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End-of-life decisions

Posted By February 5, 2012 | 11:00 am | Featured Article #2
LifeMatters

 

See below for

• Links to End-of-Life Resources

• Accepting assisted suicide creates climate for all suicide

• Oregon doctor finds support for compassionate care

• Palliative care fits Catholic health mission, but too few aware of it

• Different paths bring doctors, patients to palliative care, hospice

Protecting yourself through the end of life

By Gina Curini
Special to The CFP

When faced with a situation in which life-sustaining means are necessary to assist a patient, how can we know what is or is not appropriate, acceptable, required or optional? The answers come case by case, as circumstances are too varied and nuanced to make blanket pronouncements.
In his presentation, “Care and Treatment Decisions for Compromised Patients or Patients at the End of Life,” Father Tadeusz Pacholczyk, Ph.D., discussed how to employ medical technology ethically. Father Pacholczyk is the director of education for the National Catholic Bioethics Center. He was one of the speakers at the “To Live Each Day with Dignity” conference held at Assumption College, sponsored by the diocesan Respect Life Office and the Worcester Guild of the Catholic Medical Association.
As human beings, created by God, we are not owners of our own lives, but rather stewards of the gift of our lives, Father Pacholczyk said paraphrasing the introduction to Part Five of the Ethical and Religious Directives for Catholic Health Care Services of the United States Conference of Catholic Bishops. In other words, we owe God a life well-lived, he said. To live well imposes a duty that we must use our reason to make prudential judgments, especially in regard to technology and life-sustaining measures, he said. Making informed decisions is the only way of achieving peace of mind when we are faced with the fears either of becoming totally dependent on extreme measures to sustain life, or of not having adequate care.
Each situation has its own difficulties, nuances and circumstances to understand, he noted. To assist in making these decisions, the National Catholic Bioethics Center has published “A Catholic Guide to End-of-Life Decisions.” Additionally, the NCBC offers access to an on-call ethicist who will help look at pertinent information needed to make an informed decision. (The telephone number is 215-877-2660.)  A few of the considerations to be weighed include: the success rate of a treatment or procedure, risks and side effects, the individual’s physical and moral resources, expense, burdens on others, and access to treatment.
Another important issue that Father Pacholczyk raised was the need for a good advance medical directive and the naming of a health care proxy or surrogate. In a situation where you, as the patient, cannot make your desires for treatment known, it’s imperative to safeguard your rights, he warned.
Today there are such options as a generic living will, a “Five Wishes” document or Medical Orders for Life Sustaining Treatments (MOLST) here in Massachusetts.  All three have severe limitations, he explained.
“A living will is really sort of like writing a blank check,” said Father Pacholczyk, “because you really don’t have this ability to prognosticate or know what’s going to happen to you.”
The problem with the “Five Wishes” is that it over-simplifies the end-of-life planning process and it uses broad terms lacking nuances that often arise; moreover, it is not always applicable, he said.
MOLST is extremely dangerous in that it gives the doctor all the power over treatment options, he said.  It omits and supersedes a specific proxy and allows for the very opposite of “informed consent.”
Father Pacholczyk suggested using both an advance medical directive and two surrogates or proxies.
In regards to the advance medical directive, Father Pacholczyk said, “When you do your end-of-life planning in this written form, you have the power of the pen. You can write things in and cross things out that explain your wishes.”
Choosing a proxy or surrogate is an important decision because you will be entrusting your very being to another person, he said.  As Catholics, the surrogate we choose should know how to determine when to stop life-staining measures. The surrogate should also know that if we are facing death, the illness must have progressed to the stage of “actively dying” before removing or denying treatment.
Often a surrogate is a person close to the patient and who will be strong enough to allow reason to take precedence over emotion too.  As Father Pacholczyk stated, “Emotion should never be a substitute for sound moral thinking.”
Father Pacholczyk called the recent debate in Massachusetts over the Nov. 6 ballot question that sought to legalize prescribing medication to end life, a “powerfully emotional topic.” On the so-called Death with Dignity Act, Catholic ethical and religious health care directives are very clear: “Suicide and euthanasia are never morally acceptable options.”
Father Pacholczyk quoted Dr. Edmund Pellegrino, head of President Bush’s Council on Bioethics, on the issue.
“Assisted-suicide and euthanasia distort compassion. Compassion for the suffering and the sick is a normal human response and every society should foster that. But compassion can be distorted, especially in an age which Malcolm Muggeridge, an admirer of Sister Teresa (Blessed Mother Teresa), called the ‘age of the humane holocaust built in the name of compassion.’ Much harm has been perpetrated in the name of compassion. True compassion cannot mean elimination of the sufferer to relieve suffering. It is not compassion but a species of moral abandonment to believe a patient is not worthwhile enough to be preserved,” Dr. Pellegrino said.
Father Pacholczyk went on to emphasize that euthanasia (or “assisted suicide”) is actually a form of abandonment of those who are suffering. He said that we need to raise the quality of life for the suffering, not “give up” and end their life.
Suffering and dying is an invitation to journey with the person, he reminded the audience. The word compassion, he noted, comes from the Latin “cum” and “patio,” “with” and “suffering.”  We are called to suffer with the person, to console them.  By joining their solitude, the solitude ceases to exist; they are no longer alone.
The growth family and friends undergo through the dying process forms a community that is part of God’s plan for our life, which is actually only the beginning of a life with him.
“Dying well is such a grace and a stepping stone to a new life,” Father Pacholczyk said.

Accepting assisted suicide creates climate for all suicide

By Tanya Connor

Physician-assisted suicide doesn’t promote free choices or compassion, according to a speaker at a recent conference at Assumption College.
Richard M. Doerflinger illustrated the latter point with this story of a debate he had on Fox News with Geoffrey Fieger, Dr. Jack Kevorkian’s attorney.
Dr. Kevorkian was known for helping patients die. Mr. Doerflinger is associate director of the Secretariat for Pro-Life Activities of United States Conference of Catholic Bishops.
“‘The difference between us is, I go in and I see somebody in a hospital bed with bed sores, lying in her own feces, gasping for breath and in pain and I say, ‘Why do we have to be so cruel as to let this continue?’” Mr. Doerflinger recalled the attorney telling him.
He said he replied, “No, the difference between us is, what I would say if I saw that was: ‘Clean this woman up. Fire the doctor. Get her in a better hospital. Where’s the nurse?’ And you want to kill the victim.”
Listeners applauded Mr. Doerflinger.
“Why does physician-assisted suicide not promote free choices?” Mr. Doerflinger asked. He gave reasons cited in the bishops’ “To Live Each Day with Dignity: A Statement on Assisted Suicide.”
He spoke of the role of depression and mental illness as forms of slavery.
“This is not about so much the patients’ choices,” he said. “It’s about the decision society makes. …
“Once you undermine the values of patients’ lives, it inevitably means undermining respect for their other rights.”
Nearly 95 percent of people who kill themselves have been shown to have a diagnosable psychiatric illness; most suffer from depression, which can be treated, Mr. Doerflinger said, citing Dr. Herbert Hendin’s book “Seduced by Death.”
With advanced illness and progressively impaired physical function, symptoms of severe depression rise to 77 percent, he said.    “We’re not giving people greater freedom generally to commit suicide,” he said of societal pressure. “We’re saying … there’s a class of people whose suicidal feelings should be prevented from being put into play, and there’s this other group whose suicidal feelings should be assisted and facilitated.”
“When you pass a law like that, you’re not just saying to those who have been champing at the bit to have assisted suicide … ‘OK, now we’ll let you have it,’” Mr. Doerflinger said. “You’re creating a climate for everybody who faces those situations in the future, many, many thousands of people who don’t have that idea now but who are now going to go into a medical environment in which it is seen as rational and acceptable to have those suicidal feelings when they get this kind of diagnosis.”
Mr. Doerflinger said it has been easy in the Netherlands to move from voluntary to involuntary euthanasia. Voluntary euthanasia was justified in the name of individual freedom, he said.
After doctors practice this for awhile and know what kinds of things lead patients to make choices, they develop their own ideas of who is a good candidate for euthanasia, he said.
He told of a doctor caring for a suffering nun who said, “I knew her religion wouldn’t let her ask for euthanasia, so I just gave it to her.”
“The pressures upon people with disabilities to choose to end their lives and the insidious appropriation by others of the right to make that choice for them are already way too common in our society,” Mr. Doerflinger said. “And this is a whole class of people … who have been living with prejudice.”
Physician-assisted suicide can undermine efforts to marshall the needed resources and the will to ensure humane and dignified care for the terminally ill and severely disabled, Mr. Doerflinger said, and illustrated with the following.
Patients complain of doctors passing them by once they are diagnosed as terminal, he said, and added that it’s a natural human reaction to avoid getting attached to those about to die. But this undermines patients’ need to have medical people be with them.
After Oregon’s physician-assisted suicide law took effect, the frequency of family reports of patients’ moderate to severe pain rose from 30.8 percent to 48 percent, he said.
And a 1994 study found 185 palliative care centers in the United Kingdom, where physician-assisted suicide was illegal, and three in the Netherlands, where it was legal.
“So the key question for Massachusetts is, ‘How does Question 2 … address these concerns?’” Mr. Doerflinger asked.
He responded by talking about the following problems.
It is difficult to determine when someone has six months left to live and that can change with treatment.
One witness to the patient’s request for suicide can be an heir and one can be chosen by the facility the patient is in.
The family need not be notified.
A psychiatric evaluation is optional, if the doctor decides the patient does not have impaired judgment.
Someone else can pick up the lethal drugs for the patient, and whoever is there can give him the drugs.
The doctor does not have to be present, but does all the reporting, and he is required to lie about the cause of death.

Oregon doctor finds support for compassionate care

By Tanya Connor

Michael Freeland sought to end his life.
Barbara Wagner was trying to save hers.
Both lived in Oregon, where physician-assisted suicide is legal.
William L. Toffler, a professor of family medicine at Oregon Health & Science University told their stories to people in Worcester Saturday. A medical doctor, he was one of the speakers at the “To Live Each Day with Dignity” conference held at Assumption College.
Seeking assisted suicide, Mr. Freeland mistakenly contacted Physicians for Compassionate Care, of which Dr. Toffler is co-founder and national director. He got more positive help there.
But Dr. Toffler said a doctor gave Mr. Freeland a prescription for an overdose, without addressing his pain or long history of depression. Once while he was hospitalized for depression and suicidal thoughts, police removed deadly weapons and ammunition from Mr. Freeland’s house, but not the deadly overdose. Because he had that life-ending medication, someone suggested that providing additional care when he went home from a mental hospital might be a moot point.
Because of the support he received from Physicians for Compassionate Care, Mr. Freeland decided against suicide, and died naturally after reconciling with his daughter, Dr. Toffler said.
By contrast, Ms. Wagner didn’t want to die, but was invited to consider suicide. Dr. Toffler showed a video of her story, part of which can be viewed on www.catholicfreepress.org.
Ms. Wagner said her doctor thought the chemotherapy drug Tarceva offered her hope. So she was shocked to get a letter from the Oregon Health Plan saying it could not approve this drug, but would pay for “comfort care,” including assisted suicide.
Dr. Toffler, also interviewed in the video, said the state had a financial incentive: the chemotherapy drugs cost $4,000 per month; assisted suicide drugs cost less than $100.
Asked if it was cheaper to pay for someone to die than to help them live, the chairman of the commission that sets policy for the Oregon Health Plan said, “That is not a question that we think about. We don’t think about investing our health care dollars in that way.” But he said if they invested thousands of dollars in “one person’s days to weeks,” they would be taking those dollars away from someone.        Dr. Toffler talked about other situations in which the Oregon Health Plan won’t cover treatment.
“This is no longer theoretical for me,” he said, adding that his wife failed five different chemotherapy treatments, which she would not have received under this proviso. But by “pushing the envelope” in seeking help, they may help others learn something. He used the example of billions of dollars spent for HIV research, saying that highly effective therapy has now been discovered.
Dr. Toffler raised questions for those seeking to legalize physician-assisted suicide here.
Why reserve it for those with only six months to live, if the aim is to eliminate suffering?
Why involve doctors and corrupt the medical profession, when veterinarians are already experts at putting animals to sleep? He told of a patient asking if the doctor who was not giving her hope was “one of the death doctors.” That question wouldn’t have been asked 20 years ago, he said.
Why give pills? Lethal injection is more efficient and is used to execute people, he said. Is physician-assisted suicide acceptable on death row?
Despite everything, Dr. Toffler said, “I really do have hope for the future.” He said God brings good even out of bad. He said he’s become a daily Mass attendant, having figured if he was more faithful he might help prevent assisted suicide in Oregon.

End-of Life resources

www.usccb.org

“Ethical and Religious Directives for Catholic Health Care Services” and a statement on physician-assisted suicide, “To Live Each Day with Dignity” by the U.S. Conference of Catholic Bishops.

www.ncbcenter.org
“A Catholic Guide to End-of-Life Decisions,” which includes an advance medical directive and a proxy designation form on the National Catholic Bioethics Center website.

For more information in Massachusetts Question 2
/ Physician-Assisted Suicide

www.worcesterdiocese.org/respectlife

www.doctorsagainstsuicide.com

www.noonquestion2.org

www.suicideisalwaysatragedy.org

www.stopassistedsuicide.org

www.second-thoughts.org

Massachusetts residents with disabilities who oppose Question 2 on the 2012 state ballot, which would legalize assisted suicide.

www.pccef.org
Physicians for Compassionate Care oppose physician-assisted suicide and  promote compassionate care for severely-ill patients.

 

Palliative care fits Catholic health mission, but too few aware of it

By Nancy Frazier O’Brien
Catholic News Service
WASHINGTON (CNS) — The National Palliative Care Research Center estimates that 90 million Americans are living with serious or life-threatening illnesses and the number is expected to double over the next 25 years.
People nearing the end of life and their families often are confused about the options available to them in terms of pain control and about whether they have an obligation to use all of the life-prolonging technology available to them. These discussions are particularly lively among Catholics and in the West Coast states where physician-assisted suicide is a legal option.
In Washington, the latest state to legalize assisted suicide, Providence Sacred Heart Medical Center in Spokane offers an alternative way of dying. It provides “comfort care suites” that allow family members to stay with their dying relative in a homelike environment.
Music thanatologists specially trained to soothe the seriously ill with their voices or the playing of harps are on staff. Health care professionals participate in education programs on palliative medicine and the ethical, moral and legal issues involved in end-of-life care. A meditation garden outside the hospital is open 24 hours a day and gives family members and patients who are well enough an opportunity to experience a peaceful area of waterfalls, streams and walking paths.
At TrinityKids Care, a pediatric hospice program in Torrance, Calif., teams made up of a pediatrician, a registered nurse, a clinical social worker, a chaplain, a home health aide and specially trained volunteers help dying children and their families make the most of their last days, whether at home or in a hospital or nursing home setting. Anything from household chores to looking after siblings can be part of the hospice program, and the team also offers family counseling and grief and bereavement services when needed.
These kinds of programs are duplicated throughout the country, but too few people know about them when the time comes for them to use them.
“Most palliative care patients come in late,” said Dr. Scott Miller, team physician at the Center for Compassionate Care in Pittsburgh. On average, his patients come in three weeks before their deaths, when they could have been receiving pain management, symptom control and comfort care for many months.
Tina Picchi, executive director of the Supportive Care Coalition in Hillsboro, Ore., believes that a big part of the problem comes from the misperception that “palliative care equals hospice and is only for the end stages of life.”
Palliative care “is appropriate for anyone living with a serious illness, regardless of the prognosis,” she said. “It does not require people to limit their treatment options or to give up.”
The Supportive Care Coalition is made up of 22 Catholic health care member organizations, with more than 450 hospitals, nearly 300 long-term care facilities and numerous clinics, home health care services and hospices providing palliative care in 43 states.
“Our goal is to ensure that every Catholic health ministry has palliative care as a part of its core services — so that we are known as much for palliative care as for our concern for the poor and vulnerable,” it says on the organization’s website.
The coalition was founded by three Catholic health systems in 1994 because, Picchi says, palliative care is a natural extension of the work of Catholic health care.
“At our very roots we have a very strong belief that life is sacred, every person is truly a treasure,” she said. “From the very beginning of Catholic health care, this is the kind of health care that the religious sponsors modeled.
“The first thing that they did was to go out to the homes of people who were dying and provide very whole-person care — physical, spiritual and emotional,” Picchi said. “Palliative care is not just focused on the whole person, but the whole in terms of they and their loved ones together as a family unit. It really ought to be something that Catholic health care is taking a lead in.”
Ron Hamel, senior director of ethics at the Catholic Health Association in St. Louis, says palliative care might provide a welcome relief to a health care approach that has become too focused on what technology can do than on what a patient needs.
“Palliative care really in a sense is a return to those days when we didn’t have the technology to try to cure patients and were limited to providing relief of symptoms and companionship,” he said. “We are so technologically driven today that it is difficult to step back from the technological imperative and see that there is another way to deal with those who are critically ill and dying.”
He places some blame on the way physicians are educated, but also believes that many patients have “an inability to deal with their own finitude” and would benefit from a “more positive statement about dying within a Christian context” from church leaders, followed by a parish-based educational effort.
Hamel also blames “both the extreme right and the extreme left” for “fostering misunderstanding about church teaching and tradition” about the end of life.
In contrast to the position that a patient must be kept alive “at all costs,” he said, “at the heart of the Catholic approach is to neither hasten death nor prolong life endlessly.” Patients and their loved ones must weigh the benefits and burdens of a particular treatment and are not morally required to continue treatment that is “excessively burdensome or without benefit,” he added.
In some ways, Hamel said, palliative care is “nothing new.”
“It’s a return to the kind of care that was provided to the critically ill prior to all this technology,” he said. “It’s a return to our roots in the life and teaching of Jesus and in the early Christian community, which was marked by its care for the sick.”

Different paths bring doctors, patients to palliative care, hospice

By Nancy Frazier O’Brien
Catholic News Service
PITTSBURGH (CNS) — Dr. Scott Miller remembers when he first decided to specialize in palliative care and hospice more than 20 years ago.
He was an intern and saw the disdain with which some attending physicians treated patients who could no longer benefit from the sophisticated medical technology that hospitals could offer.
“‘That’s an intern case,’ they’d say. But we interns knew nothing,” Miller said. “The patients deserved better. It was an emphasis on technology over compassion, and it cemented in my mind that we were doing this backward.”
For Dr. Myles Zuckerman, an interest in palliative care and hospice arose from watching his patients age and develop chronic or life-threatening diseases during his 27 years of private practice as a family physician.
“I saw that they needed extra support, and I started working part time” as a hospice physician, he said. Six years ago he gave up his private practice, and “I haven’t looked back for a moment. I love that I am a part of this.”
Miller and Zuckerman both work now for Family Hospice and Palliative Care in Pittsburgh. Miller is team physician for the 12-bed inpatient Center for Compassionate Care in the Pittsburgh suburb of Mount Lebanon, while also providing medical care on an interim basis at a new 14-bed facility on the city’s East Side.
Zuckerman is chief medical officer, overseeing both inpatient and outpatient medical care. More than 80 percent of the 440 patients served last year received care only in their own homes, while 18.6 percent were admitted to the center at some point during the year.
But Family Hospice and Palliative Care — founded in 1980 by St. Clair Hospital, South Hills Interfaith Ministries, Mercy Hospital and South Hills Health System — offers much more than medical care.
The physicians are assisted by a multidisciplinary team that includes nurses, home health aides, social workers, spiritual care counselors, physical therapists, volunteers and even a 5-year-old golden retriever named Ivan.
A trained service animal, Ivan walks the halls of the Center for Compassionate Care looking for someone who might need a nuzzle or a quick game of tug of war with one of his many toys. He’s at the facility most days but goes home on the evenings and weekends with Rafael Sciullo, president and CEO of Family Hospice and Palliative Care.
Sally Bothe says her husband, Bill, 80, is a “big dog lover” who has “gotten a lot of pleasure” from visits by Ivan to his room. During a late August visit to the center, Bill Bothe was in the final stages of pulmonary fibrosis, a respiratory disease.
Although he had been diagnosed with the disease a year earlier, his decline came very rapidly, according to his wife of nearly 61 years. Bill danced at his grandson’s wedding in May, but when he tried to play golf after his return home, he found himself too weak to play more than a couple of holes.
With their children living in Connecticut and Indiana, the Bothes had no local family members to call on for assistance. After two hospitalizations in June and July, they turned to Family Hospice and Palliative Care for some help at home.
“We were hoping to get some help and guidance and reassurance,” Sally Bothe said. “We got all that and much more.”
In addition to the presence of Ivan and the option for patients to receive visits from their own pets, the center offers a variety of what they call “complementary therapies,” including music and art therapy, massage, aromatherapy and Reiki, a Japanese form of energy therapy that involves the laying on of hands. As patients anticipate the end of their lives, they get help in putting together a personal reflection, which can take the form of an audio, video or photo journal or a piece of art.
When Bill Bothe was released from the hospital but his oxygen levels needed continuous monitoring, he came to the Center for Compassionate Care. “I felt like a load had been lifted off my shoulders,” said Sally Bothe. “I was not in this alone.”
Britt Bothe, their son who lives in Connecticut, said coming to the facility also has eased his father’s fears of becoming a burden to his wife. “It made it easier for Mom, and that made it easier for Dad,” he said.
He said his mother said it best when she said, “It’s not the death; it’s the dying that’s tough.”
“This is new territory for everyone,” Britt Bothe said. “But at least we’ve got this part covered.”

 

 

By Bishop McManus

This is the last article in a series that has been devoted to informing the readers of The Catholic Free Press about the moral malice involved in Ballot Question 2, the so-called “Death With Dignity Act.” As several of our authors have highlighted, this referendum bill is “poorly written, deliberately confusing and morally flawed.”
One of the gravest flaws in the proposed legislation is that the law does not require the person who is considering physician-assisted suicide to undergo a psychological evaluation.  Mental health experts report that many people who are terminally ill, as many as 50 percent some experts claim, suffer from depression.  Often, the person who is considering or speaking about suicide is really searching for some type of emotional and compassionate support, especially in the face of experiencing terminal illness and possible suffering. By not demanding a psychiatric evaluation for a person who seeks the assistance of a doctor in ending his or her life, Question 2 lacks a necessary safeguard that such an irreversible act demands.
Question 2 stipulates that the person who is thinking about committing physician-assisted suicide must be terminally ill and diagnosed as such by two doctors as having six or fewer months to live. Physicians themselves will recognize that a diagnosis of the progress of a terminal disease is often inaccurate. Patients whose diagnoses have been that they would be dead in three or four months have lived longer and have had during that period the opportunity to spend important time with friends and loved ones.
As people learn more about Question 2, many are amazed to learn that the role of the physician in “physician-assisted suicide” ends when the doctor writes the lethal prescription. The law does not require a physician to be present when the patient ingests 100 pills of the potent drug, Seconal. Suppose for a moment that the lethal dosage of the drug causes unforeseen medical consequences or suppose the patient changes his or her mind about committing suicide after swallowing 40 or 50 pills.  The proposed law does not demand that a doctor be present to attend to the patient who might be suffering severe medical complications as a result of a suicidal act gone awry.  To die alone while regretting one’s decision to end one’s life is hardly dying with dignity.
In recent years, momentous gains have been made in the practice of palliative care that is fundamental to the medical care that such groups as hospice provide. The availability and success of palliative and hospice care are ignored by the proponents of Question 2. The Catholic moral tradition concerning the complex questions surrounding death and dying views palliative care as a moral good. Some people think that the Catholic Church teaches that when a person is imminently dying or terminally ill that all possible means of medical technology must be used to keep the patient alive.  The Catholic Church does not hold this position.
The Catholic moral tradition makes a careful distinction between ordinary (proportionate) and extraordinary (disproportionate) means of medical treatment. At the risk of oversimplifying, the distinction between ordinary and extraordinary means of medical treatment can be described in this way: if a medical treatment causes more burden than benefit to a patient, then the treatment is morally extraordinary and can be forgone or removed.  However, if a medical treatment causes more benefit than burden to a patient, then the medical treatment can be morally evaluated as ordinary and should be used. However, if an extraordinary means of medical intervention is not begun or is eventually removed, the dying patient must be provided the comfort and care that the inviolable dignity of the human person demands.  Palliative care is a commendable way of protecting the human dignity of the dying person.
It is widely recognized that when it comes to making laws or crafting public policy, “hard cases make bad law.” No doubt there are cases where a dying person does experience severe suffering that palliative care cannot adequately control. Yet as the art and practice of palliative care improves, one can hope that such difficult cases become fewer. The passage of Question 2 could set back the progress of using palliative care and thus “short-circuit” a source of care that could be of tremendous comfort for many dying patients.
One last observation about how morally flawed and deliberately confusing Ballot Question 2 really is. The law stipulates that the cause of death on the death certificate of someone who has committed physician-assisted suicide cannot be listed as “suicide.” The cause of death must be attributed to the underlying terminal disease. This is simply not true. The cause of death is not the cancer or renal failure that is afflicting the person who commits suicide. The death of the person is caused by the ingestion of a lethal dosage of a drug. In a word, suicide is the real cause of death.
Our Catholic faith teaches that every person is created in the image and likeness of God and that this reality bestows on every human being a moral worth that does not come from a government or the rule of law.  However, if a government or a legal system is to be recognized as just and humane, then it must recognize and protect this fundamental human dignity. Ballot Question 2 does not do this and therefore the citizens of the Commonwealth of Massachusetts should vote a resounding “No” to this question.  May God grant all of us the moral wisdom and conviction to do so on Election Day.

 – Bishop McManus is the chairman of the Subcommittee on Health Care for the U.S. Conference of Catholic Bishops and a member of the USCCB Committee on Doctrine and Committee on Pro-Life Activities.    

So-called ‘Death with Dignity’ flawed

By Henry C. Luthin

Question 2 on the November ballot is of particular concern to those who believe in the Culture of Life. If passed, Question 2, the so-called “Death With Dignity Act,” would legalize physician-assisted suicide in the Commonwealth of Massachusetts, and do so in a broad and irresponsible manner.
The Act, which would go into effect on January 1, 2013, would go into the Massachusetts General Laws as Chapter 201G. It purports to give terminally ill adults who are residents of the Commonwealth the right to decide to request a prescription for medication to end their life “in a humane and dignified manner.”  What at first may appear to be a good and compassionate law to help end suffering would in fact be a flawed law which could easily be abused.
No one disputes the need to alleviate the suffering of those who are terminally ill.  We have all had the experience of living with or helping a relative or close friend who has gone through an extended and debilitating period before death. The comforts brought by palliative care and the concern of good and dedicated palliative and hospice professionals are treasured memories in many families.
For many, a law to allow the patient to request drugs to end his or her life at a time of their choosing sounds on the surface to be very appealing. Yet the act which appears on the ballot on November 6 is deeply flawed.
Among the flaws in the proposed law are the following:
1. This law is premised on the accuracy of a prognosis that a patient has just six months to live (Section 1(13)). Yet how many people do we know who have passed this milestone long ago? How many have recovered or have, with good treatment, been able to lead productive lives after the six month period?
2. The petition does not require the patient to receive a psychological or psychiatric evaluation before being given a lethal dose of medication. In fact, even if the attending and consulting physician believe the patient to be depressed, a referral is only required if the doctors believe that the depression causes “impaired judgment” (Section 6). Of course, the physicians who are deciding this would generally not be specialists in psychology or psychiatry. And, “impaired judgment” is nowhere defined in the act.
3. The written request must be witnessed by two people, one of whom may be an heir or a person entitled to a share of the patient’s estate (Section 3).
4. The death certificate “shall list the underlying disease as the cause of death”  (Section 4(2)). This provision requires a public record to be falsified.
5. The act defines “self administer” to mean a patient’s “act of ingesting medication” (Section 1(12)). The act of ingesting does not mean that the patient administers the medication, merely that it is ingested.
6. The act encourages a patient to inform his or her family of the decision to request the lethal prescription (Section 8). There is no requirement that next of kin be informed.
There are other concerns. Many elderly see themselves as a burden to their families, the more so if they become terminally ill and this law passes. Likewise, the law should not be an instrument in encouraging suicide. The law should protect and enhance the lives of the terminally ill. And what of the place of the physician in society? Physicians are healers. The American Medical Association Code of Ethics states that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.” Were physicians empowered to prescribe drugs which cause death, a fundamental confusion would arise on the physician’s role. Finally, the act does not do anything to improve end-of-life care for a patient or promote better palliative care.
This is not just an issue for Roman Catholics. The Massachusetts Medical Society, the Hospice and Palliative Care Federation of Massachusetts, the American Medical Association, the American Nurses Association, the Disability Rights Education and Defense Fund, the American Academy of Neurology, and the disabilities rights organization Second Thoughts all oppose physician-assisted suicide. Please talk about this with family members, neighbors, co-workers, and fellow parishioners. Together, we can more firmly establish a culture of life here in Massachusetts.

– Henry C. Luthin is a lawyer in Boston.  He has been involved with issues relating to the culture of life for more than 30 years.

 

Called to heal not kill

 

By Marie Romagnano

I am a registered nurse and a medical case manager specializing in patients who have catastrophic injuries. My vocation and mission, as a medical professional, is always to heal and preserve life, never to harm, wound or kill.     Question 2 titled Prescribing Medication to End Life, formally known as Massachusetts Death with Dignity Act legalizes the taking of a life of a terminally ill patient with the help of a physician when s/he, afflicted with fear, pain, hopelessness or depression, requests to commit suicide. By mandating the physician to prescribe a lethal dose of drugs to terminate the life of a human person, it radically changes the calling of the physician and other healthcare professionals, from being healers to killers.
It may sound too drastic, but if we vote yes on Question 2, we make a lethal weapon available to the patients who wish to take their own lives. We enable the physician to prescribe it with instructions how to use it; we mandate the pharmacist to issue the drug bullets; we force the nurse to carry out the orders by bringing the drug bullets and helping the patient to aim the weapon properly and to put his or her finger on the trigger. The nurse has to watch the patient kill himself, clean him up and report to the doctor that the patient has successfully killed himself. The family does not need to be notified of the patient’s decision. “The attending physician may sign the patient’s death certificate which shall list the underlying terminal disease as the cause of death.” The true cause of death as a suicide is suppressed and the medical record is legally falsified.  The reality is that the physician, nurse, pharmacist, social worker and other healthcare professionals assisted, directly or indirectly in the patient’s committing suicide.
By its tendentious arguments in favor of this legislation the Massachusetts Death with Dignity Act through Question 2 creates a misleading impression that:
1.    Medicine has no palliative care or the ability to manage pain.
2.    Doctors are psychic and are able to predict death as “within six months.”
3.    Psychological sciences lack ability to manage depression.
4.    Pastoral care lacks the ability to assist the hopeless and the despairing.
5.    Nurses, social workers and families lack ability to manage catastrophic illnesses.
6.    Healthcare professionals lack conscience and have no qualms about being a part of the killing team.
Therefore, this Act manipulates people into believing that “the public welfare requires a defined and safeguarded process” on account of the experience of great suffering and lack of control over end of life. “This act, being necessary for the welfare of the Commonwealth and its residents, shall be liberally construed to effect the purposes thereof.”
These unspoken assumptions are false, groundless and misleading, as adequate resources to manage physical, emotional or spiritual pain are available through palliative care, psychological and pastoral counseling, and a family’s loving care.  Doctors are frequently wrong in predicting the last six months of life, robbing the patient and the family time together.
Further, this Act, once passed, gives the private and government insurer the ability to ration medical care: to deny expensive treatments for the terminally ill patient, who paid for the insurance policy for the right to treatment and the possibility of remission or recovery from any illness or injury.  Instead, they consider Physician Assisted Suicide as “reasonable and necessary care” and cover the low expense of the lethal drugs to kill the patient.  Could this be construed as insurance fraud?  Once again, Question 2 will give these insurers the ability to control the care of the patient in the cheapest manner, taking away the professional judgment of the physician to treat the patient, so the insurance company is now treating the patient, not the physician.
How far will this go?  We have some indications that are highly disturbing.
In 2005, The New England Journal of Medicine published The Groningen Protocol–Euthanasia in Severely Ill Newborns. This protocol includes a checklist how to end the life of severely disabled newborns with pre-set guidelines and “norms regarding euthanasia in newborns.”
According to Wesley Smith (Euthanasia Spreads in Europe in National Review on Oct. 26, 2011), there is a rise of non-consensual termination of patients’ life. There are reports that doctors in Europe end the life of coma patients, nurses kill terminally ill patients without a consequence, and surgeons harvest organs from euthanized patients.
God forbid that we imitate the history of Nazi Germany, when the medical community was recruited to rid the society of the unwanted. The Nurse Week article, Cruelty and Courage: Nurses in the Nazi Era (Oct. 18, 2004) illustrates this very dark place in medical history not to be repeated. Through complicit actions of physicians and nurses following orders, the unwanted (that is, the elderly, mentally and physically handicapped, Jews, etc.) experienced degradation, cruel treatment and death in the name of the greater good of German society.  Medical professionals acted on humans as though they were animals, hurting profoundly the lofty nature of the medical professionals’ vocation.
Physician Assisted Suicide, which is a form of euthanasia, cannot be accepted.  It is always a taking of another person’s life no matter how it is rationalized.  Whether taking the life of the unborn, terminating life of a disabled newborn or assisting an adult in committing suicide is always morally wrong. It leads to the destruction of the society.  It mortally wounds the souls of those who perpetrate it and endangers their salvation.  It rejects the very revelation of God, his love and mercy for every human being.  It transgresses the fifth commandment “You shall not kill” and the commandment of love: “Whatever you did for one of these least brothers of Mine, you did to Me” (Mt 25:40).

– Marie F. Romagnano, RN, BSN, CRC, CCM, CLCP is president of Med-Link, Inc.; and founder of Healthcare Professionals for Divine Mercy, an apostolate of the Marian Fathers of the Immaculate Conception. She is the author of Nursing With the Hands of Jesus: A Guide to Nurses for Divine Mercy at www.thedivinemercy.org/healthcare

 Why not lifeguard-assisted drowning?

By Father Tad Pacholczyk
Several states are considering legislative measures to let physicians prescribe (but not administer) a lethal dose of a toxic drug to their patients, thereby assisting their patients to commit suicide. This is known as physician-assisted suicide. Advocates of this practice assure us that this can be a good choice for someone who is dying, or who wants to die.
If physician-assisted suicide really represents a “good choice,” we need to ask: why should only physicians be able to participate? Why should only physicians be allowed to undermine public trust of their profession through these kinds of death-dealing activities?
Why not include police, for example? If a sick person expresses a wish to die, the police could be notified, and an officer would arrive bearing a suitable firearm. He would load it with bullets, cock the gun, and place it on the bedside stand of the sick patient. After giving instruction on the best way to angle the barrel, the officer would depart, and the patient could then pick the device up and shoot himself — “police-assisted suicide.”
Besides physician-assisted suicide and police-assisted suicide, “military-assisted suicide” could be offered as well. Members of the armed forces would bring in a standard-issue hand grenade upon request, explaining to the sick patient how to remove the pin properly and how to place the device so as to achieve the most rapid, painless and destructive death.
The assisted-suicide paradigm would readily admit of other creative approaches as well — society could sanction “assisted drownings” where lifeguards could be asked to assist those wishing to die by providing them millstones to take them to the bottom of lakes and oceans.
But if a life-guard helped people drown, would you want him watching your family at the beach?
It is troubling how many individuals fail to grasp the radical absurdity of allowing physician-assisted suicide. Suicide is no joking matter. Regardless of how it transpires, it is a catastrophe for those who end their own lives, for their loved ones left behind, and for society more broadly.
Some people may decide that their lives are no longer worth living, but our society has always recognized that decision to be a tragedy and a mistake; that’s why high bridges have signs encouraging suicidal individuals to seek help rather than jump. Suicide hotlines are open 24 hours a day because we seek to prevent as many deaths as we can. We treat as heroes those who walk along bridges or climb tall buildings and try to talk people down.
Commentator Greg Pfundstein stresses how this sound and consistent cultural message is flatly contradicted when we allow physicians to prescribe lethal drugs so people can kill themselves — it is like replacing the suicide intervention signs on bridges with signs that state, “Ask your physician if jumping is right for you.” Simply put, such jumping is never a “good thing,” and it is only our own foolhardiness that lets us feign it could be, whether physician-assisted or otherwise.
I remember reading a Letter to the Editor in the local paper of a small town many years ago. The woman wrote about the death of her grandparents — well-educated, intelligent and seemingly in control of their faculties — who had tragically committed suicide together by drinking a deadly substance. They were elderly and struggling with various ailments.
Her first-hand perspective was unflinching: “It took me years to forgive my grandparents after they committed suicide. I was so angry at what they had done to me and my family. I felt betrayed. I felt nauseated. At some fundamental level I just couldn’t believe it had really happened, and I couldn’t believe that they didn’t reach out to us for help. I thought the pain would never go away. The idea that suicide could ever be a good thing is a total crock and a lie. It leaves behind deep scars and immeasurable pain on the part of family and friends. We don’t have the right to take our own lives because we didn’t give ourselves life.”
I’m reminded of the words of the Mayor of one of our great cities, who declared: “The crime rate isn’t so bad if you just don’t count the murders.” Assisted suicide, similarly, isn’t so bad if you just don’t count the victims: the many broken individuals, broken families, and broken hearts.
A friend of mine in Canada has struggled with multiple sclerosis for many years. He often speaks out against assisted suicide. Recently, he sent me a picture of himself taken with his smiling grandchildren, one sitting on each arm of his wheelchair. Below the picture he wrote, “If I had opted for assisted suicide back in the mid-1980s when I first developed MS, and it seemed life as I knew it was over, look what I would have missed. I had no idea that one day I would be head over heels in love with grandchildren! Never give up on life.”

– Father Pacholczyk earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the diocese of Fall River and serves as the Director of Education at The National Catholic Bioethics Center in Philadelphia. He will speak at “To Live Each Day with Dignity – A Conference on Dignity, Dangers, and Choices at the End of Life,” Oct. 27 at Assumption College. For more information and to register, visit www.worcesterdiocese.org/respectlife or call 508-929-4311.

 

Blurring boundary between healing and killing

By Maria Parker

In their 1991 Statement on Euthanasia, the US Conference of Catholic Bishops warned: “To destroy the boundary between healing and killing would mark a radical departure from longstanding legal and medical traditions of our country, posing a threat of unforeseeable magnitude to vulnerable members of society.”
The vast majority of states have rejected proposals to prescribe lethal drugs to their citizens judging such laws as a huge threat to innocent life and to our system of equal protection under the law. But the “right to die” folks seek to legalize physician assisted suicide in Massachusetts once again. A similar attempt in 1997 failed.
Many of us realize that fears surrounding sickness and death are very real: fear of being in horrible pain, fear of suffering for a long period, and fear of being a burden to the family, among others. Advocates for assisted suicide wage clever media campaigns claiming that their proposal includes “safeguards” to prevent exploitation.  But their so called  “safeguards” distort medical facts and do not prevent abuse.
SIX MONTHS TO LIVE
The bill states that only terminally ill competent adults who are expected to live less than six months may request lethal drugs for suicide. But how do doctors know when a patient has six months or less to live? Many studies indicate that accurate diagnosis cannot always be assured, for example: a significant number of patients referred to hospice care have survived longer than six months, some for many years once their pain is managed or a last hope treatment is developed and succeeds. It is common knowledge that physicians cannot forecast the time of death with certainty. After all, doctors are not God. This bill would act to corrupt the medical profession since a patient’s trust in their doctor is based on a code of medical ethics which calls them to heal not to kill. An oath that prescribes physicians: “First, do no harm.”
MENTAL HEALTH
Another alleged “safeguard” requires that two physicians deem the patient’s condition appropriate for requesting assisted suicide, but that an evaluation of the patient’s mental health is optional. To claim that a mental health assessment is “optional” shows a complete disregard for the scientific literature. Sound research demonstrates that 90 percent of people who request assisted suicide have a diagnosable and treatable mental disorder. Furthermore, once their mental illness and physical pain are addressed, their desire for assisted suicide disappears. Not all doctors are trained to assess for the presence of depression and other mental illnesses. To not require a psychiatric evaluation in these cases demonstrates further disregard for the patient’s inherent human dignity and their right to competent and complete healthcare.
‘DUTY TO DIE’
After careful examination of ballot question 2, we conclude that it offers no protection for vulnerable, ailing patients who may be temporarily overwhelmed by depression, other forms of mental illness and physical pain. Passage of question 2 will deny the inviolable nature and inherent human dignity of some of our most vulnerable citizens, and expose them to exploitation. Moreover, the “right to die” very quickly is transformed into the “duty to die;” it comes to be expected by both family and society.  Individuals in the midst of suffering are hardly capable of a “free choice” but are rather at the mercy of those who would benefit from their death – perhaps  financially or as the medically “easy way out.” After all, it is less expensive for our healthcare system to kill a person than to provide care.
A key question in this debate is “WHO DECIDES?” Who is qualified to decide who should live and who should die in our supposedly civilized society, and by what criteria? Who has the right to take the life of another human being or even his/her own life? What is so dignified about taking a drug to kill yourself? Who is like God?
Ending a patient’s life is a decision that most health care professionals realize they have no right to make. Doctors should not be forced to participate in physician assisted suicide. We are called to do better for our fellow human beings. How we care for the weak and vulnerable among us points to what is most noble and dignified about our humanity. True mercy allows us to ease suffering, and affirm the dignity of a life at every stage of its development.
RELIEVE SUFFERING
Palliative care, meant to relieve suffering and improve the quality of life, affirms life and regards dying as a normal, natural process. It neither hastens nor postpones death but rather provides relief from pain while integrating psychological and spiritual care for the patient, and a support system for the family of the dying person. No amount of medical intervention can replace the compassion and love that a dying person needs and deserves. This is the true prescription for “death with dignity.”
We should call Question 2 what it is: the lethal discrimination against the ill and elderly whose lives are judged by some as not worth living. All major medical organizations oppose physician assisted suicide saying it “is fundamentally incompatible with the physician’s role as healer.” Our faith tells us that the moment of death is not our decision but ultimately that of the one who created us in his image and likeness, our God. Scripture warns us not to call evil good. Do not be fooled. Question 2 is not about “dignity” – it is about actively killing the innocent, and there is nothing dignified about that.

– Maria C. Parker, MBA served as Associate Director for Public Policy for the Massachusetts Catholic Conference, and in that capacity directed the “In Support of Life” initiative. She has also served as Respect Life Coordinator for the Diocese of Providence and as United Nations representative for the World Union of Catholic Women’s Organizations. In the recent past she served as an official member of the Holy See Delegation to the UN’s 54th session of the Commission on the Status of Women. She is an alumna of Anna Maria College and the University of Rhode Island.

“To Live Each Day with Dignity – A Conference on Dignity, Dangers, and Choices at the End of Life”, will be held on Saturday, Oct. 27 from 8:30 a.m. to 3:30 p.m. at Assumption College.  Speakers include Bishop Robert McManus, Dr. William Toffler, Fr. Tad Pacholczyk, and Richard Doerflinger.
The conference is sponsored by the Respect Life Office and the Worcester Guild of the Catholic Medical Association.  For more information and to register, visit www.worcesterdiocese.org/respectlife or call 508-929-4311.

 


Bad public policy – an affront to dignity

By Deacon Pete Gummere

Aside from moral considerations, the measure to legalize physician assisted suicide really is bad public policy!  This is a question I have studied for about 10 years during which time the legislature in my own state (Vermont) has repeatedly considered and rejected a bill similar to Oregon’s assisted suicide law.  I offer the following reflections for your consideration.
Much of the rhetoric promoting assisted suicide is based on a fallacious assumption that people are dying in intractable pain. Highly respected palliative care physicians and nurses assure me when someone is dying in significant pain they are not being properly medicated.  I will leave that question for other, clinically qualified authors in this series to discuss in greater detail.
At its core, assisted suicide is an affront to our inherent human dignity.  Proponents of assisted suicide debase the value of time a terminally ill person has left by suggesting that they are expendable.  In approving of assisted suicide, isn’t the state really sending the message that the life of the terminally ill person is not worthy of protection?  Isn’t the message that their lives are not worth living?  The message conveyed is that the terminally ill should simply get out of the way and allow society to save a few dollars by not caring for them any longer.
Despite the Oregon statute’s prohibition of coercion of others to opt for assisted suicide, there are at least two documented cases of Oregon officials and bureaucrats denying payment for cancer treatment to terminally ill patients and offering them assisted suicide instead. Randy Stroup and Barbara Wagner shared their stories and the letters they received from the state’s Medicaid officials before succumbing to their cancers. (This was reported by national news media – not by Church related news media.)  You do not coerce a person much more forcefully than by cutting off their hope of a cure and then offering them assisted suicide.
Lest you think that I am just being cynical, I have heard people candidly admit that they think that assisted suicide is part of the answer to control of health care expenditure.  That suggestion actually appeared in an editorial published in a reputable Vermont newspaper in July of 2011.
In the course of ethical consultations, I have dealt with family members attempting to manipulate a patient’s care with the overt intention of hastening the patient’s death and acknowledging their motive: their own financial gain. That was in a state which did not allow assisted suicide.  I can definitely conceive of similar attempts to manipulate a family member into assisted suicide.  Manipulation can be so subtle as to not be recognized by the patient or the even physician.  In reality, isn’t manipulation really just subtle coercion?
Since the measure is on the ballot in Massachusetts, voters supporting the measure will have to accept their own complicity in every single assisted suicide that would follow.
The assisted suicide measure is promoted as a means to give people more control over their own life and death.  Ironically, the measure actually enlists a physician and a second consulting physician, a pharmacist, one or more witnesses, a consulting psychologist (if deemed necessary) and probably a nurse in various clinical and procedural elements leading up to the suicide.  Frequently, the patient also enlists one or more persons to be with them at the end and help them to commit suicide.
Another serious concern with respect to assisted suicide is its effect on vulnerable populations – viz., teenagers, the elderly, the disabled and other terminally ill persons.  These segments of society are particularly vulnerable to suicide.  There is good evidence that when a teenager knows a person who commits suicide, that teenager is at significantly increased lifetime risk for suicide. These are sometimes “copycat” suicides shortly after the first suicide.  Other times it is at a point in the future.  Similar relationships have been demonstrated among the elderly.
I will leave you with the story of a friend with whom I have worked quite closely. My friend has a son who has struggled with depression repeatedly – including several years back at a time when passage of assisted suicide seemed likely.  Without his parents knowing it, the son (then a teenager) went in to see his pediatrician.  He told the doctor that since the state was about to legalize assisted suicide, and since he is suicidal and would take his life anyway, couldn’t the doctor simply prescribe the necessary drugs for him to commit suicide.  The doctor got the young man into appropriate treatment.  The point is that the state sends a strong message by what it legalizes. Do we really want our vulnerable citizens getting the message that legalizing assisted suicide will send?
My friend wrote a synopsis of that incident and sent it to every Vermont legislator and senator earlier this year.  The measure failed again this year.

– Deacon Gummere serves the Diocese of Burlington and is adjunct faculty at Pontifical College Josephinum.  He has publishes, teaches and consults on medical morality. He holds a M.S. in biological science and a M.A. in theology.  He is certified in health care ethics by the National Catholic Bioethics Center.
“To Live Each Day with Dignity – A Conference on Dignity, Dangers, and Choices at the End of Life”, will be held on Saturday, Oct. 27 from 8:30 a.m. to 3:30 p.m. at Assumption College.  Speakers include Bishop Robert McManus, Dr. William Toffler, Fr. Tad Pacholczyk, and Richard Doerflinger.  The conference is sponsored by the Respect Life Office and the Worcester Guild of the Catholic Medical Association.  For more information and to register, visit www.worcesterdiocese.org/respectlife or call 508-929-4311.

Walker Percy’s final decision: A gift of life

By Janet Benestad

The great novelist, Walker Percy, had several personal experiences with suicide, which experts say increases a person’s likelihood of contemplating suicide when difficult circumstances occur. Percy’s father and grandfather both took their own lives. When Percy himself was diagnosed with terminal cancer, he went to the Mayo clinic for treatment. The treatments were burdensome and difficult. Percy wanted to stop but chose not to forego treatment because of the children with cancer he saw while at the clinic. He hoped that his experimental and painful treatments might one day benefit them.
On Sept. 6, in an interview with Emily Rooney on WGBH, Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine, said that she could not understand why anyone would not vote in favor of Question 2, the ballot referendum to make assisted suicide legal in Massachusetts.
“It’s all about choice,” Dr. Angell said, “The patient chooses whether to ask for the drug; the physician chooses whether to comply.”
“It’s not a threat to anyone,” she added.
What is the proposal to legalize physician-assisted suicide in Massachusetts all about?
Question 2 proposes that a Massachusetts resident 18 years of age or older, diagnosed with a disease likely to kill him in six months or less, may request and receive a lethal drug for the sole purpose of ending his life.  Two physicians must concur in the diagnosis.  Two witnesses must attest to the patient’s capacity to make the request.
Question 2 is seriously flawed.  It requires no psychiatric examination of the patient requesting suicide.  Studies show that terminally ill patients are likely to be depressed and that, when the depression is treated, the request for life-ending measures desists.
Doctors tell us that diagnoses may be inaccurate regarding time left to a terminally ill person and are reluctant to make such predictions.  They tell stories about patients who outlive their diagnoses by months, even years.  A diagnosis of six months to live is usually understood to mean that the person will die even with treatment.  Ballot Question 2, however, allows for the lethal prescription with or without treatment.
Finally, certain procedural issues make the bill unacceptable.  Witnesses to the patient’s capacity need not know the patient.  The law allows, in the case of patients who cannot communicate themselves, for a surrogate to testify to a patient’s desire to end his life. The law does not require that family members of the patient requesting suicide be notified. The prescribing physician is not allowed to be present for the death; in fact, the law says that no one need be present.
The Catholic Church teaches that all suicide and assistance with suicide, even when requested to alleviate pain at the end of life, is gravely immoral, and harmful to society.  Life is a gift from God, one that we return to him when he calls us home.  “We are stewards, not owners, of the life God has entrusted to us.  It is not ours to dispose of,” states the Catechism of the Catholic Church.
Walker Percy’s courage and generous spirit prove the point – persons who are dying are still capable of great acts of generosity and heroism.  Their humanity requires that doctors, nurses and medical professionals treat them in a human, not just a humane, manner!   Percy’s decision is to do what he can with the life given to him.
Question 2 offers patients a choice that ends all choices.  Please join me in saying NO to Question 2 on November 6.

– Janet Benestad is Cabinet Secretary for Faith Formation and Evangelization in the Archdiocese of Boston.
“To Live Each Day with Dignity – A Conference on Dignity, Dangers, and Choices at the End of Life”, will be held on Saturday, Oct. 27 from 8:30 a.m. to 3:30 p.m. at Assumption College.  Speakers include Bishop Robert McManus, Dr. William Toffler, Fr. Tad Pacholczyk, and Richard Doerflinger.  The conference is sponsored by the Respect Life Office and the Worcester Guild of the Catholic Medical Association.  For more information and to register, visit www.worcesterdiocese.org/respectlife or call 508-929-4311.

 

Question 2: Deeply Troubling

By Dr. John Howland

On the Nov. 6 ballot this fall will appear Question 2, asking if voters will legalize physician-assisted suicide. As a Massachusetts doctor I find the concept of sending a patient to the drug store with a lethal prescription deeply troubling.
As physicians have since the time of Hippocrates, I have sworn primum non nocere, “first do no harm.”
The Hippocratic Oath specifically prohibits physicians from assisting patients in taking their own lives. Question 2, if passed, would undermine the role of the physician as healer in our society and cross a line that must not be crossed.
Question 2 would place patients with terminal illness in danger.         Though I certainly can sympathize with patients facing the ravages of cancer, ALS and similar diseases, the vast majority of patients facing terminal diagnoses are relatively healthy through most of their illnesses, are often able to work or, if they choose, to spend time doing the things they most enjoy with the people they most love.  Many outlive the six-month prognosis required under this law. Offering patients the means to commit suicide would tempt them to cut short their lives before natural death.
Suicide is always a tragedy. Suicide should never be promoted as a solution to a problem, even terminal illness. Suicide is never a reasonable choice but the end of all choices.
Question 2 raises a host of troubling questions. Do we really need to pass a law to help people to commit suicide? We all have the right to refuse any and all medical treatment and allow our lives to come to a natural end. No one really needs help to commit suicide; sadly thousands manage to do so without help already.
Is suicide the answer to the problem of suffering at the end of life? As a physician, I have been providing hospice care for over 30 years. Quality hospice care is what our society should be promoting, not suicide.
Question 2 is based on the idea that physicians can predict the future and accurately predict when a person has only six months to live. I can assure you, physicians have no crystal ball.
We should learn from the experience of those in Oregon where physician-assisted suicide is sadly legal.
Let me share with you just two stories. Jeannette Hall was diagnosed with cancer and told she had 6-12 months to live. She asked her doctor for the suicide pills. Instead he gave her hope, she fought the cancer, and she won the battle. More than 10 years later, in an interview, Mrs. Hall warned all of us: “Assisted suicide should not be legal. Don’t make Oregon’s mistake.”
We should also remember Barbara Wagner who had advanced cancer that failed to respond to initial treatment. Her doctor recommended additional chemotherapy. The insurance company sent Mrs. Wagner a letter saying that they would not pay for the treatment, but they would provide 100 percent coverage for physician-assisted suicide should she wish to kill herself. Mrs. Wagner was shocked, “To say to someone, we’ll pay for you to die, but not pay for you to live, it’s cruel.”
Question 2 is troubling because it lacks some essential safeguards. No psychiatric evaluations are required, so patients suffering from a treatable depression might never receive help. Family members don’t even have to be notified that a person is requesting physician-assisted suicide. You might never know that your brother or mother requested the suicide pills until it was too late. No witness is required to be present to help if something were to go wrong.  And no hospital, doctor or public safety official has any idea where the lethal dose goes once it leaves the drug store, making it susceptible to abuse by any number of people acting on suicidal impulses.
There are plenty of reasons Massachusetts’s voters should be troubled about Question 2. Instead of voting for a law that encourages suicide, we should do what’s really needed: provide hope and comfort to patients at the end of life. This is a job for all of us. Please join me in voting “No” on Question 2.

– Dr. John Howland is a family physician and has been in practice in the Diocese of Worcester for over 30 years. He is regional director of the Catholic Medical Association and founder of Doctors Against Suicide.
“To Live Each Day with Dignity – A Conference on Dignity, Dangers, and Choices at the End of Life”, will be held on Saturday, Oct. 27 from 8:30 a.m. to 3:30 p.m. at Assumption College.  Speakers include Bishop Robert McManus, Dr. William Toffler, Fr. Tad Pacholczyk, and Richard Doerflinger.  The conference is sponsored by the Respect Life Office and the Worcester Guild of the Catholic Medical Association.  For more information and to register, visit www.worcesterdiocese.org/respectlife or call 508-929-4311.

 

 

Death with Dignity

By Allison LeDoux

This November, the citizens of Massachusetts will be asked to cast their vote on the so-called “Death with Dignity Act”.
But the term “death with dignity” brings with it a dark deception.  We are, in fact, being asked to vote for or against the legalization of physician-assisted suicide in our state.  If passed, a person with a prognosis of six months or less to live would be permitted by law to request from their physician, a prescription for lethal drugs for the purpose of helping them to end their life “in a humane and dignified manner.”
Oregon and Washington are the only states who have legalized physician-assisted suicide to date.  They did so by ballot referendum, the same form of enacting the law being attempted in Massachusetts. A ballot referendum essentially by-passes the state legislature and brings the question directly to the ballot for a vote through the gathering of signatures.  Legalizing physician-assisted suicide has been attempted in other states too, but interestingly, wherever it has gone through the legislature it has been defeated.
You may recall hearing over the years of a group called the “Hemlock Society” (whose very name connotes death by poison).  They are the proponents of physician-assisted suicide or “aid in dying.”  But they have changed their name.  Now they call themselves “Compassion and Choices,” and they are targeting the northeast.  The effort to legalize doctor-prescribed suicide in Massachusetts goes by the name “Dignity 2012.”  Regrettably, if our state falls, so goes the rest of the nation.
There are many flaws in the legislation.  Predictions of life expectancy can be wrong – people often outlive their prognosis by months or even years.  Appropriate safeguards are absent.  Many suicides are caused by untreated depression which could be alleviated with the right therapeutic intervention, yet there are no requirements in the law saying doctors must provide this kind of evaluation.  The law also does not require that the actual ingestion of the drug be witnessed, nor is there any requirement to record any witnesses who may be present at the death.  Moreover, when the patient dies, the death certificate must list the cause of death as the underlying illness, not the effect of the lethal drugs; this provision requires a public record to be falsified.
While most readers of this paper are probably at least somewhat aware of this November ballot question, it appears that many more of our fellow citizens have heard little, if anything, about it.  Sadly, the culture in which we live has all too often dulled people’s consciences to the reality of the true dignity and sacredness of each human life.  This secularized outlook misleads and confuses.  When the value of a human life is measured by its level of productivity, we have truly lost our way.
It’s up to us to make sure our family and friends know the dangers of physician-assisted suicide, which violates the dignity of the dying person and eliminates the opportunity for the many graces that can come from a “good death” where love abounds and peace and reconciliation can flourish.  We must work to uphold the integrity of the medical profession whose ability and willingness to provide palliative care and effective pain management can be undermined by authorizing assisted suicide.
In the coming months, the elections will be a hot-topic of conversation.  We are called to courageously defend the truth and to proclaim the Good News.  Catholic teaching on the dignity of every human person, no matter how compromised their life may appear, is a beautiful teaching indeed.  There is nothing good about doctor-prescribed death.  We hope that the series of articles on this topic which will appear in this column each week from now through November 2, will serve not only to educate our readers but to help equip them to spread the word as well.
So let’s get started!  Whether you’re talking with parents in the schoolyard or the soccer field, conversing with an acquaintance in the checkout line, or chatting with your co-worker at the water cooler or the neighbor across the backyard fence, why not strike up a conversation about the dangers of physician-assisted suicide?
Remember, a society will be judged by how it treats its weakest members, and among its most vulnerable are surely the unborn and the dying.  The law is supposed to protect true human dignity and authentic freedom, not deny it. We thank God for our doctors and nurses who strive always to care, even when medicine cannot cure, and we are called to join them by serving those we love in their last days by offering them true compassion, upholding their God-given dignity, and walking with them in their suffering.
For more information on physician-assisted suicide, including articles, links, parish resources, and upcoming events in the Diocese of Worcester, visit www.worcesterdiocese.org/respectlife.

–– Mrs.  LeDoux is the director of the Respect Life Office for the Diocese of Worcester.  She holds a certification in Catholic Health Care Ethics from The National Catholic Bioethics Center.

“To Live Each Day with Dignity – A Conference on Dignity, Dangers, and Choices at the End of Life”, will be held on Saturday, October 27 from 8:30 a.m. to 3:30 p.m. at Assumption College.  Speakers include Bishop Robert McManus, Dr. William Toffler, Fr. Tad Pacholczyk, and Richard Doerflinger.  The conference is sponsored by the Respect Life Office and the Worcester Guild of the Catholic Medical Association.  For more information and to register, visit www.worcesterdiocese.org/respectlife or call 508-929-4311.

 

Caring for dying brother was a gift 

By William T. Clew

Tom Massarelli was 39 years old when he died.
His lymphoma progressed despite two bone marrow transplants and everything else that medical science could do.
His sister, Jo Massarelli, wrote in an article in the September issue of “Catholic Radical,” the local Catholic Worker newsletter, that after the second transplant his doctor predicted that he had eight weeks to live.
His athletic body was emaciated, she wrote. His muscles were wasted and his hands and feet were bloated.
“Simply chewing food was exhausting,” she wrote. “He compared crossing the room with accomplishing his trophy-winning triple jump. Worse was the rejection from those who stayed away, too pained to face the clear departure taking place. His loneliness came to me at night when, sleeping on the floor next to his bed, I would hear him whisper ‘Jo?’ for no reason except to know that someone was there.”
And, she said, someone always was there. He spent his remaining days in his parents home. His four brothers, Jo, her husband, Tom’s new bride and his friends were with him.
“Here he lived for five months more – dying and living, living and dying – so intertwined that his leave-taking could not dampen the rejoicing when he married his Barb in the living room just weeks before we gathered again for his funeral,” she wrote.
It was a good death, she said in a recent interview. He was confessed, she said. He was at home, attended by a prayerful community of people who loved him. He grew in his faith and that buoyed up those who were around him. He died peacefully.
“We as Catholic Christians must put forth this model of a good death,” she said. “People are less afraid of dying, but are more afraid of dying alone in strange circumstances, uncared for.”
In the months before he died, her brother  “allowed no denial of what was happening,” she wrote in the “Catholic Radical” article. “We came to speak of death as a rude guest, always interrupting and not knowing when to leave. Yet my brother was not a particularly courageous person. What he did have was the confidence of knowing that whatever he faced he did so with others who loved him, who loved life and who knew that, in the end none of us gets to stay.”
“I am most grateful that my brother gave me the opportunity to take care of him at the end of his life,” she wrote. “I am certainly not alone in my gratitude. Having cared well for a dying person is a great gift for the caregiver, one that comes with peace of mind when the last breath  is drawn. The certain knowledge that everything that could be done was done, imperfectly for sure, but in love nonetheless, is precious. … We should be prepared to defend human life on principle, as well as in practice with our presence.”
She said in the interview that when people learn of others who are sick and dying, many tend to want to stay away, feeling that there is not much they can do. As Catholics we can pray for and with them. Our  presence is doing something.
Voters who go to the polls Nov. 6 will find on the ballot Question 2, the so-called “Death with Dignity Initiative,” which would allow a terminally-ill patient given six months or less to live and judged mentally capable, to ask to be given lethal drugs.
In her article, Ms. Massarelli writes that life has a natural end and that “God gives us our last breath as well as our first (and that both and all in between are of equal worth). …”
These are basic tenets of our Catholic faith. Christ’s death on the cross reminds us that suffering and death comes to all of us. “We can truly trust him not only with our life, but with our death and dying as well,” she wrote.
God, who is the author of life made us in his image. “That alone is the source of human dignity. Therefore it is not in the domain of the human to end a life, not even one that belongs to him/her.”
She wrote that the so-called “Death with Dignity Initiative” has the potential to change the social contract “to care for one another when we are the most vulnerable.”
She said supporters of the initiative “reject the notion of human dignity as a gift from God. Rather they describe it in terms of personal autonomy, freedom and self-determination. All important concerns certainly, just not as important as the gift of life itself.”
“It is said that ‘thoughts are giants’ and ‘ideas have consequences.’ One of the consequences of physician-assisted suicide is the notion that we can reduce or eliminate suffering by eliminating the sufferer, so long as it is a free choice and in the last six months of life. Set aside for a moment that both factors are difficult to determine with certainty. Additionally it will have the effect of rendering us unwilling and/or incompetent to truly care for one another when suffering is intractable but not terminal, or when the sufferer lives until they die a natural death,” she wrote.
Ms. Massarelli, who teaches a workshop on the vulnerability of impaired people in today’s society and consults with families who seek her help, spoke on  the subject of death and dying and the potential impact of ballot Question 2 recently at the Novena to St. Joseph at Christ the King Parish, 1052 Pleasant St. She is scheduled to speak again on Oct. 29 on the topic of suffering. Her husband, Marc Tumeinski, a professor at Anna Maria College and campus minister at Worcester State University, is scheduled to speak Oct. 15. The novena begins at 7:15 p.m.