Dear Sister Mary Rose,
My name is Christina, and I am the one who sat their quietly listening. I was raised in a Catholic family, but am myself not very religious, and so it was interesting to learn about the opinions of the Catholic Church that I did not know before. I would like to thank you for taking the time to come into our class and speak with us.

The Catholic Church believes that “nothing and no one can in any way permit the killing of an innocent human being…[that] no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly…nor can any authority legitimately recommend or permit such an action.” They maintain that no one can make an attempt on the life of an innocent person without opposing God’s love and without violating a fundamental right, and that everyone has a duty to lead his or her life in accordance with God’s plan. Therefore, intentionally causing one’s own death is equally as wrong as murder and is considered to be a rejection of God’s sovereignty and plan.

According to Christian teachings, suffering during the last moments of life is a sharing in Christ’s passion and is a “union with the redeeming sacrifice which he offered in obedience to the Father’s will.” However, the Catholic Church knows that imposing this “heroic way of acting” would be imprudent, and actually suggests the use of painkillers, even though they may cause semiconsciousness. Those that cause full unconsciousness require special caution, as, according to Pius XII, “It is not right to deprive the dying person of consciousness without a serious reason.” With the use of painkillers, an increase in dosage to maintain their efficacy is usually required, which may as a consequence shorten life further. However, since death is in no way intended or sought, but rather the intention is to relieve pain, the use of painkillers is still acceptable.

Regarding the type of treatments that are acceptable in these situations, the Catholic Church states that “one is never obliged to use ‘extraordinary’ means,” means that can be determined by studying the type of treatment to be used, its degree of complexity or risk, its cost and the possibilities of using it, and comparing these elements with the result that can be expected. It is acceptable, with the patient’s consent, to resort to the most advanced medical techniques, even if they are still experimental, if there are no other sufficient remedies. It is permitted, with the patient’s consent, to stop these means if the results are not as expected, with an account of the reasonable wishes of the patient and the patient’s family, and the advice of the doctors. It is permissible to accept the normal means that medicine can offer; refusal of techniques that may pose risks is not the equivalent of suicide, but rather an acceptance of the human condition. When death is imminent and inevitable, it is acceptable in conscience to refuse treatments that would only prolong a burdensome life, so long as normal care is continued. In such circumstances the doctor has no reason to reproach himself for failing to help the patient.

Alison Davis, a woman born with myelomeningocele spina bifida, shared her point of view in an article. From her perspective, it is not up to others to determine the quality of life one has or may live; only that individual can decide that. Born with her severe physical disability, her parents were encouraged to simply leave her in the hospital and to go home and try again; instead she was given the chance to live. Now 28 years old, she has suffered considerable pain, undergone over 20 operations, is confined to a wheelchair, and has lead a full and happy life, as she says. Despite her disability, she went to school and a university, works full time defending the right to life of handicapped people, has been married eight years, and has traveled to Europe, the Soviet Union, and the United States. She owes her life to the fact that her parents refused to leave her, and she questions how anyone can decide that she would have “no worthwhile quality of life.” She believes that the doctors were acting in good faith when they offered their advice, but that their advice was not correct. In her eyes, the 28 days after birth (her age when the doctor’s gave the advice) has become accepted as the boundary of “non-personhood,” the notion of which denies the right of handicapped people to be recognized as equal human beings in society.

In the Netherlands, where active euthanasia is legal, Pieter Admiraal, a doctor of forty years in the Dutch city of Delft, regards active voluntary euthanasia as sometimes morally right and as an act sometimes required by doctors. He practices active voluntary euthanasia “openly and unashamedly,” and insists that to fail to practice this is to fail the patient.

A story of one of his patients seems to stick out in his mind as he explains why he supports active euthanasia. Carla, 47 years old, suffered from cancer; a large malignant tumor was found on one of her ovaries. After one operation and chemotherapy, her condition had improved, until 1990, when the tumor grew back. Eventually, Carla’s pain had escalated so much that her family doctor prescribed opioids. Her condition deteriorated, and she was readmitted to the Reinier de Graaf Gasthuis hospital where Admiraal visited her at least once a day. During one of these visits, she brought up the topic of euthanasia, seeking help for when the time came. Admiraal assured her that the doctors were always willing to listen and that euthanasia was not a taboo subject. He also pointed out that the decision needed to be agreed upon by two doctors, a nurse, and one of the hospital’s spiritual caregivers. After this point, Carla deteriorated further, and eventually a family meeting was called. The gynecologist, the Roman Catholic Chaplain, and Admiraal agreed that the patient’s wish should be respected. Carla signed a relevant consent form, confirmed her wish on the day that it was to take place, and died on August 6, 1990.

Admiraal believes that it was morally proper to help Carla die, and maintains that doctors have “two primary duties: to ensure the well-being of [their] patients, and to respect their autonomy.” Suffering, loss of control, and physical decline are subjective experiences, and nobody but the patient can decide when enough is enough. He maintains that it is inappropriate for the professional to impose his or her values and their understanding of suffering on the patient. Passive euthanasia, which is viewed as morally better than active, is no different than active. In both passive and active euthanasia, life is shortened, the doctor has performed an act that will lead to the patient’s death, and the doctor must take responsibility for his or her actions. To him, passive could even be considered morally worse because the patient is forced to die in a way that he or she does not want, and finds unacceptable and undignified. In those cases, “we fail to respect the patient’s autonomy; we fail to take seriously that patient’s own evaluation of suffering and pain…we fail to respect the patient as a self-determining person.” Those in the Netherlands also argue against the claim that patients would not ask for assisted suicide if their pain were adequately controlled. They say that not all pain can be controlled, and sometimes it can only be controlled through continuous intravenous infusion that will render the patient unconscious; also that pain is only one reason out of many why patients ask for euthanasia, along with loss of strength, fatigue, loss of human dignity, and complete dependence. In the Netherlands, euthanasia is always met with some hesitance, as a request for euthanasia does not mean that they will automatically perform the act. They always investigate the level of care the patient has received and whether there is something else to be done. Palliative care has also become an integral part of medical care. Admiraal believes that active voluntary euthanasia is one more way of delivering humane medical care.

Chris Hill experienced more than most people would in several lifetimes. He “once lived life to the max, always grateful that [he] had the opportunity to do just that, and always mindful to live for today because there may be no tomorrow.” Before the hang-gliding accident that would leave him paralyzed from the chest down, Hill had traveled all around the world, “embracing everything from some of the world’s most spectacular wilderness areas to its greatest cities and vast slums containing millions of impoverished souls.” After his accident however, Hill could no longer partake in the activities that once gave him pleasure. He lost his mobility. He could no longer regulate his body temperature. His muscles withered away, and he suffered from pressure sores, ulcers, urinary tract infections, hemorrhoids, shoulder pain, swollen ankles, hypersensitivity, tinea, crutch rot, headaches, and much more. He despised going to the hospital and wept at the sight of “someone standing up [or] a child skipping.” Hill says that animals are put out of their misery when they’re suffering, but he was never given that option and was instead forced to recover and live. He sees his rehabilitation as a waste of $150,000 in taxpayer money. Although he worked hard to try and rebuild his life, he could not do what others with paraplegia or quadriplegia had done – lead a successful, apparently normal and happy life. Suicide was what made him happy, because as he says, “it’s quality of life, not quantity, that’s important.” He embraced death, and could hardly think of anything that he wanted to do that he hadn’t already done yet. He was not religious – “how could anyone believe in a just, compassionate and almighty God after seeing and experiencing what I have?” – and his only regret was the thought of hurting anyone he loved and who loved him. His final paragraph in the letter states that he would like his loved ones to see death as he did, “as a release, something to celebrate.”

Personally, I feel that if you are terminally ill and suffering/decide that you have no quality of life, then physician-assisted suicide should be allowed. It’s your life and your body, so, with a good reason, you should be able to make your own decisions. Carla was terminally ill and suffered greatly. Chris Hill, though not terminally ill, was still in a lot of pain, both physically and emotionally – he suffered from the medical problems, but also from the fact that everyday activities became a hassle and that he could no longer live the life he lived before – and was miserable. Both had a legitimate reason and made the decision themselves.

One point I would like to make is that I don’t think allowing physician assisted suicide is a slippery slope, as Alison Davis stated in her article. I will agree with her that deciding for babies is wrong because that baby can’t voice its opinion and may very well live a happy life, as Davis did; but for the most part, I think it’s the terminally ill and paralyzed that request to die. For these people, no one is deciding for them whether they should live or die. Only these people truly know their pain and their misery and whatever else they’re going through, and only they make the decision for themselves. Carla made the choice herself. Chris Hill decided for himself that he didn’t want to live the way he did. So did Ramon San Pedro and Dan James. Jack Kevorkian did not decide to kill people because he felt like it; people came to him for help. The Netherlands has legalized euthanasia for however long and they have not fallen down a slippery slope. I think consent is what prevents active euthanasia from becoming a slippery slope.

For the physically disabled, I think that they should be encouraged to continue living and be shown that they can lead happy, fulfilling lives, much like Alison Davis, but should not have a life they don’t want to live forced on them if they really don’t want it.

In Million Dollar Baby, I think Frankie ultimately did the right thing. It may not have been done in the smoothest of manners, but Maggie was determined to die. She would have tried over and over until she succeeded or until she was sedated all the time. He probably should have tried to convince her to stick it out, convince her it would be ok before he helped her commit suicide though.

I would like to thank you again for coming into our class to help us better understand the Catholic Church’s point of view. It was very kind of you to take the time to speak with us, and I feel that I better understand both sides on the issue of euthanasia.