Caring When There Is No Cure

The Pontifical Academy for Life dedicated an assembly last month to the elderly and palliative care, a difficult issue when decisions for loved ones have to be made.

Euthanasia etymologically means “a good death (eu thánatos),” to die well.  Nevertheless, today euthanasia is understood as an action or omission that, by nature or intention, brings about the death of a gravely-ill person.  Thus, euthanasia always represents a form of homicide since it implies that one person causes the death of another.

It can be accomplished with an action (e.g. administering a lethal injection); this is known as active euthanasia. Or, it can be accomplished by omission (denying basic care or ordinary means); this is known as passive euthanasia.

Voluntary euthanasia is at the request of the patient.  Assisted suicide is when the patient himself carries out the procedure and a doctor only provides the tools, such as lethal injection, pills, etc.  Involuntary euthanasia or euthanasia-homicide is performed by force, without the consent of the patient.

Every form of euthanasia is gravely immoral since the means and the object, i.e. the action or omission, imply killing, and thus are ethically incorrect.

The popular justification of euthanasia is found in two basic ideas:

• the principle of individual autonomy, that one has the absolute right to control one’s life; and
• a more or less explicit conviction that the suffering that can sometimes accompany death is useless and intolerable.

The patient’s suffering is often the foundation upon which euthanasia and assisted suicide are justified or even obliged.  But suffering today, more than ever, is “curable” with adequate means of pain relief and palliative care, and with adequate human and spiritual assistance.

Behind certain euthanasia campaigns lie hidden reasons based on public spending, which in some instances is considered unsustainable and useless given the duration of certain illnesses and the ill person’s lack of “utility” or productivity to society.

A patient, regardless of his “utility,” should always be ensured basic care.  Basic care implies food and hydration (even through artificial means), cleaning, especially of bedsores, and protecting a permeable airway, i.e. that air is kept able to pass through the respiratory channels either by suctioning secretions or with a tracheotomy (making a hole through the neck into the trachea).  Any person, healthy or sick, requires food and hydration (the latter to an even greater degree).  A patient that is not nourished is more likely to be killed from dehydration and starvation than to die of his affliction.  The doctor or hospice should give basic care, the family should ensure that it is received and the patient cannot deny it.

This does not mean, however, that patients and families are required to delay death for as long as possible, by any means possible, even when there is no hope of a cure and even though it implies great additional suffering for the ill person.  Such aggressive therapy or therapeutic obstinacy is disproportionate (a concept we will address in greater detail in a follow up brief), and is called Dysthanasia.  Such “treatment” denies a patient the right to die of what afflicts him when there is no objective possibility of recuperation.

Palliative care is the appropriate means of treating such patients.  Such care doesn’t cure the patient, nor does it prolong agony, but simply makes him or her [feel] better. In contrast to basic care, a patient can deny palliative care.  Included in palliative care is adequate treatment of pain.  Today, any pain, if it can’t be eliminated, can be significantly controlled.  Palliative care is a privileged form of disinterested charity.  The ill person should feel that he is surrounded by a loving and human presence.

The use of analgesics such as narcotics (morphine) to relieve pain, even at the risk of shortening life, can be morally licit and in conformity with human dignity if the requirements of double effect are met:

• The evil effect (e.g. halting respiration, diminished consciousness) is not sought in any way.  Only the good effect (pain relief) is sought, the evil effect is unavoidable;
• The evil effect is not a means of arriving at the good effect;
• There is proportion between the good and evil effect—we are relieving unbearable pain in the face of inevitable death; and
• In order to do the good that we can, there is no possibility of acting differently: the patient no longer responds to weaker analgesics (note that only the minimum dosage necessary to effect relief should be given).

With respect to this last point, it is right to recognize narcotics are addictive, which means that one’s tolerance likely grows over time such that an increasingly-larger dose may be needed to attain the same effect.

It is licit in conscience to make the decision to renounce treatments that only produce an unstable and painful prolongation of life (our aggressive therapy, therapeutic obstinacy or dysthanasia from above) remembering always that there is a great ethical difference between “causing death” and “permitting death.”  The first rejects and denies life; the second accepts its natural end.

Because of this, there must be an evaluation of proportionality, which will be explained in another article, Caring When There Is No Cure—Part 2.