DIFFICULT MORAL QUESTIONS

Question 45: Will one spouse’s rejection of euthanasia for the other violate the Golden Rule?

You may be surprised to receive this letter from the Netherlands. A law student—a real Catholic—who met you last year is helping me write it. He will send it from his computer, and I hope you will be able to answer quickly.

My husband, Pieter, is sixty-three. Five months ago he had a stroke. At first it did not seem so bad, and we hoped he would even be able to walk. But three weeks later it happened again, and the damage was more severe. Pieter probably will never be able to walk and can use only his left hand. Still, after six more weeks I was able to bring him home.

With a nurse who comes for the day, I can care for Pieter. Though he cannot speak well, he has some words. We understand each other, and he prays with me. But taking care of him is not easy. He knows it, and during the first month or so at home he was very sad. He was sorry to be such a burden to me and wished he had died in the hospital.

For more than a month now Pieter has had a cough. Dr. Klaussen has come every week, but the cough is not getting better. He says it is not yet pneumonia but probably will come to that. Yesterday the doctor asked me to step outside, and he talked about euthanasia. He told me one need no longer have any qualms about it, that it is perfectly legal. He wants to do it, and seems to want my consent. He said “it is the right time for us to help Pieter be released from his useless body.”

That upset me. This morning I went to talk about it with the pastoral worker who brings Communion. I thought she was a real Catholic, because she does everything just as it is in the book, and earlier she encouraged Pieter when he was sad.

I told the pastoral worker I do not think it would be right for me to agree with the doctor to kill Pieter. She said Dr. Klaussen is a good physician, and I should go along with what he thinks best. I questioned that, and she pointed out that we Catholics believe “life is changed, not ended” at death, and that St. Paul says “we would rather be away from the body and at home with the Lord” (2 Cor 5.8). She also asked me: “Would you want to be in your husband’s condition?” I said no. But if I make Pieter go on as he is, she said, I will be making him be as I do not want to be myself, and that would be against the Lord’s word, “Do to others . . ..” I wondered if we should ask Pieter what he wants. She said no; that would upset him uselessly and put too much of a burden on him.

I am not sure what to say to Dr. Klaussen next week when he comes. I still do not want to have him kill Pieter. But neither do I want to go against the Lord’s word.

Analysis:

This question concerns the proper application of the Golden Rule. Since it is a moral principle for evaluating one’s actions affecting others, not for evaluating their situations or conditions, the relevant issue is whether the questioner would want euthanasia. That killing would be wrong, however, and she should not want it for herself. Even if she did, the Golden Rule would not justify killing her husband—which she rightly does not want done. The response should include a refutation of the pastoral worker’s unsound arguments. The doctor may be a technically good physician, but his training and expertise lend no authority to his judgments about killing, since killing not only is wrong in itself but outside medical competence. The legalization of euthanasia does not affect its intrinsic immorality. Asking a person whether he or she wanted euthanasia would be scandalous in the strict sense.

The reply could be along the following lines:

The Lord’s word mentioned by the pastoral worker, which often is called the Golden Rule, is: “Do to others as you would have them do to you” (Mt 7.12, Lk 6.31). This principle concerns what one does and what one would have others do, not people’s situations or conditions and whether one would want to be in them. So, the pastoral worker’s question, “Would you want to be in your husband’s condition,” was misleading. Nobody wants to be severely handicapped, but that does not imply everyone should help do away with those who are.¹⁴⁷

The pastoral worker’s question would not have been misleading had she straightforwardly asked: “If you were in your husband’s condition, would you want to be killed?” Not thinking that right, you would have said no. Then it would have been clear that you will not violate the Golden Rule by rejecting Dr. Klaussen’s proposal to kill Pieter. Thus, the pastoral worker’s argument that you should consent was fallacious. She assumed that euthanasia is morally acceptable, which was the precise point at issue.

Even if you agreed that you would want to be killed if you were handicapped as Pieter is, you would not be bound by the Lord’s word to consent to euthanasia for him. The Golden Rule assumes that those to whom it is addressed act rightly toward themselves, so that they would not have anyone do anything to them against any of the Lord’s words. But choosing to kill an innocent person or consenting to another’s proposal to do so, even as a means of ending the person’s suffering, is against God’s commandment, “You shall not kill,” which Jesus reaffirmed and the Church has held and taught constantly and most firmly.¹⁴⁸ Nobody violates the Golden Rule by refusing to consent to euthanasia, and, indeed, anyone who consents to it violates the Golden Rule.

The pastoral worker’s argument also was fallacious in supposing that, if you do not consent to euthanasia, you will “make Pieter go on as he is.” That implies you would be at fault for not ending his suffering. But that would be true only if your refusal of consent were a wrongful omission—that is, if you had an obligation to consent to euthanasia to end Pieter’s suffering and failed to fulfill it. Thus, once again, the pastoral worker’s argument assumed what it was meant to prove.

Moreover, though killing your husband would end the suffering he experiences due to the damage from the strokes, Dr. Klaussen erred in saying euthanasia would “help Pieter be released from his useless body.” That supposes a person is some sort of spiritual being who only has and uses his or her body, so that death can be liberation, a good and great benefit to the person. But the human person is a bodily being, for whom death cannot be a benefit.¹⁴⁹ As St. Paul teaches, death will remain a great evil until the end of time: “The last enemy to be destroyed is death” (1 Cor 15.26).

Of course, we also believe that the soul, the spiritual part of the person, survives death. But the separated soul is not the whole person, as St. Thomas says in explaining the need for bodily resurrection: “Now, since the soul is part of the human body, it is not the entire human being, and my soul is not I. So, even if the soul reached salvation in another life, neither I nor any human being would thereby do so.”¹⁵⁰ Though ending Pieter’s life would end his suffering and his soul would survive, only God’s gift of resurrection life will release Pieter himself not only from all suffering but from the far greater evil of death.

The phrase “life is changed, not ended” expresses a truth of Christian faith, but it does not support the view that the person is a spiritual being who is liberated by death. Rather, it expresses Christian hope in bodily resurrection, which overcomes the evil of death by restoring the bodily person to a better, an immortal life:

In him, who rose from the dead, our hope of resurrection dawned.
The sadness of death gives way to the bright promise of immortality.
Lord, for your faithful people life is changed, not ended.
When the body of our earthly dwelling lies in death
we gain an everlasting dwelling place in heaven.¹⁵¹

 For we know that if the earthly tent we live in is destroyed, we have a building from God, a house not made with hands, eternal in the heavens. For in this tent we groan, longing to be clothed with our heavenly dwelling—if indeed, when we have taken it off we will not be found naked. For while we are still in this tent, we groan under our burden, because we wish not to be unclothed but to be further clothed, so that what is mortal may be swallowed up by life. (2 Cor 5.1–4)

Dr. Klaussen may be a capable physician. But perhaps, thinking euthanasia will solve the problem, he is failing to treat Pieter’s cough as vigorously as he might. Even if he is not falling short in that respect, physicians’ judgments are authoritative only on matters within their competence, which is to sustain life and promote health. Killing obviously does neither. So, even if euthanasia were morally permissible, a decision about it would be beyond Dr. Klaussen’s competence. Moreover, his technical capabilities as a physician do not lend authority to his moral judgments. The legalization of euthanasia, to which he appeals, in no way eliminates or lessens its intrinsic immorality.¹⁵² Therefore, the pastoral worker also is mistaken in supposing you “should go along with what he thinks best.”

Now that he wishes to kill Pieter, Dr. Klaussen is a threat to his life, and no longer a good physician for him. A good physician cooperates with patients in protecting and promoting life and health, and always limits what he or she does by each patient’s judgment as to what is acceptable. By contrast, Dr. Klaussen is prepared to kill your husband without his consent. If possible, then, keep the doctor from getting near him again, just as you would keep any other would-be killer away. Besides, if Dr. Klaussen is not providing the care Pieter needs, it would be appropriate to replace him with someone who would vigorously treat the cough and possible pneumonia. So, if you can, and even at the cost of considerable inconvenience and expense, you ought to replace this dangerous person with a competent physician who absolutely excludes euthanasia.

But perhaps you have no alternative to accepting Dr. Klaussen’s medical service. In that case, make it very clear to him that you reject his offer of euthanasia as a proposal to kill your husband and try to elicit his promise not to carry it out. But do not rely on that promise. Someone willing to kill is likely to be willing to lie. Closely watch anything he does and check out anything he prescribes as carefully as you can.

Ironically, the pastoral worker was right about one thing: You should not ask your husband what he wants with regard to euthanasia. Severely handicapped and suffering, he might well consider euthanasia and be tempted to request it, so that asking him what he wants would be scandalous in the strict sense—it would gravely risk leading him into temptation and sin (see LCL, 232–39). Moreover, raising the question would suggest you are willing to have him killed, and he might interpret that as an indication that you no longer are unconditionally committed to him as a faithful wife should be, but have come to regard him as a problem to be solved, a burden to be got rid of.

Still, if you cannot replace Dr. Klaussen, it might be appropriate—only you can judge—to warn Pieter that the doctor proposed euthanasia, tell him you absolutely rejected that proposal and will never consent to it, and urge him to tell the doctor something like: I want God, not you, to decide when it is time for me to die; please do not take it upon yourself to murder me.

You also probably should seek better pastoral care for Pieter. Since the pastoral worker supports killing him, she may urge him to consider and request euthanasia. Even if she does not, her acceptance of euthanasia is likely to prevent her from providing him with the spiritual support he needs to persevere in faith and hope despite his hardships. But if you cannot arrange for a more faithful person to replace her, do not leave Pieter alone with her unless he requests it.

Finally, I would like to make a suggestion that goes beyond your question. You say taking care of Pieter is not easy, and probably it will become harder as time goes by. You also say he was sorry to be a burden to you and wished he had died in the hospital. Even if that feeling and wish have subsided, they are likely to return. But you and Pieter can still communicate with each other and pray together. I suggest that, in your prayers, you meditate on the fact that our Lord Jesus suffered for us.

This for us is mysterious and rich in meaning, but at least partly it means this: Jesus accepted suffering and death because only in them could he love us as fully as a man can love his brothers and sisters, only by them could he draw us most strongly to himself, and only through them could he reach the glory of his resurrection and bring us, if we but follow him, to share in that glory. The situation in which you and Pieter find yourselves inevitably seems a burden to be resented, and by no means a blessing to be welcomed. But perhaps you already realize that, in allowing both of you to suffer, God is calling you to love each other more perfectly and become more intimate with his Son. Try to accept your hard situation, and encourage Pieter to accept it, as an opportunity to bear witness to your faith and hope, to grow in love and holiness, and to merit for yourselves unending life together in heaven. With that acceptance, the miserable burden, no longer only yours but also Jesus’, will, as he promised, become light for you, strengthened by the power that raised him to heavenly glory.

147. For an argument against legalizing euthanasia, see Germain Grisez and Joseph M. Boyle, Jr., Life and Death with Liberty and Justice: A Contribution to the Euthanasia Debate (Notre Dame, Ind.: University of Notre Dame Press, 1979), 86–250. Also see The New York State Task Force on Life and the Law, When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context (New York, N.Y.: May 1994); this body made a careful study and, despite the great diversity of its members, reached a unanimous and cogently argued conclusion against legalization. Michael Burleigh, Death and Deliverance: ‘Euthanasia’ in Germany, c. 1900–1945 (Cambridge, England: Cambridge University Press, 1994), provides an unbiased history of euthanasia in Germany under the Nazi regime; despite the unique features of that history, Burleigh’s account helps clarify various aspects of the mentality and arguments of those who now favor euthanasia.

148. Ex 20.13, Dt 5.17, Mt 19.18, Mk 10.19, Lk 18.20; cf. CCC, 2268, 2276–83; John Paul II, Veritatis splendor, 6, 13, 15, 17, 52, AAS 85 (1993) 1138, 1143, 1145, 1147, 1175–76, OR, 6 Oct. 1993, ii, iii, viii; Evangelium vitae, 64–67, AAS 87 (1995) 474–80, OR, 5 Apr. 1995, xii–xiii. Also see, LCL, 459–88; Luke Gormally, ed., Euthanasia, Clinical Practice and the Law (London: The Linacre Centre, 1994), 37–58, 118–33.

149. See CCC, 362–65; John Finnis, Joseph M. Boyle, Jr., and Germain Grisez, Nuclear Deterrence, Morality and Realism (Oxford: Oxford University Press, 1987), 304–9; Patrick Lee, “Human Beings Are Animals,” in Natural Law and Moral Inquiry: Ethics, Metaphysics, and Politics in the Thought of Germain Grisez, ed. Robert P. George, forthcoming.

150. St. Thomas, Super primam epistolam ad Corinthios lectura, commenting on 1 Cor 15.19; see LCL, 464–67.

151. The Roman Missal: The Sacramentary, Preface of Christian Death I.

152. Strictly speaking, euthanasia has not been legalized in the Netherlands. However, court decisions and governmental actions have generated a state of affairs in which physicians are not punished for killing patients even without their consent. Drawing on a Dutch governmental report (the Remmelink Report) of 1991, Richard Fenigsen, “Euthanasia in the Netherlands,” in Encyclopedia of U.S. Biomedical Policy, ed. Robert H. Blank and Janna C. Merrick (Westport, Conn.: Greenwood Press, 1996), 72–76, states that in 1990 the rule that active euthanasia can only be carried out at the request of the patient was followed in 5,859 cases and disregarded in 5,941 cases; when patients’ lives were terminated without their request, consultations with other doctors were omitted in 52% of the cases and except in one case doctors did not state the truth in the death certificate. John Keown, “Further Reflections on Euthanasia in The Netherlands in the Light of The Remmelink Report and The Van Der Maas Survey,” in Gormally, ed., op. cit., 219–40, analyzes the same document in greater detail, but comes (236) to essentially the same conclusion: “Doctors have killed with impunity. And on a scale previously only guessed at: the Survey discloses that it was the primary purpose of doctors to shorten the lives of over 10,000 patients in 1990, the majority without the patient’s explicit request.” Herbert Hendin, Seduced by Death: Doctors, Patients, and the Dutch Cure (New York: W. W. Norton, 1997), 21–134, provides evidence, including detailed reports of interviews with leading Dutch advocates and practictioners of euthanasia, supporting Fenigsen’s and Keown’s analyses and revealing the disingenuousness of attempts to explain away the facts.