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We Lay Down Our Lives To Take Them Up Again
A Pastoral Statement on Euthanasia and Physician Assisted Suicide
@Wilton D. Gregory, S.L.D.,
Bishop of Belleville
October 7, 1996

A. The Pastoral Statement
B. Outline of the Pastoral Statement with accompanying discussion questions
C. References for the study of the Catholic Church's position on Death and Dying
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INTRODUCTION

In his recent Encyclical letter The Gospel of Life, Pope John Paul II challenges us to develop a culture of life in which the incomparable value of every person is protected and affirmed. As we celebrate Right to Life Month, all of us sadly know that such a culture is not yet a reality. In addition to the ancient scourges of poverty, hunger, and war, new crimes against life have emerged that, in some ways, are more urgent because they are falsely or erroneously justified in the name of freedom and seek authorization by the State.

In this month dedicated to life, I want to present the teaching of the Church in regard to the issue of physician-assisted suicide that we hear and read about with increasing frequency in the media. Not only has there been a sharp increase in the publicity surrounding national and local incidents of active physician-assisted suicide, but existing laws against assisted suicide have been challenged in many states.

The emerging debate surrounding physician-assisted suicide forces all the members of society to pause and clarifies the shared assumptions about life and death that our laws are meant to protect. The Church has a rightful place in this public discussion because the issues surrounding death are not only medical and legal, but they are religious and moral as well.

THE LIGHT OF FAITH

As Christians, our faith shapes our attitude toward sickness and death in three important ways. First, we believe that human life is good. Human life is a gift from God to be cherished and respected because every human being is created in the image and likeness of God (Gen. 1:26). Our Church teaches that we are stewards of life and in heeding God's command, "Thou shall not kill" (Exodus 20:13), we recognize that we cannot dispose of life as we please.

Secondly, we believe that the Son of God became man to reconcile us with the Father and to be our model of holiness (Mt. 11:29). His sacrifice of himself is the model of the new law, "Love one another as I have loved you" (Jn. 15:12). By living among us, Jesus has created a new communion or solidarity among us (1 Cor. 12:26-27), making everyone a neighbor worthy of our charity and care (Lk 10:25-36).

Thirdly, we believe that we are redeemed by Christ and called to share eternal life with him. The Christian vision of death is expressed in the funeral liturgy when we pray:

Lord, for your faithful people life is changed, not ended. When the body of our earthly dwelling lies in death we gain an everlasting dwelling place in heaven. [Preface for Christian Death I]

As Christians, we face death with the confidence of our faith in Him who has conquered death by his resurrection (Rom. 6:3-9; Phil 3:10-11). Christians live in the world knowing that although the advantages that science and technology provide enrich our lives immensely in so many different ways, they will never exempt us from our own personal encounter with the mystery of death. Christ has overcome death. He has rendered death's dividend barren. Still, each one of us must follow the Lord in His triumphant passage to life. Our faith does not dispense us from this encounter with the vanquished foe that we call death.

THE TEACHING OF THE CHURCH

These convictions guide the Church's teaching and practice with regard to euthanasia and physician assisted suicide. In the recently revised Catechism of the Catholic Church, the Church condemns absolutely "an act or omission which, of itself or by intention, causes death in order to eliminate suffering" [#2277].
The meaning of this statement can be made clear by two examples. Active euthanasia occurs when a doctor or medical staff person administers a lethal dose of medication with the intention of killing the patient. Assisted suicide occurs when a doctor or medical staff prescribes the lethal amount of medication and leaves the choice between a natural or an accelerated death to the patient. In both active euthanasia and assisted suicide, death is induced before its time.

FACING OUR OWN DEATHS

The discussions that are going on in our society about physician assisted suicide represent, in part, our anticipation and fear of the circumstances of our own deaths. What we may fear first of all is being given too much technology and dying not at peace but in a wild frenzy of efforts to give us a little more time to live. Secondly, we may fear that, despite all the marvelous successes of medicine and technology, they will not be able to help us recover our health but merely entrap us in the dying process longer than we can endure.

To help guide the decisions that we may face about medical treatments for ourselves or for others and to give us some control in the dying process, the Church draws a distinction between ordinary and extraordinary means of preserving life. When we use these terms, we often focus on the level of sophistication of the technologies that are at our disposal to maintain human life. Unfortunately, trying to categorize treatments this way reduces the distinction to the difference between customary and unusual treatment.

To avoid this misunderstanding, the Church has recently used the terms of proportionate and disproportionate means of treatment. This more appropriate terminology aims to show that the use of technology is at the service of the total well-being of the person. Treatments cannot be evaluated without reference to the patient receiving them.

As stewards of life, we are obligated to use only proportionate means of treatment to maintain life; they are those means that offer a reasonable hope of benefit and do not involve an excessive burden. We are not obligated to use disproportionate means to maintain life; they are those means that do not offer us a reasonable hope of benefit or impose on us an excessive burden. To forego disproportionate means of treatment is not the same as suicide or euthanasia; rather, it signals the acceptance of the inevitability of death as part of human life.

With these distinctions, the Church helps guide us in making a prudential treatment decision. In assessing the burdens and benefits of the medical options that are available to us, we should inquire whether the treatment offers any hope for recovery, whether the procedure may be painful or dangerous, or whether the treatment will impose on us or on others considerable hardships as when it may be excessively expensive.

HELP IN DYING

Finally we fear that when a person decides to forego disproportionate means of treatment and remove the barriers to death, he or she will face death in the most dramatic way -- alone. Facing death can be a time of isolation, anguish, and despair; it can also be a time of extraordinary spiritual growth and fulfillment. Each of us will long for the saving touch of Christ through the sacraments. The Church offers us in our infirmity the comforting grace of the Anointing of the Sick and the Eucharist as the sacrament of passing over from death to life, from this world to the Father (Jn. 13:1).

Each of us, too, will long for the warmth of a human touch in the form of being accompanied through the final mystery of life. None of us wants to die deserted and isolated from human love. When faced with death, a person should be given an opportunity to say good-bye to family and friends. As fearful as it might be, we should be willing to take the risk to selflessly walk with those who experience in their illness the limitations and fragility of the human condition. We must keep company with the dying in order to affirm their dignity in every phase of life. No amount of medical intervention can replace the compassion and love that the person needs and deserves in the hour of death.

This deep love for the sick and dying has given rise to a long and outstanding history of charity. All of us in the Church of Belleville can be particularly grateful to the many women religious, doctors, medical staffs, and pastoral care ministers who, through their leadership in the health care ministry in our diocese, present an eloquent example of Christ's compassion toward the sick.

MANAGING PAIN EFFECTIVELY

The contemporary discussion in which we are involved also goes to the heart of the purpose of the medical profession. Physicians and other caregivers have the obligation to maintain life and to relieve pain. These two duties, however, may come into conflict in the dying process.

Proponents of physician-assisted suicide at times argue that their initiatives are the only way to protect the dying from severe and intractable pain. It is true, too, that public opinion polls reveal that many people who favor assisted suicide do so because they do not want to endure a physically painful death. Quite understandably, people want to make the last steps in life without pain. It is important to point out that the effective treatment of pain guarantees that no one will suffer a painful death. Healthcare providers must make every effort to insure that the available medications to eliminate or control pain are provided to a patient.

From a moral perspective, a physician may responsibly administer medications to control or alleviate pain even when doing so may hasten death. The physician's intention is not to kill the patient but to relieve pain effectively with the medicines available.

Much of the debate in this matter fails to distinguish between pain and suffering. The distinction is far more than academic for a person of faith. Pain most frequently refers to the physical experience of discomfort. Suffering is more profound than the endurance of physical pain and may well be present even in the absence of pain. Suffering can also be an expression of one's faith and love. Suffering endured out of love is redemptive. Our suffering, from Apostolic times, has also been a way that each one of us identifies with and shares in the salvific work of Christ Himself [Col 1:24 and 1 Peter 4:13].

CONCLUSION

As a people of faith, we have an important role in the public discussion about physician-assisted suicide. In this public conversation our position must not only be stated clearly and confidently, but our opposition to assisted suicide must be backed up with compassionate action. Our opposition to physician assisted suicide is not to hinder freedom but to protect the right to die with human and Christian dignity. Between the two extremes of active euthanasia or assisted suicide and the use of every possible means to prolong life at all costs, the Church offers a third alternative of action that can help to guide the public discussion.

The Church recognizes a person's right to refuse disproportionate medical treatment. What we must safeguard in our society is that a person's informed treatment decisions are respected.

The Church also recognizes the need for the proper management of pain. In this regard, we must insure in the clinical setting that a person need not seek death in order to escape pain.

And finally, the Church recognizes the importance of the interpersonal aspects of human suffering and death. As members of the Church, we offer to the sick and dying our service of charity as a resplendent sign that "God has visited his people" (Lk. 7:16). It will be our compassion towards the sick and dying that will ultimately make our teaching on assisted suicide effective and credible enough to shape and guide the public agenda.

In the midst of the final looming controversy over his own fate, Jesus uttered the words of faith that continue to inspire and to guide the Church's teaching in this mystery of the death of a Christian: "This is why the Father loves me, because I lay down my life in order to take it up again." [John 10:17]
B. OUTLINE AND QUESTIONS
I. Introduction

1. "Gospel of Life" (JPII) - develops a culture of life.
2. New crimes against life are falsely justified in the name of freedom and seek authorization by the state.
3. The Church has a place in the public discussion of euthanasia and assisted suicide because the issues surrounding death are religious and moral, as well as medical and legal.

Questions:
1. Have you read "The Gospel of Life" by Pope John Paul II?
2. What are some of the medical, legal, religious and moral issues of death?

II. The Light of Faith

1. Faith shapes our attitude toward death in 3 ways:
· Human life is good, a gift from God, of which we are a steward.
· God became a human being to reconcile us. By living among us, Jesus created solidarity among us, making everyone a neighbor worthy of our charity and care.
· We are redeemed by Christ and called to share eternal life with Him.
2. Our Faith does not dispense us from our personal encounter with death.

Questions:
1. How does Faith shape our attitude toward sickness and death?
2. How has science and technology enhanced our lives? How have they been death denying?

III. The Teaching Of The Church

1. The Church condemns "an act or omission which, of itself or by intention, causes death in order to eliminate suffering." (#2277 - Catechism of the Catholic Church).
2. Active Euthanasia - a lethal dose of medication is administered with the intention of killing the patient.
3. Assisted Suicide - a lethal dose of medication is prescribed and leaves the choice between a natural or accelerated death to the patient.

Questions:
1. Define euthanasia vs. assisted suicide.
2. What is the teaching of the Church regarding actions intended to eliminate suffering through death?


IV. Facing Our Own Deaths

1. Discussions about euthanasia and assisted suicide represent:
· Anticipation and fear of our own death
· Fear of a "wild death."
2. Advanced technology may only trap us in the dying process, but not lead to recovery.
3. Proportionate vs. disproportionate means.
· The use of technology is at the service of the total well being of the person.
· We are obligated to use only proportionate means of treatment to maintain life. These offer a reasonable hope of benefit and do not involve excessive burden.

Questions:
1. "Fill out" your own death certificate and write your own obituary. What fears and expectations did you experience? Did you feel trapped in your dying process?
2. Discuss proportionate vs. disproportionate means.
3. What is "wild death?"

V. Help in Dying

1. Facing death can be:
· A time of isolation, anguish and fear;'
· A time of spiritual growth and fulfillment
2. The Church offers:
· Anointing of the Sick;
· Eucharist
3. Keep company with the dying to affirm their dignity in every phase of life.

Questions:
1. Who, by their ministry, are examples of compassion and love for the dying?
2. Talk about the sacraments of Anointing of the Sick and Eucharist. How do these sacraments help us to pass from death to life, from this world to our Creator?
3. Bishop Gregory has said: "Facing death can be a time of isolation, anguish, and despair; it can also be a time of extraordinary spiritual growth and fulfillment." What does this mean to you? As one who journey's with the dying, how can I assist the dying person in this process?

VI. Managing Pain Effectively

1. Physicians and other caregivers are obliged to maintain life and relieve pain.
2. Assisted suicide is favored because people to not want to endure a physically painful death.
3. Effective pain treatment will ensure that no one will suffer a painful death.
4. Morally, a physician may administer medications to control/manage pain, even when this may hasten death.
5. The distinction between pain and suffering:
· Pain: the physical experience of discomfort;
· Suffering: more profound than the endurance of physical pain; can be present in the absence of pain; can be redemptive.

Questions:
1. Define the following:
· Pain vs. suffering
· Pain management
· Redemptive suffering
2. Can physicians administer medications to control pain if they hasten death?
· If you answer yes - why?
· If you answer no - why?

VII. Conclusion

1. We oppose assisted suicide to protect the right to die with human and Christian dignity.
2. The person has the right to refuse disproportionate medical treatment. This is the choice offered by the Church between the extremes of assisted suicide/euthanasia and prolonging life at all costs.
3. Proper pain management is needed so a person will not seek death in order to escape pain.
4. There are interpersonal aspects of human suffering and death.
5. Christian compassion toward the sick and dying will guide the public agenda on assisted suicide.

Questions:
1. Summarize the Church's position on:
· Euthanasia
· Assisted suicide
· Prolonging life at all costs
· Proportionate vs. disproportionate means
2. What is Christian compassion towards the sick and dying?

C. REFERENCES FOR THE STUDY OF THE CATHOLIC CHURCH'S
POSITION ON DEATH AND DYING

DECLARATION ON EUTHANASIA, Congregation for the Doctrine of the Faith, USCC Publication No. 704-9

EVANGELIUM VITAE - The Gospel of Life, Pope John Paul II

Ethical and Religious Directives for Catholic Health Care Services, National Conference of Catholic Bishops, 1994, USCC Publication #029-X

Euthanasia, Moral and Pastoral Perspectives, by Richard Gula, SS; Paulist Press, New York, Mahwah, NJ, 1994, (Short book and easy to read).

Richard McCormick, SJ, moralist from Notre Dame University recommends this book by Daniel Callahan, THE TROUBLED DREAM OF LIFE, Simon and Schuster, 1993. Daniel Callahan is the director of the prestigious Hastings Center. While this book has excellent material, it is not easy reading.

NB. "We Lay Down Our Lives To Take Them Up Again" was written by Bishop Wilton Gregory. Fr. Gene Neff developed everything else in this article.



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