End-of-Life Choice, Palliative Care and Counseling

U.S. Catholic bishops misunderstand our death-with-dignity lawsby Jay

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Meeting in Bellevue, the bishops take a firmer line on physician-assisted aid-indying
laws and make allegations about abuses that are not supported by the
experience in Oregon and Washington.

By Harris Meyer, July 5, 2011

The U.S. Conference of Catholic Bishops’ policy on physician-assisted suicide,
approved at their national meeting in Bellevue last month, is the latest move by
Roman Catholic leaders to intervene in Americans’ personal health care decisions.

The eight-page policy, which the bishops passed 191-1 at their annual spring
meeting, is full of inaccurate and misleading statements about the Death with
Dignity laws in Washington and Oregon and the policy positions of the laws’
supporters. It ignores 14 years of experience in Oregon and two years in
Washington. The head of Compassion & Choices, the main group supporting those
laws, criticized the bishops’ policy statement as “full of reckless, unsubstantiated
accusations.”

The bishops’ statement warns that the voter-approved Death with Dignity laws —
which allow terminally ill, mentally competent adult patients to receive
medications from their doctor to end their lives — essentially legalize murder. And
it makes the stunning claim that U.S. leaders of the Death with Dignity movement
in effect advocate ending the lives of people who have not sought help in dying.

“A society that devalues some people’s lives, by hastening and facilitating their
deaths, will ultimately lose respect for their other rights and freedoms,” the bishops
said. “Taking life in the name of compassion also invites a slippery slope toward
ending the lives of people with non-terminal conditions.”

The new policy, “To Live Each Day with Dignity,” is the U.S. church’s first
official policy on aid-in-dying, which also is legal in Montana under a 2009
Montana Supreme Court ruling. The policy follows increasingly aggressive efforts
by the bishops to require Catholic health care facilities and providers to insert and
maintain feeding and hydration tubes in terminally ill patients — even those who
have written advance directives stating they don’t want them.

The bishops also have cracked down on Catholic hospitals that performed tubetying
operations for women who are not going to have more babies. Last year, a
bishop expelled St. Charles Medical Center in Bend, Ore., a century-old hospital
founded by nuns, from his diocese for refusing to stop performing tubal ligations.

These policies matter because the bishops oversee more than 600 Catholic
hospitals and hundreds of Catholic nursing homes, assisted living centers, and
hospices.

Some Catholic ethicists and administrators in Catholic health facilities have
expressed concerns about the bishops’ aggressive new mandates. One worried
Catholic hospital administrator who didn’t want to be named criticized the bishops’
2009 ethical and religious directive requiring Catholic health facilities to provide
feeding and hydration tubes to patients with chronic and irreversible conditions —
including persistent vegetative state, massive stroke, and advanced Alzheimer’s
disease. The administrator told me the directive is a “slippery slope” that could
lead to widening disregard for patients’ end-of-life wishes.

But there is growing pressure on everyone within the Catholic establishment to
hew to the party line. A new article in Crisis Magazine by Cardinal Newman
Society president Patrick J. Reilly called out prominent theologians at four major
Jesuit universities who have supported the physician-assisted suicide movement.
These professors “have done more than betray the Catholic Church,” Reilly wrote.
“When professors deny the truths of faith and disregard the common good —
especially of those whose lives are snuffed out prematurely — they violate the
mission of a Catholic university.”

Barbara Coombs Lee, president of Compassion & Choices, a national group that
supports and monitors patients using the Death with Dignity laws, blasted the
bishops’ statement on physician-assisted suicide and what she called the church’s
McCarthyesque attack on Catholic dissenters. “It’s one thing to state your position
based on your religious beliefs, and quite another to falsify, bully, sanction, lobby,
and impose that religious belief on others,” she said in a written statement. “The
bishops misstate our work, our beliefs, our mission and 14 years of Oregon
experience with aid in dying. That experience shows better end-of-life care, more
choice, and more peaceful deaths.”

The bishops’ statement on physician-assisted suicide claims leaders of the aid-indying
movement support “ending the lives of people who never asked for death,
whose lives they see as meaningless or as a costly burden on the community.” But
the Washington and Oregon laws spearheaded by Compassion & Choices set out a
detailed procedure allowing only terminally ill patients to ask a physician to
prescribe the lethal medication; that doctor and a second doctor independently
determine whether the patient likely has less than six months to live, is mentally
competent, and made the request voluntarily.

At a June 15 news conference in Seattle, Coombs Lee stressed that Compassion &
Choices opposes providing aid-in-dying to anyone who doesn’t meet the legal
criteria. “A bright line separates assisting suicide, which is a felony, from the
medical practice of aid in dying,” she said. “To blur that line does a grave
disservice to terminally ill patients.”

The bishops also claim that people with chronic illnesses or disabilities which
are life-threatening only if they don’t receive treatment could qualify for lethal
prescriptions under the Death with Dignity laws. “Thus the bias of many ablebodied
people against the value of life for someone with an illness or disability is
embodied in official policy,” they said.

There’s no evidence for that assertion. The Oregon and Washington laws define a
qualifying terminal disease as “incurable and irreversible.” Dr. Tom Preston,
medical director of Compassion & Choices of Washington, said Compassion &
Choices would never consider working with patients whose condition could be
reversed or effectively treated except to advise them they didn’t qualify under the
law.

Another unfounded argument by the bishops is that offering terminally ill patients
the option of assisted suicide undermines effective pain management and palliative
and hospice care. In fact, studies show that the overall use of hospice care
increased in Oregon to one of the highest rates in the country after the Death with
Dignity law took effect in 1998. In Washington and Oregon, more than 80 percent
of patients who received lethal prescriptions and died in 2010 were enrolled in
hospice — far higher than hospice participation rates nationally. “We insist on
good comfort care,” Preston said.

The bishops further contend that terminally ill people seeking aid in dying
commonly suffer from mental illness such as depression, and that Death with
Dignity laws and proposals ignore this issue. “Even a finding of mental illness or
depression does not necessarily prevent prescribing the [lethal] drugs,” they said.

Supporters of aid in dying do worry about clinically depressed patients receiving
lethal prescriptions. But Dr. Linda Ganzini, a psychiatrist at Oregon Health &
Science University who has consulted on dozens of Death with Dignity cases and
has studied the issue, told me her experience is that most people who want assisted
suicide do not have depression or another mental health condition that would affect
their decision. And if either of the two physicians who independently evaluates
each patient’s eligibility thinks there is a possible mental health issue, that doctor
must order a psychological evaluation. Under the Oregon and Washington laws,
patients cannot receive a lethal prescription if their judgment is found to be
impaired.

Finally, the bishops argue that dying patients’ pain can be alleviated through
competent medical care, freeing them to focus on “the unfinished business of their
lives, to arrive at a sense of peace with God, with loved ones, and with
themselves.” In contrast, they said, assisted suicide “results in suffering for those
left behind — grieving families and friends, and other vulnerable people who may
be influenced by this event to see death as an escape.”

But Tony Rizzo of Puyallup, a self-identified Roman Catholic, said he
“respectfully disagrees” with the bishops based on his and his wife Joyce’s
experience at the end of her three-year battle with cancer. At Compassion’s June
15 news conference, Rizzo described how his wife of 43 years was suffering
“excruciating” pain, despite her pain medication. She asked for and received a
lethal prescription under the Death with Dignity law, and used it to end her life last
September.

“Joyce was facing a painful and difficult death, and there was absolutely no hope,”
he said through tears. “She obtained the peaceful, dignified death she desired. The
whole family supported her decision. I shudder to think of the pain she would have
experienced without the medication and without that choice, which the bishops
would deny her.”

It would appear that the bishops need to take off their black robes, visit a hospice
or hospital ICU, and silently watch and listen to expert staff work with terminally
ill patients.

For more information please visit www.compassionandchoices.org.