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Friday, January 05, 2007

Piergiorgio Welby

I saw a story in The Tablet today - A life too burdensome by John J. Paris, S.J., professor of Bioethics at Boston College - about Italian poet and muscular dystrophy sufferer Piergiorgio Welby, who has been allowed to die by his doctors, as he asked, and who was then refused a Catholic funeral.

Here below is a little from The Tablet article. It was long, so I left out the part which discussed the evolution of Catholic thinking and thinkers on the issues, from Francisco de Vitoria onwards - best to read the whole thing ...

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What, if any, is the difference between killing a patient and letting him die? Or euthanasia and the withdrawal of life-sustaining medical interventions?

These issues once again captured the world's attention when Piergiorgio Welby, an Italian poet and a long-time advocate for euthanasia, composed an eloquent letter to the President of Italy pleading to be allowed to die. "I love life, Mr President," he wrote. But after 40 years of battling muscular dystrophy and nine years attached to a ventilator, Welby was losing his capacity to speak or to eat. He concluded his letter with the words: "What is left to me is no longer a life. It is an unbearable torture." He then asked to be allowed to have his ventilator removed. That request, honoured on a regular basis in hospitals across the world, caused uproar in Italy. His plea was denounced by critics as a demand for suicide or euthanasia. After a doctor defied an Italian court ruling and switched off the ventilator the Diocese of Rome denied Welby a Catholic funeral. Church officials said his "will to end his life was known, as it had been repeated and publicly affirmed, in contrast to Catholic doctrine".

Earlier, the judge ruled that while Welby had a constitutional right to be free of unwanted medical treatment, Italy's medical code "requires doctors to maintain the life of a patient". "Physicians", she wrote, "even when faced with the request of the patient, must not carry out ... treatments aimed at causing death." The judge concluded her opinion with the observation that Italy's penal code outlaws the "homicide of a consenting person and helping [someone] to commit suicide".

How in Catholic Italy did such confusion arise over the distinction between withdrawal of burdensome medical interventions and suicide/killing? In America, the courts and the American Medical Association have categorised both artificially supplied nutrition and fluids and the use of ventilators as medical interventions. The Church's teaching has in the main agreed with this. A notable exception was John Paul II's "Allocation" in 2004 to the Pontifical Council for Life in which he was quoted as saying, "artificial nutrition and fluids are natural means and thus always obligatory". But this statement was a one-off, delivered to a private audience, and had no theological basis. It was never repeated by Pope John Paul, nor has it been by his successor, Pope Benedict.

Much more reliable is the Vatican's 1980 Declaration on Euthanasia, which states: "One cannot impose on anyone the obligation to have recourse to a technique which is already in use but which carries a risk or is burdensome. Such a refusal is not the equivalent of suicide [or euthanasia]; on the contrary, it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected." .....

The rich, nuanced and highly developed Catholic teaching that there is no duty to use medical measures artificially to prolong life is clear. "The problem" in the Welby case, notes Cardinal Javier Lozano Barragán, the Vatican's top official for health, in a recent interview in La Repubblica, "is to know if we find ourselves truly in front of a case of artificially prolonging life." Piergiorgio Welby responded to that question in his letter to the Italian President: "What is natural about a hole in the windpipe and a pump that blows air into the lungs? What is natural about a body kept biologically functional with the help of artificial respirators, artificial feed, artificial hydration, artificial intestinal emptying, of death artificially postponed?"

At the end of his long journey towards death Pope John Paul II declined the option of returning to Gemelli Hospital, where earlier his failing breathing was assisted by a respirator and his nutrition supplied through a feeding tube. Rather than return to those mechanisms that might have extended his earthly life John Paul II's parting plea was, "Let me go to the house of the Father." No one confused the Pope's action with suicide. Nor should they do so with Welby's refusal to endure what he described as "the unbearable torture" of being attached to a respirator.

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9 Comments:

Anonymous Anonymous said...

I hardly consider myself a medical ethicist, but I have to confess that I do always think that no so very long ago, we didn't have the technology or the medication to keep people alive in the way that we now have it.

I see many of my parents' generation (they were both born in 1930) having extended lives with quite a low quality of life. I sometimes think that there is something to be said for the death my grandfather had - a heart attack at 68, out in the garden, building a fence - something that he loved to do.

I'm not sure of the ins and outs of Italian laws, but here in the UK, doctors do have some legal obligations to keep patients alive by any means possible. And I think this includes, in some cases, the legal obligation to refuse to omit treatment. I don't know what "the right answer" is but my heart goes out to people who no longer want to go on and on in pain and sometimes in distress and indignity.

3:24 PM  
Blogger crystal said...

Hi Pam,

My grandfather dies that way too - quickly of a heart attack. When I put myself in the place of the person who is suffering, I feel I'd want the right to decide if I should go on or not, but I guess that violates, in some peoples' minds, the belief that being is slways better than not being. I don't know the right answer either.

3:55 PM  
Blogger crystal said...

I should add, my mom died of lung cancer and suffered a lot, but it was always clear that she wanted to live every minute that she had left.

When it get difficult, I think, is when one person decides for another, who can't speak for themselves, whether they should live or not. I'm glad I've never had to make such a decision, but if so, I'd probably err on the side of life.

4:30 PM  
Blogger Jeff said...

Interesting and confusing case. It looks to me like De Vitoria was denied a Catholic funeral not so much for the way he died but for his advocacy of euthanasia while he was alive. As far as I understand it, he had no moral obligation to stay on a respirator.

Human life has transcendent value. It is not simply a human product. It is transcendent in its origin, destiny, and dignity. Back in the 1950s, Fr. Gerald Kelly (mentioned in the Tablet article) and Fr. John Ford were regarded as the premier US Catholic moral theologians. The teaching up to that time had been that we are responsible for being stewards of our own lives by using ordinary means to preserve it. You had no obligation to be a grave burden to yourself or to others. Pius XII expanded upon this by stating that you don't have to use any treatment or therapy that imposes excessive pain, expense, or inconvenience. Ordinary means were ones that had a reasonable chance of success. You were not obliged to use extraordinary means. Around that time someone asked Kelly about withdrawing intravenous fluids... He treated that as an extraordinary intervention if there was no possibility for success. He was criticized in several quarters for that. The objection was that this meant starvation, and that nutrition was minimally necessary. With all of the newer technologies that came a long later, the issue got trickier.

JPII took up the question partly because of the question of the persistent vegetative state. Vegetative state or not, the intrinsic value of each person does not change. Nutrition and hydration were considered normal means, and not extraordinary. Ventilators and respirators are considered one thing, but hydration and nutrition are something else.

My father died painlesly of a heart attack in his sleep. My mother died after a long, hideous year of cancer. I deeply resented veiled suggestions by the oncologist about what I perceived to be intimations around euthanasia. I'm all for finding advances in pain management, but we would never have considered euthanizing my mother, and she wouldn't have heard of it, in spite of her suffering.

8:35 PM  
Blogger crystal said...

Hi Jeff,

I think there's a big difference between people who decide for themselves that they want to be allowed to die, and people such as those in persistent vegetative states, who have the decision made for them ... I was against Terri Schiavo being euthanized.

I know what you mean about your mother, I think. My mother had lung cancer too, and the docs kept telling her it was hopeless, that she should do the hospice thing, but she was a fighter and never gave up trying to get better.

The only time I had to decide about whether someone should die was when my three other cats were very sick. I kept them alive as long as I could - Spot laster two and a half years with kidney disease. It was really awful to have them put to sleep ... I stayed with them at the Vet's and held them on my lap so they wouldn't be afraid. I don't think I could make that same decision for a person.

10:12 PM  
Anonymous Anonymous said...

Jeff - Thank you for the interesting elaboration. The problem, for me, becomes where do we draw the line between ordinary and extraordinary means. What is ordinary today was extraordinary 50 years ago.

For me also, there is no problem with people suffering for many years who are clear that they want to hold on to the last.

Personally, I would not want to be on life-support if I'd been unconscious for many, many years. At the same time, I would also probably not be able to decide to withhold treatment for another.

As I understand UK law at the moment (and I may be wrong), I don't actually have any right at all to have a living will stating that I would want life-support withdrawn in the event of being in a permanent vegetative state for X number of years, but the doctors WOULD have the right to make that decision on my behalf after the fact. Something seems a bit wrong there to me. Theologically, I appreciate that my life belongs to God, but I do question where human iterference in God's sovereignty rests within the context of technology that can keep a brain-dead person alive for decades.

2:29 AM  
Blogger Jeff said...

Hi Pam,

Those UK laws sound a bit odd to me as well. You are right in pointing out that technology has a way of making these questions more and more difficult. I just look at the world my children will be growing up in, and I often think about the challenges they will be facing over end-of-life-issues, anti-aging biotechnolgy, stem cells, genetic screening and engineering, and cloning.

9:34 AM  
Anonymous Anonymous said...

How arrogant of the Church to demand that this man endure the interminable crucifixion of being connected to that respirator, utterly incapacitated and beyond any participation in human life.

God damn all of you who make excuses for this.

9:03 AM  
Blogger crystal said...

You have a right to your opinion. I feel people should be able to decide for themselves if they want to live or not, but those who don't (the Church) have an argument that's at least worthy of investigation. What good does damning people do?

11:27 AM  

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