Offering Dignity through Hope, Not Death with Dignity

In February of 2015, Valentina Maureira, a 14-year-old Chilean girl with cystic fibrosis, created a viral video appealing to Chile’s President for assisted suicide.¹ She explained that she was tired of fighting the disease. Although her request was denied as physician-assisted suicide is illegal in Chile, the video garnered numerous comments of support for the teen as well as a personal response from the Chilean President. A month later, Maureira announced she had changed her mind after meeting other patients with cystic fibrosis who had lived past 20 years old.²

In her initial plea for physician-assisted suicide, Maureira said she first started thinking about the idea when she heard about the case of Brittany Maynard in the United States. Maynard, a 29-year-old with terminal brain cancer, became the new face of the “death with dignity” movement. In October 2014, she shared with the world that she was choosing to end her life in the near future, a decision which offered her “peace during a tumultuous time.”³ Maynard’s article for CNN portrayed a world of stark choices: she could suffer for weeks or months, slowly undergoing physical and emotional changes while waiting for death, or she could obtain a prescription to ingest which would end her life at a time of her own choosing. By taking the latter option, she stated that she would be able to have a “death with dignity,” implying an indignity otherwise.

These stories of Maynard and Maureira are compelling: none of us wants to face a terminal illness or be in serious, prolonged pain. Indeed, after her death on November 1, 2014, Maynard’s story of having to uproot herself from California and to move to Oregon in order to access legalized assisted suicide, propelled other states to consider passing laws to allow assisted suicide as well. Maynard’s story has “inspired” at least one other person, Christy O’Donnell, a 46-year-old California woman with terminal cancer, to declare a desire for physician-assisted suicide, also. She is advocating that more state laws are passed which would allow more people to choose a “death with dignity.”⁴

Too often, we have heard the same argument in support of physician-assisted suicide: without this choice, patients will have to suffer a drawn-out and painful death, instead of having a “merciful” choice in arranging their own deaths, when and how they wish. Here is the crux of the lie perpetuated about “death with dignity:” that with long-term diseases or terminal illnesses, one must remain in continual pain, rather than having the choice to end one’s life in order to avoid a life of pain. But, are these the only choices available?

Palliative care is a third option, standing in direct opposition to this false dichotomy. It allows patients to live out the remainder of their lives—no matter how long or how short—with their pain properly managed. Palliative care improves the quality of life for patients facing life-threatening illnesses without an intention to hasten or postpone death. Thus, palliative care is juxtaposed with physician-assisted suicide, which seeks to hasten death while promoting the attitude that one must pursue every available means in order to prolong one’s life. The term is often used interchangeably with hospice care, although the two are not synonymous. Palliative care is applicable to any chronic illness (such as chronic respiratory disease, AIDS, or ALS) as well as terminal illness (such as advanced or incurable cancer). Hospice, on the other hand, applies to patients with an illness which has progressed to the point where curative treatment is no longer desirable or beneficial.⁵ Thus, all hospice care is palliative care, but not all palliative care is hospice care. Through palliative care, patients are offered a holistic approach to treatment, with attention being paid to their physical, psychological, and spiritual needs.

Physical needs are met by addressing the physical symptoms of the illness. Depending upon the patient’s medical condition, a range of treatments directed to the underlying illness can be pursued, from conservative to aggressive. Pain management is also an important aspect of caring for a patient’s physical needs, providing appropriate comfort for the patient, particularly as death becomes more imminent. Studies have shown that nearly all chronic pain can be managed using normal pain control methods.

Psychological needs that can arise for a patient with a chronic or terminal illness include emotional and social needs. Depression, fear, and anger are certainly not unexpected emotions. There may be inner turmoil that comes with feeling a loss of “self” due to the physical limitations of the illness. Counseling can help address these emotions, and offer ways to come to grips with the patient’s new status. Other emotions such as the isolation of illness, or the sense that one is a burden to family and friends, have their roots in societal needs. These needs can be met through open communication and providing the patient the love and support he or she needs. Indeed, these psychological and emotional needs, if left unmet, can actually lead one to seek physician-assisted suicide. In an article commenting on “death with dignity,” Barbara Kay rightly observed in a 2015 National Post article that “suffering people usually don’t really want to die.”⁶ Of the seventy-one people who died by physician-assisted suicide in Oregon in 2013, only two were referred to psychiatric counseling before the legal prescription was dispensed, according to Oregon’s public health records. How many of those seeking physician-assisted suicide are doing so because they feel that they will be, or are, a burden to others (whether or not this proves to be true)? And, how many seriously ill people are suffering from untreated depression?

The spiritual needs of the patient can also be met through palliative care. A new awareness of one’s mortality can evoke the sense of dread, anxiety, or fear. Here, the Church, through her ministers, have a most important role to play, namely, in sharing the faith with those suffering with the message that all human beings are created to share in God’s own life and, therefore, our lives have a greater, other-worldly meaning.⁷  The Church has the opportunity to preach and teach her belief in the resurrection of the dead. Palliative care is an opportunity to physically manifest this belief. Pastoral care—including the offering of the Sacraments, and the opportunity to help one prepare for death—is of the highest value as it deals with not only one’s life here on earth, but with one’s eternal life.

Respect for the dignity of the human person requires us to recognize that physical health (and with it, being pain-free) is merely one good among many, and is not, in itself, the highest good. As Fr. James F. Bresnahan, S.J., put it, “Catholic thought has recognized and reacted vigorously to the increased danger of an attitude and practice that makes death the only enemy.”⁸  In other words, the single-minded pursuit of a longer life is not the highest objective. Palliative care is in accord with human dignity by the fact that it neither hastens nor prolongs death. Such care also treats the patient as more than merely a composition of physical parts and physical problems, but rather as a whole person in ministering to both body and soul.

The Church has made it clear that physician-assisted suicide is never a morally licit choice. Perhaps, it is best stated in the Congregation for the Doctrine of the Faith’s “Declaration on Euthanasia”:

It is necessary to state firmly once more that nothing, and no one, can in any way permit the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. Furthermore, 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. For it is a question of the violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity.⁹

The prohibition against physician-assisted suicide is clear. However, the Church’s discussion must not stop there.  As with the abortion debate—which focused initially on telling women not to get an abortion without showing them an alternative path—the physician-assisted suicide discussion has been focused on the negative as well. We need to preach the moral error in those choices, but we must go beyond that. The Church has an obligation to promote and support palliative care by offering hope, and by upholding the dignity of every human person, including those nearing the end of their lives.

The discussion regarding the ethics and legalization of physician-assisted suicide will only continue to grow in the upcoming months and years. We, as a Church, need to point out the false choice which is being laid out for those suffering from chronic or terminal illnesses. Even more importantly, though, we have an obligation to offer hope and compassion through the lens of a Christ-centered charity. We must be prepared to listen past the literal language of the request for a self-inflicted death, and hear the true cry for help behind it, being prepared to meet the needs of those facing a terminal illness or continued pain. In so doing, we are able to honor the dignity of every human person.