Thou Shalt Not Kill: The Church Against Assisted Suicide

Will we allow doctors to become accomplices in self-destruction? That's a question the U.S. Supreme Court is facing. The results of its decision will be felt everywhere.

WHEN I FIRST SAW my 39-year-old friend Jim lying in a nursing-home bed, he was barely responsive. I didn't know what to think. He was emerging from a coma a month after a car wreck near the parish where he served as pastor. He had experienced a terrible blow to the head. His passenger had died. After a disappointing few weeks at a rehab center early this year, life seemed to offer a bleak and painful future for this young priest.

Consecrated to serve the needs of others, would he now become merely an expensive burden on his small religious order and his family? Or on the Medicare system? He could not speak and it was unclear how much he understood what was going on around him. He was being fed by a tube. I couldn't help but think that, were assisted suicide or euthanasia allowable options, someone in a prolonged coma or even in Father Jim's severely disabled condition might well be a candidate. That is not even to mention very old people or those who know they will die soon from illness.

Physician-assisted suicide could become a legal option in the near future in some states. True, 15 state legislatures have defeated measures to allow the practice since Oregon's voters accepted assisted suicide in 1994. But opinion polls show a closely divided public.

This month the U.S. Supreme Court is expected to hand down a ruling that will likely set the stage for upcoming political battles nationwide. Considering cases from Washington and New York, the Court will decide whether these states' prohibition of physician-assisted suicide violates the U.S. Constitution.

While Catholic organizations scramble to keep the Oregon pro-assisted-suicide law from going into effect and to prevent such legislation elsewhere, a privacy clause in the Florida Constitution may be what "opens the floodgate," according to attorney Robert Castagna, lobbyist for the Oregon Catholic Conference. The legal case based on Florida's Privacy Amendment will set a precedent for the 12 other states which have similar language in their constitutions. Short of an outright Supreme Court ban on physician-assisted suicide, state constitutions will weigh heavily in determining whether or not assisted suicide can be legalized.

The Church--both officially and through lay efforts--is in the midst of the emerging fray as moral teacher and advocate for justice. In this article you will hear from some people who have taken on the struggle against physician-assisted suicide as a pro-life cause.

Dr. William Toffler and attorney Robert Castagna are in Oregon, the state that narrowly legalized assisted suicide in 1994 but, until this April, had been stopped from implementing the law by the federal appeals court. Now a coalition of groups including the Oregon Catholic Conference is working to place a repeal referendum on Oregon's November ballot. Attorney Lisa Gigliotti is a disability-rights advocate in Michigan, where Jack Kevorkian has admitted assisting in at least 45 suicides, yet has been acquitted in each of three prosecuted cases. (A fourth trial is scheduled to begin June 10.) Richard Doerflinger, a layman, leads the U.S. bishops' efforts to fight assisted suicide. And in a sidebar hotlinked at the end of this article, we speak with Dr. Zbigniew Zylicz, director of a hospice program in the Netherlands, where physician-assisted suicide is practiced freely. He gives a first-hand account of what has happened in the only nation that condones the practice.

First, though, it might help to review some basics. Assisted suicide happens when a person commits suicide with the help of someone else. Jack Kevorkian, disbarred from medical practice in 1991, is the best known of these helpers. He sets up a machine and the person who wishes to die operates it. Voluntary euthanasia, on the other hand, occurs when someone kills another person at that person's request, presumably to end suffering or some other undesirable condition. Withdrawal of medical equipment which is creating more burden than benefit is neither suicide nor euthanasia: The Church teaches that it is ethical to withdraw useless medical intervention and accept natural death. The Church also teaches that drugs used to eliminate pain are desirable, even if they hasten inevitable death.

Oregon Makes History
The current campaign to legalize physician-assisted suicide in the United States began with the Hemlock Society and Compassion in Dying, two groups which started in the West but now operate nationally. These suicide advocates organized a ballot campaign in Washington that was narrowly defeated in 1991. They then turned their sights on California and narrowly failed again in 1992.

After they adjusted their strategies, their efforts paid off in Oregon's becoming the first jurisdiction anywhere in the world ever to legalize assisted suicide. In a 1994 ad campaign pro-suicide groups characterized the debate over Oregon's Ballot Measure 16 as the Catholic Church against the people of Oregon. The measure won 51 percent to 49 percent--by about 16,000 votes. A referendum to repeal Measure 16 may well appear on Oregon ballots this November.

William L. Toffler, M.D., is a family physician and faculty member at the Oregon Health Sciences University in Portland, Oregon. He teaches medical students, interns and physicians when he is not treating patients or caring for his family of seven children. He is cofounder and president of the fledgling Physicians for Compassionate Care--a multistate group vocally opposed to assisted suicide. Membership is 900-strong and growing. He is a committed Catholic and was a leader in the unsuccessful drive to defeat Measure 16 in 1994. It was Dr. Toffler who appeared on a CBS 60 Minutes program preceding the 1994 vote on assisted suicide and who debated Hemlock Society president and "how-to" suicide author Derek Humphry on Oregon TV.

Advertising swayed Oregon's voters, though, insists Dr. Toffler: "The average ballot-measure campaign depends upon advertising totally--mostly 15- to 30-second TV sound bites," he says during a Saint Anthony Messenger interview in Portland. Radio played an important part, too, he adds. "There were literally radio pieces that said, 'Don't let those Christians impose their morality on you. Don't believe that garbage the Catholic Church is telling you.' That's a quote," he insists. These ads that stirred anti-Catholic sentiment were well documented by national news programs.

The Church, indeed, had taken the lead role in opposing the ballot measure. Robert J. Castagna has held the job of general counsel and executive director of the Oregon Catholic Conference for the past 13 years. On behalf of Oregon's Catholics, he leads official Church efforts against suicide legislation. He tells Saint Anthony Messenger that assisted suicide not only flouts Catholic convictions about the sanctity of life, but also goes to the very heart of who we are as a society.

"I believe this is the most dangerous issue confronting this nation today," he says. Castagna sees physician-assisted suicide's acceptance as driven by our inability to provide medical care for all citizens. This attorney and lobbyist sees freedom of choice in dying as a surface issue: "I think the stronger public policy issues revolve around demographics and the economics of health care." As Baby Boomers enter the senior population, their medical needs will increase, he observes. That will place a growing burden on our health-care system.

"This is the most dangerous issue confronting this nation today.... [It revolves] around demographics and the economics of health care."

Castagna notes that this social aspect of assisted suicide is what drove a diverse panel of New York leaders in 1994 to recommend unanimously against physician-assisted suicide as "unwise and dangerous public policy." The panel found that poor, weak and vulnerable people, people without access to health care, people who had been discriminated against in society in the past, would be the ones whose lives would be at risk in the face of such a public policy.

Castagna's legal sensibilities are offended by the Oregon law, too. "This one precedent would pollute and corrupt the entire English-American legal system," he says. He cites the British Parliament's select committee on medical ethics: "They called the prohibition against intentional killing a cornerstone of law and of social relationships."

Both Castagna and Dr. Toffler are gearing up for a major effort to sway the small percentage of Oregon voters who will make the difference in the campaign to repeal Measure 16 in November. Toffler thinks that some people will take the campaign far more seriously this time than they did in 1994. "I wish I had a nickel--or a dollar--from everyone who came up to me afterward and contritely said, 'I never thought it had a serious chance!' They had no idea of the depth of darkness that pervades our society," he says. Toffler credits disrespect for life to poor moral formation and a deeper rejection of God.

In the Land of Kevorkian
Lisa K. Gigliotti is an attorney and policy adviser for the Michigan Senate Majority Policy Office in the areas of physician-assisted suicide, mental health, welfare and Medicaid. She was one of a group of leading anti-suicide and anti-euthanasia advocates who gathered for an April conference in Washington, D.C. The conference was sponsored by the National Conference of Catholic Bishops, The Catholic University of America and the Center for Jewish and Christian values.

Gigliotti herself has chronic rheumatoid arthritis and myasthenia gravis, a neuromuscular disease that can be fatal. Citizens with disabilities, like Gigliotti, have been some of the most outspoken against physician-assisted suicide. One group, called Not Dead Yet, brought pickets, wheelchairs and speeches to the Michigan legislature and even to the front of the U.S. Supreme Court as oral arguments were being heard in the Washington and New York cases some months ago.

Lisa was a college student preparing for medical school when she first became ill with rheumatoid arthritis. Before the illness, she ran three miles daily. "I lived to run," she says. As she became increasingly disabled, she was cared for by her mother and grandmother: "It hit really hard really fast. I was totally incapacitated. I needed someone to lift my head and hold a glass for me to drink, and I needed to use a bedpan and had to be cleaned."

Then worse things happened. Her mother and grandmother were killed in an auto accident, leaving no one to care for Lisa. Two weeks later she was diagnosed with the neuromuscular disorder. She was admitted to a nursing home. But her condition improved and gradually she was able to gain independence again. She spent three years using a wheelchair.

When Lisa heard that Jack Kevorkian helped to kill another woman with rheumatoid arthritis, she became alarmed. Now her passion is to protect the dignity of vulnerable people. "I know there can be dignity in infirmity," she insists. "My mother and grandmother valued my life. I could tell that. They kept encouraging me to keep preparing for medical school."

Unfortunately she's seen the undignified side, too. With a touch of sarcasm she recalls bitter memories of her nursing-home years: "They were nice enough there to put me in a room with a woman 10 years older than me who was in a persistent vegetative state," she says. "Here I was wanting to be in medical school so badly, and grieving so deeply for Mom, who was my best friend, my advocate. I would wake up and open my eyes and here would be someone staring right at me, a woman in a coma." There were 45-minute waits for a bedpan, "and then they were so impatient and rude," she recalls. There were times when mistaken nurses would try to get her to take someone else's medicine. She could scarcely argue with them because they didn't speak English. "Even the strongest of human psyches is affected when treated as a burden rather than treated with dignity," she laments.

Gigliotti thinks that people are attracted to physician-assisted suicide because they fear their own pending weakness. "But how do you know until you get there? Running was so important to me. It was something I did every day," she recalls. She would have emphatically denied that she could ever be happy without running, she recalls. "Yet who would ever have known that I would be in the position I am in now, as a policy adviser to our state senators, in Michigan of all places! And I know both sides!"

She also knows that people facing terminal illness fear a loss of dignity. Yet "we are the ones who take away each other's dignity," she emphasizes, with the compassion of someone who has suffered. "If my caretakers had treated me with patience and respect, it would have made things so much different!"

Lisa sees encouraging signs of the Church in Michigan opposing physician-assisted suicide, but she says she wishes Church leaders in her state would take a stronger lead. That's all the more true in light of efforts to put a pro-assisted-suicide referendum on the Michigan ballot for 1998, assuming that the U.S. Supreme Court will leave the matter up to states. "We need to start taking charge now," she says. "Kevorkian and others have desecrated that beautiful gift of truly giving and receiving compassion." Euthanasia advocates view helping a disabled person to die as the paramount act of compassion, she says, quoting Hemlock Society literature. "Yet a truly compassionate society would provide whatever ongoing support is necessary to embrace members of the society with disabilities."

A National--and International--Concern
Attorney Lisa Gigliotti was just one of several hundred anti-suicide advocates who gathered at Catholic University to share strategies in April. Massachusetts State Senators John H. Rogers and David T. Donnelly were there, gathering information on the issue which already is cropping up in their state. "We think it's important to get out on this issue early and frame the debate," says Senator Donnelly, chairman of the Ethics Committee for his legislature.

Another participant, attorney Thomas A. Horkan, Jr., retired director of the Florida Catholic Conference, spent a moment explaining for Saint Anthony Messenger readers the pending Supreme Court ruling.

Whether in this ruling or subsequent ones, says Horkan, the Court will ultimately determine one of three very different possibilities. They are: 1) the U.S. Constitution guarantees the right to assisted suicide, 2) the U.S. Constitution prohibits assisted suicide or 3) the U.S. Constitution allows the question to be resolved by state legislatures. It is possible that the Court's current ruling will be limited to the particulars of the Washington and New York laws. If that happens, other cases will be before the Court soon.

The common prediction among the lawyers, doctors and other Church advocates gathered at Catholic University was that the High Court will step cautiously into this new legal area and, at least for now, leave it to the states to decide.

"We are the ones who take away each other's dignity. If my caretakers had treated me with patience and respect, it would have made things so different!"

If state legislatures are permitted to ban assisted suicide, it seems likely that most will. That's the opinion of Richard M. Doerflinger, associate director for policy development in the pro-life activities office of the National Conference of Catholic Bishops. During the past three years he has lent support of materials, advice and sometimes Church funds to help defeat 15 state legislative attempts to legalize the practice. "The more the legislators learn, the less support they lend to physician-assisted suicide," says Doerflinger. He predicts that the American public will follow suit. It was Doerflinger who organized the Catholic University conference, the first ever to bring together major experts from Canada, Britain, the United States and the Netherlands.

People are attracted to the slogan of freedom of choice, he observes. "But if you begin to tell them what this really entails, that it gives doctors a new power to distribute lethal drugs to their patients, that people could be pressured into this in a cost-conscious health-care system, that the most vulnerable people fear this the most, there's an opportunity to turn public opinion around.

"People need to learn a lot more about it," Doerflinger contends, and his small staff is doing what it can to help. Besides letters to Congress and the Supreme Court, and supporting the work of state Catholic conferences, the pro-life office publishes a monthly newsletter on euthanasia trends, called Life At Risk, which currently has a circulation of 8,000. He fears that "a right to die will soon become a duty to die." If the option is available, Doerflinger and others predict that those who would become a burden on their loved ones or on society would almost certainly feel pressured by societal or family expectations to end their lives. Several conference speakers told chilling tales of how that is happening already in the Netherlands.

Rabbi David Novak, from the University of Toronto, put the issue of assisted suicide into perspective when he quoted Communist dictator Joseph Stalin: "I solve social problems by eliminating the people who cause them: No people, no problems." Those who are fighting assisted suicide in this country fear that the same logic is at work behind the push towards physician-assisted suicide and euthanasia beyond. Could it be a coincidence, they ask, that managed care and managed death appear at the same time?

The Author of Life
When the nine Supreme Court justices hand down their ruling on the Washington and New York cases soon, my injured friend Father Jim will probably walk over to his TV and turn up the volume. I visited him many times over the past several months. Against predictions, he rapidly progressed from a state of confusion along a path of dramatic recovery. One day he quit drooling. Another day he reached out and grasped my hand. Visited often by his loving family, he suddenly started speaking in sentences as he regained control of his mouth muscles. His thinking powers are intact, though he doesn't remember anything surrounding his injury. The feeding tube is gone. He walks, with some effort. On the 10th anniversary of his ordination in May, he was able to concelebrate Mass, though he still will be in recuperation for some time.

True, his is an unusual case. But Father Jim is now a sign to those around him that God is the author of life, that we do better to trust even what we do not fully comprehend rather than to wrap things up neatly at any cost. Whether it be a person who will be severely disabled, or a person who is without a doubt in the final phase of life, none of us really know what physical and spiritual healings are in store for us before we die. The medical evidence is that, when pain is managed effectively, when depression is treated, people can encounter life's final passage with dignity, in God's hands.

John Bookser Feister is editor of American Catholic Online and an assistant editor of Saint Anthony Messenger and managing editor of Catholic Update. He holds an M.A. in humanities from Xavier University, Cincinnati.