Why are they accelerating the promotion of euthanasia?Notes for reflection and argument on the euthanasia lawAeneas and euthanasiaThe publication a few weeks ago of the "Little Lexicon on the End of Life" led several media outlets to publish reports stating that the Catholic Church had begun to change its position on euthanasia, almost permitting it in some cases. This is not the case.
Pablo Requena, a member of the Pontifical Academy for Life and professor of bioethics at the Pontifical University of the Holy Cross (Rome), these interpretations are the result of a lack of clarity in understanding the words used and a superficial or non-existent reading of the document.
Requena stresses that the document is a "work of synthesis that offers a balanced explanation of several issues that can be very complex".
A few weeks ago, an update to the "Little Lexicon of the End of Life" was published. Why is this update being made?
-I would say that more than an "update" it is about gathering in a small book some terms that are key to the discussion on the moral issues related to the end of life.
As explained in the introduction, often in many discussions on this topic there is a lack of clarity in understanding the words used: the euthanasia with the withdrawal of treatments or palliative sedation, brain death with the vegetative state, advance directives with the request for assisted suicide?
In this sense, I think that the lexicon is a good tool to understand the terms in which the different debates are situated, both at the moral level and in public opinion.
In addition, this "Little Lexicon" offers the indications of the Magisterium of the Catholic Church on many of the ethical questions that arise at the end of life. From the Statement on euthanasia (1980) to the Letter Samaritanus bonus (2020), documents published by the Congregation for the Doctrine of the Faith, 40 years of great technological progress in medicine have passed, with more than a few questions in the bioethical field, some new and some not so new.
In these years in which theologians have studied and discussed ways of responding to these questions, the Magisterium of the Church has not failed to give some indications of different depths depending on the case. We can think of the solemn condemnation of the euthanasia the encyclical Evangelium vitae (1995), or the Message from Pope Francis for a meeting that was held at the Vatican in 2017, co-organized by the World Medical Association and the Pontifical Academy of Life, on end-of-life issues, in which he explained that when the so-called "therapeutic proportionality" is lacking, it is necessary to forego a certain treatment.
How should Catholics read this vademecum?
-I think that the "Little Lexicon" is to be received and read with gratitude, as it represents an attentive work of synthesis by its various authors, who come from the fields of medicine and moral theology. In less than a hundred pages, they offer a balanced explanation of several topics that can be very complex.
This booklet is not a document of the Magisterium of the Church: it does not pretend to resolve any of the many open questions that remain in the discussion of moral theology. But it is a summary of the indications that the Magisterium has made in recent years. In addition, at the beginning, it offers a fairly exhaustive list of Vatican documents published in the last forty years, to which are added other sources of some interest, such as some documents of the "Comitato Nazionale per la Bioetica" (Italian National Committee for Bioethics), and some legislative texts.
Certainly the lexicon reflects the authors' interpretation of some of the magisterial documents in situations where not all moralists are unanimous in offering an ethically acceptable solution to a particular problem. In this sense, some voices may be more to one's liking than others, or be more or less in tune with one's own way of evaluating certain questions.
Some media have understood, when reading this vade-mecum, that the Church has changed or relaxed its position on euthanasia, specifically when referring to the hydration and feeding of persons in a vegetative state. What does the vade-mecum really say? Has the Church's position changed? Where does the confusion come from?
-I do not understand that an interpretation of the document can be made in the sense of relaxing the Church's position on euthanasia, unless one has not read the text - something that unfortunately seems quite likely in some press releases - or that one reads the "Little Lexicon" with a negative bias.
In the voice "Euthanasia" the definition is recalled, citing. Evangelium vitae 65, and explains the unlawfulness of the practice as being against the fundamental good of life and the unique dignity of the human person.
As regards the question of artificial nutrition and hydration for persons in a state of chronic unconsciousness, and specifically, in persons in a vegetative state, I would say the following. This is a complicated ethical question that has occupied moralists for several decades.
The lexicon explains that in these situations, as with any medical intervention, discernment is necessary to conclude that nutrition and hydration are for the good of the patient.
Then remember the response of the Congregation for the Doctrine of the Faith in 2007 to the North American bishops who asked about this question. In that response, the following can be read: "In affirming that providing food and water is, in principleIn some very isolated or extremely poor regions, artificial feeding and hydration may not be physically possible, therefore, the Congregation for the Doctrine of the Faith does not exclude the possibility that, in some cases, artificial feeding and hydration may not be physically possible. ad impossibilia nemo teneturHowever, the obligation remains to provide the minimum care available and to seek, if possible, the necessary means for adequate life support.
Nor is it excluded that, due to supervening complications, the patient may not be able to assimilate food and liquids, making it totally useless to provide them. Finally, we do not rule out the possibility that, in some rare cases, artificial feeding and hydration may involve an excessive burden on the patient or considerable physical discomfort linked, for example, to complications in the use of the instruments used".
Therefore, it does not change anything in the Church's position.
The vademecum rejects, however, therapeutic obstinacy Where does "all means" end and this obstinacy begin?
-This question is not easy to answer, as it depends on the pathology under consideration, the patient's specific situation and the means available in the health care context in which he/she finds himself/herself.
In fact, the "Little Lexicon" devotes an item to "irrational obstinacy", which would be an alternative term to "therapeutic persistence", which, as they rightly explain, is not an adequate way of describing medical practice, even in cases where the action taken is exaggerated.
On the subject of therapeutic limitation I wrote a text a few years ago in which some indications on this subject are given. In modern medicine we have stopped using "all means" (to use the expression of the question) and we speak of therapeutic limitation or adequacy, which occurs in two situations: when the treatment is considered disproportionate, exaggerated, futile (and this is when we speak of "obstinacy"); or when, being proportionate and reasonable, it appears too burdensome for the patient and he/she decides not to carry it out.
There are more and more situations in which medical ethics is confronted with the study of the eticity of certain limitations. And this study takes time. It was necessary with the first of the great limitations, which gave rise to the "do not resuscitate" (DNR) indications, and it has been necessary for those that have followed and continue to follow: think, for example, of the limitation of assisted ventilation, dialysis or new cycles of chemotherapy.
In these cases, easy answers and ready-made prescriptions are not useful: a proper discernment is necessary, case by case, to determine the best way to proceed in this situation with this patient.
