Every human being comes up against the questions of suffering and death. These questions are dramatic at their core, but they have been further complicated by our medical technologies that allow for a greater care, but also a greater manipulation, of human life. In 1995, Pope John Paul II issued the encyclical Evangelium Vitae (The Gospel of Life) to “reaffirm with the authority of the Successor of Peter the value of human life and its inviolability, in the light of present circumstances and attacks threatening it today” (EV, 5). This encyclical remains a touchstone in terms of the Church’s pastoral role as the great protector of human life, but also in doctrinal terms of answering the theological-philosophical question of what human life is.

Here we are able to hear from two theologians specializing in bioethics, Lesley Rice (professor at the Pontifical John Paul II Institute in Washington, D.C) and Julia Palmieri (sessional instructor at St. Augustine’s Seminary in Toronto, Canada), who help us to look at the specific topic of euthanasia and introduce us to the core themes of Evangelium Vitae.

What is the distinction between euthanasia and physician assisted suicide?

Julia: The two key aspects that define an act of euthanasia are i) death is directly caused and ii) death is directly intended. Euthanasia is defined by the Church as “an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated,” in the 1980 Declaration on Euthanasia by the Congregation of the Doctrine of the Faith (Iura et Bona).

Lesley: In common parlance, euthanasia means something that is done to a suffering person, while physician-assisted suicide is done by the suffering person, enabled by medical professionals and, in a growing number of jurisdictions, with the sanction of the law. One significant difference is that anyone can perform an act of euthanasia (this could be a medical professional, but it could also be a friend or family member), while legalized physician-assisted suicide essentially involves the medical profession and thus, I would say, perverts the work of healing as well as the meaning of law. In both euthanasia and PAS, the person dies as a result of human initiative rather than a natural cause. Choosing to end a life, whether one’s own or someone else’s, is a grave offense against the dignity of human life, and so both euthanasia and physician-assisted suicide are always wrong. It is true that the one who commits these acts might be motivated by sincere empathy or by the desire to end one’s own severe suffering, and the Church in fact acknowledges that in certain cases the guilt of the perpetrator may be reduced or absent. But the fact remains that we never have the authority to put an end to our own life or the life of an innocent person. This authority belongs to God. Our task is to find ways to help one another to bear the sufferings that befall us.

What, then, is the difference between euthanasia and the licit withdrawal of medical treatment?

Lesley: Euthanasia is ending someone’s life by acting or failing to act, with the motive of eliminating suffering. The Church says that we may never do this. However, the fact that we may not end a life does not mean that we are obligated to pursue every medical treatment to preserve or prolong life. On the one hand, life is a fundamental good. It is a gift from God and all of his other gifts depend on it. On the other hand, our life on earth is not the ultimate good. Our life here is oriented to fulfillment with God in eternity. We are not meant to be anxious about preserving our temporal existence at all costs. Instead, we must learn to accept that death is a reality that each of us must face eventually. We have a duty to take care of our life, and our health, as something entrusted to us by God. This means that we need to seek and offer what is referred to as “ordinary” care — means of care that offer reasonable hope of benefit without imposing excessive burdens or expenses — regardless of the particular circumstances or prognosis. These are basic ways of showing love and respect to a suffering person. But this basic obligation does not mean that we need to pursue every available medical remedy. We are permitted to refuse or to withdraw medical treatment that is “extraordinary,” that is, means of care that are less certain to be beneficial, or involve significant pain or great effort, or impose serious financial burdens. These kinds of questions are matters of prudence and involve taking into account all the circumstances in which the patient finds himself: his medical prognosis, the price and burdens of treatment, his obligations to his family, and so on.

Julia: Yes. It is important to understand that the removal or withdrawing of treatment is not an act of killing if the treatment has become disproportionate to the patient’s condition. Why? A therapeutic treatment is intended to restore a patient’s health and/or save their life, but there comes a time when the treatment only serves to stave off death. When therapeutic treatment can no longer serve the goal of health/life, it becomes disproportionate to the patient’s condition. Continuing treatment that no longer serves the intended goal of restoring health or saving one’s life can lead to what Samaritanus Bonus refers to as the artificial delaying of death. It can be extremely hard for a family to make the decision to cease treatments for their loved one and to “let go.” However, discontinuing treatment does not mean suspending care nor does it mean abandoning the patient to their pain. Of particular necessity is the provision of nutrition and hydration to a patient. We are morally obligated to continue to provide food and water to someone who is sick and/or dying, unless their body is no longer able to receive it.

Euthanasia and Physician-Assisted Suicide are desired as a way out of the suffering that accompanies dying. What can be said about this?

Julia: The media portrays physician-assisted suicide (known in Canada as “Medical Aid In Dying”) as a “care option” that can treat pain and suffering. It can be seen as an enticing portrayal that offers the dying person relief from suffering, and relief from being a financial or emotional burden to their family. But a “painless” death by lethal injection does not treat pain and suffering: it eliminates the person, and leaves deep ramifications for those left behind. There needs to be more said about the nature of suffering in order to understand what it is, and how we ought to respond to it, and this is something the Church helps us understand.

Lesley: Christians view death in a distinctive way. On the one hand, we know it to be a truly alienating reality, a punishment for sin that bespeaks the disruption of our relationship with God. On the other hand, death is also an experience into which the Son of God has preceded us and which he has ultimately destroyed. Although we all must pass through death, it does not have definitive power over us because of the grace of the Resurrection. This means we can approach death not only with trepidation, which is natural, but also with hope of “sons in the Son” — the hope of people learning to say, “Into your hands, I commend my spirit.” The Church, in fact, invites us to practice saying this every night at Compline. Without faith in this defining relationship to God the Father, though, death appears to be a definitive end, something we would want to defer at all costs. And our medical system has become so powerful in certain respects that even Christians can get into a mindset of wanting to stave off and control death as far as possible. We need to examine this mindset with the eyes of faith.

In the face of suffering, "compassion" is a word used by people for and against euthanasia/PAS. What is the Church's understanding of compassion and how does it respond to suffering and death?

Lesley: True compassion means to “suffer with,” to join the person in his or her suffering. It is helpful to think of Mary at the foot of the Cross. At other moments in her life with her Son, she was called to give him practical help, to look after his needs. This is often our call as well, relative to our loved ones. But at the Cross, at the culmination of Christ’s earthly life, in a moment of the utmost suffering, Mary’s task was only to stay with him. She was not among those who encouraged Jesus to save himself and demonstrate his power by coming down from the Cross (Mark 15:30). It was simply by being present that she helped him bring his saving work to completion. Fr. Vincent Nagle, F.S.C.B., says something very interesting in his beautiful book Life Promises Life: Pages from the Diary of a Hospital Chaplain: God doesn’t always take our sufferings away, even though we sometimes desire this, because he loves us and wants us to fulfill our vocation. We each have a part to play in the work of redemption. This inevitably involves suffering, and our compassion for one another needs to be shaped from the inside out by our desire to strengthen our loved ones to complete their task on earth. This we can do in very simple ways, even by our mere presence. Certainly, there are some problems that we can and should solve, and some sufferings that can and should be alleviated. But the mystery of suffering is at the heart of human existence before God in a fallen world, and we can’t imagine that compassion means eliminating this mystery by our own power.

Julia: John Paul II says that “true ‘compassion’ leads to sharing another's pain; it does not kill the person whose suffering we cannot bear,” (EV, 66). His point is that it is utterly false to call euthanasia an act of compassion or mercy. This can seem backwards to society because it considers physician-assisted suicide to be a good option — even a right — for someone in pain; however, this view deeply misunderstands the purpose of medicine and denies that there can be any meaning in suffering or pain. But a person cannot be left alone in their suffering. When pain and suffering are “experienced in close connection with love received and given,” as John Paul II put it, then a person can be helped to discover the value or meaning contained in their circumstances (EV, 97). This is the tragic dilemma of our society, as I see it: people are left alone in their suffering.

Evangelium Vitae asks, "Why is life good?" What can we answer? In light of all the suffering we see and experience, why is life good?

Lesley: There are times when the goodness of life is just evident. When we are enjoying the company of people we love, or exploring a beautiful place, or finding fulfillment in our work, we are caught up in the goodness of life, and we don’t think about asking “why?”. The question comes up when life doesn’t deliver what we were hoping for, or does deliver something that is hard to bear. Then we have to ask for the courage and grace to trust that even now God is providing for us, and to look for the beauty that is hidden in our situation, perhaps precisely in the aspect where goodness and beauty seem most contradicted. Cardinal Ratzinger’s 2002 message to the Meeting in Rimini teaches us how central this is to Christianity. And David Brooks’ recent article in The Atlantic gives a beautiful account of the surprising goodness that came out of a man’s final illness. Brooks acknowledges that this illness was difficult and burdensome for his adult children, who were not particularly close to one another at the time. Brooks writes, “His care became a burden they all shared, and that shared burden brought them closer. Their father died but their closeness remains. Their father bestowed many gifts upon his children, but the final one was the gift of being a burden on his family.” These moments of dependence, especially at the end of life, can be humbling and intimidating, both for the one suffering and for the one offering care. We can’t idealize this. But these moments also reveal what is most true about us: that we are not our own, that we are our brother’s keepers, that this world is not our final destiny. As John Paul II says in Salvifici Doloris, situations of suffering unleash greater love into the world. And love is the heart of life’s goodness.

Julia: John Paul II begins Evangelium Vitae by explaining that the first, crucial message concerning the value of life is that we are made to share in the very life of God. It is for this reason that human life is good, no matter how short or long, healthy or unhealthy. We are called to a fullness of life that exceeds the dimensions of earthly existence, and this is why human life is fundamentally good. Although our earthly existence is only a “penultimate” reality because it is not our final home, it is still a sacred reality, because it is by way of our earthly life that we receive the gift of everlasting life.

Are there any last things you would like to share with us?

Lesley: Our conversation reminds me of the apse mosaic of the church San Clemente in Rome, in which the great paradox of Christianity is vividly represented: the Cross, the instrument of Christ’s painful death, is shown as the Tree of Life in the garden of Eden, from which we were banished when death first entered the world through our sin. From the Cross, a mighty vine curls throughout the whole apse, sheltering every form of living thing. The pain of the Cross is real, but it is also fruitful. “All things work for good for those who love God, who are called according to his purpose” (Romans 8:28). Joseph Ratzinger wrote a beautiful commentary on this apse in which he says “The descent of God’s goodness brings the whole tree, with all of its branches, into the ascent of the Son.[...] The descending Cross is […] the fishhook of God, with which he reels up the entire world to his height. No longer circling but ascent is now the direction of history and human life. Life has received a destination; it goes with Christ to the hands of God.” The saints give witness to the mystery of the Cross in our own lives and its relevance to our own sufferings. Servant of God Chiara Corbella Petrillo is a powerful witness in our own day of trust that God’s plan for us is loving and meaningful, and that it is possible to find joy in surrendering to His design even amid tremendous pain and heartache. The monastic life, which as a whole can be thought of as a preparation for death, also offers a great testimony about how to live the sufferings of earthly life from a truly Christian vantage point; Nicolas Diat’s recent book A Time to Die: Monk’s on the Threshold of Eternal Life gives us much to ponder in this regard. An article by my friend Ruth Ashfield, who was a hospice nurse and is now a Sister of Life, is another source for reflecting on the privileged work of accompanying the dying.

Julia: Samaritanus Bonus says that everyone who cares for someone who is sick or suffering has “the moral responsibility to apprehend the fundamental and inalienable good that is the human person.” This can be incredibly difficult to do in front of the extreme ugliness of pain or despair. It is for this reason that we have to redouble our efforts, so to speak, in cultivating what John Paul II called the “contemplative outlook,” which he explains as: “the outlook of those who see life in its deeper meaning, who grasp its utter gratuitousness, its beauty and its invitation to freedom and responsibility. It is the outlook of those who do not presume to take possession of reality, but instead accept it as a gift, discovering in all things the reflection of the Creator and seeing in every person his living image. This outlook does not give in to discouragement when confronted by those who are sick, suffering, outcast or at death's door. Instead, in all these situations it feels challenged to find meaning, and precisely in these circumstances it is open to perceiving in the face of every person a call to encounter, dialogue and solidarity” (EV, 83).