Biomedical subjects
Publications and source records attributed to R M Gula.
People's fear of enduring a prolonged, costly dying while attached to life-sustaining machines has prompted support for the legalization of active euthanasia. Four major principles--sanctity of life, prohibition against killing, autonomy, and the common good--have a bearing on the debate.
To show what makes euthanasia an affront to Catholics' most basic convictions, Catholics must be a virtuous community of interdependence, care, and hospitality. The Catholic community's challenge in opposing euthanasia is to help convert society from an aggregate of individuals pursuing their self-interests to an interdependent covenantal community. The Catholic healthcare community may contribute to the bonding that can make living interdependently liberating and life giving by being a catalyst for collaboration between the subcommunities within the Church--hospitals, schools, parishes, and religious organizations. To oppose euthanasia, caring must become the alternative to curing. Caring accepts decline and death as part of being human. A caring Catholic community can provide educational services to the wider community, focusing on managing health and assuming responsibility for treatment. In a community of hospitality the dying should be able to live as free from pain and as much in control as possible. Everyone who has contact with the sick, the elderly, and the dying has the moral responsibility to communicate that they are worthy of respect and are not being isolated or abandoned. Hospitality also must be directed to care givers. The lack of support for those who spend endless hours caring for the terminally ill has been a crucial factor in cases of euthanasia.
According to the Roman Catholic perspective, we are not obliged to ward off death at all costs, but we should not deliberately intervene to bring death about. The "sanctity of life" principle, which rests on the human person's unique relationship with God, is the basis of the Church's honoring of human life as a basic value. Under this principle, direct intervention to end the life of a patient in a terminal condition would not be condoned. This negative position also follows from the religious principle of divine sovereignty--the idea that God alone is Lord over life and death, and the end of human life is not subject to a person's free judgment. Catholic moral tradition distinguishes between actions, on the one hand, or omissions that constitute intervention to put the patient to death and, on the other hand, the withholding of useless treatment that could not significantly reverse or prolong the progressive deterioration of life. The distinction rests on the difference between ordinary and extraordinary means. Also to be considered is the intention--the physician's goals versus the foreseeable yet unintended results. Thus death may not be directly sought, but it may be tolerated as an inevitable side effect of one's goal (such as the relief of suffering). These moral principles need to be rooted in the specific ways a moral community cares for its sick and dying. The religious convictions of grace and covenant and corresponding virtues of gratitude and fidelity enable the community to uphold its convictions about euthanasia.
Our response to the euthanasia movement brings us to the depths of moral character and spirituality. Character bears witness to the true significance of our Catholic convictions about the dignity of persons, the value of life, our dependence on God, and our interdependence on one another. To be credible players in public debates on euthanasia and assisted suicide, we have to bear convincing witness, personally and corporately, to the ways we care first for ourselves and for those who are not as fortunate as we--the sick, the elderly, the indigent, and the dying. Who we will be in the face of death will have a lot to do with what we have come to believe about life, with the values we have upheld, with the attitudes we have taken, and with the habits of thought and behavior we have formed. So we need not be victims of what dying has in store for us. Rather, we can engage our dying by developing those habits of the heart which will make a difference in the way we adapt to unwanted circumstances and endure what we cannot change. We cannot develop strength of character if we are not nurtured by a community of character. In addition to personal character, we also need to be a community that gives witness to those fundamental religious and moral convictions which shape our living and dying in ways that would make euthanasia unthinkable.
The quality-of-life factor used in making difficult decisions about life-sustaining treatment should refer to the patient's definition of meaningful survival. The significance of this is founded on theological convictions that respect life's value and promote its meaning according to the ability to actualize life's potential, especially through love. The appropriateness of quality-of-life criteria is entailed in the principle of beneficence: doing good for the patient. Beyond medical good, this must include each aspect of the patient's total good--autonomy, preferences, and ultimate (spiritual) good. The proportionate-disproportionate distinction exemplifies this by weighing treatment effects against patient benefits. The difficulty in applying the quality-of-life factor primarily involves who determines the criteria, as answered by one of three approaches: The "gold standard" gives priority to informed patients capable of deciding for themselves. The "silver standard" is the proxy judgment substituting for patients' previously communicated wishes. The "bronze standard" is the judgment made in patients' best interests when no wishes have been expressed. Healthcare delivery can address quality-of-life considerations using five guidelines: 1. Respect the wishes of informed patients capable of decision making. 2. Treat incompetent patients as similar patients have chosen to be treated. 3. Act to restore patients' capacity for meaningful relationships. 4. Determine if treatment yields a reasonable balance between treatment effects and patient benefits. 5. Refer doubtful treatment decisions to an institutional ethics committee.
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