Euthanasia. 100 questions and answers
Foundation: Spanish Episcopal Conference, Committee for the defence of life.
source : Spanish Episcopal Conference.
language original: Spanish.
Copyright: No.
Publication: February 1993.
Checked on 16 May 2002.
Euthanasia. 100 questions and answers on the defence of human life and the attitude of Catholics.
Presentation
When, almost two years ago, the Episcopal Committee for the Defence of Life, dependent on the Spanish Episcopal Conference, presented the book "EI Aborto: 100 questions and answers on the defence of human life and the attitude of Catholics" to public opinion, it announced that this was only the first in a series of publications that would see the light of day in the future. The common idea was one: to study the value and dignity of human life from the particular perspective of a monographic treatment of a current problem. On that first occasion, it was abortion; today, it is euthanasia.
The broad social discussion generated by those "100 questions on abortion", the diffusion achieved by the text in Spain, in Latin America and throughout Europe, especially in the countries that have recently emerged from the communist experience, did not fail to be an important incentive for the Committee to fulfil its initial purpose of continuing that work on abortion with other similarly topical subjects. The million copies sold of the "100 questions on abortion" and the news of its permanent use as an instrument of work and study in the most varied scholarly, academic and religious environments on various continents, have encouraged the intense effort of the Episcopal Committee for the Defence of Life, which has worked for more than a year in multiple plenary meetings and at discussion paper, to outline the text that is now being made public.
Doctors, philosophers, pharmacists, nurses, theologians, jurists, moralists, have written, rewritten, discussed and finally drafted this text on euthanasia during long months of work, aiming to achieve a final product faithful to the double goal of this collection of works: technical and scientific rigour in the treatment and clarity and simplicity in the exposition.
While we were preparing this work, two referendums were held in the USA on euthanasia, both of which were rejected by the majority of citizens; discussion has been reopened in the Netherlands - once again in that country - on the decriminalisation of euthanasia; in various countries, news of "cases", sentences, opinions and proposals concerning euthanasia have appeared in the media. These events have not altered the Committee's work plan, although they have been studied, assessed and considered.
When our work was almost finished, the Spanish Government has C a project of Penal Code - currently in process in the congress of the Deputies - in which euthanasia is regulated as a singular offence deserving of a considerably lighter penalty than that of homicide. This is the beginning of a trend of "legal understanding" in our country towards euthanasic practices which, we fear, could end in the short term with total impunity, as has happened with abortion, partially decriminalised to deal with certain "extreme cases" and legalised in practice to the point of already constituting a lucrative business protected even by certain State institutions.
The Government's legislative initiative makes the present work highly topical, which is intended to serve as an element of reflection for all citizens - also for those who cast their vote as Deputies and Senators - and as a factor of formation for the enlightened conscience of Catholics.
This document addresses euthanasia without shying away from or obscuring the arguments of its supporters; without omitting the most contentious points of view; without silencing the most controversial issues, for we believe that society - Catholics and non-Catholics alike - can and should take reasonable time to reflect and educate itself before passing judgement on such an important issue.
In our time there are growing sentiments of ideas that are very much in line with the idea of man, justice and human rights that underlies this work, but at the same time practices that are incompatible with human dignity are being imposed on our societies. The Episcopal Committee for the Defence of Life is convinced that we can promote the most positive aspects of our culture if we all make an effort to be consistent with the humanism that has inspired the most positive aspects of Modernity. For this reason, it offers for the responsible consideration of all citizens - including politicians, doctors, educators, families and others who have to decide on euthanasia - a work that is inspired by a profound respect for every man, every woman, every human being, who - for those of us who believe in God - is the object of a singular and personal love since before creation and will never end, projecting itself into eternity after death.
Cardinal Narciso Jubany Arnau
President of the Episcopal Committee for the Defence of Life
I. Terminology
1. What is euthanasia?
The word "euthanasia" has throughout the ages meant very different realities. Etymologically, euthanasia (from the Greek "eu", good, "Thanatos", death) means nothing other than a good death, a good death, nothing more.
However, this word has since ancient times acquired another, somewhat more specific meaning: to procure a painless death for those who are suffering. But this meaning is still very ambiguous, since euthanasia, understood in this way, can mean realities that are not only different, but profoundly opposed to each other, such as putting to death a newborn infant who is presumed to lead a diminished life, helping a suicidal person to achieve his or her goal, eliminating an elderly person who is presumed to no longer live a dignified life, refraining from persisting in painful or useless treatments to prolong an agony without human hope of cure for the dying person, and so forth.
2. What is meant by euthanasia today?
Today, more strictly speaking, euthanasia is understood as so-called mercy killing, i.e. causing the death of another out of pity for their suffering or in response to their wish to die for whatever reasons.
However, in the social discussion about euthanasia, this word is not always taken in the same sense, and sometimes, depending on the moment, one or the other meaning is preferred to defend one or another dialectical position. This often leads to the sterility of discussion and, above all, to serious confusion among the general public.
3. Is the meaning of the words in this subject particularly important?
This is extremely important because, depending on the meaning given to the term euthanasia, its practice can appear to people as an inhumane crime or as an act of merciful solidarity. Such huge differences are often due to the different understanding of the meaning of the word, i.e. the reality it is intended to designate.
It cannot be ignored, however, that in the public discussion there is also often, on the part of euthanasia's sponsors, a certain manipulation of words - whether intended or not - whose result aim is to present the reality of euthanasia to public opinion as something more innocuous than it really is (they say "sweet death", "dignified death"), and thus encourage its social acceptance; as if the central fact that in euthanasia a human being consciously and deliberately kills another human being did not exist, or was secondary, no matter how noble or altruistic the motivations that encourage him/her to carry out such an action may appear to be, and no matter how inconspicuous the means used to do so may be.
All this is not to say that the discussion on euthanasia would cease to exist if we all talked about the same thing and gave the term the same meaning. The discussion would also exist even if by euthanasia everyone meant one and the same thing: causing the death of another, with or without their consent, in order to spare them physical pain or suffering of another subject, considered unbearable.
If euthanasia is taken in this way, there are some people and groups in favour of legalising it and giving it social respectability, because they interpret that human life only deserves to be lived under certain conditions of fullness, in contrast to the majority conviction that human life is a superior good and an inalienable and unavailable right, i.e. that it cannot be left to the decision of others, nor to one's own decision.
4. What will be understood by euthanasia in this work?
Euthanasia is the act of causing the death of a human being in order to avoid suffering, either at the human being's request or because it is considered that the human being's life lacks the minimum quality to be considered worthy.
Thus considered, euthanasia is always a form of homicide, since it involves one man putting another to death, either by a positive act or by the omission of care.
5. Why is this definition chosen?
Because it contains the essential elements that make up the complex phenomenon of euthanasia:
- death must be the intended goal , it must be in the intention of the euthanasia practitioner: it is not euthanasia, therefore, to apply a necessary treatment to alleviate pain, even if it shortens the patient's life expectancy as an unwanted side effect, nor can it be called euthanasia to result of death due to imprudence or accident;
- can occur by action (administering lethal toxic substances) or by omission (denial of medical care attendance ); the death of another is to be sought, not one's own. We will not consider suicide as a peculiar or autonomous form of euthanasia,
Motives are a substantial element of proper euthanasia.
- can be carried out because it is requested by the person who wants to die. We do consider aiding or abetting suicide as a form of euthanasia;
- can be carried out in order to avoid suffering, which may be present or future, but foreseeable; or because it is considered that the victim's quality of life will not reach or maintain an acceptable minimum (serious mental or physical deficiencies, degrading illnesses of the organism, advanced age, etc.).
The subjective feeling of eliminating the pain or deficiencies of others is a necessary element of euthanasia; otherwise we would be dealing with other forms of homicide.
6. Isn't the meaning of euthanasia too strict?
Rather than being strict, it wants to be precise, and this for two reasons: firstly, because only by precisely delimiting the reality that we want to designate will it be possible to know what we are referring to; secondly, because this meaning also coincides with what the sponsors of the legalisation of euthanasia want to see prosper: that it legitimises one man's killing another given certain circumstances.
As will be seen below, for example, the Withdrawal hopeless therapeutic obstinacy - which is often referred to as "therapeutic incarceration" - deserves a separate consideration and, strictly speaking, cannot be considered euthanasia, although from a purely etymological point of view it is, of course, a way of favouring a "good death". This is a concrete example of how easily confusion is introduced in this subject by the different meanings that can be given to the same word.
7. How many types of euthanasia are there?
Depending on the criteria used, there are different classifications of the phenomenon of euthanasia, which also depend on the meaning given to the term.
From the victim's point of view, euthanasia can be voluntary or involuntary, depending on whether it is requested by the person who wants to be killed or not; perinatal, agonistic, psychological or social, depending on whether it is applied to deformed or handicapped newborns, the terminally ill, those suffering from irreversible brain damage or the elderly or other persons considered socially unproductive or burdensome, etc. Some speak of self euthanasia as referring to suicide, but this is not, strictly speaking, a form of euthanasia, although many of its sponsors also defend, according to their own logic, the right to suicide.
From the point of view of the practitioner, a distinction is made between active and passive euthanasia, depending on whether he or she causes the death of another by action or omission, or between direct and indirect euthanasia: the former would be that which seeks to bring about death, and the latter that which seeks to mitigate physical pain, even in the knowledge that such treatment may effectively shorten the patient's life; but the latter cannot properly be called euthanasia either.
There are many more possible classifications, and the same action may in turn fall into several of the modalities referred to here. But all this is basically secondary, and often contributes to increasing confusion about the reality of the problem, rather than helping to clarify the issue. Hence, in order to be able to refer to a concept that is acceptable to both pro-euthanasia and pro-life advocates, we have defined it in the terms set out above, without dwelling on further divisions or classifications.
8. What is meant by dystanasia?
Dystanasia (from the Greek "dis", evil, something badly done, and "thánatos", death) is etymologically the opposite of euthanasia, and consists in delaying the onset of death as long as possible, by all means, proportionate or otherwise, even if there is no hope of cure and even if this means inflicting on the dying person additional suffering on top of what he already suffers, which will obviously not succeed in avoiding the inevitable death, but only in postponing it for a few hours or a few days in conditions that are pitiful for the patient.
Dystanasia is also called "overkill" and "therapeutic overkill", although it would be more accurate to call it "therapeutic obstinacy".
9. What is orthothanasia?
With this word (from the Greek "orthos", straight, and "thanos", death), the intention was to designate the correct action in the face of death on the part of those who care for the terminally ill person suffering from an incurable illness. Orthothanasia would be as far from euthanasia, in the sense mentioned here, as it is from distanasia or therapeutic obstinacy. This recent term has only become established in certain academic circles, without making a name for itself in the usual lexicon of the street; but its mere coining reveals the need to use a word other than "euthanasia" to designate precisely the good death, which is what euthanasia is supposed to mean, but which it no longer means, because it designates the other reality mentioned: a form of homicide.
10. Are we therefore faced with the "hijacking" of the word "euthanasia"?
Rather, one should speak of the distortion of its meaning, which has been due both to the desire of some to make "mercy killing" more socially acceptable (and from this point of view one can speak of a "hijacking" of this word), and to the lack of an adequate term for this kind of killing. This is one of the reasons why the terminological aspect is of paramount importance in this whole issue.
11. What are the main arguments used for promote the legalisation of euthanasia?
The legalisation of euthanasia and its social acceptability is often promote with five kinds of arguments:
- the right to a dignified death, expressly desired by those who suffer atrocious suffering;
- the right of everyone to dispose of his or her own life, in the exercise of his or her freedom and individual autonomy;
- the need to regulate a situation that exists de facto. Faced with the scandal of its persistence in clandestinity;
- the progress represented by suppressing the lives of the profoundly mentally handicapped or the terminally ill, since these are lives that cannot properly be called human;
- the manifestation of social solidarity that means the elimination of meaningless lives, which constitute a heavy burden for the relatives and for society itself.
Not all supporters of euthanasia share all these arguments; but all, however, share the first two, and often the third.
In the course of this text, we will refer to each of these arguments and examine them in their proper context.
II. Man in the face of pain and death
12. Are pain and death part of human life or, on the contrary, obstacles to it?
Pain and death are part of human life from the moment we are born in the midst of our mother's labour pains until we die causing pain to those who love us and suffering from the very process that leads to death. Throughout the whole of existence, pain - physical or moral - is present as a matter of course in all human biographies: absolutely no one is alien to pain. The pain produced by physical accidents - small or great - is a companion of man throughout his life; moral pain (the product of the incomprehension of others, the frustration of our desires, the feeling of impotence, unjust treatment, etc.) accompanies us from our earliest childhood to the threshold of death.
Pain - and its subjective aspect, suffering - is part of every human life and of human history: this is attested to by the personal experience of each one of us and by world literature, in which the experience of pain is not only a source of inspiration, but also an object of constant reflection.
Death is the inevitable destiny of every human being, a stage in the life of all living beings which - whether we like it or not, like it or not - constitutes the natural horizon of the life process. Death is the foreseen culmination of life, although uncertain as to when and how it will occur; and it is therefore part of us because it affects us and those around us, and because the attitude we adopt towards the fact that we are going to die determines in part how we live.
Pain and death are not obstacles to life, but dimensions or phases of it. An obstacle to life is the attitude of those who refuse to admit the naturalness of these facts that constitute all life on earth, trying to flee from them as if they were totally avoidable, to the point of turning such a flight into a supreme value: this denial of reality itself can become a cause of dehumanisation and vital frustration.
13. Should, then, every man give up the idea of fleeing from pain in general, and from the pain of agony in particular?
Every human being instinctively flees from pain and anything that causes suffering, and this attitude is appropriate to the natural constitution of man, who is created to be happy and therefore reacts with aversion to anything that threatens his happiness.
The rejection of what is painful, of what causes suffering, is therefore natural to man. And, therefore, this rejection is just and not reprehensible. However, to make the avoidance of pain the supreme value that must inspire all conduct, to try to flee from pain at all costs and at any price, is an attitude that ends up turning against those who maintain it, because it means denying at the root a part of man's reality, and this error can easily lead to injustice and acts that are reprehensible as anti-human, even though on the surface it may seem otherwise.
These ideas are particularly evident in the case of agony, of the pain that may eventually precede death. Making the absence of pain the preferential and even exclusive criterion for recognising the supposed dignity of death can lead to legitimising homicides - under the name of euthanasia - and to depriving the dying person of the humanising effect that pain itself can have.
14. Does this mean that pain has any positive value for a human life?
Pain and suffering, like any other natural dimension of every human life, also have a positive value if they help us to better understand our nature and its limitations, if we know how to integrate them into our process of growth and maturation. Every human being makes himself during his life by realising the possibilities of fulfilment that are in his natural constitution, or by rejecting such possibilities.
It is a universal experience that pain cannot be totally avoided and that it can be source of personal humanisation and social solidarity. The person who suffers and accepts his or her suffering becomes more human, because he or she understands and takes on a basic dimension of life that financial aid makes the personality richer. Those who try at all costs to flee from pain are probably destroying their chances of happiness, as this is impossible.
The experience of humanity is that pain, if accepted as a dimension of life that must be fought against but is unavoidable, is a school that can help bring about fuller human lives.
15. If death is inevitable, and pain is a "school of life", what is the point of scientific research efforts to mitigate pain and to bring the moment of death as far away as possible?
Pain is inevitable in every human life, but we all have the clear idea that man aspires to happiness. Therefore, striving to mitigate pain is positive, but this goal is absurd, because it is impossible, if eradicating pain becomes an absolute good to which all other noble goals of human action must be subordinated. In every human life there are dimensions or facets that are not always congruent with each other if we try to give absolute value to each of them; every human being has the right to defend his opinions, but if he makes this right an absolute value, he will probably end up being a dictator for others; every man longs for his well-being, but if he puts this dimension of his nature above any other consideration, he will be incapable of any manifestation of generosity, etc.
It is the same with pain: the struggle to mitigate it is positive, and the efforts of modern science in this direction are commendable, but to turn this struggle and this effort into an absolute value is, in addition to being chimerical, unjust, as it obliges us to renounce other valuable dimensions of human life.
Some ideologies in the last century have considered certain partial or relative dimensions of the human being as absolute values and, in doing so, have generated clamorous injustices: this has been the case with those who have built their vision of the world exclusively on race, colour, social class, nation or ideology. Any philosophy or attitude to life that makes absolute any one dimension or facet of the pluriform human reality leads to unjust and anti-humanist approaches, for humanism demands balance and a global, integral vision of the human being on earth.
This, which is evident in totalitarian ideologies, does not appear so clearly in today's attitudes that tend to see health as an absolute good and the absence of pain as the supreme value of man, but the phenomenon is the same: from these attitudes flows the legitimisation of actions against those who do not respond to this absolute ideal of "quality of life": the handicapped, the sick, the dying, the elderly, etc.
16. Is the fear of dying natural?
It is natural to fear death, because man is in happiness, and death is presented as a traumatic rupture with an uncertain destiny. The biblical explanation of death as a consequence of sin and, therefore, as an element alien to the primordial nature of man, fits perfectly with the personal and collective psychology that accredits an instinctive resistance to death.
However, it can lead to inhuman results to make this innate human rejection of death absolute: death is a fact, and an adult human being must accept it as such, otherwise he or she would set himself or herself against his or her own reality.
17. Is it natural to fear the way of death?
Of course, it is natural to fear a painful death, just as it is natural to fear a life in pain. If this aversion is taken to the extreme, it becomes an absolute value to which all others must yield. The fear of a painful and dramatic way of dying can become so intense that, by overriding all other values, it can lead to the desire for death itself as a means of avoiding such a painful situation. This is, in fact, the main incentive for those who advocate the legal and social acceptance of euthanasia. But experience shows that when a suffering patient asks to be killed, in reality he is almost always asking to be relieved of the suffering, both physical and moral, which sometimes surpasses the former: loneliness, incomprehension, lack of affection and consolation in the supreme trance. When the sick person receives physical relief and psychological and moral comfort, he stops apply for to end his life, according to common experience.
18. Are there, then, no definite boundaries that delimit when it is good to accept pain and death, and when it is good to try to avoid them?
It is good to accept the certain and inevitable fact of pain, and it is also good to fight to mitigate it. It is good to fight to overcome illness, and it is not good to eliminate sick human beings so that they do not suffer. It is good to fight for life against death, and it is not good, because it is unrealistic, to reject death as if it could be avoided. But there is no catalogue of solutions that can resolve all the doubts and perplexities we face when confronted with the reality of pain and death. The same is true for many other situations in life, where it is not possible to establish rigid rules, but we have to act, based on the knowledge of general principles, with an upright and prudent criterion.
19. And couldn't the reasons for our action be an appropriate criterion?
It is necessary to know that the motives for which we act (compassion, desire that loved ones do not suffer...) cannot change the intrinsic purpose of our actions, which in euthanasia is to deprive another of life or to cooperate in their suicide. If motives were to prevail over the nature of the acts to the point of making them socially and legally justifiable, coexistence would not be possible, because any act, whatever it may be, could be legitimised by virtue of the intimate motives of its author. It is possible and necessary to understand and help those who act wrongly; it is also possible and necessary to assess the circumstances that influence human acts and modify responsibility. But the general rule can never say that what is wrong is right, no matter how much the perpetrator of the action thinks he is doing something good. The end - the subjective motive - does not justify the means - in this case, killing.
Proponents of the ethical and legal admissibility of euthanasia often confuse the intimate moral disposition of individuals with what the law or society should regard as acceptable; and they also confuse circumstances that may mitigate or even nullify responsibility with what the general rule should provide for.
20. Nevertheless, there are those who believe that a painful death or a very degraded body would be more unworthy than a quick and "sweet" death, brought about at one's own pleasure.
In their ultimate nature, human pain and death contain a mystery, which is none other than the mystery of the very human being placed on this earth; it is also the mystery of freedom and love, which are living, intimate, yet intangible realities that cannot be sufficiently explained by physics or chemistry.
Pain and death are not apt criteria for measuring human dignity, since human dignity is a human right for all human beings by virtue of the fact that they are human beings; pain and death will be dignified if they are accepted and lived by the person; but they will not be dignified if someone uses them as an instrument to attack that person.
A dignified death does not consist only in the absence of external tribulations, but is born of the greatness of spirit of the person facing it. It is clear that, when the supreme moment of death arrives, the protagonist of this trance must face it in the most bearable conditions possible, from the point of view of both physical pain and moral suffering. Painkillers and palliative medicine (which will be discussed elsewhere) on the one hand, and moral consolation, companionship, human warmth and spiritual support on the other, are the means that enhance the dignity of the death of a human being who always, even on the threshold of death, retains the same dignity.
III. Medicine and euthanasia
21. Is the issue of euthanasia a medical problem?
Euthanasia, as proposed by the advocates of its legalisation, affects the world of medicine, since the proposals of its sponsors always involve doctors or health personnel. But the issue of euthanasia is not, strictly speaking, a medical problem, or should not be.
Euthanasia deserves the same ethical qualification if it is carried out by a doctor or a nurse in the technical environment of a hospital as if it is carried out, by any other means, by a relative or a friend of the victim. In both cases, it is a matter of one person killing another.
Euthanasia is not a form of medicine, but a form of homicide; and if it is practised by a doctor, he or she is denying medicine.
22. Why is euthanasia the negation of medicine?
Because the raison d'être of medicine is the cure of the sick at any stage of their illness, the alleviation of their pain, and financial aid to bear the supreme trance of death when cure is not possible. Euthanasia, on the other hand, is not only the Withdrawal to that raison d'être, but consists in the deliberate decision to practice precisely the opposite of Medicine, since it is to put another to death, even if it is by virtue of a presumed compassion. Anyone is perfectly capable of seeing the substantial difference between helping a sick person to die with dignity and causing death.
Euthanasia is not a technique, a resource of Medicine: euthanasia expels Medicine, it replaces it. Euthanasia, moreover, precisely because it is the negation of medicine, turns against the doctor who practises it.
23. Why does euthanasia turn against the doctor who performs it?
For two reasons: on the one hand, it is easy for the doctor to slip into a habitual practice of euthanasia once the first case has been admitted; and on the other hand, euthanasia destroys the basis of the medical act: the patient's trust in the doctor.
When a doctor has killed a patient out of pity for him, he has already taken a step that is very difficult to return. People suffering from the same disease are very similar in their symptoms, reactions and suffering. When a doctor has felt "pity" for a patient to the point of deciding to take his life in order to spare him suffering, it will be relatively easy for him to experience the same state of mind when faced with another patient suffering from the same illness; and this can happen relatively often, because professional specialisation imposes on almost all doctors the need to treat patients who are very similar to one another. In such a situation, the doctor's own virtues (non-discrimination in the treatment of different patients, foreseeing future illnesses or complications) become potentially multiplying factors in euthanasia, because it is very difficult to determine the boundary separating extreme seriousness from a critical situation, or enormous suffering from unbearable suffering, whether physical or mental.
On the other hand, it is not possible for medicine to exist if the patient, instead of having confidence in his doctor to the point of putting his life, health and physical integrity in his hands, comes to fear him because he does not know whether the medical professional or the nurse in charge of his health is going to decide that his case is worthy of cure or susceptible to euthanasia.
If doctors were given the power to perform euthanasia, they would no longer be a friendly and benevolent reference but, on the contrary, a feared and threatening one, as is already the case in some Dutch hospitals.
Humanity has progressed in humanitarianism by removing the power to decree death from rulers and judges (abolition of the death penalty). Proponents of euthanasia seek to take a step backwards by giving such power to doctors. If they were to do so, they would achieve two steps backwards for the price of one: they would recreate a variety of legal death and degrade, perhaps irreversibly, the practice of medicine.
24. Isn't the dividing line between euthanasia and the cessation of care that is no longer necessary a fine one?
Only in a few terminal situations without human hope, the appearance of the doctor's gestures may be similar in both cases; but the doctor knows, without a doubt, what is in his intention: he knows whether what he is doing is intended to cause the death of the patient or whether, on the contrary, he is renouncing therapeutic incarceration. The former will never be admissible; the latter is.
25. What is therapeutic incarceration?
This term, or the term "therapeutic overkill" - which is perhaps less accurate than "therapeutic obstinacy", which better reflects the intention with which it is practised - is intended to designate the attitude of the doctor who, in the moral certainty given by his knowledge that cures or remedies of any nature no longer provide any benefit to the patient and only serve to prolong his agony needlessly, is obstinate in continuing the treatment and does not let nature take its course.
This attitude is the consequence of an ill-founded overzealousness, stemming from the desire of doctors and health professionals in general to try to avoid death at all costs, without renouncing any means, ordinary or extraordinary, proportionate or not, even if it makes the dying person's situation more painful.
On other occasions, one can speak more properly of therapeutic overkill, when terminally ill patients are used for experimentation with new treatments or instruments. Although this is not normal nowadays, history unfortunately provides us with some examples.
In any case, therapeutic obstinacy is gravely immoral, as it instrumentalises the person by subordinating his or her dignity to other ends.
26. Is this not another vague boundary to distinguish therapeutic obstinacy from constant and solicitous care?
There is no mathematical rule for gauging whether or not there is a well-founded hope for a cure. Medical practice has abundant experience of patients who seemed irrecoverable and who nevertheless came out of very difficult situations. The solution to such conflicts can only come from the clear criterion of proportionate use of therapeutic means. The doctor must respect the dignity of the human person and not allow himself to be overcome by abusive medical technicalities.
27. And isn't this a form of euthanasia?
No. Always referring to the terminally ill and faced with the imminence of inevitable death, doctors and patients must know that it is permissible to be satisfied with the normal means that medicine can offer, and that the rejection of exceptional or disproportionate means does not amount to suicide or to the irresponsible omission of the help due to another, but simply means the acceptance of the human condition, one of the characteristics of which is inevitable death.
There may be specific cases in which it is difficult to make an ethically and professionally correct decision, as happens in many other aspects of life: the judge who must decide whether someone is guilty or innocent when the evidence is not clearly conclusive; the teacher who must choose between approve or fail at student and has reasonable doubts about the rightness or wrongness of either option; the parent who hesitates between severity or leniency towards a child with problems, and so on. In these cases, an appropriate moral rule is to disregard possible selfish motives for one's own decision and to seek the advice of other experts in order to make a prudent decision. With these requirements, a doctor - like a judge, a teacher or a parent - may err, but will not commit a crime.
28. But how can ordinary therapeutic means be distinguished from extraordinary ones?
Obviously, it is useless to establish an objective casuistry of ordinary and extraordinary means, because this depends on such changing factors as the patient's situation, the state of research at a given moment, the technical conditions of a given hospital, the average level of health care attendance in one country or another, etc. What is considered to be an ordinary means for one patient in one particular circumstance may have to be considered extraordinary for another person, or after a certain time, or in another place. In fact, this is constantly the case in everyday reality.
Faced with these certain problems of interpretation, some prefer not to speak of ordinary and extraordinary means, but rather of means proportionate and disproportionate to the situation of each patient, as this makes it possible to better assess the decision in each case.
According to agreement , when a patient in danger of death has a definite chance of recovery (e.g. a young patient in coma due to trauma in an accident), medicine considers that all possible technical means are provided, because there is a well-founded hope of saving his or her life. The problem arises when there is no longer any hope of recovery, but only of prolonging life or, more precisely, of prolonging the agony. It is then that the prudence of the doctor must advise him to refuse to persist in using means that are already useless, and in any case to respect the will of the dying patient himself, if he is in a position to express it.
On the other hand, it is legitimate for a dying patient to prefer to await death without implementing a medical device disproportionate to the insignificant results that may follow; it is also legitimate for him to take this decision without imposing disproportionate or excessively burdensome costs on his family or the community as a whole. This attitude, due to the ambiguity of the language, could be confused, for the uninformed, with the euthanasic attitude for partner-economic reasons, but there is an absolutely essential difference: that which goes from the acceptance of inevitable death to its intentional provocation.
29. So, are there any rights for the dying patient?
Indeed. The right to a genuine death with dignity includes:
- the right not to suffer needlessly;
- the right to have their freedom of conscience respected;
- the right to know the truth about their situation;
- the right to decide about himself and about the interventions to which he is to be subjected;
- the right to have a confident dialogue with doctors, family, friends and successors at work;
- the right to receive attendance spiritual.
The right not to suffer unnecessarily and the right to decide about oneself protect and legitimise the decision to renounce exceptional remedies in the terminal phase, as long as they do not conceal a suicidal intention.
30. And can these rights not legitimise some form of "passive" (by omission) euthanasia?
No. When death appears inevitable because there are no more effective remedies, the sick person can determine, if he or she is in a position to do so, the course of his or her last days or hours by one of these decisions:
- to accept that experimental drugs and techniques, which are not risk-free, be tested on him. By accepting them, the patient can set an example of generosity for the good of humanity;
- refuse or discontinue the application of such remedies;
- to be content with the palliative means that medicine can offer to alleviate pain, even if they have no curative virtue; and to reject medications or operations at the experimental stage because they are dangerous or excessively expensive. This refusal is not tantamount to suicide, but is an expression of a considered acceptance of the inevitability of death;
- in the imminence of death, to refuse obstinate treatment that will only result in a precarious and painful prolongation of his or her existence, but without refusing the normal or common means that allow him or her to survive.
Euthanasia is absent in these situations, which implies - let us repeat - a deliberate desire to end the life of the sick person. It is an attack on a person's dignity to deliberately seek his or her death, but it is in keeping with that dignity to accept his or her arrival in the least painful conditions possible. And it is in the heart of the doctor and the patient that the difference is made between causing death or awaiting it in peace and in the least painful way possible, by means of care that is limited to mitigating the final suffering.
31. How can the pain of the terminally ill be alleviated?
One of the rights of the sick person is not to suffer unnecessary physical pain during the process of their illness. But experience tells us sample that the patient, especially the terminally ill, experiences, in addition to physical pain, intense psychological or moral suffering, caused by the collision between the proximity of death and the hope of continuing to live that still lingers within him or her. The physician's duty is to remove the cause of physical pain or at least to alleviate its effects; but the human being is a unit, and the physician and other nursing personnel, together with the relatives, also have a responsibility to provide moral and psychological comfort to the suffering patient.
In the face of physical pain, the health professional offers analgesia; in the face of moral anguish, he must offer consolation and hope. Medical ethics thus imposes positive duties to alleviate the physical and moral suffering of the dying, to maintain as far as possible the quality of life that is declining, to be the guardian of respect for the dignity of every human being.
32. What does "Palliative medicine" mean?
Palliative medicine is a civilised way of understanding and caring for terminally ill patients, mainly opposed to the two extreme concepts already mentioned: therapeutic obstinacy and euthanasia.
This is a new specialization program of medical care for the terminally ill and their environment, which looks at the problem of human death from a profoundly human perspective, recognising their dignity as a person in the framework of the grave physical and psychological suffering that the end of human existence generally brings with it.
At final, palliative medicine is, no more and no less, a change of mentality towards the terminally ill patient. It is the knowledge that, when we can no longer cure, we can still care; it is the awareness of when to initiate that change: if you cannot cure, relieve; and if you cannot relieve, at least comfort. That old aphorism encapsulates the whole philosophy of palliative care.
33. How is palliative medicine organised?
Palliative medicine, which seems to have its antecedents in Great Britain, is still scarcely contemplated in the Spanish health care system, and it would be desirable that the public authorities should recognise its existence with greater sensitivity. It is basically based on the recognition of the triple reality that shapes the process of imminent death in today's society: a terminally ill patient with physical pain and psychological suffering, an anguished family that cannot accept the situation and suffers for their loved one, and a doctor educated to fight against death. All of them are immersed in a society that does not seem to want to admit failure when death is considered a failure.
Palliative Care Units, which are care areas physically and functionally included in hospitals, provide comprehensive care for terminally ill patients. A team of professionals assists these patients in the final phase of their illness, with the sole aim of improving the quality of their life in this final stage, attending to all the physical, psychological, social and spiritual needs of the patient and their family, goal . All the actions of palliative medicine are aimed at maintaining and, as far as possible, increasing the peace of mind of the patient and their family.
34. And what are the needs of these terminally ill patients?
These are physical, psychological, spiritual or religious, and social needs.
Physical needs derive from severe bodily limitations and, above all, from pain, especially in cancer deaths, where pain is present in 80 percent of terminally ill patients. With appropriate treatment, 95 percent of pain can be controlled.
The psychological needs are obvious. The patient needs to feel safe, needs to trust the team of professionals treating him, to have the security of a company that supports him and does not abandon him. They need to love and be loved, and they need to be considered, which strengthens their self-esteem.
Spiritual needs are unquestionable. The believer needs God. It is a grave civil and political irresponsibility that the religious care of patients is not clearly present in all clinics and hospital institutions.
The social needs of the terminally ill patient are no less important in order to ease the distressing ordeal. The terminal illness causes the sufferer and his or her family a great deal of expense and family disruption. All the attention of the members of the family unit is generally focused on the sick family member and, if survival is prolonged, the disruption can be long-lasting. The patient sees it and also suffers from it.
35. Is palliative medicine the alternative to euthanasia?
In reality, no. Palliative medicine is more properly an alternative to what is known as "therapeutic incarceration" or "therapeutic obstinacy". It is not an alternative to euthanasia, because euthanasia is nothing but a serious attack on human life and dignity.
It can be said that palliative medicine has always existed and has traditionally been practised by physicians, even if it has not been technically considered as a specialization program. Its principles are imprinted in the Hippocratic oath and in the historical conception of medical practice. But, certainly, as a specialisation within the healthcare organisation it represents a novelty, which is to deal with the peculiarities of the dying process in the healthcare field. This process has become extraordinarily complicated, and requires the emergence of a new doctor who is as attentive as possible to scientific advances and who has a deep understanding of the needs of the terminally ill patient.
36. Can it not then be considered a form of euthanasia to apply analgesic substances, knowing that this may shorten the patient's life?
No. When the treatment of pain is practically the only thing that can be done for the terminally ill patient, the secondary effect that certain analgesics have in terms of shortening life cannot be considered as a form of euthanasia, because the aim is not to destroy that life, but to alleviate pain; and this palliative purpose may, in the face of imminent death, be preferable in order to await the arrival of death in the least distressing conditions.
It is the same for those who - mountaineers, firemen... - take a certain risk, but intend a good thing without any suicidal intent. This is legitimate even if it may eventually lead to death.
On the other hand, the old struggle between treating pain and shortening life can be largely overcome: recent advances in the effective treatment of pain and terminal illness have almost completely reduced the risk of unduly anticipating the death of certain patients.
37. What is the "death with dignity" argument that euthanasia advocates refer to in an attempt to justify euthanasia?
This argument is one of the main ones used today for promote the legalisation of euthanasia. In short, it can be formulated as follows: Modern medical technology has the means to prolong people's lives, even in a situation of serious physical deterioration. Thanks to it, many lives can be saved which a few years ago were irretrievably lost; but there are also cases in which endless and dramatic agonies occur, which only prolong and increase the degradation of the dying person. For these cases, legislation should allow a person to decide, voluntarily and freely, to be helped to die. This would be a dignified death, because it would be the final expression of a dignified life.
38. Is this argument acceptable?
It is not, because it contains, alongside reasonable considerations about the cruelty of therapeutic obstinacy, a profound manipulation of the notion of dignity. Underlying this argument is a serious confusion between the dignity of life and the dignity of the person. Indeed, there are dignified lives and unworthy lives, just as there can be dignified deaths and unworthy deaths. But however unworthy the life or death of a person may be, as such a person always has the same dignity, from conception to death, because his or her dignity is not based on any circumstance but on the essential fact of belonging to the human species. This is why human rights, the first of which is the right to life, do not discriminate between persons, but, on the contrary, are established for all, regardless of their condition, their state of health, their race or any other circumstance.
It is certainly dignified to renounce therapeutic obstinacy without any hope of cure or improvement and to await the arrival of death with as little physical pain as possible; just as it is dignified to prefer to await death with full awareness and experience of the final suffering. None of this has anything to do with euthanasia; provoking the death of a fellow human being, however compassionate the motives, is always alien to the notion of the dignity of the human person.
39. So, is this a concrete example of language manipulation?
Consciously or unconsciously, yes. So capable of rejecting therapeutic stubbornness without any expectation of improvement, what is actually sponsored is the positive act (by action or omission, it makes no difference) of putting another to death, as if this deserved the same consideration as refraining from using unreasonable means to prolong a precarious existence and leaving the dying person to live as dignified a life as possible when death comes.
On the other hand, the expression "aid in dying" is another concrete example of misrepresentation of the meaning of words, since helping someone to die is not the same as killing them, even if they are killed out of apparent compassion and at their request. The expression "aid in dying" evokes a philanthropic and disinterested, generous and compassionate attitude, which would immediately vanish if what is carried out through euthanasia is expressed with the harsh, of course, but precise word, which is killing.
IV. Society in the face of euthanasia
40. Is the issue of euthanasia a social problem?
Euthanasia was a social problem in those primitive societies in which the elimination of lives considered useless was practised, a custom that was allowed for newborns with malformations or the elderly in different ancient peoples, until the influence of Christianity put an end to such inhumane practices. Since the advent of Christianity, euthanasia ceased to be a social problem until the 20th century, when some people made it a problem again by seeking to legalise it.
Since the 1930s, associations in defence of euthanasia have been formed and permissive laws have been proposed in various countries, which have usually been rejected. However, the pro-euthanasia attitude of these small groups, and a certain mentality of relativisation of the respect due to the human being (which is expressed, for example, in abortion), are taking hold in society, making euthanasia once again a social problem that is reappearing after having been overcome for centuries.
41. Isn't the acceptance of euthanasia a sign of civilisation?
No. What is a sign of civilisation is precisely the opposite, that is, the foundation of the dignity of the human person in the radical fact of being human, independently of any other circumstance such as race, sex, religion, health, age, skill guide , or mental or economic capacity. This essential vision of man signifies a very important qualitative progress, which rightly distinguishes civilised societies from primitive ones, in which the life of the prisoner, the slave, the handicapped or the elderly, depending on the time and place, was despised.
The scientific and technical progress in the fight against pain, so typical of the modern era, can give this false appearance of civilisation to euthanasia, insofar as it is presented as another way of fighting pain and suffering. But we already know that euthanasia is not that, but eliminating the sufferer so that he or she will stop suffering. And this is incompatible with civilisation, because it reveals a profound contempt for the radical dignity of the human being. A human being does not lose dignity because he suffers; what is unworthy is to base his dignity on the fact that he does not suffer.
Moreover, it is particularly contradictory to defend euthanasia precisely at a time like the present, when medicine offers alternatives, as never before, to treat the terminally ill and alleviate pain. It is likely that this resurgence of euthanasic attitudes is a consequence of the conjunction of two factors: on the one hand, scientific advances in delaying the moment of death; on the other, the contemporary mentality of escape, of fleeing from pain at all costs and of considering suffering as a failure. From this denial of reality arises the contradiction.
42. Can the social effects of accepting euthanasia be foreseen?
In recent times, euthanasia has not been legal in any country - with the exception of the Nazi experience - but we can easily foresee what would happen if we contrast the data provided by the legalisation of abortion in this century and the well-known "Dutch case", a social experience of admitting the practice of euthanasia that has recently received some legal coverage.
The experience of abortion proves that permissive laws are supposedly passed to provide a solution to certain extreme cases that are particularly dramatic for the common sensibility, but end up creating a mentality that trivialises induced abortion to the point of turning it into a socially admissible act that is carried out for increasingly trivial reasons. The permissive legislation would be presented to us as a solution for "borderline cases" of "vegetative life", "therapeutic incarnation", etc. and would end up being a normal option in cases of more or less irreversible illness or biological decline.
The process described above responds to the most elementary human psychology: when something forbidden is allowed and begins to be practised, it is increasingly considered normal, especially if it is good business for some, helps to eliminate cumbersome situations for others and is also defended by some ideological currents.
In the Netherlands, a sad experience of the practical admissibility of euthanasia - a unique case in the world - has been going on for years. A witness to this reality, Richard Fenigsen, a Dutch cardiologist, describes it: "Dutch general practitioners practice voluntary active euthanasia on about 5,000 patients a year. The higher figure of 10,000 probably also includes hospital patients. However, figures in the order of 18,000 to 20,000 cases per year have been mentioned. (...) 81% of Dutch general practitioners have performed euthanasia at some point in their professional career; 28% euthanise two patients per year and 14% three to five patients per year. (...)
A large number of people in the Netherlands carry a will with them in which they ask to be euthanised "in case of bodily injury or mental disturbance from which a sufficient recovery cannot be expected to lead a dignified and reasonable existence". Recently these written wills have been replaced by small "credit cards for an easy death". In 1981 the number of people carrying these cards was 30,000, but it is estimated that this number is much higher now. (...)
Acceptance of "voluntary" active euthanasia is growing among the Dutch. According to two surveys conducted in consecutive years, in 1985 70% of the Dutch accepted active euthanasia, while in 1986 it was 76% (...) Many people accept that people with serious handicaps, the elderly and even individuals without a family should be denied treatment. Moreover, surveys show that the majority of people who advocate voluntary euthanasia, freedom of choice and the right to die, also accept involuntary active euthanasia, i.e. the denial of freedom of choice and the right to life" (...).
Dutch doctors let at least 300 handicapped newborn babies die; they refuse to perform congenital heart operations on children with Down's syndrome, refusing to anaesthetise them; and they refuse to implant pacemakers in patients over 75 years of age or to treat pulmonary oedema in elderly patients without close relatives. Some doctors justify these actions by saying that it is in the patients' interest to die as soon as possible, but often the explanation is that the burden of keeping these patients alive should not be placed on society. These decisions are made without the patients' knowledge and against their wishes.
Legalised euthanasia would open the door to sinister practices, as compassion could be used as an excuse to justify the elimination of the weak, the handicapped, the terminally ill. There is "understandable" talk of alleged public interests in the elimination of those who represent a burden to society without providing any material benefit; even to the point of creating sufficient psychological pressure so that those who, because of their age or condition, feel they are an "unbearable" burden to others, feel almost obliged to ask for their elimination. This is not a pure exercise of the imagination, and the testimony quoted indicates as much.
43. What are, from the terminal patient's point of view, the main effects of the acceptance of euthanasia?
The main effect is fear. Fear that those around you may diagnose you as being in need of euthanasia; fear of health professionals; fear of relatives; fear of care institutions.
Indeed, a society in which euthanasia is a crime conveys the message that every life has value, that the terminally ill person can rest assured that doctors and relatives will endeavour to support his or her life and death with dignity and in the best possible conditions. On the contrary, a society in which euthanasia is neither prosecuted nor punished by the public authorities is telling its members that it does not matter much if they are eliminated if they no longer see any future or use for them. In a society where euthanasia is legalised, the elderly or seriously ill person would have a very justified fear that the health professional or any other person on whom they depend for one reason or another would not be a help to their life, but an executioner of their death.
44. But all this concerns euthanasia that is not voluntarily desired. If only voluntary euthanasia were allowed, would there not be positive social effects?
This is a widespread misconception, which experience itself has repeatedly disproved. Indeed:
a) The experience of the cases of euthanasia that have been heard before the courts in the countries around us in recent decades shows that the supporters of euthanasia very easily take the step from accepting the voluntary request of a patient to be "helped to die" to "helping someone to die" who, in their opinion, should make such a request given their condition, even if in fact they do not ask for it. This has happened in the well-known cases of euthanasia of AIDS patients in the Netherlands, of Dr. Hackethal and nurse M. Roeder in Germany or of the nurses at the Austrian Lainz Hospital, among others. If it is legitimate to kill a person in a given situation at his or her request, there is nothing strange in the fact that a person in the same situation - but without the possibility of requesting death - is also presumed to have a wish to die.
b) The experience of Germany in the 1930s and 1940s shows how one can easily and quickly move from scientific pro-euthanasia theories to the practice of euthanasia carried out on increasingly subjective, relative and trivial grounds. This was certainly favoured by a dictatorial environment, but a different environment does not ensure that the phenomenon cannot be repeated.
c) The experience in the Netherlands, where a permissive mentality towards euthanasia is already established, is that a parallel "moral coercion" is created which leads the terminally ill or "useless" to feel obliged to apply for euthanasia. A group of severely handicapped adults recently told the Dutch Parliament: "We feel that our lives are under threat.... We realise that we are a very big expense to the community.... Many people think that we are useless.... We often find that people try to convince us to wish for death.... We find it dangerous and frightening to think that the new medical legislation may include euthanasia".
Experience sample has shown that campaigns in favour of euthanasia have always started with the assurances of its promoters that, in all cases, it must be voluntary, that is to say, expressly desired and requested by the person who is to be killed by this means procedure. But experience also shows that the next step - requesting euthanasia for those who are not in a position to express their will: the disabled, the newborn, the agonisingly unconscious - is only a matter of time, because the principle of respect for the fundamental right to life has already been broken. What is more, when debates on the legalisation of euthanasia begin, the same contradiction always occurs: they insist on legalising only voluntary euthanasia, but to illustrate the "borderline cases", examples are given of terminally ill patients who are unconscious and therefore incapable of expressing their will.
The difference between voluntary and involuntary euthanasia does not exist in practice: once the former is legalised, it is easy to fall into the latter, since practical cases arise immediately, and the social capacity to defend the life of the innocent is already relaxed.
45. How does euthanasia affect the family institution?
Given that all legal systems recognise - to one extent or another - the right of the next of kin to decide for the sick or incapable person who is unable to express his or her own wishes, the theoretical possibility of relatives deciding that euthanasia is appropriate introduces a feeling of insecurity, confrontation and fear into family relationships, totally alien to what the idea of family suggests: solidarity, love, generosity. This is especially true if one takes into account the ease with which selfish motives can be introduced when deciding for one another at subject euthanasia: inheritance, elimination of burdens and discomfort, cost savings...
From another perspective, in a family where it is decided to euthanise one of its members, the psychological and affective tension that is generated by having encouraged a homicide can be, and is in fact, source of problems and emotional instabilities, given the inevitable ethical connotations of such conduct.
46. But might not a certain social acceptance of euthanasia respond to a genuine feeling of compassion towards those who suffer and have no remedy?
From a purely subjective point of view, it may be: someone - doctor, relative - may be convinced that he is doing good to another by procuring his death. But if we were to turn personal sensibility, subjective feelings, into source of the morality of one's actions, one could come to objectively inhuman conclusions: a medieval European prince might sincerely believe that tormenting a prisoner would do him good, since it would tell the truth and save his soul on the scaffold; an 18th century American might think that owning slaves was a way of helping them to survive; and a parent at the end of this century might think that killing a subnormal newborn child is helping him to avoid future suffering.
The sentiments of the medieval prince, the eighteenth-century American and the contemporary infanticidal father alluded to may be subjectively kind, but they are objectively inhuman. The same is true of euthanasia: those who decide to practise it or help it to be practised may act in the belief that it benefits the person who is being killed, but objectively their action is repudiatory, since they are arrogating to themselves the right to decide what is good or bad for others. If social coexistence were to be based on subjective feelings, forgetting objective moral realities, there would be no possibility of establishing general rules of behaviour and we would be in the jungle, where the law of the strongest would prevail, since by definition every voluntary action is seen by its author as a good.
47. Is it therefore possible to establish selfishness under the guise of piety?
Yes, it is perfectly possible, because we men tend very easily to justify any means when the end seems good to us. In this century we have seen leading intellectuals turning a blind eye to Stalinist crimes, or even justifying them, because they share the "progressive" end they supposed in Stalin's policies; or those who have justified human rights abuses perpetrated by certain regimes in South America, because they share the proclaimed anti-communist aim of those dictatorships.
In the field of the right to life and physical integrity this phenomenon is already taking place: since it is good to have children and the desire for them is natural, there are couples who believe it is positive to have children by means of assisted reproduction techniques, even if these inevitably entail the destruction of embryos; good and pious parents request sterilisation for their subnormal children, because they are trying to avoid the pregnancy of the incapable one; mothers who are diagnosed with the serious deficiency of the child growing in their womb, abort to avoid a miserable life for the child. In all these cases the end - seen as subjectively good - leads to very grave objective evils.
In principle, everyone affirms that the end does not justify the means, but in practical, concrete life - in the particular case that concerns everyone - there is unfortunately no consistency between what many good people advocate that, if it did not affect them personally, would seem inadmissible.
With euthanasia, a phenomenon like the one described above is taking place: some people who would be horrified just to think that someone could kill their parent, their wife or their child, understand euthanasia under the pressure of the image of pain, illness or physical degradation, without being consistent with the reality that euthanasia implies killing, however many euphemisms are used to disguise this action.
48. But there are occasions when the life of some sick or disabled people is almost only vegetative. Shouldn't these situations be considered with another criterion?
Indeed, there are people who think, even in good faith, that there are situations in which human life is so impaired that it cannot be said to be properly human, that is to say, proper to rational and free beings: a patient with an irreversible brain injury, in a state of unconsciousness, connected to a respirator, can be kept that way for a long time, but he lives a purely vegetative life, he is like a vegetable; his life cannot be said to be properly human; a profoundly deficient person, unable to express himself or even to know, irreversibly immersed in the darkness of his damaged mind, can only with sarcasm be said to lead a human life. For those who reason in this way, keeping such people alive is, rather than an act of protection and respect, a form of torture disguised as humanitarianism. It is therefore necessary, they conclude, to seriously consider the legalisation of euthanasia for these extreme and definitive cases, however painful it may be, because such a life does not deserve to be lived.
49. And isn't this argument acceptable?
It is not, because the right to life derives directly from the dignity of the person, and all human beings, however ill they may be, do not cease to be human, nor do their lives cease to deserve the utmost respect. Forgetting this principle because of the dramatic vision of profound handicaps leads inexorably to making the right to life dependent on the quality of life, which opens the possibility of placing the boundary of the right to life according to increasingly demanding "quality controls", depending on the Degree of selfishness or comfort that prevails in society.
This process was taken to the extreme with the large-scale euthanasia programmes of the Nazi era, which also began with a borderline case of "mercy killing", that of a blind, subnormal child with only two limbs, placed in the paediatric chronicle of the University of Leipzig at the end of 1938; the child's grandmother asked Hitler to grant her a "mercy killing", which was subsequently carried out. Thereafter, Hitler ordered a programme to be set up to apply the same criteria of "mercy" to similar cases. On 18 August 1939, it was made compulsory to declare all newborns with physical defects.
The experience of Nazism is not of remote antiquity or of a savage and primitive people, but of the middle of the 20th century and of one of the most technologically advanced and cultured peoples of its time. Nor does it refer to a notoriously bloodthirsty and inhuman people, but to a normal people, in which only about 350 of the 90,000 German doctors agreed to carry out these crimes, with the chilling results that have since become known. And all this was possible because the theory of "human lives of no vital value" was accepted, i.e. lives which, because of their precariousness, do not deserve to be lived.
This argument in favour of euthanasia is also based on another serious error, which is that of conceiving the human body as an object, as opposed to man himself as a subject; according to this, man would be the subject, who "has" a body which he can use, manipulate, even suppress, for the sake of the dignity of that personal subject. This profound error denies human reality by denying that the human being is body and spirit, body and mind, and that both elements constitute the human being in an inseparable way.
The human person is not the mere spirit, to which the qualities of the person as a subject would be appropriate: freedom, responsibility, moral value, etc., while the body would be a mere object, belonging to the order of things, and therefore lacking in moral value and dignity worthy of respect. If this anthropological error is made, it is inevitable to end up defending the elimination of those human beings whose humanity is prevented by the prison of their defective bodies development plenary session of the Executive Council . But the human person is not a thinking and free subject who has been installed in a body; the human person is (also) a body, and that is why respect for the dignity of the person is absolutely incompatible with radical disrespect for the body, to the point of suppressing it because it is seriously deficient.
50. If this is the case, is it not also a manipulation of the meaning of words to speak of "truly human lives"?
Undoubtedly. The expression "vegetative life", which is a technicality expressing the realisation of certain vital functions, evokes the notion of "vegetable", thus trivialising the death of a deficient human being by vaguely assimilating him or her to a kind of plant. On the other hand, the expression "truly human life", as applied to these cases, is used metaphorically, in the sense that it is a fully achieved human life, in possession of all its possibilities, in contrast to a de facto diminished life. But it is clear that the life of a human being, however impaired, cannot cease to be a human life. And this metaphor is used to justify a consequence - physical death - which is not metaphorical at all.
51. Can euthanasia not be a manifestation of social solidarity?
The defenders of euthanasia put forward the following argument: the illness, disability or old age of some people has reached extremes that make these lives meaningless, useless and even seriously burdensome, not only for their relatives and loved ones, but also for the public coffers, which have to bear huge outlays in social security health benefits and subsidies of various kinds, with the burden that this entails for taxpayers. Moreover, these situations are prolonged by advances in scientific research that have considerably lengthened people's life expectancy. The state therefore has the right, and even the duty, not to burden the community with the burden of sustaining these meaningless lives. The effect of this action will be to the benefit of the community as a whole, which is a manifestation of social solidarity.
The argument of "unproductive lives", for reasons easy to understand, is never raised at the beginning of the social discussion on euthanasia, but there is also no shortage of those who, in restricted forums or in academic environments, mention "meaningless lives" as candidates for euthanasia for socio-economic reasons.
52. Is this argument acceptable?
It is not in any way. The sacrifice of sick, elderly or disabled human beings so that they are not burdensome for their relatives, or to improve the economic conditions of the community, is a manifestation of totalitarianism, that is, of the prevalence of the community over individuals to the point of despising the right of the latter to live even if they are a hindrance to the community. As harsh as it may be, we must remember what happened in the Hitler regime, where, under the name of euthanasia, what ended up being carried out was the genocide of those considered "useless parasites", i.e. "meaningless lives", according to the euphemism of those who advocate euthanasia for socio-economic reasons.
Here again, the profound perversion of human and social values appears, and the most atrocious manifestation of lack of solidarity, which consists in the physical elimination of burdensome, annoying or useless fellow citizens, is masked under the guise of an alleged "social solidarity". This is not just a distortion of the meaning of words, but their complete reversal.
53. If euthanasia is so reprehensible, how is it that there are people and groups that socially promote its acceptance?
The fact that certain legislation, or certain social behaviours, are reprehensible or even monstrous does not mean that they are always seen as such by everyone in every age. History is replete with examples in this respect. In the case of euthanasia in the present time, the first thing to say is that the people and groups who support euthanasia legislation constitute a tiny minority in relation to society as a whole. But this does not mean that this proportion cannot increase in the future, because it is clear that campaigns are underway to influence public opinion in this direction.
54. Do these campaigns exist and what do they consist of?
Unfortunately, they exist, just as they exist in relation to abortion, as we have learned when some of the promoters realised the terrible extent of their work, publicly repented and revealed the techniques they had used to intoxicate public opinion.
Campaigns aiming at promote opinions in favour of euthanasia often develop in this way:
- the first thing that is presented is a "borderline case": an example of a particularly striking terminal situation that excites the collective sensibility is sought in order to justify euthanasia in such a dramatic and singular case. Once a case is admitted, serious reasons disappear for not admitting others like it, and others more, on an increasingly permissive slope. It is the same process we have already seen with regard to abortion: here the oligophrenic girl raped by her father is replaced by the intubated patient with only vegetative functions, in order to generate a feeling of compassion in public opinion that leads it to be in favour of fixing this "problem". At the same time, it is concealed that "fixing the problem" means killing, just as in pro-abortion campaigns it is concealed that "fixing the problem" of the raped girl is, in the abortive proposal , killing a human being.
- This is complemented with ideological and semantic euphemisms, taking advantage of the conceptual and terminological complexity of the phenomenon of euthanasia as explained in Chapter I. Thus, there will never be any talk of "killing the sick person" or, more gently, of "taking his life", but rather of "helping him to die", facilitating the "end of life", achieving his "self-liberation", etc., euphemisms that try to divert attention from the material reality of what is being advocated: that one person can kill another with impunity.
- At the same time, the defenders of life in the face of euthanasia are portrayed as backward, intransigent, opposed to individual freedom and progress, etc.; in this way, discussion is distracted and the opinions in favour of human dignity are not heard with serenity and equanimity, but through the prejudices created about their defenders.
- since many religious denominations, especially those with Christian roots - not only the Catholic Church, of course - react strongly against attempts to legalise euthanasia because of its moral seriousness, the false idea is conveyed that euthanasia is a purely religious, intimate matter, of mere individual conscience, and that therefore, as long as euthanasia is not compulsory, it should be accepted in a pluralistic society.
As a complement to these strategies, surveys are promoted to then claim that the majority of citizens, doctors or cancer patients are in favour of euthanasia. The universal experience on subject of euthanasia is that these surveys are not reliable, given the confusing terminology and the emotional components of topic: depending on how the questions are posed and the answers interpreted, the results can be interpreted in any way. Recently in Spain we have seen an exemplary case in this respect: the headlines announced that, according to a survey, the majority of doctors in Barcelona were in favour of euthanasia. When the actual content of this survey is analysed, it turns out that these doctors are against therapeutic obstinacy and against euthanasia, i.e. they have the same opinion as that expressed in this document, but their opinion has been manipulated in the service of an idea they do not share.
55. However, is it not true that claiming that euthanasia should be prosecuted as a crime implies that one part of solitude seeks to impose its own morality or religion on another part?
No, not at all. The defence of the dignity of the person and his or her rights, including the first of these, the right to life, must be the primary aim of society and the state, otherwise society's institutionalisation of public power and its instruments, such as the law, would be nothing more than an expression of violence in the service of pure force.
Defending life against euthanasia (as against induced abortion) is not a religious stance, but a humanist one, even if religious motives may contribute to it in the case of believers.
Societies and states have an obligation to provide the means, including legal means, to ensure that human beings are not killed, and therefore also to ensure that euthanasia, which is a form of killing, is not practised; just as they have an obligation to provide the means to ensure that people are not murdered, raped or robbed. When the State prohibits and punishes rape, it is not defending Catholic morality in an intransigent way against other opinions, even if it agrees with Catholic morality that rape should be rejected. The same is true of euthanasia.
56. If, however, there were a majority consensus in a particular nation in favour of euthanasia in certain particularly serious cases, would such a practice not be permissible in those cases?
No. The only thing that would happen is that the public authorities would not prosecute or punish those who kill others in euthanasia, because they would have accepted the legitimacy of violence and pure force as a criterion for regulating the relationship between private individuals.
In such a case, euthanasia regulates what it really is: the act by which one human being kills another. And this act - even if it is done with the approval of the law - is intrinsically and essentially reprehensible, as is discriminating against women over men in Iraq, or torturing and killing Jews, or anti-communists, or communists in Nazi Germany, Khmer Cambodia or certain recent Spanish-American dictatorships, respectively. The fact that laws and public authorities protect conduct contrary to human dignity does not make such conduct licit, but rather such laws rejectable and illegitimate because they are inhuman.
57. With regard to euthanasia, are society's obligations limited to its prosecution as a criminal offence?
Obviously not. The criminal sanction is a last guarantee against homicidal attitudes, but this is not the only operative measure in the real field in which euthanasia is prevented: Just as important, if not more so, and certainly prior to the criminal rule , is the attitude of individuals and social groups towards the sick, the elderly, the handicapped.
The euthanasic mentality thrives best in a social climate of rejection of everything that involves sacrifice, effort for others, and the pre-eminence of the immaterial over the material. If the predominant values are the cult of the body, material well-being, selfishness alien to human solidarity, contempt for the family and materialistic economism - and this is a growing reality in our society - it is not surprising that a conception of life based on pure utilitarian pragmatism characterises the attitude of some towards those who are seen not as human beings, but as sources of expenses that do not bring income; not as beloved family members, but as unacceptable obstacles to personal development ; not as patients, but as absurd overloads of meaningless work.
If we want behavioural habits and respected values in our society to be consistent with a desirable humanism and therefore averse to practices such as euthanasia, it will be necessary for such a society:
Degree - death is not a taboo topic , but a natural fact that is as much a part of human life as birth, growth, sex or intelligence; no one - neither judges, nor legislators, nor doctors - can claim the right to decide that some human beings do not have rights or have lesser rights than others because of their deficiencies, colour, sex, age or state of health;
- the family is respected and cherished as a natural environment of solidarity between generations, in which healthy and sick, young and old, able-bodied and disabled, and disabled and able-bodied are welcomed, protected and cared for;
- The hospital organisation should no longer be seen as a place where the sick and elderly are abandoned, but the home should once again become a natural place of welcome in sickness and old age and where death is experienced with affection and lucidity;
- social initiatives to care for the terminally ill in a humane atmosphere, respectful of the person and their pain and technically prepared to help them face death with dignity and a sense of being a person, such as the British "hospices" inspired by Dr Cicely Saunders, a work that does more to prevent euthanasia than a million speeches;
- Medicine should be oriented towards the care of the individual, and not be limited to a purely technological effort to extend life.
This last aspect deserves special attention, since the euthanasia mentality transforms doctors, even unwittingly, into a kind of executioner, and it is necessary for doctors to be promoters and protagonists of a medical practice concerned with man and his dignity along the lines of what today - as we have seen above - is known as palliative medicine.
V. The State in the face of euthanasia
58. Is the issue of euthanasia a political problem?
It certainly is, because one of the primary duties of the state is to respect and ensure respect for the fundamental rights of the individual, the first of which is the right to life, and euthanasia is nothing more than the destruction of innocent human life under certain conditions.
59. Does the Spanish legal system recognise the right to life?
Yes, the Spanish Constitution recognises the right to life of all human beings, and the rest of the laws, especially the Penal Code, protect this right by prohibiting any attempt on the life of any human being and imposing the most severe penalties on anyone who takes the life of another.
In recent years, however, some laws have broken the traditional principle of absolute protection of the right to life by allowing, or not punishing, the violation of the life of the conceived and unborn through abortion, or the destruction of human embryos created on laboratory. Such laws on abortion and artificial procreation techniques have opened a gap in the coherent line of legal protection of human life, which some now seek to widen even further by permitting euthanasia.
On the other hand, in recent years, there has also been a growing ethical consensus on the need to ban the death penalty, a prohibition which is commendably enshrined in the Spanish Constitution.
60. How do legal norms and states protect the right to life of human beings?
States are actively engaged in the defence of human life through many of their activities, as well as through laws and other legal norms.
The rules that regulate road traffic or the existence and functioning of hospitals, institutions such as the police or the army, the fight against epidemics, the practice of health professions, the rules on safety at work, the regulation of food quality, and a thousand other activities and laws that the state promotes or protects, are all expressions of the commitment of the state and society to the defence of human life and its quality.
Since it is in any case impossible to prevent the appearance of those who, for one reason or another, refuse to respect the right to life of others, all civilised countries also provide criminal protection for human life, considering attacks on life as a crime and threatening those who commit them with the most serious punishments that exist in each country. In Spain, the law that protects human life through the threat of imprisonment is the Penal Code.
61. How does the Spanish Penal Code protect human life?
The Spanish Penal Code protects human life by considering as a crime any voluntary action carried out by a person to kill another human being; and by establishing that anyone who kills another human being shall be subject to the most severe penalty of deprivation of liberty that exists in Spain.
The crimes against human life established and punished by the Penal Code have different names depending on the circumstances of the crime, the criminal or the victim: abortion, if an unborn child is killed; infanticide, if a newborn child is killed to avoid the dishonour of the mother; murder, if another is killed in circumstances involving special malice (in exchange for money, with premeditation, with malice aforethought, etc.); parricide, if ascendants, descendants or spouse are killed; and homicide, if another is killed without any of the aforementioned circumstances.); parricide, if one kills ascendants, descendants or spouse; and homicide, if one kills another without any of the above-mentioned circumstances.
There are other offences in the Penal Code that are also intended to protect, among other things, human life: for example, failure to assist someone in danger, or assisting another to commit suicide, or causing fires or floods... and many others.
62. Doesn't the Penal Code distinguish between the punishment of someone who kills another person according to the victim's health Degree or the usefulness of his life?
Leaving aside the issue of abortion, which is not the topic issue at hand, the Penal Code protects every human being and his or her right to live against anyone who wants to kill him or her. It makes no difference whether the victim is healthy or sick, newborn or old, useful or useless to society, physically, sensory or mentally deficient or healthy. It also makes no difference whether the killer does it out of cruelty or compassion, for ideological reasons or for any other motivation: Killing someone else is always a crime, and the person who commits it is punished accordingly.
It is logical that this should be so, because every human being has the right to life by the mere fact of belonging to the human species, by being born by the mere one of us, irrespective of age, race, Degree health or any other circumstance. This is a basic conviction of humanity, the foundation of ethical conscience, which, thanks to the moral and legal progress of men and nations, has come to be affirmed by all civilised societies and protected by all legal systems.
63. Is it not true, however, that there have been cultures and civilisations that have admitted the legitimacy of suppressing the life of certain people (of another race or tribe, slaves, useless because of their age or illness, etc.)?
Indeed, it is true. Almost always in the history of humanity, the ideal of guaranteeing respect for life in customs and laws, on the one hand, and, on the other, forms of human relations based on violence, or on ideologies or prejudices that deny that certain groups of human beings deserve to live, have coexisted in permanent tension.
In different times and cultures, the right to live has been denied by some to those who belong to other nations or other tribes, to those who are of another race or are enslaved, to the aged and infirm, or to defective women or newborn babies. But in the face of these inhuman customs, ideas or laws, there has always - in all peoples and in all ages - been a growing ethical idea that all human beings are essentially equal and have a right to life regardless of their race or the various circumstances of their lives. It should be added that in every age there is a tendency to see as unacceptable practices the brutalities which in the previous age were considered normal, but the cirrhotic sense disappears and the eyes are closed, consciously or unconsciously, to the barbarities which the age itself admits in its laws or its social customs.
Humanity has progressively eliminated inhuman customs and laws. Thus, slavery, torture, racism, infanticide, the withdrawal of the elderly and sick, contempt for women, have been disappearing - with ups and downs - from the customs of the most civilised peoples. The influence of Christianity in Western culture has been spreading the clear idea of "thou shalt not kill", which is taking hold as the depth of the practical applications of this commandment are discovered.
Although the ethical awareness of the respect that every human being deserves has never been completely lost, in every age some social groups have convinced themselves that there are some human beings who have no right to live: this has been the case with regard to blacks, slaves, Jews, aristocrats, the bourgeoisie, peasants, those of another nation, the unborn or those called "useless" because, due to poor health or advanced age, they are no longer productive and are a burden.
64. Has this contradiction been overcome today?
In our days we are living through the experience, quite common in history, of a culture which vigorously defends the dignity of the person and is committed to the defence of human rights, but which, at the same time and incongruously, lends its tolerance and even its support to practices such as abortion or euthanasia, which are opposed to the inalienable rights of the person. This means that the above-mentioned tension exists today as in other times, and it is everyone's responsibility to ensure that, here and now, the demand for respect for all human beings does not admit of exceptions.
65. What does the Spanish Penal Code say about euthanasia?
Our laws do not mention the term "euthanasia" at all. The Penal Code does not contain any special regulation of euthanasia, as it considers homicide to be homicide both when it is committed out of "compassion" or to avoid pain and when it is committed for any other reason. Killing is always a criminal offence under Spanish law, regardless of the motive.
66. What do our laws say about suicide?
Suicide is lawful in our legislation, as it is in most countries of our culture. Our laws do not allow the right to commit suicide. However, suicide is not considered a crime for obvious practical reasons: if the person who wants to take his own life succeeds, there is no longer anyone to punish; and if he does not succeed, threatening him with imprisonment would only serve to aggravate his suicidal desires.
67. Does this mean that the law refrains from any judgement on suicide?
No. In Spanish law, suicide is a licit conduct, and therefore the conduct of both those who induce someone to commit suicide and those who help someone else to take their own life is considered a crime. Article 409 of the Penal Code establishes that "whoever aids or induces another to commit suicide shall be punished with the penalty of major prison; if he aids or induces another to commit suicide to the point of executing death himself, he shall be punished with the penalty of minor imprisonment".
As can be seen, inducing and assisting suicide is punishable, as is actually taking the life of someone who wants to commit suicide. The latter is commonly known as "homicide-suicide" or "consensual homicide", and is punished in the same way as homicide, because for our Penal Code, as for ethics, killing another person is just as reprehensible if it is done with their consent as without it.
68. Isn't euthanasia a form of consensual homicide?
Euthanasia is always killing another person, with or without his or her consent, for allegedly compassionate reasons or to spare him or her pain or dramatic situations. For our Penal Code, euthanasia is homicide, and if practised at the request of the victim it is the "homicide-suicide" mentioned above. In all cases the penalty would be the same.
69. According to this, isn't a person's decision to dispose of his or her own life legitimate?
No. In the preservation of human life there are both individual and social interests; and neither the former can prevail over the latter in exclusivity, nor the latter over the former.
No human being is an isolated reality, source autonomous and exclusive of rights and obligations. We are all in solidarity through the mutual interaction between parents and children, between each other and the rest of society; that is why no one has the right to eliminate life, even one's own. This has been the understanding of the Western legal tradition, which has denied any validity to the consent given to receive death, considering the right to life as unavailable, that is to say, as a "right-duty".
That is why, in our law, aiding suicide is a crime, consensual homicide is punished with the same penalty as any other homicide, and failure to prevent a suicide when it could be avoided is also a crime: the crime of omission of due assistance. And for the same reasons, our Courts have recognised the right to force-feed those who put themselves in danger of death by hunger strikes, or the right of doctors to save the lives of those who put their lives at risk by attempting suicide, or the right of judges to authorise medical acts to save the lives of patients who refuse normal, risk-free treatment.
70. Why should the state prevent people from giving up the right to live but allow them to give up other rights, such as voting, marriage, association, etc.?
Because the Withdrawal to exercise the right to marry, to vote, to associate or to express an opinion on a specific subject , for example, refers to rights that are not annulled, but which can be exercised in other circumstances. These rights-freedoms are not lost by the Withdrawal to exercise them at a specific moment.
There are, however, other rights of the individual which, if they were to be renounced, the individual himself or his dignity would be nullified. In such cases, the state and the law deny validity to the expression of the will of the person Withdrawal . This is the case with the right to life: if a person intends to die or asks others to help them to die, they are definitively nullifying their dignity and their rights; this is why the law does not disregard this decision, but considers it ineffective and obliges it to provide the means to prevent it from becoming irreversible.
Moreover, the argument of the patient's alleged right to decide how and when to die comes up against an insurmountable obstacle in practice. Insofar as his own clinical situation makes him incapable of committing suicide, the holder of this supposed right cannot exercise his self-determination alone, but must necessarily involve other people in his decision. As it is a right of the patient that affects his own life, these people would be obliged to respect it, since conscientious objection is not possible against the exercise of human rights. This would lead to the creation of an "obligation to kill", a nonsense that is not only repugnant to the most elementary notion of freedom, but also to common sense.
71. Is the right to life the only inalienable right?
Certainly not. Many rights cannot be waived by their holder in modern societies. The Withdrawal to physical integrity, to the right to education, to decent working conditions, etc., is unacceptable. The consent of a person to be mutilated or injured does not prevent the one who mutilates or injures from committing a crime; or the wish of a boy and his parents to forego basic education is not taken into account by the law and the state, which oblige the young person to receive the education that the law defines as compulsory.
At subject the example is very clear and close to home: in our society there are many people who are willing to work in hygienic or safety conditions that are inferior to those required by law, or to work longer hours than those permitted or for less pay than the minimum legally established; however, the law and the state do not recognise the validity of the consent of these people, and they obligatorily impose respect for the rights of the workers even against the latter's will. In an extreme case, consider what a voluntary contract of slavery would look like.
There are even more important reasons why the State and its laws consider the right to life, which makes all the others possible and which, if lost, cannot be recovered, as it is the basis for the good it protects: the life of human dignity itself.
It is the same with seat belts in cars: citizens may or may not want to wear them, but the state obliges them to do so by threatening them with a fine if they do not respect this obligation. The reason for this is that it is assumed that the life of each individual is not only in his or her private interest, but that society is entitled to demand that each individual ensures that he or she does not risk his or her life gratuitously or recklessly.
72. Is there a doctrine of the Constitutional Court on whether or not the Constitution admits the right to die?
The Spanish Constitutional Court has stated in several rulings that our Constitution does not recognise a right to end one's own life.
The Constitutional Court has denied that there is a right to die protected by the Constitution, when it has been asked about the legitimacy of the Administration and the Courts to order the forced feeding of imprisoned terrorists in danger of death by hunger strike (cf. Judgments 120/1990, of 27 June and 137/1990, of 19 July, among others).
73. So, should we assume that it is impossible for euthanasia to be legalised in Spain, because it is unconstitutional?
No. It is not impossible for the Constitutional Court to give its approval to euthanasia. The magistrates who sit on it may, even in good faith, look for arguments to accept what the majority of Parliament wants, even if this is contrary to what they have already ruled in other cases, where denying the right to die was what the State's lawyer on behalf of the Government was requesting.
74. And is there not a contradiction between the denial of the right to kill oneself and the enshrinement of freedom as one of the highest values in the Constitution itself?
There is none. If freedom, understood as the ability of human beings to do whatever they want, were source absolute and unconditional rights, there would be no legal systems, no society, no state, because each person determines for himself what is just or unjust, good or bad, permitted or prohibited; and Parliament, courts, governments, laws and human rights would be illegitimate.
Freedom, as a superior value recognised in the Constitution, is made e . effective in the rights that it specifically guarantees, and cannot be an excuse either for denying such rights or for violating the rest of the laws. This is how the Spanish Constitutional Court has rightly understood it in the aforementioned judgments.
Suicide has never been considered a human right. In fact, when the Universal Declaration of Human Rights was drafted at the United Nations, this so-called right was not included, and this was not by unintentional omission, as there were several proposals to incorporate it into the Declaration, and they were rejected. It will be said that in another future historical moment it could be the other way around, and it is indeed the case, but that would not change the profound reality of things. The mention of the current situation is adduced here only as a statement of fact.
75. So, is it not a curtailment of freedom and individual autonomy to deny human beings the ability to decide when and how they want to die?
It is not, because it makes no sense to contrast the right to free self-determination of the person - as an expression of his or her dignity - with the good of human life, since human life, whatever its state of fullness or deterioration, is always personal life, and therefore inseparably enjoys the indivisible dignity of the person, a unitary reality of body and spirit.
To consider freedom and life as incompatible, even in certain circumstances, would be tantamount to the contradiction of carrying out, in the name of the dignity of the person as a free subject, an act against the dignity of the person, since life, which is a fundamental good of the person, enjoys the same dignity.
This subject of approaches to freedom and individual autonomy conceals the fallacy of considering freedom as a good detached from any reference to truth and the good of the person. The alleged right to end one's life is not an affirmation of human dignity, but an attempt to deny it at its very root.
To claim that man is not fully free if he is not allowed to decide his own death is as puerile a sophistry as claiming that God is not omnipotent because there is one thing He cannot do: evil, i.e., He cannot go against Himself.
76. However, this idea is widespread even among people who consider themselves enlightened. Why?
Because there is a widespread subjectivist conception of ethics and law, which is based on denying human beings the ability to ascertain for themselves the objective reality of things, converting individual will into the sole source of morality and ultimately - potentially - of legality.
This way of thinking, closely linked to the basic orientation of so-called modern philosophy (Cartesian rationalism and its derivatives and epigones), has its most striking practical manifestations today in an anti-ecological contempt for nature, considered as limitlessly manipulable by the human will, and in legal positivism, which considers the legislative will as the creator of injustice and rights and, therefore, legitimised to deny or suppress them.
This way of thinking has the consequence of relativising everything, and makes all legitimacy depend on the social consensus of the moment, which leads us to the absurdity of considering human rights not as the patrimony of every human being by virtue of the fact of being human, but as objects at the disposal of the will of the majority.
But fundamental human rights, the first of which, it bears repeating, is the right to life, do not belong to the realm of statistics, the play of majorities, religious confessionality or social consensus, which is so characteristic of democratic societies in other matters. On the contrary, human rights constitute the very foundation and the source of any rule of law on which freedoms and democracy rest, and their intangibility does not derive from their promulgation, but from their insertion in the very nature of the human being. Forgetting this reality can only lead to a social organisation built on the law of the strongest - even if that strength is based on a legislative majority - opening the door to all totalitarianism, however much it may paradoxically be disguised as freedoms. Legitimacy of origin is necessary to legislate with legitimacy, but this in turn does not legitimise any class legislation. It is well known that Hitler came to power legitimately and democratically, but that does not mean that his use of power was not based on the law of the strongest. The democratic election of legislators and rulers legitimises them as such, but not all their decisions, which will be correct if they are in accordance with the dignity of the person, and illegitimate if they oppose it.
Respect for the dignity of the person, whose budget inexcusable is respect for his life, is not subject susceptible of acquiring or losing legitimacy through voting. On the contrary, the power of the State or the legislative chamber that pretends to arrogate to itself the skill power to decide at its discretion which men and women have human rights and which do not, loses legitimacy.
77. However, is it not obvious that man uses his freedom (rightly or wrongly, that is another matter) when he decides his own death?
The term "freedom" conceals two entirely different realities. On the one hand, freedom can be understood as the mere School to do or not to do, to do one thing or another, without further ado. Understood in this way, freedom is nothing more than the mere realisation that man can act without being coerced, but whether what he does is good or bad, just or unjust, praiseworthy or repugnant, is completely disregarded. The exercise of freedom thus understood tells us nothing about whether what man does or does not do is ethically or legally permissible or recommendable, or whether, on the contrary, it should be avoided and, if necessary, prosecuted and punished.
But the term "freedom" can also be understood to designate those human behaviours that reflect the possibility for man to realise the best of what he is capable of, thus giving an ethical connotation to acts that are considered free. In this sense, the man who kills, rapes or steals does not properly exercise his freedom; the man who thinks, loves, votes or works does. In this second sense, the term "freedom" allows for an examination of human conduct that leads to more than the mere observation that it is in fact possible without coercion.
The confusion arises when one moves from the first sense to the second, as if the pure circumstance that an action is free (in the sense that it is carried out without coercion) means that it is morally acceptable and legally defensible for that reason alone. But experience shows that this logical leap is not possible. If it were, one would have to admit the absurdity that rape, robbery and torture, if carried out consciously and voluntarily (i.e. freely, in the first meaning), would not be abominable crimes but rights protected by law.
At final, in a certain sense it can be said that man uses his freedom when he decides his own death, if he makes this decision in full Schools and without being coerced; but whether he uses it well or badly is not "another matter", but is precisely what matters, what is decisive, when it comes to establishing an ethical or legal judgement on his actions.
78. How is the argument of avoiding clandestinity used by some to defend the legalisation of euthanasia formulated?
It is often expressed in this way: there are situations of extreme gravity and dramatic circumstances in which people kill others out of compassion for their intolerable suffering, or in response to the express wish of those who want to shorten their lives, because they are in the terminal phase of an incurable illness. These practices exist and, as they are not legally regulated, they are carried out clandestinely, which completely prevents any kind of control over the excesses or abuses that may occur. Consequently, regulation of these cases must be established.
This is an argument that is repeated whenever there is an attempt to legalise, or to leave unpunished, certain attacks on the life of the innocent, such as abortion and euthanasia, and it is not usually presented alone, but is generally accompanied by considerations of the "right to die", which we have already seen.
79. Is this not a reasonable argument, since it concerns only the most dramatic and irresolvable cases?
No, certainly not. The fact that crimes are committed - obviously underground - is no reason why such conduct should be legalised. According to this strange logic, tax evasion should be regulated in the borderline cases of taxpayers who have extreme difficulties in fulfilling their duties to the Treasury, so that they do not defraud underground.
When special circumstances are involved in the commission of a crime, the reasonable attitude is not to legalise the crime in such circumstances, but for the judge to take them into account when weighing the responsibility of the perpetrator(s), if any, in the corresponding trial.
On the other hand, also in this subject of arguments we are faced with the manipulation of words and their meaning. Supporters of euthanasia advocate its legalisation in order to prevent "excesses or abuses" through its control. This way of presenting the issue presupposes that, under certain circumstances, the practice of euthanasia is not an excess or abuse; in other words, it blinds the possibility of debating the very nature of euthanasia, because it gratuitously assumes that there are abusive euthanasias and correct euthanasias, which is false. Moreover, this way of arguing tries to create the impression that we are asking for restrictive legislation, when in reality we are asking for a permissive rule , which is exactly the opposite.
80. Does the unrenounceable, inalienable and unavailable nature of the right to life have absolute value in Spanish law, or does it admit exceptions?
There are several laws that have admitted exceptions to this principle: those that have legitimised the death penalty, those that allow non-punishable abortion in certain cases and those that make possible without criminal sanction the destruction of human embryos and foetuses in the context of assisted reproduction techniques and experimentation and research related to these techniques.
At Degree lower than the right to life, our Penal Code allows in some cases to go against the physical integrity of people, a right closely related to the right to life: these are the cases of sterilisations and organ transplants, which, if consented to, are not a crime. From a moral point of view, transplants are normally praiseworthy, while sterilisations deserve serious moral reproach.
81. Does Spanish law allow for any case in which an attack on the physical integrity of a person without their consent is not punishable?
Yes, a reform of the Penal Code in 1989 modified its article 428 to allow the forced sterilisation of mentally handicapped persons. This is the first case in which Spanish legislation has opened the door to the legal legitimisation of attacks on the physical integrity of persons without their consent, thus admitting the dangerous principle that mentally handicapped persons, just because they are mentally handicapped, can have their fundamental rights limited - because they are persons like any other - as recognised by the Constitution.
As it is easy to see, once the principle is accepted, it is impossible to set a logical, absolute and immovable limit to the process of limiting the rights of the disabled or those who are in similar situations due to age or illness.
This rule, apart from being intrinsically immoral, has introduced a scale of values in Spanish law that can lead to a smooth slide towards euthanasia, towards the deprivation of the right to life for those who for one reason or another are not in the fullness of their potential Schools.
82. Can the so-called "euthanasia of the newborn", i.e. the killing or leaving to die without attendance of a newborn child when it is known, after birth, that the child is defective, in any case not be a criminal offence?
No. In Spain, killing a newborn baby because it is defective is always a crime.
However, the day may come when the legislator will consider that in such cases no one should be convicted or even prosecuted, arguing that a favour is being done to the handicapped by killing them to prevent them from leading a poor quality life. If, once the impairment - or the mere probability of impairment - is detected before birth, the law allows a human being to be killed by means of a non-punishable abortion up to 22 weeks of intrauterine life, there is no logical reason to prevent the child from being killed three and a half months later if the child's impairment is then detected.
Non-punishable "eugenic" abortion has introduced a logic of elimination of deficient lives that does not have to stop at the moment of birth. In countries geographically and culturally close to ours, there have already been cases of parents who have killed their newborn children because they were deficient, and have been acquitted by the courts with arguments such as these.
83. Since the right to life is inalienable, can doctors make whatever decisions they want to keep their patients alive?
No. Spanish law is based on the principle that medical treatment is only legitimate if the patient consents to it. If a doctor decides to act on a patient against the patient's will, he could commit the offence of coercion. However, the patient's freedom to receive or not to receive a certain treatment, or to undergo or not to undergo a surgical intervention, does not go so far as to force the physician to commit a crime such as taking the patient's life. If the patient's will reveals a clearly suicidal attitude, the doctor could and should - with judicial authorisation, if necessary - apply ordinary, non-risky treatments to keep the patient alive, otherwise he could commit the crime of omission of due assistance.
84. What is the offence of omission of due assistance?
The Penal Code defines it in Article 489 ter as follows:
"Anyone who fails to assist a person who is helpless and in manifest and serious danger, when they could do so without risk to themselves or to a third party, shall be punished with a major arrest or a fine of 30,000 to 60,000 pesetas.
The same penalty shall be incurred by anyone who, being prevented from rendering assistance, does not urgently call for help from others.
If the Victim is a victim of an accident caused by the person who omitted to render assistance, the penalty shall be a lesser term of imprisonment".
It is a crime not to render assistance to a person whose life or physical integrity is in danger. This is a manifestation of social and human solidarity, and is based precisely on the fact that everyone has the right to be helped by others when they are in danger, regardless of whether this happens through no fault of their own or through their own free will.
The existence of this crime, and the ethical enforceability of this conduct of helping someone in danger, shows that there is no right to take one's own life. If this were not the case, the police officer who tries to prevent the suicidal person from throwing himself out of the window, or the doctor who tries to save the life of the injured person who is admitted in serious condition as a result of a suicide attempt, would be committing the crime of coercion.
Moreover, anyone who would not do everything possible to save the life of another, even if the latter wished to die, would violate the principle of justice, which requires giving to each what is his own and recognising his dignity even if he does not wish to do so.
85. What is the principle of justice?
It is one of the general principles of law according to which every human being must be respected and his dignity protected and protected by others - including the state - even if he explicitly and expressly renounces it. This elementary principle of social ethics and common conduct implies that justice prevails over the autonomy of the individual, so that no one may harm another even if the latter asks for it.
The principle of justice is an expression of the basic ethical sense of humanity, the basic foundation of all laws and of social coexistence itself. Without it, there would be no justification for law or the courts, and a society organised on foundations other than the law of the strongest and the institutionalisation of violence would be impossible.
86. If this is so, how is it that some say that euthanasia should be legalised in order to avoid therapeutic incarceration?
Those who defend such an argument are either making pure demagogy by calling "therapeutic incarceration" the fact that doctors cannot be forced to end the life of their patients when they or their relatives request it, or they are deceiving - in good or bad faith - public opinion by pretending to make it fall into the error of legalising one evil (euthanasia) to avoid another evil (therapeutic incarceration), when the truth is that both evils are already prohibited and punished by law.
87. What is your overall assessment of Spanish legislation in terms of the protection of the right to life?
Currently, opinions are growing and legislative proposals are being drafted that seek to widen the cracks already existing in the coherent block that a centuries-old tradition has built to actively engage the State and the Law in the defence of human life. However, except in relation to unborn human beings, or those conceived on laboratory, the legal protection of the right to life in Spain is quite correct.
88. Is the so-called "living will" valid in Spain?
If by "living will" is meant a command given to a person to end one's own life if one is seriously ill, disabled or in severe pain, such a will is null and void and totally ineffective, because no one can compel another to kill him or her either by action or omission.
On the other hand, if by "living will" is meant the expression of a person's will to renounce the use of disproportionate means to artificially or mechanically prolong dying when it is no longer possible to save his or her life, such a will is legally and ethically valid.
As a concrete example of a perfectly valid and admissible "living will", the Spanish Episcopal Conference has approved and proposed to Christians. Its text reads as follows:
Living will
My family, my doctor, my priest, my notary:
If the time comes when I am unable to express my wishes about the medical treatment to be given to me, I wish and request that this Declaration be considered as a formal expression of my will, made in a conscious, responsible and free manner, and that it be respected as if it were a will.
I consider that life in this world is a gift and a blessing from God, but it is not the supreme and absolute value. I know that death is inevitable and puts an end to my earthly existence, but in faith I believe that it opens the way to a life that does not end, together with God.
Therefore, I, the undersigned ...................., request that if I should become critically ill and unrecoverable, I should not be kept alive by means of disproportionate or extraordinary treatments; that I should not be actively euthanised, nor should my dying process be unreasonably and abusively prolonged; that I should be given the appropriate treatments to alleviate my suffering.
I also ask for help in coming to terms with my own death in a Christian and human way. I wish to be able to prepare for this final event of my life in peace, with the company of my loved ones and the comfort of my Christian faith.
I subscribe to this Declaration after mature reflection. And I ask that those of you who have to take care of me respect my will. I am aware that I am asking you for a grave and difficult responsibility. It is precisely in order to share it with you and to mitigate any possible feelings of guilt that I have written and signed this declaration.
Date....................
signature
89. Does the requirement to respect the principle of justice allow us to speak of a "human ecology"?
Of course we do. Just as we humans have gradually become convinced of the need to respect Nature without manipulating it abusively in the selfish service of our own exclusive interests, we must also be convinced that human beings deserve even greater respect. It would be aberrant if, while the ecological mentality is becoming a legitimate source of pride for our contemporaries, we were to exclude human beings from this mentality of respect.
In Spain, as in other so-called civilised countries, there is the paradox that laws are passed to protect animals from hurtful treatment or unnecessary experiments, and at the same time laws are proposed (and sometimes passed) that legally disprotect human beings, so that the State and the law are less committed to respecting human dignity than to defending animals from degrading treatment. Given that these contradictions exist, it is not only possible, but necessary to speak of a human ecology, involved and committed to safeguarding life as an inalienable, indisposable and inalienable right.
VI. The Church in the face of euthanasia
90. Is the issue of euthanasia a religious or a moral problem?
In addition to being a medical, political or social problem, euthanasia is a serious moral problem for anyone, believer or non-believer.
Those of us who believe in a personal God who not only created man but who loves each individual man or woman and awaits them for an eternal destiny of happiness, and especially Catholics, have more reason than anyone else to reject euthanasia, because those of us who think this way are convinced that euthanasia involves killing a being loved by God who watches over their life and death. Euthanasia is thus a grave sin against man and therefore against God, who loves man and is offended by everything that offends human beings, which is why God once pronounced "thou shalt not kill" as a requirement for anyone who wants to be with Him at agreement .
For Catholics, euthanasia, like any other form of homicide, is not only an unjustifiable attack on human dignity, but also a grave sin against a child of God.
Opposing euthanasia is not the exclusive position of those who believe in God, but for them it is natural and not renounced: for them, life is a free gift of God and no one has the right to end the life of an innocent person.
91. However, the Church does not condemn war and the death penalty in all circumstances. Is this not contradictory to its position on euthanasia?
It is not contradictory because war and the death penalty can be an expression of the right to self-defence against unjust aggression, which the Church has always recognised for individuals and societies and which, moreover, is recognised by all contemporary legal systems as well as by international declarations on human rights. Euthanasia, on the other hand, can never be understood as self-defence, even if its material effect is the same as that of war or the death penalty.
One of the requirements criteria for considering legitimate self-defence admissible is that of proportionality between the attack received and the harm caused to the aggressor. Today there is a widespread conviction among many moralists - and this has been reflected in some texts of the world episcopate - that the existing means of mass destruction make any war in which these means are used disproportionate. There is also a widespread view that the proven ineffectiveness of the death penalty as a deterrent also makes it disproportionate to morally justify it as a legitimate social defence. Therefore, to the extent that means other than the death penalty and war are sufficient to defend human lives against the aggressor and to protect the public peace, these non-bloody means should be preferred as more proportionate and more in keeping with the end pursued and with human dignity.
Hence, several Bishops' Conferences have taken an official position in favour of the abolition of the death penalty and against the just nature of any war that is not purely defensive, a position which this document shares, for, if life is to be defended, this principle is indivisible, and must be applied in all cases.
92. Why does the Church condemn suicide and euthanasia and, on the other hand, exalt martyrdom?
Human life in its bodily dimension certainly participates, as mentioned above, in the dignity of the person and, for this reason, it cannot be violated for any reason whatsoever.
The Church therefore condemns suicide and homicide in their various forms and for whatever motives they may be committed. Euthanasia is just as condemnable as a form of homicide for reasons of pity and compassion, as is the attempt on one's own life for a religious motive, which would then, of course, be suicide.
But it is clear that the martyr is not a suicide who takes his life for a religious reason. The martyr does not take his own life: it is taken. He does not commit suicide, but is the victim of a homicide. He does not, therefore, in any way violate the principle of the inviolability of human life as a fundamental good of the person.
However, human life in its bodily dimension participates in the dignity of the person, but it is not identified with this dignity. The human person is a body, but is also more than a body. The dignity of the person therefore includes other values that are higher than that of his physical life, and for which man can submit his life, spend it and even shorten it as long as he does not directly harm it. Human life, being a core value of the person, is not the absolute and supreme value.
The Church, which condemns suicide and homicide as an attack on a fundamental and inviolable good of the person, exalts martyrdom because it is a submission that the martyr gives up his physical life for the sake of values superior to it, such as his fidelity and love of God, thereby giving heroic testimony of a life consistent with the highest demands of the dignity of the human person, far from attacking this dignity, it is a maximum affirmation of it.
That the submission of life is a sample of the dignity of the human person is, moreover, easy to see. Everyday experience provides us with examples of lives that are given up, spent at every moment in the exercise of family, professional or social responsibilities. The mother who breaks her health by spending whole nights at her husband's or son's bedside; the fireman who risks his life to put out a fire; the businessman or trade unionist who suffers illnesses resulting from the stress of holding down a job; the lifeguard who is in danger of drowning? These are all examples, among many others, of ways of spending, cutting short and risking one's own life for the sake of values of solidarity. When the value at stake is a supreme value, the supreme offering of one's life is a coherent and admirable attitude, and it is clear that none of this has anything to do with euthanasia.
It is in this logic of the submission, of the gift of life, that martyrdom is framed, and for which it deserves to be exalted.
93. Can it be said, then, that human life is not an absolute value for the Church?
Human life is not for the Church an absolute value to which all others must be subordinated; what is an absolute value for the Church is the dignity of the human person, who is made in the image and likeness of God. That is why martyrdom or risking one's own life to save others is not only not a sin, but can be something valuable and even morally obligatory.
Thus, the Church has raised to the altars a person like Maximilian Kolbe, who, for supernatural reasons, performed an act of supreme generosity by giving his life to save the life of another person.
There is, therefore, no contradiction between the Church's strict rejection of euthanasia and the fact that for the Church there are higher values than human life: to kill an innocent human being is a grave sin; for a human being to accept death in order to do the good that he or she ought to do or rather than be forced to do evil is a virtuous attitude.
94. Can the Church's teaching on euthanasia be summarised in a few words?
The Church's teaching on euthanasia has been set out in this document, but can now be summarised in the form of a Decalogue:
1. It is never permissible to kill a patient, not even to spare him or her suffering, even if he or she expressly asked for it. Neither the patient, nor the doctors, nor the health personnel, nor the relatives have the right School to decide or cause the death of a person.
2. Action which by its nature directly or intentionally causes the death of the patient is not lawful.
3. It is not permissible to omit a service due to a patient without which he or she will irretrievably die, for example, the vital care (tube feeding and normal therapeutic remedies) due to every patient, even if he or she is suffering from an incurable illness or is in the terminal phase or even in an irreversible coma.
4. It is unlawful to refuse or forego possible and available care and treatment when it is known to be effective, even if only partially effective. In particular, treatment of comatose patients should not be withheld if there is any possibility of recovery, although it may be discontinued when it is found to be totally ineffective. In any case, supportive measures should always be maintained.
5. There is no obligation to subject a terminally ill patient to further surgery when there is no well-founded hope of making his or her life more bearable.
6. It is lawful to provide narcotics and analgesics that relieve pain, even if they attenuate consciousness and secondarily cause a shortening of the patient's life. Provided that the purpose of the action is to relieve pain and not to surreptitiously cause a substantial shortening of life; in this case, the morality of the action depends on the intention with which it is done and that there is a due proportion between what is achieved (the reduction of pain) and the negative effect on health.
7. It is permissible to withhold disproportionate treatment from a patient in an irreversible coma when all brain activity has been lost. But it is not permissible when the patient's brain retains certain vital functions, if such omission would result in immediate death.
8. Disabled or malformed persons have the same rights as other persons, in particular with regard to receiving therapeutic treatment. In the prenatal and postnatal phase, they must be provided with the same treatment as foetuses and children without disabilities.
9. The State cannot claim the right to legalise euthanasia, since the life of the innocent is a good that exceeds the power of disposition of both the individual and the State.
10. Euthanasia is a crime against human life and against divine law, for which all those involved in the decision and execution of the murderous act are jointly responsible.
95. In situations where the doctor, nurse or believing family members are not confronted with moral problems that are very difficult to solve?
Such problems may arise and may be difficult to resolve, as is also the case in many other areas of life (what is a fair wage, what is the attitude towards a delinquent child, husband or wife, what taxes are fair, etc.), but a fair solution can be reached if the moral principles, the goods to be respected and the evils to be avoided are clear. In the case of the terminally ill person, it will be necessary to contrast opinions with other medical and moral experts, and to reflect carefully and with sincere loyalty to the other person and his or her rights before making a decision.
If doubt nevertheless remains, the morally prudent attitude is to refrain from taking the risk of doing something immoral, an old and highly effective principle.
96. And is it not too ambiguous to leave it purely to the discretion of the physician, or to the state of science at a particular time, to determine what are proportionate or not proportionate means of sustaining life?
No, it is not ambiguous: it is profoundly human and realistic. It is useless to attempt to list all possible cases in a casuistic way, because such a list is impossible. Morality (like law, both ecclesiastical and civil) defines the principles of right action, identifies the goods to be respected and highlights the evils to be avoided. Then it is the subject of the moral act, the person with the capacity to know and to will, who must decide - according to his or her previously formed conscience - in the concrete situation. This - the decision - is the responsibility of every human being and must be made with God in mind, because it is He who ultimately judges.
This is true not only with regard to euthanasia, but in a thousand other areas: the worker who considers going on strike, the employer who sets wages and working conditions, the legislator or politician who makes decisions that affect millions of citizens, the seller who prices his or her products, the judge who passes judgement, the parent who is faced with a problem child, They have no all-encompassing list of cases at their disposal, but must rely on the moral principles that the Church teaches, and also on the various changing, sometimes fleeting, sometimes difficult to learn circumstances of the reality on which their decision will have an impact.
The doctrine is clear and certain; the circumstances may not be known with complete certainty, and the decision - the morally relevant act - will always be an act of the man confronted with the conflicting situation. This is the greatness and servitude of the freedom that characterises man.
97. What is the Church's doctrine on pain and death?
For those who have faith, the question that all people ask themselves about evil is all the more pressing, because faith makes us aware of an all-powerful God who loves every human being. Well, the knowledge that, in reality, God's loving providence towards every human being is compatible with the existence of pain and suffering, shows us that pain - even if we cannot explain it - has a meaning.
When Christ was asked about one of the facets of pain, he was sparing with words: he practically only explained that it was not a divine punishment (cf. healing of the man born blind; Jn. 9:2-4). But Jesus did something better than uttering words about pain: he suffered total pain on the Cross, turning that pain and that death, through the Resurrection, into the Good News, giving it the maximum meaning: that atrocious pain until death is the maximum good of Humanity and gave meaning to man, to history and to the universe.
Perhaps the most we can do is to imitate Christ: to say few words about pain, but to live the experience of making sense of it by turning it, in the hope of resurrection and eternal life, into source of love and self-improvement, to unite ourselves in spirit with the suffering of Christ, who promised bliss to those who suffer: to the poor, to those who mourn, to those who hunger and thirst, to those who are persecuted.
Christ did not theorise about pain: He loved and consoled those who suffer and He Himself suffered even unto death, even death on a cross. The Church does not elaborate theories on pain, but she wants to bring to humanity a vocation of preferential donation to those who suffer, and also the experience of the meaning of pain that Christ gave us with his death, and which so many millions of Christians have been trying to relive every day for twenty centuries.
98. What should be the attitude of a Christian towards euthanasia and, in general, towards suffering and death of one's own or of others?
All Christians can and must contribute by our words, our actions and our attitudes to recreate in the fabric of everyday life a culture of life that makes euthanasia unacceptable. In particular, and merely by way of example, we can all help in this immense task:
- accepting pain and death, when it affects us personally, with the supernatural vision of a Catholic who knows that he or she can join Christ in his redemptive suffering and that, after death, the embrace of God the Father awaits us;
- by actively supporting those who suffer, according to our means, possibilities and circumstances: from a smile to the dedication of time and money, we can do a thousand things to alleviate the pain of others and help those who suffer to draw love and deep joy from their pain, and not hatred and sadness;
- praying for those who suffer, for those who care for them, for health professionals, for politicians and legislators in whose hands it lies to legislate in favour of euthanasia or in favour of the dignity of the suffering. Prayer is the most powerful and effective soul we Christians have;
- facilitating the emergence of vocations to those institutions of the Church which by their founding charism are specifically dedicated to caring for suffering humanity and which constitute today - as centuries ago - a wonderful expression of the Church's love for and practical commitment to those who suffer;
- welcoming with supernatural love, human affection and naturalness within the family the suffering, handicapped, sick or dying members of the family, even if this entails sacrifice;
- being present in the media and other forums of influence on public opinion to make our convictions on pain and death and our alternatives to homicidal euthanasia clear: letters to director, phone calls, medical studies, conferences, etc..;
- voting, in the electoral processes of our country, with responsible attention to the attitude of each political party towards issues such as the family, health, policy towards the disabled and the elderly, euthanasia, etc.;
- doctors, nurses and other health professionals, by promoting a truly patient-centred subject of medicine and hospital attendance , in the dignified treatment of the patient.
In any case, we have at our disposal a sacrament - the anointing of the sick - specifically created by God to prepare for a good death.
99. What is the Sacrament of the Anointing of the Sick?
It is one of the seven Sacraments of the Church intended to comfort those who are tried by illness.
This Sacrament bestows on the Christian a special gift of the Holy Spirit, through which man receives a grace of strengthening, peace and courage to overcome the difficulties inherent in the state of serious illness or the frailty of old age. This grace renews the recipient's faith and trust in the Lord, strengthening him against the temptations of the enemy and the anguish of death, so that he can not only bear his ills with fortitude, but also fight against them and even obtain health if it is necessary for his spiritual salvation; likewise, the anointing of the sick grants him, if necessary, the forgiveness of sins and the fullness of Christian penance. Anointing is a sacrament of the sick and a sacrament of life, a ritual expression of the liberating action of Christ who invites and at the same time helps the sick to participate in it.
It is advisable to receive this Sacrament in serious illness, old age or danger, such as a life-threatening surgical operation, and it may be repeated even within the same illness if it worsens, and should not be reserved for when the sick person is already deprived of consciousness.
Thus the Council says: "... it is not only the sacrament of those who are in the last moments of their lives. Therefore, the opportune time to receive it begins when the Christian is already beginning to be in danger of death through sickness or old age" (SC 73).
Together with this Sacrament, the "Viaticum" or reception of the Eucharist, which helps fill in on the way to the Lord ("Viaticum" means "Viaanda" for the journey), will perfect Christian hope by "voluntarily associating himself (the sick person) to the passion and death of Christ" (L.G. 11).
100. What should be the attitude of a Christian in the face of death?
Christians should view death as the final meeting with the Lord of Life, and therefore with calm and confident hope in Him, even if our nature is reluctant to take that last step which is not an end, but a beginning. Ancient Christianity rightly called the day of death "dies natalis", the day of birth into true Life, and it is with this mentality that we should all approach death.
Christian piety has always identified in short ejaculatory prayers the wish that should animate all Christians in regard to her death: that in the last agony the Mother of God is very close to us, as she was at the foot of the Cross when her Son was dying.