Assisted Dying – A Catholic Response

The Catholic Medical Association Newcastle branch held a meeting in Bede House, Newcastle on November 29th 2012 on the topic of “Assisted Dying – A Catholic Response”. The presenter at the meeting was Professor Julian Hughes, Consultant Psychiatrist at North Tyneside General Hospital.

He drew comparisons between the 2005 Mental Capacity Act (MCA) and Catholic Church teaching in Pope John Paul’s 1995 encyclical Evangelium Vitae and in the Catechism of the Catholic Church.  Some have expressed concern about the MCA that it could be used to introduce euthanasia by

neglect. The principles of the Act, however, are arguably in accordance with Church teaching.  A core feature of the MCA is that, in matters relating to life-sustaining treatment, persons making decisions about the care of any patient must not be motivated by a desire to bring about the death of the patient. It also states that the wishes and feelings, beliefs and values of the patient must be considered by those making decisions on their behalf. This is essential if the “best interests” of the patient are to be respected. Furthermore, the Act states that in relevant situations “all reasonable steps which are in the person’s best interests should be taken to prolong their life”. It recognises that there are situations “where treatment is futile, overly burdensome to the patient or where there is no prospect of recovery. In circumstances such as these, it may be… in the best interests of the patient to withdraw or withhold life-sustaining treatment, even if this may result in the person’s death. …” In Evangelium Vitae, Pope John Paul II had already dealt with this issue in similar terms: Euthanasia must be distinguished from the decision to forego so-called ‘aggressive medical treatment’, in other words, medical procedures which no longer correspond to the real situation of the patient, either because they are by now disproportionate to any expected results or because they impose an excessive burden on the patient and his family”. He adds that “there is a moral obligation to care for oneself and to allow oneself to be cared for, but this duty must take account of concrete circumstances. It needs to be determined whether the means of treatment available are objectively proportionate to the prospects for improvement. To forego extraordinary or disproportionate means is not the equivalent of suicide or euthanasia; it rather expresses acceptance of the human condition in the face of death.” The MCA seems to reiterate Church teaching by enshrining these principles in law. Dr Hughes drew attention to a 2007 statement from the United States Conference of Catholic Bishops in relation to the provision of artificial nutrition and hydration: “Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be excessively burdensome for the patient or [would] cause significant physical discomfort …”

The International Association of Catholic Bioethicists also issued a statement in 2009 reminding us that “the ultimate purpose of human existence is union with God and not longevity.”  The Association warned, however, that “awareness of the finitude of human life, however, can never justify forgoing ordinary (i.e., morally obligatory) care and treatment with the intention thereby of ending one’s own life or that of another person.”   

The important ethical concept of Double Effect from the teachings of St Thomas Aquinas was highlighted. An act can have a two-fold effect where a good effect is intended and a bad effect is merely foreseen but not intended. The classic example is the use of morphine to relieve intractable pain. In fact, if morphine is used properly to treat pain, it does not shorten life. But where the intention is to relieve suffering, although a treatment can be foreseen to cause adverse side effects, even death, it is not morally wrong to use the treatment to relieve suffering, as long as side effects are kept to a minimum.

Catholic Church teaching takes seriously the question of intention. In the Catechism of the Catholic Church it teaches that “the morality of human acts depends on the object chosen, the end in view or the intention and the circumstances of the action” (CCC§1750).

We are only morally obliged to do the ordinary. If a treatment (or investigation) is unlikely to be effective or likely to be burdensome this is considered extraordinary. For example, cardiopulmonary resuscitation in patients with advanced cancer or severe dementia is likely to be ineffective and possibly burdensome for the patient and can be considered extraordinary management.

Those in favour of legalising euthanasia and assisted suicide use a variety of arguments to further their cause including the notion of autonomy, the right” to die, the issue ofunbearable suffering” and problems associated with an ageing population and aduty” to society to die! They also attempt to downplay the slippery slope idea that introducing euthanasia and assisted dying with legal restrictions will eventually lead to more liberal practices.

The Oxford Professor of Jurisprudence, John Finnis, addresses some of these concerns when he stated to a House of Lords committee that “at present, there is a clear principle: never intend to kill the patient; never try to help patients to intentionally kill themselves. That is the law, it is the long-established common morality, it is the ethic of the health care profession and it is Article 2 of the European Convention on Human Rights.   …If autonomy is the principal or main concern, why is the lawful killing restricted to terminal illness and unbearable suffering? If suffering is the principle or concern, why is the lawful killing restricted to terminal illness? Why must the suffering be unbearable if there is real and persistent discomfort?” (Select Committee on Assisted Dying for the Terminally Ill Bill Minutes of Evidence January 2005) 

On the question of prohibiting euthanasia Prof Hughes gave the final word to Lord Walton, for many years a professor in Newcastle, addressing the House of Lords in connection with the Medical Ethics Select Committee Report back in May 1994: “society’s prohibition of intentional killing … is the cornerstone of law and of social relationships.”