.


The question, then, which doctors should have a unanimous reply to if it is a fact which supports a doctrine of intrinsic morality, is whether there is objectively such a thing as continuing intolerable pain.


There may well be an instant of objectively intolerable pain in which mortality is extinguished, but is there an objectively intolerable pain which can persist long enough for a mind and will to choose to incur the spiritual debt of rejecting life?


roy chen yee | 01 February 2024  

It’s taken me a little time to digest this article. A number of people die suddenly through accident, misadventure and war. Each summer we hear of drownings at sea and in waterways. Sometimes our end is slow in drawing near and this is where the Church can show, by practice and compassion, how to navigate this time. Life is sacred and we must cherish the life of each person. The Bishops have no easy task and must continue to speak out about and, most importantly, live out why this sacredness is so powerful. This commission is always about living right to the end.


Pam | 01 February 2024  

The relatively small number of people I know who committed suicide all had serious psychiatric problems. None of them was a Catholic. People like them need a mixture of psychiatric and spiritual help. There is a shortage of qualified, able and readily available people in these fields. Recently a disabled veteran in Canada, who requested a lift for her wheelchair, was offered euthanasia 'if life became too much for her', The moral universe has changed. Not in a way I endorse.


Edward Fido | 01 February 2024  

While I am categorically opposed to euthanasia it appears to me that the contemporary focus on wellness signifies an unhealthy cultural change in the context of which a pernicious new secular commandment has invaded the culture, viz. 'thou shalt strive to live as healthy a life as possible', any threat to which must invoke a kind of Doomsday or End Times belief that actually promotes the view that those who are 'saved' may proceed to Heaven without experiencing death. I have one or two Plymouth Brethren friends who, following the supposed St James' Gospel, actually teach this pernicious nonsense.

In general, and elderly as I now am, I make it a point whenever this topic arises in the geriatric circles to which I am increasingly directed to confine myself to ask about life issues, including the accessibility of grandchildren and others of diverse age and culture, (beyond those employed to care for the infirm!) and especially about the silos that hallmark our geopolitical location, especially in mass urban conglomerations.

There is surely something terribly wrong with this trend, including the glorification of lifestyles that are childless by choice, thereby pointing to a society that has lost touch with living itself.


Michael Furtado | 02 February 2024  

"... a society that has lost touch with living...
Yes, Michael Furtado, largely because, increasingly, we, society's members, devalue the irreplaceable status and roles of the family as our basic social unit, expecting the State to discharge responsibilities properly our own, especially in health and education.


John Kelly | 09 February 2024  

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