Euthanasia and assisted suicide are now legal in all Australian States. In each State, however, there are conditions and restrictions. Advocates for euthanasia are currently calling for a review of some of these restrictions.
There has been, for instance, a call that advice on euthanasia and assisted suicide should be available via telehealth. It should not be restricted to a personal face-to-face interview with a doctor. It is argued that regional patients in particular are disadvantaged by the current restrictions. Although a recent Federal Court judgement (Justice Abraham: 30 November, 2023) rejected such a submission, it is inevitable that a variation of the original submission will be drafted and re-submitted in the near future.
There is also lobbying that doctors and health care professionals should be permitted to initiate discussions on euthanasia with patients rather than being restricted only to answering patient-initiated enquiries.
It is not surprising, then, that the Australian Catholic Bishops Conference should have responded to these further attempts to make euthanasia more accessible, firstly, by restating the Church’s strong opposition to euthanasia and all forms of assisted suicide, and, then, addressing some of the emerging issues that may arise specifically for Catholics in this end-of-life context.
The bishops’ document: To Witness and Accompany with Christian Hope, (27 November, 2023), draws directly on a previous Vatican Letter, Samaritanus Bonus (14 July, 2020), which in turn draws on the Encyclical Letters of Pope John Paul II Veritatis Splendor (6 August, 1993), and Evangelium Vitae (25 March, 1995). The Australian bishops also acknowledge as a source parallel documents drafted by the New Zealand Catholic Bishops Conference.
The Vatican Letter, Samaritanus Bonus, begins by rehearsing the traditional Catholic arguments against euthanasia and assisted suicide, in specific, the dignity and inviolability of human life and the adverse social effects of compromising this basic human value. It then goes on to distinguish euthanasia from what is morally permissible, namely, foregoing needlessly aggressive and futile treatments in the terminal stages of life. It insists, however, that basic nutrition, hydration, nursing and health care must always be maintained unless their administration, too, becomes unduly burdensome.
The Letter then adverts to the specific case of infants born disabled with severely limited life prospects. Even though their situation is irredeemably parlous, this does not disqualify them from being treated under the same principles already outlined for terminally ill adults. This very specific section of the Letter dealing with disabled infants with limited life prospects is particularly pertinent in view of the number of cases that have recently been brought to the attention of the Vatican.
'Even though the Catholic priest or chaplain is unable to administer the sacraments of Penance, Viaticum and Anointing of the Sick to a terminal patient who has definitively committed themselves to euthanasia, this does not mean that the Church has abandoned, or ‘wiped its hands of’ such patients. The priest or chaplain is strongly exhorted to accompany these patients right up to the time that the lethal dose is administered.'
There is a parallel section, too, insisting that the general principles apply also to those in a vegetative state and in a state of minimal consciousness, while recognizing, of course, that what constitutes overly aggressive or futile treatments in such situations is both specific to the patient and variable in view of their condition.
Samaritanus Bonus then openly canvasses the use of strong analgesics to combat pain. Even though the use of such analgesics may result in terminal unconsciousness, it is permissible provided that the intention is to alleviate pain and any resultant hastening of death, while possibly foreseen, is not intended. Indeed, the administration of such analgesics, as with palliative care in general, may extend, rather than hasten, death.
The importance of family and hospice support, the rights of health care workers and the respect that must be accorded to their conscientious objections to euthanasia and assisted suicide, the importance of palliative care as an alternative to euthanasia – all these are treated extensively within the parameters of the Catholic tradition in the Vatican Letter.
It is in the section of Samaritanus Bonus which addresses the traditional pastoral accompaniment that the Catholic Church provides for the terminally ill – the sacraments of Penance, Eucharist (Viaticum) and Anointing of the Sick – that the Vatican Letter intersects most significantly with the parallel section of the Australian Bishops’ document. What is to be done where a terminally ill Catholic patient requests access to the sacraments when at the same time their clear and definitive intention is to embark on euthanasia and assisted suicide?
The Vatican Letter does address this issue in its penultimate section. It deals with the situation sympathetically, admitting that the decision to postpone absolution and to refuse Viaticum does not necessarily ‘imply a judgment on the imputability of guilt, since personal responsibility could be diminished or non-existent’. It counsels ongoing accompaniment for such terminally ill patients despite their ‘misguided’ conscience. It is only if such accompaniment could be construed as support for euthanasia that such assistance should be moderated or even withdrawn – but only as a last resort. A Catholic priest or chaplain, however, should not be present at the bedside when the lethal dose is taken or injected.
The Australian Catholic Bishops’ document develops this sympathetic response in greater detail in the final section of its statement. Once again, the stress is on ongoing accompaniment. The priest or chaplain will recognize that, despite their best efforts to appreciate the Church’s teaching, a patient may, in good if misguided conscience, still choose euthanasia:
‘It is possible that, despite a patient’s best efforts to make the Church’s teaching their own, and the best efforts of the priest or other carers to explain that teaching and to provide personal support and understanding, a patient remains convinced that deliberately ending their life is a good thing for them to do. If such a person is ‘in good faith’, then he or she will experience a conflict between their own personal judgment and the teachings of the Church to which they give allegiance.’
The bishops’ document recognizes that this personal judgment to embark on euthanasia may arise from a variety of causes: ‘They might be focused on such thoughts as ‘I cannot go on living this way’ or ‘ I cannot ask my family to keep supporting me’’, or there is ‘…mistaken reasoning that is based on deep unresolved psychological factors (fears, obsessions, compulsions, etc.) which limit the patient’s freedom and insight into the good.’
Whatever the source of this reasoning and the consequence that the patients is not permitted to access the sacraments of Penance, Viaticum and Anointing of the Sick, the priest or chaplain is exhorted to remain close to the patient, not only in the hope that there may be a change of heart, but also because such a choice for euthanasia does not necessarily imply a negative judgment about the patient’s guilt. Even further, the Australian document invokes Pope Francis’ recent response to the doubt put to him by the five Cardinals prior to the Synod on Synodality: ‘…it should be clear that all the conditions that are usually attached to confession are generally not applicable when a person is in a situation of agony or has very limited mental or psychological capacities.’ (2 October, 2023).
Further again, even though the priest or chaplain must withdraw when the lethal dose is about to be taken or injected, as he/she withdraws he/she should assure the patient that ‘he will pray for them and that, if requested, he will return to pray the Prayers for the Dead.’ A final note suggests that a Catholic funeral is not to be denied for such a patient.
There is, then, a strong pastoral, non-judgmental theme that animates the Australian Bishops’ document. It recognizes that even ‘good’ Catholics may be attracted to euthanasia, particularly if they are confronted with the prospect of an extended and pain-filled terminal phase. In this vulnerable condition it may seem to them that they can choose euthanasia ‘in good conscience’. To this degree both Samaritanus Bonus and the Australian bishops acknowledge that moral responsibility may be diminished or even absolved.
Even though the Catholic priest or chaplain is unable to administer the sacraments of Penance, Viaticum and Anointing of the Sick to a terminal patient who has definitively committed themselves to euthanasia, this does not mean that the Church has abandoned, or ‘wiped its hands of’ such patients. The priest or chaplain is strongly exhorted to accompany these patients right up to the time that the lethal dose is administered. He/she should return to recite Prayers for the Dead after death has supervened.
Nor should a Catholic funeral de denied for such patients, provided, of course, that this is not construed as acceptance of euthanasia. As the document concludes: the patient whose life has ended through euthanasia continues to be a son or daughter of the Heavenly Father, a brother or sister in Christ and a loved member of the Church who ought to be kept in our prayers seeking, through God’s infinite mercy, the repose of their soul.
Bill Uren, SJ, AO, is a Scholar-in-residence at Newman College at the University of Melbourne. A former Provincial Superior of the Australian and New Zealand Jesuits, he has lectured in moral philosophy and bioethics in universities in Melbourne, Brisbane and Perth and has served on the Australian Health Ethics Committee and many clinical and human research ethics committees in universities, hospitals and research centres.
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