Medicine traditionally recognises that human life is a basic good, and that patients come to doctors for healing and the restoration of health, writes Fr Seán MacGiollarnáth O. Carm.
In 1997, John Rawls, Ronald Dworkin and other philosophers submitted a brief to the US Supreme Court which called for assisted suicide. Paul Weithman, their colleague, disagreed but acknowledged that “it is only natural to feel the weight of these burdens. It is only human to desire relief when they come to seem unbearable”.
There are times in which families experience “one calamity followed upon another” which leave them “destitute, bereft and sick all in a short space of time”, as Muriel Spark tells in The Only Problem. Although not all families experience such sheer weight of suffering, no family goes through life without the shadows cast by death and illness.
These questions are now before the Oireachtas. According to Deputy Gino Kenny, his Dying with Dignity Bill permits terminally ill people “to control their own death when they decide their suffering is no longer bearable”.
The licence which the bill proposes to give to doctors has serious implications for medical care. A person with an incurable and progressive illness and who has “a clear and settled intention to end his or her own life” may ask a medical practitioner to prescribe a deadly substance.
This can be orally ingested so as to kill the patient. The matter is more complex than the title of the bill suggests.
The demand for euthanasia is nothing new. Assisted suicide is something of which the Hippocratic tradition was aware. The burden of illness has often prompted patients to ask doctors to give them ‘deadly medicine’. This was long before the anaesthetic and pain relief treatments now used in palliative care were available.
As the art, teaching and practice of medicine grew, it was necessary to articulate some ground-rules. The solemn undertaking in the Hippocratic Oath, ‘‘I will give no deadly medicine to anyone if asked, nor suggest any such counsel” is intended to draw a red-line. Nowhere, never under any circumstances, should a doctor cross that line.
Why so? The rule against such counsel and assistance is straight-forward. The rule recognises that human life is a basic human good, and that patients come to doctors for healing and the restoration of health.
Where the patient has a terminal illness, there are no circumstances which justify a doctor partaking in the intentional killing of a patient. Whatever the condition of a patient, doctors always have the obligation to respect human life, and the human life of the particular patient.
They have to take the long view of their craft and the context in which it is exercised. Hippocrates recognised this when noting that “life is short; the art long; experiment treacherous; opportunity fleeting; and judgment, difficult”. Deputy Kenny’s bill completely misses this.
Were a doctor to assist in the killing of a terminally-ill patient, he may plead that the killing or assistance in hastening death may be directed towards some further end, such as the relief of the patient’s distress. He may plead motivation through some sense of compassion.
However, the absolute nature of the prohibition of doctors killing their patients is explained by the risks of allowing human desire and human feeling to undermine the aim of medicine, which is health and healing.
What might be suggested in the title of the bill is that doctors are not sufficiently attentive to patient dignity, but that assisted suicide would cure this shortfall”
Does this make medicine and law harsh or unkind? It does not. Whatever our feelings may be, and whatever our desires may be, it is not the case that we can always act on them, nor can we necessarily request that others do as we feel and desire. After all, others will have their own feelings and desires about the course of action proposed to them.
Can doctors be prohibited from assisting in the deliberate killing of their patients and also act in a caring and properly attentive way when dealing with patients with a terminal illness? Of course they can.
What might be suggested in the title of the bill is that doctors are not sufficiently attentive to patient dignity, but that assisted suicide would cure this shortfall.
Firstly, we normally consider doctors who kill their patients to be acting both unlawfully and unethically. Such cases as have come before the courts have shocked the public. The burden of proof does not lie with those who respect this tradition.
Secondly, the act of assisting in the killing of a terminally-ill patient suggests that dignity is entirely linked with control of one’s health. It is partly linked with it – sickness tends to bring us away from what Wittgenstein calls “the habitual, normal state of our bodies” towards that “high narrow rock, surrounded by precipices in which everything looks different”.
Finally, a decline in health, cognitive and physical, is often alarming. But there is a deeper sense of human dignity. All human beings share in the good of existence.
There is human solidarity and the protection of human life and human dignity”
To judge that someone is better off dead, and to provide a fatal substance, is to impugn their dignity in a way in which no illness can.
On the contrary, where there is attentive care, including all necessary palliative care, and a respect for the inviolability of human life, there is human solidarity and the protection of human life and human dignity.
The inelegantly named ‘Dying with Dignity’ bill is a threat to human solidarity, human life and intrinsic human dignity
Fr Seán MacGiollarnáth O. Carm. is parish priest of Whitefrair Street in Dublin and a qualified solicitor.