Nowadays, the spread of assisted suicide and euthanasia is especially disturbing those who are working against the legalisation of voluntary euthanasia. In considering the typical arguments raised by the pro-euthanasia groups, the opponents of voluntary active euthanasia and PAS ultimately reject the claims:
- Individuals should have an autonomous freedom to choose when, where and how they should die; and
- Killing someone is morally equivalent to allowing them to die.194
Among the major arguments concerning the public debate of euthanasia and PAS, perhaps the most troubling issue is the concept of autonomy.195 Most people agree that to challenge or to interfere with an autonomous person, especially when his or her actions are not harming anyone else, is considered “not only to be bad social form but also disrespect of human dignity.”196
Therefore, it is easy to appreciate the significant place of autonomy in efforts to endorse PAS or euthanasia as a moral practice and legal policy. However, regarding the argument of autonomy many bioethicists rebut this assertion. Daniel Callahan, a philosopher widely recognized for his innovative studies in biomedical ethics, holds that euthanasia
191 Cf. Tran, Advancing the Culture of Death, 66.
192 James Rachels’ most sustained argument for euthanasia and against the moral significance of the distinction
between killing and allowing to die is in The End of Life: Euthanasia and Morality (New York: Oxford University Press, 1986), 106-28.
193 Cf. Rachels, The End of Life, 108.
194 Tran, Advancing the Culture of Death, 70. 195
This concept was discussed in section II.2.3. Autonomy. 196 Gula, Euthanasia: Moral and Pastoral Perspectives, 9.
cannot be properly classified as an autonomous act of managing one’s private affairs. Since euthanasia involves at least one other person, it must be regarded as a form of public action and so be assessed with its social dimensions and implications.197 In the view of societal ethics, the risk of sanctioning euthanasia is simply too great, and Callahan expresses this idea very impressively in these words: “the history of the twentieth century should demonstrate that killing is a contagious disease, not easy to stop once unleashed in society.”198
Furthermore, also according to Callahan the very right of self-determination upon which euthanasia depends is actually contradicted when we give another the freedom to end his or her life. To give up one’s freedom permanently is a contradiction to freedom. As he says: “If I am by right master of my fate, I cannot transfer my right of mastery to another, nor can any other person receive it from me.”199
Life is the fundamental condition, which makes freedom and self-determination possible. To protect freedom or autonomy, we must protect life.200 About the distinction between active killing and allowing to die, some people in the medical community may prefer to call it a distinction between active euthanasia and what we might call ‘passive euthanasia’. Generally speaking, opponents of PAS and euthanasia maintain that there is a clear moral distinction between merely allowing to die and actually causing or deliberately hastening someone’s death.201
In the definition of ‘euthanasia’ in the Vatican’s
Declaration on Euthanasia, the phrase “which of itself or by intention causes death” is
necessary in order to affirm that not taking steps to prolong life when such steps are morally required is just as much the cause of death as a lethal injection would be. Likewise, refusing treatment with the intention to end one’s life is suicide. ‘Intention’ makes the difference. This is straightforwardly the case of PAS and euthanasia. These practices both incorporate intentions that the patient die (either at the hands of the physician or at his or her own hand with physician’s help). Thus, euthanasia and PAS really incorporate lethal intent and totally contrast with terminal sedation (and other practices such as honouring a patient’s refusal or withdrawal of life-prolonging medical interventions) where lethal intent is absent.202
With her teachings, the Catholic Church firmly opposes the practice of PAS and euthanasia. Since the very early days, the Church has condemned the killing of innocent human life or
197 Cf. Daniel Callahan, “Aid-in-Dying: The Social Dimension,” Commonweal 118 (August 1991): 477. 198 Callahan, “Aid-in-Dying,” 480.
199
Daniel Callahan, “Can We Return Death to the Disease?” in “Mercy, Murder and Morality: Perspectives on Euthanasia,” Hastings Center Report 19 (January/February 1989): 5.
200 Tran, Advancing the Culture of Death, 118.
201 Manning, Euthanasia and Physician-Assisted Suicide, 45. 202
T. A. Cavanaugh, Double-Effect Reasoning: Doing Good and Avoiding Evil (Oxford: Clarendon Press, 2006), 189.
suicide. Catholic believers view human life as a gift of God’s love, “which they are called upon to preserve and make fruitful.” Intentionally causing one’s own death, through suicide or euthanasia, is equally as wrong as murder.203 The classic prohibitions against suicide are maintained for euthanasia: It fails to fulfill one’s responsibility to God, violates one’s own natural desire to exist, betrays self love, and injures one’s own community.204
Nonetheless, until Vatican Council II, there were not comprehensive statements about euthanasia made by ecumenical councils or popes, except Pope Pius XII. He condemned the policy ‘eugenic euthanasia’ of the German National Socialists as a violation of God’s sole dominion over innocent life, and as a refusal to accept unitive suffering with Christ. He wrote:
Conscious of the obligations of Our high office We deem it necessary to reiterate this grave statement today, when to Our profound grief We see at times the deformed, the insane, and those suffering from hereditary disease deprived of their lives, as though they were a useless burden to Society; and this procedure is hailed by some as a manifestation of human progress, and as something that is entirely in accordance with the common good. Yet who that is possessed of sound judgment does not recognize that this not only violates the natural and the divine law written in the heart of every man, but that it outrages the noblest instincts of humanity? The blood of these unfortunate victims who are all the dearer to our Redeemer because they are deserving of greater pity, “cries to God from the earth” (Gen 4:10).205
More radically than ever, Pope John Paul II found it necessary to issue teachings on euthanasia and PAS as these practices have become more widespread. The Congregation of the Doctrine of the Faith’s Declaration on Euthanasia is the first and fullest direct statement on the subject ever made by the Magisterium.
It is necessary to state firmly once more that nothing and no one can in any way permit the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. Furthermore, no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly, nor can any authority legitimately recommend or permit such an action. For it is a question of the violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity.206
203 Cf. Declaration on Euthanasia (1980), section I.
204 Kevin O’Rourke, “Value Conflicts Raised by Physician Assisted Suicide,” Linacre Quarterly 57, no. 3
(August 1990): 44.
205
Pius XII, Mystici Corporis Christi, Encyclical Letter (1943), n. 94.
John Paul II himself has placed the stamp of his magisterial authority on the condemnation of euthanasia with his encyclical Evangelium Vitae:
Taking into account these distinctions, in harmony with the Magisterium of my Predecessors and in communion with the bishops of the Catholic Church, I confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. This doctrine is based upon the natural law and upon the written word of God, is transmitted by the Church’s Tradition and taught by the ordinary and universal Magisterium.207
That is the reason why “Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way.”208 It is also clearly stipulated in the Charter for
Health Care Workers of the Church:
Medical and paramedical personnel – faithful to the task of “always being at the service of life and assisting it to the end – cannot cooperate in any euthanistic practice even at the request of the one concerned, and much less at the request of relatives. In fact, individuals do not have the right to euthanasia, because they do not have a right to dispose arbitrarily of their own life. Hence no health care worker can be the executive guardian of a non-existent right.209
Heath care workers, however, are invited to acknowledge the truth that if care is administered properly at the end of life, only the rare patient should be so distressed that he or she desires to commit suicide. Medical professionals must clarify all issues for their patients: Do people who ask to be put to death truly seek death? Are their patients only appealing for appropriate medical treatment to alleviate their pain and depression? Have their patients lost control of exactly what they need due to their suffering? Most importantly, these questions express the need of the human heart for the warmth and love of those who care for them. “Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that they can live with dignity until the time of natural death.”210
207 John Paul II, Evangelium Vitae, n. 65.
208 United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, n. 60.
209 Pontifical Council for Pastoral Assistance to Health Care Workers, Charter for Health Care Workers, n. 148. 210 United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, n. 60; cf. also Declaration on Euthanasia (1980), section IV; Edward J. Furton, “Physician-Assisted
Suicide and Euthanasia,” in Catholic Health Care Ethics: A Manual for Ethics Committees, ed. Peter J. Cataldo and Albert S. Moraczewski (Boston, Massachusetts: The National Catholic Bioethics Center, 2001), 13/4.
IV. END-OF-LIFE ISSUES IN VIETNAM: AN OPPORTUNITY TO LIVE OUT THEIR CATHOLIC IDENTITY