End-of-Life Choice, Palliative Care and Counseling

Dogma vs. Dignityby Barbara

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Compassion & Choices works to improve care and expand choice at the end of life. We dream of a time when all can live and die as free people — in dignity according to their own values and beliefs.

It’s an interesting circumstance that the United States Conference of Catholic Bishops (USCCB) met in Washington to adopt its first formal teaching on life-ending medication as an end-of-life choice. While this is a new attack, the Catholic hierarchy has a long, well-documented history of opposition to patient autonomy at the end of life. In 2008 Washington citizens passed a Death with Dignity Act by large margins. The Catholic Church’s political arms were principal funders of the opposing campaign. Support for aid in dying is strong in every corner of the state, and Compassion & Choices of Washington is a highly respected partner with healthcare providers, churches and other institutions to improve end-of-life care, increase hospice utilization, and ensure access to and compliance with the Death with Dignity Act.

We are proponents of comprehensive end-of-life choices and defend our advocacy as compassionate, moral and just. Most Americans believe a mentally competent, terminally ill person should be able to obtain medication for peaceful dying from their physician. The Gallup organization has polled this question since 1947 and never found less than a solid majority in favor. Like the bishops meeting in Seattle today, we oppose assisting suicides, because suicide is the self-destructive impulse of a mentally ill person. Assisting a suicide is a felony in Washington and Oregon, and the Oregon legislature is expanding that felony to include mailing suicide kits into the state. A bright and wide line separates the crime of assisting a suicide from the medical practice of aid in dying. Blurring that line, or pretending it doesn’t exist, does a tremendous disservice to terminally ill patients and to a society struggling to perfect end-of-life care.

The Catholic Conference’s battle against the medical practice of aid in dying has been vigorous, and it promotes an error of logic by lumping it together with the crime. Their position is not new, but we welcome – and are deeply grateful for – today’s clarity and affirmation that religious objection is the foundation of opposition to the medical practice of aid in dying.

In 1994 Oregon’s then-Archbishop Levada was the first and most vocal opponent of the Oregon movement for Death with Dignity, and everyone understood opposition arose from a particular set of religious beliefs. In subsequent campaigns, religious arguments faded into the background. From 1995 – 2011 opponents concentrated on secular arguments. But 14 years of practice, volumes of medical research and diligent state oversight in Oregon and Washington have disproven every secular argument. No credible claim remains that aid in dying compromises end-of-life care, weakens hospices, threatens people with disabilities, discriminates against women, elders or vulnerable populations, or in fact harms anyone. So we are back to 1994. Only the arguments based on religious teaching remain intact, and the USCCB reinforces those teachings today.

We respect the role of the Conference of Bishops in affirming Catholic doctrine and guiding those of the Catholic faith. But we cannot accept that the instruction of one religious authority would overrule the most personal decisions of individuals of every faith; not in a religiously diverse society. The choice of how to address suffering in a terminal illness must be the province of dying individuals themselves in consultation with their doctors, families, clergy and conscience. Our government has no place policing religious doctrine at the bedside of dying Americans.

The hierarchy of the Catholic Church uses its political and lobbying force across this nation to shape the law, limit patient choice and impose its teachings on all Americans. This year they led the campaign to overturn the Montana Supreme Court’s decision affirming aid in dying for terminally ill Montanans. The policy statements adopted here by the bishops have practical consequences for every American. Their teachings govern Catholic healthcare providers and restrict the choices of all patients – Catholic or non-Catholic – who purchase Catholic health plans or enter Catholic institutions.

The Conference makes special note of the words in the name of our organization, which reflect our values. I’d like to set the record straight.

The Conference’s statements say our compassion focuses on eliminating patients, not suffering. No, our compassion focuses on providing comfort and peace of mind to individuals who fear they will suffer unbearably in their dying. Comfort and peace of mind come from obtaining, or knowing they could obtain, medication to bring about a peaceful death. Patients need not ingest the medication to achieve peace of mind. Every year, one in six dying Oregonians inquires about the Death with Dignity law. Only one in one-thousand die under its provisions. Few use the law, but many are comforted by it. The purpose of prescriptions written under the law is to provide comfort.

The Conference’s statements also say Death with Dignity laws restrict choice. This claim defies logic. Simply adding a healthcare choice in no way pressures people to exercise that choice. People feel comforted, not pressured; and safeguards in the law guarantee it remains this way.

Human choice – the right to make important life decisions – is a part of the liberty and dignity that follow us all our lives, to our deaths. The government in a civilized society, one that protects religious freedom, owes its people no less than that liberty and dignity.

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Take Action: Sign our Open Letter to the U.S. Conference of Catholic Bishops now, and affirm your personal belief that no one – and no institution – should have the power to dictate your choice at the end of your life. www.CompassionAndChoices.org/openletter