Dealing With Death

Australian Bioethicist Reflects on Issues Involved

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By Father John Flynn, LC

ROME, MAY 4, 2012 (Zenit.org).- We will all die, and how we respond to illness and suffering says much about who we are, reflects Nicholas Tonti-Filippini in his recent book, “Caring for People Who are Sick or Dying,” (Connor Court Publishing).

Tonti-Filippini is the Associate Dean and Head of Bioethics at the John Paul II Institute for Marriage and Family, in Melbourne, Australia. He was Australia’s first hospital ethicist, 28 years ago, at St. Vincent’s Hospital, Melbourne.

Apart from his professional qualifications, he has first-hand experience, as someone who is terminally ill and who for many years has battled a variety of chronic health problems. In fact, the book contains a sprinkling of his own experiences as a hospital patient and how he lived first-hand the application, or lack of, bioethical principles.

In the first chapter of the book Tonti-Filippni discusses a number of general matters regarding the relationship between patients and the health care system. In one section he deals with the matter of health care principles as developed in Catholic tradition.

One of them, stewardship, originated in the Middle Ages and centers on the idea that humans are stewards, responsible for the care of their body. This is greatly different from a worldview that sees life as expendable if it loses its utility. The principle of the inviolability of human life is related to the first.

A third principle is that of totality, which sees each part of the body as existing for the good of the whole. According to this the lower functions of the body are never sacrificed except for the better functioning of the total person, and the fundamental faculties that essentially belong to being human are never sacrificed, except when necessary to save life.

Extraordinary care

The book’s second chapter deals with the various issues of care for those who are dying. The distinction between ordinary and extraordinary means in treatment dates back to the 16th century, Tonti-Filippini observes.

According to this, medical procedures that are disproportionately burdensome or disproportionate to the expected outcome can be discontinued. This is very different from suicide, which contradicts the natural inclination to preserve our lives.

One topic examined in the chapter is that of resuscitation orders. When a person is suffering from a serious disease an attempt to re-start a person’s heart if it fails is unlikely to succeed. Attempting to resuscitate every person would mean no one could die in peace, Tonti-Filippini explained. Resuscitation is also very intrusive and cardiac massage often breaks ribs, especially in the elderly.

The author says that among the factors to be taken into account in deciding whether or not to issue a “do not resuscitate order” are: the patient’s state of mind and any inclination to suicide, whether the patient has all the relevant medical information, and the judgment of the patient’s doctor.

On the matter of discontinuing food and water to patients Tonti-Filippini is of the view that a Catholic facility should do its best to persuade a person who is refusing nutrition and hydration in order to die to change their minds.

Turning to euthanasia, which is distinct from withholding a futile treatment, and which deliberately ends someone’s life by a fatal treatment, Tonti-Filippini observed that while we should indeed respect a person’s autonomy, taking one’s life ends any opportunity for autonomy in the future. Indeed, Immanuel Kant said that suicide was wrong because it involved treating oneself as an object or a means to an end.

Physician-assisted suicide also contradicts the role of a doctor in seeking to maintain life and health. If euthanasia were possible the focus would shift from palliative care to that of ending people’s live.

Not for nothing, Tonti-Filippini stated, have virtually all national medical organizations in the English-speaking world unequivocally rejected the practice of euthanasia and physician-assisted suicide as contrary to the ethos of medical care.

Respect for life

Responding to the criticism that the sacredness of human life is a religious belief that should not be reflected in civil law, Tonti-Filippini commented that the inviolability of human life is not only a religious notion, but is recognized in international human rights law.

When it comes to people who are in an unresponsive state, the respect for their lives remains intact because it is not based on the function they can or cannot carry out, but on who they are.

Proponents of euthanasia frequently argue that carefully drawn-up legislation will prevent any abuses and will limit the practice to those really in need. Tonti-Filippini pointed out that the experience in countries where euthanasia is legal demonstrates the contrary. There is indeed a “slippery slope” and moreover the will to live is likely to be affected by the option of euthanasia as some people will feel they should not be a burden on their families.

In other chapters Tonti-Filippini explores themes such as mental illness, suffering as seen from a Christian perspective, and what it means to live with chronic illness and pain. Overall, the book manages to combine in a very persuasive way ethical norms and Christian principles, illuminated by the very poignant personal experiences of the author.