Killing Is Not Compassion

I call heaven and earth to witness against you this day, that I have set before you life and death, blessing and curse; therefore choose life, that you and your descendants may live, loving the LORD your God, obeying his voice, and cleaving to him . . . (Deuteronomy 30:19-20)

True Crime Story?

    Imagine you’re reading a book, or watching a film.  In this story a caregiver, a trusted figure, secretly puts a sleep-inducing drug in the coffee of an unsuspecting person under her care.  Once the victim is no longer conscious, the perpetrator tries to administer a more powerful drug, a lethal drug.  The victim (who had previously expressed to her care provider a desire to continue living) wakes up and fights back.  The caregiver calls upon accomplices (from the victim’s own family, no less!) to restrain her, and forcibly administers the deadly injection. Sounds like a crime thriller, doesn’t it?  But wait, there’s more . . . here the story changes from a crime thriller into a Kafkaesque dystopian nightmare. The deed comes to the attention of the authorities, who conclude that the killer should indeed go to trial . . . but not to punish her wicked crime.  Rather, despite conceding the lurid details above, they conclude that she “acted in good faith”, and seek a trial in order to establish a legal precedent that other health care providers may likewise kill unknowing, and even unwilling, persons without fear of punishment.

Healer, or killer? (detail from painting by Mikhail V. Nesterov)

    As you may have guessed, the scenario above is in fact a true story, which recently took place in the Netherlands, as detailed in this article from LifeNews.com. The only major detail left out of my retelling, and the only thing (at least in the minds of the Dutch Review Committee that investigated the case) that makes what appears to be an act of unspeakable wickedness into a “good faith” medical procedure, is the fact that the victim was suffering from dementia.  As more and more places are following the Netherlands along the path of the legalized killing of the old, infirm, and, increasingly, those who are simply unhappy, it would be wise to take a look at cases like this to see what lies ahead.

In the Eyes of the Law

Prof. Theo Boer (Daily Mail photo)

    The case above is a chilling illustration of how, once we cross the line of giving legal sanction to the direct taking of innocent life, we unleash a force beyond our control, in which the “logic” of death overwhelms supposedly rational considerations.  Let’s start with what Dutch law provides for, and see how it compares to what actually happened in the situation above.  Theo Boer, a professor of Health Care Ethics at Kampen Theological Seminary in the Netherlands recently published an article in the British Catholic Medical Quarterly explaining why he no longer favors the pioneering Dutch law allowing physician assisted suicide. We’ll get to his reasons in a moment; first I’d like to take a look at his summary of the law in question.  Pr. Boer explains that, according to Dutch law:  

-1. “First, there should be a request from the patient” - There was no such request, and in fact, according to an article in the UK’s Daily Mail,

. . . the patient said several times ‘I don’t want to die’ in the days before she was put to death, and that the doctor had not spoken to her about what was planned because she did not want to cause unnecessary extra distress. She also did not tell her about what was in her coffee as it was also likely to cause further disruptions to the planned euthanasia process.

-2.  “there should be unbearable suffering without prospect of improvement” - The daily Mail tells us that “she often exhibited signs of fear and anger, and would wander around the building at nights. The nursing home senior doctor was of the opinion that she was suffering intolerably”, but  adds that “she was no longer in a position where she could confirm that the time was now right for the euthanasia to go ahead”. In other words, in the subjective judgment of outside observers her life was no longer “worth living”; other facts in the case indicate that the person living that life didn’t concur in that judgment.

-3. “the doctor should inform the patient of his situation” - demonstrably no.

-4. “doctor and patient together should have come to the conclusion that there is no acceptable alternative” - again, manifestly not.

-5. “the doctor should have consulted a colleague” - it is unclear from the Daily Mail article whether the “senior doctor” is the same who administered the lethal injection, but it is likely that more than one doctor on the staff participated in discussing the case.  If so, this is the one point on which the doctor unambiguously complied with the actual requirements of the law.

-6. “The assisted dying should take place in a medically sound manner” - well . . .

. . . secretly drugging a patient, then forcibly injecting her as she fights for her life doesn’t fit my standard of sound medical manner, but others may have a different opinion. In any case, the attending physician incontestably violated provisions 1,3, and 4 of the law, arguably number 2 and, if one is to take a civilized view, number 6 as well.  Setting aside for the moment the morality of any such law (I’ll get to that), the doctor euthanizing this patient blatantly flouted most of the specific provisions of the law. How in this world is it possible that the Review Committee would not only bless the doctor’s efforts, but would also be so confident that the courts would agree?

Gospel of Life

    To answer that question, I suggest we go back to St. John Paul II’s Encyclical Evangelium Vitae (The Gospel of Life), published in 1995, six years before the passage of the Dutch assisted suicide law.  St. John Paul, in speaking of both legalized abortion and legal euthanasia, wrote (my bold):

The end result of this is tragic: not only is the fact of the destruction of so many human lives still to be born or in their final stage extremely grave and disturbing, but no less grave and disturbing is the fact that conscience itself, darkened as it were by such widespread conditioning, is finding it increasingly difficult to distinguish between good and evil in what concerns the basic value of human life. (Evangelium Vitae 5)

St. John Paul II

In other words, not only are the acts themselves immoral and unjust, but they tend to corrupt the moral understanding of society as a whole, and consequently the morals of everyone in it.  Why should we expect anyone to honor the specific provisions of man’s laws if we no longer recognize the legitimacy of the moral law, God’s Law, itself?

    There is a clear pattern to the way this corruption works in concrete instances, which we can see in the legal history of contraception and abortion over the past century: The rare, extreme case is offered as an exception to a ban on something that had previously been considered intrinsically wrong; once the line has been breached, however, there is no longer any reason in principle to deny to others what was at first permitted to only a few.  If it’s not wrong for married couples experiencing certain difficulties to use contraception, why should it be wrong for others? If it’s not murder for one woman to abort her baby, how can it be so for another? We have now seen the same thing happen here in the United States with marijuana laws: first only “medical” marijuana for people with glaucoma and other conditions, but followed in short order by the general lifting of restrictions.  We should expect that, once rare “hard cases” have been used to legitimize legal euthanasia, the killing will become increasingly more commonplace, and “acceptable” in an ever wider range of situations.

It Can’t Happen Here . . . Can It?

    Pr. Boers details how this exact thing has happened in the Netherlands with assisted suicide and direct euthanasia.  The law was proposed to apply to people who were suffering late-stage terminal illness and suffering extreme pain.  Before very many years, those people became the exception to the rule:

. . . what was once considered a last resort, now becomes a default mode of dying for an increasing number of people. The unbearable character of the suffering is lesser described in terms of physical suffering and more in terms of ‘meaningless waiting’.

    In fact, most of the people requesting euthanasia aren’t dying at all:

Whereas in the first years hardly any patients with psychiatric illnesses or dementia appear in reports, these numbers are now sharply on the rise. Cases have been reported in which a large part of the suffering consisted in age related complaints. Loneliness occurs in 50 out of the last 500 cases that I reviewed before stepping back. Many of these patients could have lived for months, others for years or even decades. We have seen a number of ground breaking cases: ‘euthanasia for two’, for example couples in which the caregiver gets cancer and his partner chooses to die the same day and the same way; euthanasia in blindness; euthanasia for a man with autism who fears retirement; assisted dying for a mother of two suffering from tinnitus. Undeniably, assisted dying for one group of patients leads to demands from others.

    Similar results are reported in Oregon, the first US state to legalize assisted suicide, and in other states that have followed since.  There, the most common reason given is the abstract, amorphous "loss of autonomy" (see chart below). Less than a third cite pain (and not all of those are actually experiencing pain: for some it is only fear of possible pain). In fact, the most common factor among those seeking assisted suicide is not pain or terminal illness but depression, a treatable, non-fatal condition.  Studies conducted in both the United States and the UK indicate that over 90% of those seeking assisted suicide are suffering from mental problems. Nevertheless most of these people receive no psychiatric assistance prior to their death.   In fact, we have seen in the United States, and Pr. Boer reports the same in the Netherlands, that the doctors who preside over these deaths often have no professional relationship at all with their patients, and sometimes don’t even know them.

The Law as a Teacher

    The idea that “The Law is a Teacher” is an old one, going back at least to St. Paul’s letter to the Galatians.  So what does a law permitting killing people because they are old or sick teach us?  Surely it sends the message that human life is not sacrosanct, but instead something that can be disposed of when it becomes difficult . . . and if difficult lives are expendable, then why not inconvenient lives?  And where do we go from there?  St. John Paul explains that:

It is a problem which exists at the cultural, social and political level, where it reveals its more sinister and disturbing aspect in the tendency, ever more widely shared, to interpret the above crimes against life as legitimate expressions of individual freedom, to be acknowledged and protected as actual rights.  (Evangelium Vitae 18)

    Pr. Boer, in language strikingly like that in the passage above, confirms that such has in fact been the case in the Netherlands, saying that “there is a shift in public opinion. Whereas in the beginning assisted dying was seen as a last resort, public opinion is shifting towards considering it a right” (my italics).  Boer goes even further, however, adding:

. . . public opinion is shifting towards considering it a right, with a corresponding duty on doctors to act. A law that is now in the making obliges doctors who refuse to actively refer their patients to a ‘willing’ colleague.

The Culture of Death

Dance of Death by Venne Adriaen Pietersz

   We can expect the pressure on doctors to participate in killing to grow more intense in jurisdictions that have legalized euthanasia.  The idea of such killing as a legitimate good likewise puts pressure on family members to seek it for loved ones who may be unable to ask for it themselves (which may have been a factor in the Dutch case discussed above), and also on those who are themselves suffering to “spare” their relatives the trouble of caring for them.  This very concern is among the most cited reasons given by those asking for assisted suicide or euthanasia.  And so we see the corrupting power of sin: doctors, who have dedicated themselves to healing, are increasingly compelled to do the opposite and kill; close family members see themselves in mortal conflict with those whom they love . . . and killing off grandma becomes little more exceptional than "putting to sleep" the family dog.

    That’s the future that’s in store for us if we continue down the path of killing as a remedy for suffering, old age, and mere ennui.  We can look forward to more and more people implicated in ever greater acts of injustice, and ever wider waves of corruption spreading throughout society as a whole.  As we can see from events in the Netherlands this is no longer conjecture, but, in many places, a reality, a reality famously described by St. John Paul II as a "culture of death"  (Evangelium Vitae 12). The people who are relentlessly pushing Death as the solution to a myriad of problems will try to paint killing as “compassionate”, but the truth is very different. Killing is not Compassion.     

Death and Human Dignity

The Throwback below was first published 17 August 2015

Here is a sign of things to come, or more accurately, a present reality that is becoming all too common:

A British woman with no serious health issues ended her life July 21 at a suicide clinic because, she said, she didn't want to grow old. Gill Pharaoh, 75, said her work in a nursing home revealed the "awful" truth of old age and burdens placed on loved ones and caregivers, the Telegraph reports by way of the Sunday Times.   

Gill Pharaoh, in a photo from her blog

     Let me emphasize at the outset that I don’t wish to ridicule Pharaoh: I pray that she can find God’s mercy in the hereafter.  She provides us with a concrete example, however, of how today’s conventional wisdom promotes death as the solution to our problems.  The appeal to relieve the “burdens placed on loved ones and caregivers”, for instance, is one of the primary emotional appeals that euthanasia advocates use (and both euthanasia and abortion promoters rely heavily on an appeal to emotion). Pharaoh herself, who wrote extensively about her decision before she killed herself, dismissed the idea that she should expect the support of her children in her old age, saying: "I had children for the personal and selfish reason that I wanted them for the pleasure and joy they bring. I want them to enjoy their middle years without having to worry about me."

       This is a sad and confused argument.  Again, I don’t doubt Pharaoh’s sincerity, but I can’t believe that she was as selfish as she claims.  Surely she changed diapers, cleaned up vomit, awakened from much-needed sleep to feed or comfort crying babies, none of which is very joyful or pleasurable, and that didn’t deter from giving birth again.  Did she really think of her children as merely a “burden”?  Of course not.  I’m sure she thought the “joy and pleasure” well worth the “burden” and, yes, the “worry” of caring for her children from birth to adulthood.  By even the crassest calculus, isn’t it reasonable to expect her children to return the favor when she needs them to do the same for her?

      Needless to say, we shouldn’t limit ourselves to the crassest calculus.  I’m sure Gill Pharaoh endured the discomforts and inconveniences of child-rearing for the same reason that any of us who are parents do: because we love our children, not because of some loss/benefit ratio.  We see the trouble we endure for their sake as a way of expressing our love, of making it real; that’s why, despite all the trouble they cause us, our children bring us joy and pleasure.  Ironically, what she has done now is really much more selfish: she has deprived them of the opportunity to love her in the same way.  Even worse, by citing their convenience as a primary reason for her premature death, she is placing responsibility for her decision on them.

    And, of course, there is more to the ‘"awful" truth of old age’ to which she refers than the purported inconvenience to loved ones:        

  

she recounted a life slowly sapped of former joys like long walks and gardening sessions. "Not to mention the hundred and one other minor irritations like being unable to stand for long, carry a heavy shopping bag, run for a bus, remember the names of books I have read, or am reading, or their authors."  

A few decades ago, when we as a society still recoiled at the thought of intentionally ending any innocent person’s life, euthanasia advocates relied on searing anecdotes about terminally ill people undergoing excruciating suffering, or about people such as Karen Ann Quinlan who were kept alive only by machines, and who seemed to have no hope of ever regaining consciousness.  More recently we have reached the point where few of us seem to find it remarkable that we commonly starve to death people who aren’t even dying or unconscious, but are merely extremely old or disabled.  And so now, apparently, we are expected to accept that simply slowing down, or having to put up with “minor irritations”, is reason enough for otherwise healthy people to take their own lives.

The aged St. John Paul II

     There’s no reason to think that it will end here.  We live in a culture that has increasingly rejected the belief in the sacredness of anything, including human life.  Public schools (and many private, even religiously affiliated, ones) reinforce this worldview in a variety ways, and it is communicated by popular culture in countless messages both subtle and overt. It follows that if all we really are is protoplasm, or a particularly complex assemblage of molecules, what could possibly be sacrosanct? If the materialist view is correct, then there cannot be any sort of “meaning” to anything; human life itself is meaningless and suffering, which (in this view) is nothing but pointless pain and distress, is worse than useless: why not just put an end to it all?  In such a world suicide clinics can only multiply. Is it any wonder that St. John Paul the Great spoke of a “Culture of Death”?

      In response to this Gospel of Despair we Christians can point to the Mystery of the Cross.  Christ showed us in his own agonizing, distressing death that suffering even to the end can be not just meaningful, but redemptive: through our suffering we, too, can accomplish great good.  We have seen the lesson of Christ’s redemptive suffering reflected in the lives of countless of his followers, from the first martyrs to St. John Paul himself, who taught a worldwide audience that “death with dignity” does not mean taking it upon ourselves to cut off the concluding chapters of our lives.

      Many of us know family and friends who have likewise embraced the Way of the Cross. In my case I’m thinking in particular of an aunt whose faith-filled serenity during a slow and difficult death from cancer had a profound impact on everyone who saw her in her final days. I couldn’t help but think of this aunt when I read that Gill Pharaoh had said: "I do not want people to remember me as a sort of old lady hobbling up the road with a trolley".  My aunt’s loved ones don’t picture her infirmity when they remember her: they talk about her, how she exuded love and joy despite her suffering, an image of beauty in the midst of the ugliness of her fatal illness.  They don’t remember her depleted body, they remember her.  

     Again, my purpose isn’t to criticize Gill Pharaoh. She, along with the 611 of her fellow British citizens who ended their lives in Swiss suicide “clinics” between 2008-2012, and an ever lengthening list of others throughout the Western World, is a victim of a Godless, and therefore anti-human, worldview, a philosophy that tells us our “dignity” somehow lies in escape from what we are.  The Truth is very different.  St. Irenaeus said that “The Glory of God is Man fully alive.”  Suffering is a part of every human life: we can’t escape from it without denying our humanity.
     

Should We Give Up At 75 Years Old? (Worth Revisiting)

Last weekend we marked the 43rd anniversary of the U.S. Supreme Court's notorious Roe v. Wade and Doe v. Bolton decisions, "an exercise of raw judicial power" (in the words of dissenting Justice Byron White) which eradicated the abortion laws of all fifty states, imposing an unlimited abortion license on the United States. The war on the sanctity of human life, however, is being conducted on more than one front. While abortion attacks life at its beginnings, there are numerous if less obvious assaults on the later stages of life as well, one of which I examine in this Worth Revisiting Post originally published in September, 2014 on the blog Principium et Finis. 

To enjoy the work of other faithful Catholic bloggers see Worth Revisiting Wednesday, hosted by Elizabeth Reardon at theologyisaverb.com and Allison Gingras at reconciledtoyou.com.

The Culture of Death

There are those who say that St. John Paul II was exaggerating, or at least being unduly harsh, when he coined the term “Culture of Death” in his encyclical Evangelium Vitae.  If only that were true. The secular world simply insists on offering death as the “compassionate” response to all sorts of things: suffering at the end of life, difficulties at life’s beginning and, increasingly, trouble in between.  Today I’d like to explore one recent example of the Culture of Death at work, and a second next week.

The Architect of Obamacare

     Let us consider  Ezekiel Emmanuel, brother of President Obama’s former Chief of Staff Rahm Emmanuel.  Ezekiel, one of the prime architects of the ironically named Affordable Care Act (a.k.a. Obamacare), published a piece in The Atlantic last fall [October 2014] called “Why I Hope To Die At 75” [here].  The wide-ranging essay explores at great length the disadvantages of old age: reduced productivity, lessened vitality, the host of physical ailments that proliferate as we age, but, interestingly, doesn’t focus on the effect of these things upon the sufferer:

Doubtless, death is a loss . . . But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.[my italics]

It is selfish of us, you see, to force others to experience our decline: the compassionate thing is to quit while we are ahead.  Emmanuel is most emphatic that he is not advocating euthanasia or physician-assisted suicide, quite correctly pointing out that “the answer” to the desire to actively bring about one’s own death “is not ending a life but getting help. I have long argued that we should focus on giving all terminally ill people a good, compassionate death—not euthanasia or assisted suicide for a tiny minority.”

Just One Man's Opinion?

     So what is he advocating? He claims that he will refuse any “life-prolonging” treatment of any sort: “I will stop getting any regular preventive tests, screenings or interventions.  I will accept only palliative – not curative – treatments if I am suffering pain or other disability.”   After a lengthy recitation of the routine treatment he intends to forgo, Emmanuel says “I will die when whatever comes first takes me.”

     We could just dismiss this as no more than one opinionated man’s personal view, and Emmanuel encourages us to do just that:

I am not saying that those who want to live as long as possible are unethical or wrong. I am certainly not scorning or dismissing people who want to live on despite their physical and mental limitations. I’m not even trying to convince anyone I’m right. . . And I am not advocating 75 as the official statistic of a complete, good life in order to save resources, ration health care, or address public-policy issues arising from the increases in life expectancy.

But he gives the game away when he adds:

What I am trying to do is delineate my views for a good life and make my friends and others think about how they want to live as they grow older. I want them to think of an alternative to succumbing to that slow constriction of activities and aspirations imperceptibly imposed by aging. Are we to embrace the “American immortal” or my “75 and no more” view? [my italics]

There Are Opinions, And Then There Are Opinions

And what is the point of getting others to think of alternative ways to live (and die) if not to persuade them to change their behavior?  In truth, underneath the welter of medical facts and figures and the personal focus, we see two very familiar arguments: the “quality of life” argument (i.e., a “diminished” life isn’t worth living) and the “appeal to compassion” (we should spare our family and society the “burden” - including the financial burden - of our  infirmity).

Ezekiel Emmanuel

     Nonetheless, isn’t that just his opinion?  No, because when a prominent man, one with a “Dr.” in front of his name, expresses his opinion, buttressed with all sorts of impressive medical sounding data, and in very engaging and (truth be told) well-crafted prose, it has an impact.  The more often such opinions come from such sources the less unthinkable such opinions become in the wider world, until they eventually become commonplace.  We have seen this strategy employed to perfection in recent years in the campaign to redefine marriage (more on that next week). 

     There is also the fact that, despite his disclaimers, Ezekiel Emmanuel is still has a great deal of influence on public policy: in addition to his well-known public connection with Obamacare he is the director of the Clinical Bioethics Department at the National Institutes for Health.  Add it all together and, as Ben Shapiro points out in a piece on the Breitbart site [here],

                 . . . his opinion carries weight.

Enough weight that the same day Emanuel’s piece published, a 21-member Institute of Medicine panel announced that we need to revamp our end-of-life care. “The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly,” said David M. Walker, former US comptroller general and chairman of the panel. The panel also encouraged end-of-life conversations with as many elderly folks as possible, and that costs could be slashed by thinking about aging differently.

           

That's a rather curious coincidence, don't you think?  And perhaps its no coincidence, as Shapiro points out, that "Ezekiel Emmanuel was elected in 2004 to the Institute of Medicine". 

     Finally, while Emmanuel explicitly opposes euthanasia and suicide (and I don’t doubt his sincerity), the attitude towards aging that he is validating and encouraging will inevitably make those “options” more and more acceptable; and if the public thinks there’s nothing wrong with it, why shouldn’t the government facilitate it . . . or require it? I am reminded of Blessed Paul VI’s warning about birth control measures (if we change Paul's reference to "married" people to "ordinary" poeple) :

Finally, careful consideration should be given to the danger of this power passing into the hands of those public authorities who care little for the precepts of the moral law. Who will blame a government which in its attempt to resolve the problems affecting an entire country resorts to the same measures as are regarded as lawful by [ordinary] people. . . ? (Humanae Vitae, 17)

The slope is getting more slippery all the time.