Joseph Cardinal Bernardin
Euthanasia in the Catholic tradition
Cardinal Bernardin clarifies terms involved in the discussion of euthanasia, describes developments in the movement to make euthanasia legal, and gives reasons for these developments. A consistent ethic of life, he maintains, can be helpful in bringing Catholic tradition to bear on decisions about morality and public policy.
The Alpha Sigma Nu-Vincent Daues, S.J. Visiting Scholar Lecture delivered at Rockhurst College, February 1, 1995.
This evening, I will share with you some thoughts on an ethical issue that confronts us in the United States and in many other first world nations. It is paradigmatic of broader cultural or societal movements that have already affected or will impact all of us. I am speaking of the movement to legalize euthanasia or assisted suicide.
I will a) describe the movement to legalize euthanasia or assisted suicide, b) offer some reasons why it has become so popular, and c) examine the issue in the light of the Catholic tradition. Let me begin, however, by clarifying certain terms.
As the U.S. Catholic Bishops pointed out in their Ethical and Religious Directives for Catholic Health Services, approved last November 17, euthanasia “is an action or omission which of itself or by intention causes death, in order to alleviate suffering.” In assisted suicide a third party provides the means for a person to kill himself or herself – by lethal injection, a prescription for a lethal drug, or another means. To cause death, rather than allow it occur in the natural course of life, makes all the difference in deciding whether or not a given procedure is euthanasia or assisted suicide. To respect a patient’s refusal of treatment or a request to cease treatment is not euthanasia. To administer medication to relieve pain, even if the foreseen but unintended effect may be to hasten death, is not euthanasia. The intention in euthanasia and assisted suicide is to cause death, not merely to allow it to happen.
Moves to legalize euthanasia
In the United States advocates of euthanasia, or “mercy killing” as it used to be called, have been around for decades. However, up to recently, they have had little impact on our society, its laws, and its public policies. Today, this is rapidly changing – a cause of grave concern for many of us.
One of the reasons for this disconcerting change in attitude stems from the fact that the advocates of euthanasia no longer refer to it as “mercy killing.” They now use such ambiguous euphemisms as “aid in dying,” similar to the practice of pro-abortion forces in the United States, who prefer to identify themselves simply as “pro-choice.” This tactical change has accompanied a growing attention in this country to the plight of families when confronted with a loved one with a debilitating or painful fatal disease as well as to the condition of those who are permanently unconscious, in what is known as a persistent vegetative state.
As a result, three kinds of initiatives have been introduced around the country: 1( state referendums, which, in addition to codifying laudable and appropriate clarifications of the law, have also sought to secure the right to provide “aid in dying” to patients; 2) court cases, which seek to have state legislation against euthanasia or assisted suicide declared unconstitutional; and 3) the provocative actions of Dr. Jack Kevorkian, a retired Michigan pathologist.
Let us first consider the state referendums, Initiatives to legalize euthanasia were defeated by voters in the state of Washington in 1991 and in California in 1992 by 54% to 46% margins. While these efforts failed, the bad news is that the margin of victory was not great and required the expenditure of significant amounts of money.
More recently, having learned from their failures in Washington and California, the pro-euthanasia forces drafted similar but revised proposals for a referendum in Oregon in order to achieve at least part of their objective and gain the support of a majority of voters. The modified their proposals to exclude lethal injections and to limit the role of physicians to prescribing lethal drugs. This apparently made measure 16, as it was called, less objectionable to voters. Last November 8, the measure passed by a margin of 51% to 49%, and Oregon became the only state in our nation to decriminalize physician-assisted suicide for terminally ill patients – that is, those who are expected by their doctor to die within six months.
On December 27, 1994, U.S. District Judge Michael Hogan granted a preliminary injunction against implementation of Measure 16. In his opinion, he noted that the “law invokes profound questions of constitutional dimension.” He concluded that “surely the first assisted suicide law in this country deserved a considered, thoughtful constitutional analysis.” He also noted the seriousness of the plaintiffs’ objections to the Measure, including, for example, the possibility of misdiagnosis of terminal illness or that physicians and death care workers might be required by the new law to comply with procedures contrary to their religious and moral convictions.
A second set of initiatives has involved challenging state laws that prohibit physician-assisted suicide. Currently, 31 states have statutes banning assisted suicide, and almost all of them have homicide statutes under which it can be prosecuted. In a case in the state of Washington, concluded on May 3, 1994, U.S. District Judge Barbara Rothstein stated that a competent, terminally ill adult does have a constitutional- guaranteed right under the 14th Amendment to commit physician-assisted suicide. This ruling is the first judicial decision that alleges a constitutional right to assisted suicide. However, as its critics immediately pointed out, the judge’s decision blurred the fundamental moral distinction between allowing someone to die and causing that person’s death. Moreover, Judge Rothstein based her opinion, in large part, on alleged analogies with the U.S. Supreme Court decisions on abortion, especially the 1992 Planned Parenthood v. Casey. It comes as no surprise that Judge Rothstein’s decision is under appeal.
On December 5, 1994, U.S. District Judge Thomas Griesa in New York came to the opposite conclusion in another case that tried to overturn New Yorker’s statute on assisted suicide. The plaintiffs had argued in terms similar to Judge Rothstein’s, but Judge Griesa concluded that their attempt to apply Supreme Court abortion decisions on constitutional rights was “too broad.” He also held that it is not “unreasonable or irrational for the state to recognize a difference” between “refusing treatment in the case of a terminally ill person and taking a dose of medication which leads to death.
The legal battles will continue, and we can expect that, eventually, some cases will appear before the U.S. Supreme Court.
The third kind of initiative in support of assisted suicide is Dr. Jack Kevorkian’s public flaunting of a Michigan statute by helping people commit suicide. Last Spring, Dr. Kevorkian was tried under a law that banned assisted suicide, but a Detroit jury, quite surprisingly, found him not guilty even though he had admitted what he had done. The statute’s constitutionally has been challenged before the Michigan Supreme Court, and the state legislature is working on another law. Meanwhile, last November, Dr. Kevorkian helped another person commit suicide by supplying her with carbon monoxide gas. This was the 21st death in which he assisted since he began his activities in June, 1990. We can expect that he will vigorously continue his efforts to legalize assisted suicide. Unfortunately, the extensive media coverage about his actions often ignores alternatives available to the elderly and the terminally ill –including, for example, living wills.
Outside the U.S.
The movement to legalize euthanasia or assisted suicide is not confined to the United States. In April of 1990 the Committee on the Environment, Public Health, and Consumer Protection of the European Parliament adopted a motion for a resolution concerning care for the terminally ill. Again, as in some of the proposed U.S. legislation, many of its recommendations were positive and quite acceptable. For example, reflecting widespread concern about the inappropriateness of some aggressive, very burdensome treatments at time of terminal illness, the document acknowledges “attempts to cure at all costs … must be avoided.” It also urges that all health care personnel be trained to have a persistently caring attitude toward the dying.
The document further calls for “palliative care” units in all European hospitals to care for those who are terminally ill. Such care seeks to reduce the distressing symptoms of a disease without treating its cause. The goal of this care is to help the patient “fight against pain, discomfort and fear” in the face of incurable illness. Moreover, pointing to the importance of the loving presence of relatives and friends to the dying, the resolution proposes that the treatment of the terminally ill should take place in the familiarity of their home whenever possible.
Unfortunately, the resolution also went far beyond these recommendations. First, in somewhat subtle manner it sought to redefine the meaning of the human person so that personhood could easily be identified with consciousness. Obviously such a change would have dire consequences for the unconscious, persons with serous mental disorders, and persons with certain disabilities. It is a change that must be resisted.
The document also recommended the use of euthanasia when 1) no cure is available for a terminal illness, 2) palliative care fails, 3)”a fully conscious patient insistently and repeatedly requests an end to an existence which has for him been robbed of all dignity,” and 4) “a team of doctors created for that purpose establishes the impossibility of providing further specific care.”
In other words, as Archbishop Charles Brand, President of the Commission of the Episcopates of the European Community, has pointed out, the resolution “claims to legitimate acts which terminate life when it is considered to be no longer dignified and human.” Such a change not only violates the injunction, “You shall not kill.” Found in the Decalogue and other foundational religious documents, but also is a radical departure from the entire code of medical ethics as it has been handed on for over two millennia. This code was first expressed in the so-called Hippocratic Oath attributed to an ancient Greek physician. This oath is still used at some medical school graduations. Its second section includes a pledge to use only beneficial treatments and procedures and not to harm or hurt a patient. It includes promises not to break confidentiality, not to engage in sexual relations with patients or to dispense deadly drugs. It specifically says: “I will never give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.”
In a moment I will speak of the religious and moral issues involved in the rejection of the injunction “you shall not kill.” For now, however, I will address the consequences of revising a traditional code of medical ethics which has been widely accepted and respected.
What would happen to the doctor-patient relationship if the proponents of euthanasia or assisted suicide are successful in legalizing these unethical, immoral activities? Would you trust a doctor who is licensed to kill? Would you entrust the life of your elderly mother or father, a seriously ill or disabled child –or your own life- to such a person?
Moreover, what added pressures would patients face. If euthanasia or assisted suicide were legal, might this not influence the decisions of elderly persons, for example, who do not want to be a burden to their families? Would not the poor be especially vulnerable to such pressure? Would they perhaps think that the best thing to do would be to ask their doctors to end their lives before their natural death? Moreover, when we are seriously ill, can we know clearly what we want? Would these truly be free choices?
These are significant, realistic issues that must be addressed. Some would respond by saying that they reflect unnecessary fears, that they are nothing but a “smoke screen” to cover up an attempt to perpetuate an outdated morality. In developing a response to this charge, let us consider what has happened in the Netherlands.
As you might know, the Netherlands has a unique position on the question of euthanasia. Technically, euthanasia is still illegal. However, since 1973, a series of court cases has allowed the current practice to develop. In effect, these court decisions give doctors considerable latitude in deciding whether or not to resort to euthanasia in each case. A doctor is expressed to report an act of euthanasia to a public prosecutor who must then decide whether or not to prosecute the doctor. Rather than claiming innocence, doctors are to justify their actions by pointing to mitigating circumstances –when explicitly asked for “aid in dying by mentally competent patients.
In such a context it is not a stretch of the imagination to surmise that many, if not most, acts of euthanasia are simply not reported. This means that few cases are actually investigated by public authorities. And this, in turn, means that it is difficult to get an accurate picture of precisely what is going on there. It is widely known, moreover, that Dutch doctors often misrepresent the cause of death on death certificates to avoid having to report acts of euthanasia and face the possibility of prosecution.
Several years ago, the Dutch government established a commission to study the practice of euthanasia in that country. Personally, I found the results of that study to be appalling, but not surprising. The so-called Remmelink Commission concluded that more than 1,000 patients underwent without their consent. The lives of another 14,000 patients were shortened by painkilling medication, also without their consent. The Dutch government has said that only about 200 cases of euthanasia are reported annually. However, according to Catholic News Service, the Remmelink Commission counted 2,340 cases of voluntary euthanasia, 390 cases of assisted suicide, and 1,040 of “life terminating acts without explicit and persistent requests” in 1990 alone!
In other words, the Dutch experiment justifies the concerns I mentioned earlier. There is no convincing evidence that euthanasia or assisted suicide can be regulated and managed. There is a valid reason to be concerned about the impact it would have on the doctor-patient relationship, not to mention the entire code of medical ethics. We may rightly question how safe our most vulnerable persons would be in any society that accepts euthanasia or assisted suicide.
A popular movement
In the light of information like this one might legitimately question why the euthanasia movement has become so popular. In the United States there are at least three possible explanations.
The first relates to the world of medicine and medical technology, As I noted earlier, for centuries those in the health care professions have had, as an essential aspect of their identity and mission, the responsibility to heal and preserve life. That responsibility has entered a new era with the development of medicines and technologies that have given physicians previously unknown capabilities in this area. We are grateful, indeed, for the great good that these advancements have brought to the human family.
This good, however, has been a mixed blessing. It is fairly easy for technology or medicine to become an end in itself, and for life to be preserved when, in fact, death should be allowed to occur. This possible domination of technology over the proper course of life has left many people fearful of being kept alive in an inhumane fashion. And this fear has led some to say to their loved ones: “Do whatever you must, but do not let me live that way.” The fear, then, of the pain and discomfort of a life prolonged inappropriately has led to an erosion of the natural instinct to preserve one’s own life.
A second possible explanation is more particular to the United States and its legal system. Although recent years have seen the enactment of legislation that has alleviated many legal problems, a fear remains that sick persons or their families will be prevented from making the necessary medical decisions on their own, and that they will have to become embroiled in a contentious legal process.
The pro-euthanasia forces in this country have exploited these two fears –being kept alive needlessly and losing autonomy to the complexity of the legal system-. Many people who now favor the legalization of euthanasia or assisted suicide do so not because they see this as a good in itself, but because they view it as the only avenue available to remedy these fears effectively.
This leads to the third explanation for the spread of pro-euthanasia attitudes. While this reason is present in the United States, it moves far beyond our borders and infects many parts of the world. It pertains to certain assumptions that have dominated, or are beginning to dominate, many of the world’s cultures. For our discussion today I will note four such assumptions. In doing so, I am building on the work of Harvard University Professor, Arthur J. Dyck.
First, there is a sense of human autonomy that asserts that an individual’s life belongs entirely to the individual, and that each person is free to dispose of that life entirely as he or she wishes. Second, in addition to the absence of external restraint, there is an understanding of human freedom to make moral choices that says that one must also be free to take one’s own life. In other words, there are no internal restraints. Third, it is possible to identify times when life simply is not worth living. This can be because of illness or handicaps or even despair. Finally, the true dignity of being human is to be found in the ability to make conscious, rational choices that control life. In the absence of that capacity, human dignity is lessened.
While one might nuance these assumptions, they capture something of the ethos of the euthanasia movement. And to be candid, there is something to be said for these assumptions. For example, they remind us that there are values in addition to the value of physical survival. Also, death is not the worst evil a person can face.
But they also contain great weaknesses. For example, they contain neither limits nor controls. There is no reason to believe they cannot be extended in a fashion similar to that of Nazi movement to conclusions that would be destructive to the human family in general and, in particular, to those who are the most vulnerable. Moreover, these assumptions self-evidently attack the basic notion of the human person as a member of a human community that is to be characterized by trust and care for one another. In other words, the movement to legalize euthanasia or assisted suicide involves not only decisions at the end of life but also certain assertions about the very nature of human life.
This means that, if one carefully analyzes the assumptions that would support the legalization of euthanasia, one finds a perspective that challenges the underpinnings of human civilization as we know it. This is why I have chosen this topic for our consideration this evening. As people of faith, we must attend to this threatening force with conviction and fervor. If we remain silent, the course of human history will be significantly altered.
A consistent ethic of life
But how can we proceed in a meaningful fashion in a pluralistic society like our own? The obvious answer is that we must find a common ground that will unite us in responding to this challenge, while respecting the religious diversity of our society.
Over the past eleven years I have sought to develop such a common ground within the Catholic tradition through what I have described as a consistent ethic of life. I have proposed it as a comprehensive concept and a strategy that will help Catholics and, indeed, all people of good will to influence more effectively the development of public policy on life issues.
The grounding principle for this ethic is found in the Judeo-Christian heritage, which has played such an influential role in the formation of the national ethos of this nation. In this religious tradition, human life is considered sacred because God is its origin and its destiny. Consequently, innocent human life must not be directly attacked, threatened, or diminished. Many other people of good will –not of this tradition- also accept the basic premise that human life has a distinctive dignity and meaning or purpose. They, too, argue that, because of the privileged meaning of human life, we have the responsibility for preserving, protecting, and nurturing it.
The second principle underlying the consistent ethic of life is the belief that human life is also social in nature. We are not born to live alone, but, rather, to move from the dependency of prenatal life and infancy to the interrelatedness of adulthood. To be human, then, is to be social, and those relationships, structures, and institutions that support us, as individuals and as a community, are an essential aspect of human life.
If one accepts these two principles about human life, then one may argue that two precepts or obligations necessarily flow from them. First, as individuals and as a society, we have the positive obligation to protect and nurture life. Second, we have a negative obligation not to destroy or injure human life directly, especially the life of the innocent and the vulnerable.
These principles and the resulting precepts have served as the foundation for much of what is known as the Anglo-Saxon legal tradition. They are the context for laws, which oppose abortion, murder, and euthanasia or assisted suicide. This movement from religious insight, to public policy is an important one. In the common law tradition these laws have been maintained, not because of religious insight, but because it is recognized that they pertain to the common good of society. In other words, the commonweal of public life and order would be destroyed if innocent human life could be directly attacked. In more recent years this same insight regarding the fundamental dignity of the human person has been given international recognition in the United Nations Charter of Human Rights.
I have addressed the need for a consistent ethic of life because new technological challenges confront us along the whole spectrum of life from conception to natural death. This creates the need for a consistent ethic, for the spectrum cuts across such life-threatening issues as abortion, capital punishment, modern warfare, and the care of the terminally ill. Admittedly, these are all distinct, complex problems that deserve individual treatment. Each requires its own moral analysis. No single answer or solution applies to all. At any given time, because of the circumstances, one may demand more attention than another. But they are linked!
Moreover, life-threatening issues are also linked with life-diminishing issues such as racism, sexism, pornography, prostitution, and child abuse. Wherever human life is considered “cheap” and easily exploited or wasted, respect for life dwindles and, eventually, every human life is in jeopardy.
The concept of a consistent ethic of life is challenging. It requires people to broaden, substantively and creatively, their way of thinking, their attitudes, their response to life issues. Many are not accustomed to thinking about all the life-threatening and life-diminishing issues in such an interrelated way. As a result, they remain somewhat selective in their response. Some, for example, are very committed in their efforts to eradicate the evil of abortion in this nation, but neglect issues of poverty. Others work very hard to alleviate poverty, but neglect the basic right to life of unborn children.
Given this broad range of challenging life issues, we desperately need a societal attitude or climate that will sustain a consistent defense and promotion of life. In other words, it is not enough merely to assert an ethical principle like the consistent ethic of life. It must also be implemented and when it is, it necessarily impacts all areas of human life. It responds to all the moments, places, or conditions which either threaten the sanctity of life or cultivate an attitude of disrespect for it. A consistent ethic is based on the need to ensure that the sacredness of every human life, which is the ultimate source of human dignity, is defended and fostered from the genetic laboratory to the cancer ward, from the ghetto to the prison.
Morality and public policy
The movement from moral analysis to public policy choices is a complex process in a pluralistic society like the United States. There is a legitimate secularity of the political process. But there is also a legitimate role for religious and moral discourse in our nations’ s life because nearly every important social issue has a moral or ethical dimension. Moreover, this ethical dimension usually does not exist apart from complex empirical judgments where honest disagreement may exist even among those who agree on the principles involved.
In the legal tradition of our country, however, it is not the function of civil law to enjoin or prohibit everything that moral principles enjoin or prohibit. So when dealing with law or public policy we must ask, in addition to the moral or ethical implications, whether the requirements of public order and the common good are serious enough to take precedence over the claims of freedom. Achieving a consensus on what constitutes a matter that is both moral or ethical and essential for public order and the common good is not easy. But we have been able to do it –by a process of debate, decision-making, then a review of our decisions and their impact on human lives, especially the most vulnerable.
My efforts to articulate the need for a consistent ethic of life have helped many people, both Catholic and non-Catholic, see the need for addressing in a consistent way a full range of life issues from conception to natural death. Moreover, I believe that human life has a meaning and a purpose that affirm the integrity and inherent value of body and spirit, even in the midst of suffering. I also affirm that all human persons need and desire to be able to trust the community in which they abide. And I am convinced that individual choices influence the moral tone and character of the community and, indeed, the entire human family.
That is why I am opposed to the legalization of euthanasia. It compromises the fundamental dignity of the human person in its inordinate exaltation of rational consciousness and in its challenge to the belief that there is significance to human suffering. It does inconceivable violence to the trust that should exist between doctor and patient –and indeed, among all human persons. And it naively pretends that individual human choices are isolated moments that have no impact on the lives and well being of others. Both my faith and experience tell me otherwise!