End-of-life decisions: the moral issues at stake

End-of-life decisions: the moral issues at stake

David Perrin

David Perrin is a former member of the Victorian Parliament who opposed the Medical Treatment and Power of Attorney legislation at the time these were introduced. He is currently President of the Australian Family Association.

The recent decision of one judge in the Victorian Supreme Court to allow a woman with a degenerative disease to be starved and dehydrated to death gives us a timely opportunity to renew our understanding of Catholic social teaching about end-of-life issues.

When Pope John Paul II visited Australia he constantly urged Australians to fight the culture of death and to work for life. The Catechism of the Catholic Church reaffirms for Catholics and for all Christians Our Lord's command, "You shall not kill" because human dignity comes from God alone.

It forbids direct and intentional killing as "gravely sinful" and makes the intention to kill a key principle that must be applied to any medical decisions. This intention is aimed at decisions as much for unborn and born babies as it is for children with terminal illnesses and older people.

This intention to kill is reinforced by the Church when it defines euthanasia as "the putting an end to the lives of handicapped, sick or dying persons", which it describes as morally unacceptable.

The discontinuing of medical treatment is morally acceptable when the treatment is burdensome, dangerous, extraordinary, or disproportionate to the expected benefits. But the key principle of intent to kill must first be applied before the criteria of burden, danger, extraordinary, or usefulness.

The 1980 Declaration on Euthanasia, issued by the Vatican to be applied throughout the world, allowed the withdrawal of medical treatment where death is imminent, provided that the normal care in every case due to the sick person is not interrupted.

The Church condemns the use of painkillers to produce a deliberate death if the death is willed or an end in itself, again applying the key principle of intention to the use of painkillers. If death is the unintended effect of the use of painkillers then it is morally acceptable.

It follows that while the discontinuing of medical treatment may have occurred both painkillers and food and water (nutrition and hydration) should be continued. This is disinterested charity which the Church encourages.

When it comes to food and water the key principle of intention to kill must be first applied. After this, the Code of Ethics For Catholic Health and Aged Care Workers allows the withdrawal of food and water where they cannot be assimilated by a person's body, they do not sustain life or their only mode of delivery imposes grave burdens on the patient.

All these criteria have a common thread of either the body's unfitness to take the food and water or the body's unfitness to accept the apparatus for the delivery of the food and water. In other words, when the food and water will not work. These criteria are clearly different from those for the withdrawal of medical treatment.

Quality of life

The Church does not support the intentional bringing about of the death of a patient because of the loss of quality of life or any other factors relating to a patient's utility. Unfortunately, this lack of the quality of life of a patient was the criterion used by the Victorian judge in making the above decision.

This erroneous decision of the court was foretold by a world leader in Catholic ethics, Professor John Finnis, when in 1989 he said, "There is a risk that the courts will get hold of this issue (withdrawal of food and water), like they got hold of abortion and produce a wildly permissive judgement that would in effect allow at least voluntary euthanasia".

It is wise for patients who have a likelihood of being unable to make decisions in the future to appoint an agent to act on their behalf. However, it is quite another matter to attempt to preempt what medical complications may arise particularly towards the end of an individual's life.

The Church allows patients to legally appoint agents to act on their behalf but only where their reasonable will and legitimate interests are respected. The judge erroneously claimed that it was in the patient's best interests to be starved and dehydrated to death, something rejected by the Church.

While the Catholic Church and the Voluntary Euthanasia Society of Victoria both condemned the withdrawal of food and water as a cruel, inhumane and undignified way of intentionally causing death, there was a vital difference. The Euthanasia Society strongly supported the case for the starvation and dehydration decision, then condemned it, preferring a lethal injection because it was quicker.

The Catholic Church in Victoria strongly opposed the 1988 legislation legalising the withdrawal of medical treatment, with Dr George Pell, then a Melbourne auxiliary bishop, claiming the legislation, "endorsed killing by omission," since treatment could be withheld "not just in extreme situations, but at any time there is unreasonable distress."

Archbishop Denis Hart of Melbourne more recently summed up the Church's teaching of rejecting the extremes of either feeding people no matter what, or regarding patients as better off dead.

The Church led the way in support of human life and dignity, fearing for the victims and for Catholic health professionals and hospitals that could in the future be forced to stop feeding patients in order to hasten their deaths.

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