ONCE MORE: YES, TO ALLOWING TO DIE
The word orthothanasia was used for the first time in the 1950s. It means correct dying, or allowing to die or letting die.
ALLOWING TO DIE, OR ORTHOTHANASIA
It is vital to note the difference between allowing death to occur and intending death to happen. While in euthanasia the death of the patient is directly intended and caused, in allowing to die his/her death is directly caused by a grave pathology: the morphine administered to the patient in great pain causes directly the relief of his pain and indirectly and unintendedly may perhaps advance his death, which is merely foreseen and tolerated.
Let us underline that in the case of letting die, what is directly intended is the relief of the acute pain of the patient. In allowing to or letting die, therefore, death is neither directly caused nor intended. It just happens. It is an event, part of the temporal life of every human being. Hence, allowing to die. or orthothanasia, is anti-euthanasia, which directly and unethically anticipates death, and anti-dysthanasia, which unduly prolongs dying and prolongs death.
ALLOWING TO DIE: POSSIBILITIES
Allowing to die includes, in particular, three possibilities.
First possibility for allowing to die: when the treatment to prolong life is useless or futile for the patient, and therefore ought not be generally given. We remember the words of the poet: For man to want to live when God wants him to die is madness.
Second possibility for letting die: when the prolongation of life (of dying) or the postponement of death is unduly burdensome in the first place for the patient - also for the family. On this point, the Catechism of the Catholic Church summarizes well the traditional teaching of the magisterium: “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted” (CCC, 2278).
Third possibility for orthothanasia: when the patient needs painkillers or medical sedation, which does not intend the death of the patient. These painkillers directly mitigate suffering and indirectly may shorten life. Physicians and significant others are committed to relieve pain and suffering, which is their professional commitment, or moral duty limited only by the prohibition against direct killing. Summing up the traditional teaching of the Church, we go back to the Catechism: “The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable” (CCC, 2279).
Related to the option of allowing to or letting die, we usually face, among others, three objections: one objection refers to doubtful treatment, another to the real meaning of death with dignity, and the third to patients in persistent vegetative state (PVS).
How about a doubtful treatment? If treatment is beneficial to the patient and not unduly burdensome, it ought to be given: we are to administer our life well. If treatment is truly useless, generally it should not be given. Moreover, if the treatment is doubtful or uncertain, the “best-interest of the patient” principle suggests providing treatment for it might have a potential benefit: in doubt, it is good to be on the side of life.
“DEATH WITH DIGNITY”
Another objection is: How may we understand ‘death with dignity’? It is often understood wrongly as “death without pain,” as if those who die with pain cannot have a death with dignity. The word dignity is often – as someone put it - “high-jacked” by those who favor euthanasia. For believers and others, to die with dignity means respect for the dying, preparing for death and accepting it when it comes. The saintly Pope John Paul II says that the elderly – and all human beings - have “the right to a worthy life and to a worthy[FG1] death.” Palliative or comfort, or hospice are is a way to a worthy death, or a death with true dignity.
Death with dignity then is an ambiguous expression that may mean two opposite things. One meaning is the justification of killing - of euthanasia and assisted suicide - based upon the unethical principle of absolute personal autonomy. A second meaning is this: “letting die in peace” or allowing to die, which is ethical. Death with dignity means for the Christian a good and dignified death that respects the principles of stewardship (God is the Lord of Life and Death), of solidarity (we are members of the human family and God’s family), and the principle of respect for all persons, beginning with the respect due to our own person, dignity and rights, including the basic right to life, which ends with a dignified death. Palliative care helps achieve a death with dignity that is, a death that comes after achieving peace with God, with ourselves, loved ones, and neighbors.
The final objection we wish to face: How about patients in deeply comatose or a persistent vegetative state (PVS)? What kind of treatment should they be given? The main problem here is a reliable and true diagnosis: How certain may we be of the diagnosis? Certainly, these permanently comatose patients have to be given beneficial and not too aggressive or undue burdensome treatment. Food and drink should always be given. These are not medical treatment, but a human need of every person. The basic teaching of the Church is well formulated by the American Bishops (USA) in their significant Ethical and Religious Directives for Catholic Health Care Services: “There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.”
A final radical question: Is there any equivalence between killing and allowing to die? There is, indeed, no equivalence at all but profound difference between killing and allowing to die: while killing is intrinsically and objectively evil, allowing to die is the moral option that respects life and considers death as inevitable part of human life.
From a humanist and Christian perspective, the ethical possibility is the third, that is, allowing or letting the patient die. When we are in doubt regarding the application of the ethical guidelines at the end of our own life and the life of our loved ones, we ask those who may know better than us. However, we decide on our own cases – when we are able to; if not, our closest decide for us, and, if possible, according tour own – the patient - god wishes.
Certainly, life is a wonderful gift and deserves to be lived always (also when we are limping), while death is a passage to another life, hopefully a better life: we die not to remain dead, but – thanks God - to rise from death to our resurrection. ###
(F. GÓMEZ BERLANA OP)