The Pontifical Academy for Life held its annual assembly in March on the theme of end of life assistance to the elderly. While there are numerous Vatican documents and papal statements that address this issue, a renewed focus on the moral and ethical care of the elderly is both welcomed and needed. It seems that even as hearts and minds are persuaded to oppose abortion,[i] there is a growing acceptance of hurrying death at the other end of the life spectrum.
For example, the Supreme Court of Canada recently ruled that the law banning assisted suicide is unconstitutional. The Court declared that Canadians who are competent consenting adults and who have severe and incurable but not necessarily terminal medical conditions have a right to physician-assisted suicide in order to end their suffering. The Canadian government now has one year to rewrite its law in order to regulate the practice of assisted suicide.
In the United States, physician-assisted suicide is legal in Oregon, Washington, and Vermont. An attempt to legalize assisted suicide in Colorado was narrowly defeated in a legislative committee vote. At least 14 other states are grappling with assisted suicide legislation.[ii] High profile cases like that of John Rehm, who chose to starve himself to death because he no longer wanted to endure the end-stage effects of Parkinson’s Disease, create an emotional response that engenders support for suicide while ignoring the moral implications. Rehm’s wife, Diane, is a syndicated talk show host for National Public Radio and is using her notoriety to campaign for physician-assisted suicide.[iii]
In Europe, the practice of physician-assisted suicide has devolved even further to include both passive and active euthanasia. The notorious Liverpool Pathway of the United Kingdom’s National Health Service deprives the elderly of food and hydration when a medical provider deems the person is no longer worthy of continued medical care. No input from the patient or his family is required for this determination.[iv] Active euthanasia is legal in Belgium, The Netherlands, and Luxembourg. It is estimated that over 10% of all deaths in The Netherlands are the result of euthanasia.[v]
It is against this backdrop that the Pontifical Academy pro Vita convened. The focus of this meeting is much broader, however, than just a condemnation of euthanasia and physician-assisted suicide. As morally reprehensible as these practices are, they are mere symptoms of a broader utilitarian ethos that regards the elderly as having outlived their usefulness and therefore as disposable. The Academy offers positive steps to counter this with discussions of a more dignified approach to health care, the importance of family in the lives of the elderly, and the responsibility of all of society to express solidarity with the elderly.
Recognizing the intrinsic human dignity of the elderly is key to appropriate medical care. No level of cognitive or physical infirmity can diminish this dignity. This does not mean that every medical intervention is appropriate for those who are approaching the end of their earthly lives. There is no moral imperative to accept extraordinary medical care. Treatment options can be evaluated and judged to be too burdensome relative to the potential benefits they offer.
Human lives, on the other hand are never too burdensome. We must diligently preserve this distinction between judging the value of therapy, which is entirely appropriate, and judging the value of a human life, which is never appropriate. At no point does an individual ever become unworthy of care. It is also important to note that this care must include nutrition and hydration as long as the body is capable of deriving benefits from such measures. Failure to do so, especially if such care is omitted in order to hasten death, is a form of passive euthanasia.
The experience of The Netherlands shows that what is initially presented as a “right to die” can quickly become a “duty to die.” Surveys indicate the Dutch elderly often feel pressured to end their lives to avoid being a burden to their children or to society as a whole.[vi] Similarly, in Oregon and Washington over 25% of those opting for physician-assisted suicide did so because they did not want to be a burden to family members.[vii] Clearly family dynamics are grossly distorted when senior citizens assume their loved ones would prefer them dead.
We must bring back into focus the continuum of family love. While life begins with parents sacrificing themselves out of love for their children, there is a gradual transition as children grow more independent. Eventually the roles may reverse and it is the child who must make loving sacrifices to care for his parents. The elderly and their families should see this shift as an opportunity to cultivate many virtues. Becoming more dependent requires humility. Becoming the caregiver requires generosity and patience. The sting of death is mitigated when the final moments are immersed in familial love.
Pope St. John Paul II said, “A society will be judged on the basis of how it treats its weakest members; and among the most vulnerable are surely the unborn and the dying.” It is therefore fitting that the Pontifical Academy concludes its meeting with consideration of the question, “What is social solidarity?” Care of the elderly is not solely a private affair of the family or a professional matter for health care providers. How we treat the elderly, especially when they are dying, is a reflection of how we value all human life. Our families, our health care institutions, and our public policies must work together to affirm the intrinsic value and dignity of our senior citizens. We must invigorate a culture of compassion that gives our elders hope that we will patiently accompany them as they journey towards death. We will not abandon them to the despair that fuels acts of desperation like assisted suicide or euthanasia. Our most vulnerable elderly, those who are dying, must be confident that they are not alone and they are loved.