RITE AND REASON: Euthanasia was the theme of yesterday's Day for Life 2002, designated by the Catholic Bishops. Acceptance of euthanasia would weaken respect for life, writes Father Kevin Doran.
Shortly after I was ordained, a lady told me about her husband who was dying of cancer. She wanted me to visit him and to pray with him. "But don't let on that he is dying," she said. When I did visit him some days later, he told me that he knew he was dying, but he asked me not to let on to his wife because she would be very upset.
This is a common enough scenario. We all know that death is part of the human condition, but when it touches our own lives or the lives of those we love, we often have difficulty in dealing with the unfamiliar emotions to which it gives rise.
Thirty years ago, Dr Elizabeth Kubler-Ross questioned why nobody ever seemed to ask dying people themselves what they thought and felt. She began to invite her patients to talk to her about death and dying. "My goal," she said, "was to break through the layer of professional denial that prohibited patients from airing their innermost concerns."
She discovered that people who were dying were afraid of two things: they were afraid that, once treatment was of no further value, nobody would come near them and they would be left to die alone. They also worried that their doctors or their relatives might not be honest with them. Dr Kubler-Ross understood that talking honestly about the sadness, the fear, and the sense of "unfinished business" associated with dying was often far more helpful than sedation.
These insights are at the heart of what we now call palliative care. This involves a multidisciplinary team in caring for the various physical, emotional and spiritual needs of the patient who is dying. Palliative care is really an attitude to care, which sets out to help patients to live as fully as possible until death comes naturally. It upholds absolute respect for human life but at the same time acknowledges human mortality and the limited dominion we have over life.
Nowadays, it is possible in most cases to keep pain within reasonable limits, by the use of drugs. But drugs which control pain can also have side-effects. They can affect the appetite and depress the breathing. While the patient's quality of life is improved he or she may die a little sooner due to these side-effects.
Under the traditional moral principle of "double-effect", such drug treatment is perfectly legitimate from a moral point of view, provided that there is no intention to end the life of the person who is dying, and the reduction in the patient's length of life is not out of proportion to the pain relief he or she experiences.
The principle of "double-effect" is not a "fudge", as was suggested in an Irish Times editorial last Tuesday. It is simply an expression of the fact that doctors cannot do the impossible, and that the morality of what they can do is determined in part by their intention.
Euthanasia, by contrast, is any action or omission which is intended to end the life of a sick or elderly person. It involves a decision that the person's life is no longer worth living. The Catholic Church absolutely rejects euthanasia as a response to chronic or serious illness.
People sometimes request euthanasia during a bad period of symptom control, or even a clinically treatable depression. It may be suggested that someone who is seriously ill should not be expected to go on living "like that". The whole point of palliative care, of course, is that people don't have to go on living "like that".
In most cases, when the symptoms are better managed, and the depression treated, the request for euthanasia is no longer heard.
Moral considerations apart, good palliative care will support most people through the difficult moments when they might wish they were dead. But what should we say to those who still ask for euthanasia, or even insist on their "right to die"?
Our response must always be compassionate, and their insistence must lead us to try even harder to relieve their distress. But if we were to accept the principle of euthanasia in response to a small number of individual cases, we would weaken the ethos of respect for life in society as a whole. The legalisation of euthanasia would also fundamentally change society's perception of healthcare professionals as people whose whole ethos is rooted in respect for life.
Advances in technology and in drug treatment now make it physically possible to sustain life in cases where, in the past, people would have died. This is a welcome development, but it also means that doctors and nurses sometimes feel they must sustain life at all costs, even if it is not in the best interests of the patient.
People want the best possible care for their relatives. In some cases the "best possible care" is to accept that life is coming to an end, and to make the sick person as comfortable as possible in the last hours and days, without any dramatic medical interventions. Christian faith can help us in that process of letting go, because it offers us the promise of a new springtime, when "every tear will be wiped away".
Father Kevin Doran is a member of the Irish Bishops' Bioethics Committee, which last week published the booklet End of Life Care: Ethical and Pastoral Issues.