The Franciscans of Life have as part of their foundational charism “paying special attention to…the chronically and terminally ill and their families and caregivers”.
In particular, we are called to”bring Christ’s compassion to the sick, especially those whose lives are threatened by the culture of death. We believe that death with true dignity occurs when man dies at the time and in the manner determined by Providence, not by man. To accelerate death in the name of dignity is a distortion of the meaning of dignity. It takes away from man what God has given him, the capacity to share in redemptive love. […] To help families and healthcare providers choose life, the brothers will work for the creation of education programs on end of life issues that proclaim the moral law and teach that the sick and elderly are not a problem to be solved, but brothers and sisters to be loved.”
Yet, “Recognizing that we are simple men, we do not aspire to do great things, but to be faithful in the small things”, with the Church and in submission to the Local Ordinary and the Magisterium of the Holy Father. This of course implies that we collaborate closely with other groups. First and foremost, of course, with Respect Life Ministry Archdiocese of Miami.
But we are also in fruitful exchange with other national and international groups that tackle the issue of euthanasia and assisted suicide.
One of our friends, indeed one of the most outspoken and reputable groups against assisted suicide, is the Euthanasia Prevention Coalition, headquartered in Canada. Their documentary “The Euthanasia Deception” is an eye-opener.
One of the traits of the Franciscan charism is the emphasis on “preaching and using words only when necessary” (a phrase attributed to St. Francis, but actually coming from the writings of Brother Thomas of Celano, his biographer). In general, Franciscans do not argue. Argument leads to division. Yet, instructing and correcting are some of the works of mercy that our Lord entrusted to his followers. Therefore the brothers’ formation includes an academic aspect, “without extinguishing the spirit of prayer”, as St. Francis wrote to St. Anthony of Padua. This formation implies that although the brothers may be men of silence, they are not rocks. And we know that sometimes it becomes necessary for rocks to cry out (cif. Luke 19:40).
Far be it for us to enter into a dispute with our esteemed friends of the EPC, or to argue with one of the world’s foremost critics of assisted suicide and utilitarian bioethics, Wesley Smith JD. Yet, this time we have to rise to the occasion for the sake of clarity and for the benefit of the voiceless.
Earlier this month, EPC featured an article from Dr. Smith titled “Removing life support is NOT euthanasia“. We must humbly observe that both the article and its title are incomplete and, unfortunately, problematic under several aspects.
First and foremost, the author zeroes in on a patient who wants to remove his ventilator and die for the sake of organ donation…thus falling into the fallacy of doing an evil to accomplish a good.
As the Catechism reminds us, “a good intention does not make intrinsically disordered behavior good. The end does not justify the means. A morally good act requires the goodness of the object, of the end, and of the circumstances together. An evil end corrupts the action, even if the object is good in itself. It is therefore an error to judge the morality of human acts by considering only the intention that inspires them or the circumstances which supply their context. There are acts which, in and of themselves, independently of circumstances and intentions, are always gravely illicit. One may not do evil so that good may result from it.”
Beyond this point (which we will address again later), the fundamental premise of the article is flawed, namely that “we all have the right to refuse medical interventions even if it is likely to lead to death“. On the contrary, we know that there are certain medical interventions that we are morally obliged to seek and provide! To do otherwise would constitute euthanasia.
The author pointedly mentions that the patient’s wish to remove his ventilator and die “is his right”. We respectfully disagree: there is no such a”right to die”.
As one renowned pro-life apologist states on Catholic Answers, “a right is a moral claim, and we have no claim on death — death has a claim on us. Some people see the “right to die” as a parallel to the right to life, but this is based on faulty reasoning. The right to life is based on life being a gift we can neither destroy nor discard, whereas the “right to die” is based on the idea that life is a thing we possess and may discard when it no longer meets our satisfaction.The culture of death, which chants, “My body, my life, my choice” also chants—by the same logic—”My body, my death, my choice.”
By skipping over some critical issues regarding end-of-life care and life-support, the article fails to grasp the fact that removing life support is too often the most common (and most hidden!) form of euthanasia, even though it may happen in plain light and with the full support of “the law”, as in the well-known case of Terri Schiavo and the less-known (but much closer to us) case of the sister of our Founder and Superior (see here, and follow-up article here).
But let us go back to the issue at hand: the removal of life support.
Too often, life support measures such as feeding tube, water, and oxygen are defined in the medical paperwork as “extraordinary means to prolong life” (or, worse, “to prolong the natural dying process”). When their removal causes death, it is a form of euthanasia. One quite common in Florida.
Ask yourself the following question: can we ordinarily live without food and water?
Yet, patients (especially elderly patients in hospitals, nursing homes, and hospices) are often asked if they want to “die a natural death” or “prolong the dying process through extraordinary means” (where food and water are defined as “extraordinary means to prolong life”!). The former (“die a natural death) appears to be the way to go, even for a well-formed Catholic…except that it actually gives the caretaker the ability to pull out your feeding tube and hydration. There is nothing natural in death by starvation and dehydration!
As St. John Paul II reminded us, Catholic bioethics and morality states that Artificial Nutrition and Hydration (ANH) “always represents a natural means of preserving life, not a medical act”. This applies also and especially to persons in persistent vegetative state (PVS). The CDF clarified that the only three moral exceptions are “(1) when ANH would be impossible to provide; (2) when a patient may be unable to assimilate food and liquids; and (3) when ANH may be excessively burdensome for the patient or may cause significant physical discomfort”.
The National Catholic Bioethics Center reminds us that “We should provide food and water, even by [alternative] means, to all who are in need of them and can physiologically benefit from them. There are various means of providing nutrition and hydration, some of which are more invasive than others. The least invasive means of providing food and water should be used. The more burdensome to the patient a particular intervention, the less likely it is to be morally obligatory. In principle, the provision of nutrition and hydration by artificial means does not differ in its moral dimension from the provision of food and water by fork and cup. Both constitute ordinary means of preserving life. The fact that someone is in a state of unconsciousness and is not expected to recover [does not justify] depriving that person of food and water. If the provision of food and water proves to be useless (if they are not being assimilated by the body) or if it causes serious complications (aspiration pneumonia, infections, etc.), it can be stopped. ”
In short: “Whenever a recommendation is made not to provide food and water, one question to ask is “What will be the cause of death?” If the answer is dehydration and starvation, and artificial nutrition and hydration can be easily supplied and assimilated, then not supplying them is a form of euthanasia.”
The Catholic Medical Association also agrees that “discontinuing nutrition and hydration for a patient who is not imminently dying violates in its intention the distinction between ‘causing death’ and ‘allowing death.’”
Now let’s go back to the ventilator issue addressed in the article. A ventilator is a machine for artificial respiration.
Can we ordinarily live without oxygen?
Neuroscientist Fr. Pacholczyk, Ph.D. (National Catholic Bioethics Center) explains that “ordinarily, a ventilator offers a reasonable hope of benefit for the patient that can be obtained and used without excessive pain, expense, or other significant burden. Ordinary implies a moral obligation.”
However “if the patient’s condition is worsening with the nearly certain outcome that he will die in a few hours or days, then ventilation would be “extraordinary”, assuming all end-of-life matters have been taken care of. It may be decided that the use of a ventilator becomes extraordinary or disproportionate because it no longer achieves its perceived outcome. Withdrawing the ventilator would not be an act of euthanasia, because the patient would be dying due to the underlying condition. Yet, occasionally, ventilators may end up being part of a long-term solution.”
It is unclear from Dr. Smith’s article whether the patient who generously wishes to donate his organs is in a position to request in good conscience the removal of his ventilator. We are only told that the patient is “dying of ALS (Amyotrophic Lateral Sclerosis)”, which can have multiple interpretations. One of the question on the table (and our friends at the National Catholic Bioethics Center are much more qualified to answer it) is whether, upon removal of the ventilator, the patient would die as a result of the ALS (allowing death) or as a result of suffocation (causing death). Another question is whether the ventilator is excessively burdensome on the patient. In any case, the bottom line is the distinction between ordinary and extraordinary means of supporting life. Sorry, it is not as simple as “it’s his right” to remove the ventilator; nobody has an a priori right to die.
We could address DNR, dialysis, chemotherapy, radiotherapy, invasive surgery, heart-lung resuscitation, and antibiotics, and when they may be judged morally extraordinary or disproportionate. But this is beyond the scope of this article.
We do hope that we have clarified the main topic: more often than not, removing life support IS euthanasia, when we look carefully at the whole picture. Only then we realize that most of the time such life support is ordinary, beneficial…and morally binding.
For those who wish to learn more, the Franciscans of Life are always available to provide more information. You can touch base with us here. You may also want to learn more about Living Will and Advanced Medical Directives that can protect you and your loved ones from the dangers of “hidden euthanasia”. The page of the Florida Conference of Catholic Bishops (FLACCB) provides them in English and Spanish. Again, we are here to point you in the right direction, whether you are a patient, a family member, an inquirer, or a healthcare practitioner, physician, or nurse.
Vita ad vitam vocat – Life calls out to life.
Please note: the contents of this article do not constitute medical or legal advice. When it comes to end-of-life decisions, you should consult with your pro-life physician, spiritual director, confessor, chaplain, or another highly qualified authority such as the experts of the National Catholic Bioethics Center by calling their 24/7 hotline (215) 877-2660 (select Option 4 if urgent) or by submitting an online request.
Br. Bernardo, FFV