U.S. Catholic Bishops Misunderstand Our Death-with-Dignity Laws

Meeting in Bellevue, the bishops take a firmer line on physician-assisted aid-in-dying laws and make allegations about abuses that are not supported by the experience in Oregon and Washington
The Lund Report

July 7, 2011 -- The U.S. Conference of Catholic Bishops’ policy on physician-assisted suicide approved on June 16 is the latest move by Roman Catholic leaders to intervene in Americans’ personal health care decisions.

The eight-page policy, which the bishops passed 191-1 at their annual spring meeting in Bellevue, Wa., is full of inaccurate and misleading statements about the Death with Dignity laws in Washington and Oregon and the policy positions of the laws’ supporters. It ignores 14 years of experience in Oregon and two years in Washington. The head of Compassion & Choices, the main group supporting those laws, rightly criticized the policy statement as “full of reckless, unsubstantiated accusations.”

The bishops’ statement warns that the voter-approved Death with Dignity laws -- which allow terminally ill, mentally competent adult patients to receive medications from their doctor to end their lives – essentially legalize murder. And it makes the stunning claim that U.S. leaders of the Death with Dignity movement advocate ending the lives of people who have not sought help in dying.

“A society that devalues some people’s lives, by hastening and facilitating their deaths, will ultimately lose respect for their other rights and freedoms,” the bishops said. “Taking life in the name of compassion also invites a slippery slope toward ending the lives of people with non-terminal conditions.”

The new policy, “To Live Each Day with Dignity,” is the U.S. church’s first official policy on aid-in-dying, which also is legal in Montana under a 2009 Montana Supreme Court ruling. The policy follows increasingly aggressive efforts by the bishops to require Catholic health care facilities and providers to insert and maintain feeding and hydration tubes in terminally ill patients -- even those who have written advance directives stating they don’t want them.

The bishops also have cracked down on Catholic hospitals that performed tube-tying operations for women who are not going to have more babies. Last year, a bishop expelled St. Charles Medical Center in Bend, Ore., a century-old hospital founded by nuns, from his diocese for refusing to stop performing tubal ligations. These policies matter because the bishops oversee more than 600 Catholic hospitals and the hundreds of Catholic nursing homes, assisted living centers, and hospices.

Even Catholic ethicists and administrators in Catholic health facilities have expressed concerns about the bishops’ aggressive new mandates. One worried Catholic hospital administrator who didn’t want to be named criticized the bishops’ 2009 ethical and religious directive requiring Catholic health facilities to provide feeding and hydration tubes to patients with chronic and irreversible conditions -- including persistent vegetative state, massive stroke, and advanced Alzheimer’s disease. The administrator told me the directive is a “slippery slope” that could lead to widening disregard for patients’ end-of-life wishes.

But there is growing pressure on everyone within the Catholic establishment to hew to the party line. A new article in Crisis Magazine by Cardinal Newman Society president Patrick J. Reilly called out prominent theologians at four major Jesuit universities who have supported the physician-assisted suicide movement (http://www.crisismagazine.com/2011/bishops-betrayed-on-assisted-suicide). These professors “have done more than betray the Catholic Church,” Reilly wrote. “When professors deny the truths of faith and disregard the common good – especially of those whose lives are snuffed out prematurely – they violate the mission of a Catholic university.”

Barbara Coombs Lee, president of Compassion & Choices, a national group that supports and monitors patients using the Death with Dignity laws, blasted the bishops’ statement on physician-assisted suicide and what she called the church’s McCarthyesque attack on Catholic dissenters. “It’s one thing to state your position based on your religious beliefs, and quite another to falsify, bully, sanction, lobby and impose that religious belief on others,” she said in a written statement. “The bishops misstate our work, our beliefs, our mission and 14 years of Oregon experience with aid in dying. That experience shows better end-of-life care, more choice and more peaceful deaths.”

The bishops’ statement on physician-assisted suicide claims leaders of the aid-in-dying movement support “ending the lives of people who never asked for death, whose lives they see as meaningless or as a costly burden on the community.” But the Washington and Oregon laws spearheaded by Compassion & Choices set out a detailed procedure allowing only terminally ill patients to ask a physician to prescribe the lethal medication; that doctor and a second doctor independently determine whether the patient likely has less than six months to live, is mentally competent, and made the request voluntarily.

At a June 15 news conference in Seattle, Coombs Lee stressed that Compassion & Choices opposes providing aid-in-dying to anyone who doesn’t meet the legal criteria. “A bright line separates assisting suicide, which is a felony, from the medical practice of aid in dying,” she said. “To blur that line does a grave disservice to terminally ill patients.”

The bishops also claim that people with chronic illnesses or disabilities which are life-threatening only if they don’t receive treatment could qualify for lethal prescriptions under the Death with Dignity laws. “Thus the bias of many able-bodied people against the value of life for someone with an illness or disability is embodied in official policy,” they said.

There’s no evidence for that. The Oregon and Washington laws define a qualifying terminal disease as “incurable and irreversible.” Dr. Tom Preston, medical director of Compassion & Choices of Washington, said Compassion & Choices would never consider working with patients whose condition could be reversed or effectively treated except to advise them they didn’t qualify under the law.

Another unfounded argument by the bishops is that offering terminally ill patients the option of assisted suicide undermines effective pain management and palliative and hospice care. In fact, studies show that the overall use of hospice care increased in Oregon to one of the highest rates in the country after the Death with Dignity law took effect in 1998. In Washington and Oregon, more than 80 percent of patients who received lethal prescriptions and died in 2010 were enrolled in hospice -- far higher than hospice participation rates nationally. “We insist on good comfort care,” Preston said.

The bishops also contend that terminally ill people seeking aid in dying commonly suffer from mental illness, such as depression, and that Death with Dignity laws and proposals ignore this issue. “Even a finding of mental illness or depression does not necessarily prevent prescribing the [lethal] drugs,” they said.

Supporters of aid in dying do worry about clinically depressed patients receiving lethal prescriptions. But Dr. Linda Ganzini, a psychiatrist at Oregon Health & Science University who has consulted on dozens of Death with Dignity cases and has studied the issue, told me her experience is that most people who want assisted suicide do not have depression or another mental health condition that would affect their decision. And if either of the two physicians who independently evaluates each patient’s eligibility thinks there is a possible mental health issue, that doctor must order a psychological evaluation. Under the Oregon and Washington laws, patients cannot receive a lethal prescription if their judgment is found to be impaired.

Finally, the bishops argue that dying patients’ pain can be alleviated through competent medical care, freeing them to focus on “the unfinished business of their lives, to arrive at a sense of peace with God, with loved ones, and with themselves.” In contrast, they said, assisted suicide “results in suffering for those left behind – grieving families and friends, and other vulnerable people who may be influenced by this event to see death as an escape.”

But Tony Rizzo of Puyallup, a self-identified Roman Catholic, said he “respectfully disagrees” with the bishops based on his and his wife Joyce’s experience at the end of her three-year battle with cancer. At Compassion’s June 15 news conference, Rizzo described how his wife of 43 years was suffering “excruciating” pain despite her pain medication. She asked for and received a lethal prescription under the Death with Dignity law, and used it to end her life last September.

“Joyce was facing a painful and difficult death, and there was absolutely no hope,” he said through tears. “She obtained the peaceful, dignified death she desired. The whole family supported her decision. I shudder to think of the pain she would have experienced without the medication and without that choice, which the bishops would deny her.”

Unfortunately, the bishops’ position is based on dogma rather than facts or experience. Few people would care except the bishops control a significant share of the U.S. health care system. That’s why they need to take off their black robes, visit a hospice or hospital ICU, and silently watch and listen to expert staff work with terminally ill patients.

Dying is personal. None of us wants a group of self-righteous moralists telling us how to do it.

This article originally appeared in Crosscut.com.


Harris Meyer is a freelance journalist based in Yakima, Wash., who writes about health care, law, business and wine for various national publications.

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Reading this brought back a lot of memories. My husband chose death with dignity in 2010. Dan had ALS, which was diagnosed in August 2009 and he was given less than four months to live on Feb. 2, 2010. He knew that he did not want to artificially prolong his life prior to this diagnosis and had signed his advanced directives years before. He chose the end of March as his time. We had a grandson due early in the month as well as our 37th anniversary. He had the time he needed to complete those items in his life important to him. Our Compassion and Choices counselors were wonderful and helped us talk about what his needs were and how he wanted things to be. Our extended family and children where supportive and understood Dan's decision. He was able to pass at home in his bed with his family around him. He was not alone as many who die in our healthcare system can be. I have been a RN for 37 years and have been with several patients as they died. Death is not the enemy. We all will die, so why not make it as loving, peaceful, and dignified as possible.

We shouldn't expect the Bishops to condone assisted suicide. The bible is fairly clear on that issue. You have to understand that they believe the bible takes precedent over the wishes of the individual. Assisted suicide to date, has been chosen by very few patients anyway. The bigger issue is the requirement that patients with advanced dementia, chronic vegetative state, etc. be required to receive tube feedings. There is absolutely nothing in the bible that would justify such a requirement. Spoon feeding maybe, but tube feeding, no. Also, these patients could live for years longer with forced feeding, all the while, these Catholic healthcare facilities are getting paid to care for them. It's a little too convenient that their policy on this issue enriches a Catholic business. I think their policy would "find religion" quickly if Medicare/Medicaid changed their policy, and stopped paying for forced/coerced tube feedings in such cases. If they can find a biblical basis for their current policy, they will quickly find a biblical basis for changing it when the money runs out.

I am in total sympathy with this entire article. However, in how you describe yourself, you say that you are "a news source, not a blog." There's also a difference between "news" and "editorial." As journalists, I'm sure you know the difference and appreciate the distinction. This article fits much more on the "editorial" side of things compared to the "news" side. I think that's an important acknowledgment to make to your readers.

For Catholic bishops to establish Catholic doctrine is entirely appropriate, and citizens who are Catholic can reasonably be bound by that doctrine. After all, in the US, one's acceptance or rejection of Catholicism is a matter of free choice. But for the bishops to impose or attempt to impose that doctrine on non-Catholics, either by law or by the happenstance that non-Catholic patients are often served in Catholic-affiliated hospitals is deeply wrong. And if hospital accreditation requirements do not require that duty to the patient and the patient's known wishes always comes first, this too is deeply wrong. We do, as I say, have a choice in accepting or not accepting a particular religion, but if we are ill or injured, we generally do not have a choice as to which hospital is nearest or has the best capability of treating us. If they are licensed healthcare professionals, they have a professional duty to render care in accord with our, not their wishes. This is basic bioethics. Moreover, making assistance in dying illegal does not keep it from happening. It is merely forced underground into an unregulated environment that magnifies the opportunity for the very ills the bishops claim to worry about. I live in California, where we do not yet have a sensible DWD law, but believe me, aissted dying takes place here, on one county or another, every day.

I agree with the comment that this article was not news, but I disagree that it was an editorial. It was rather a diatribe against the Catholic Church. I am disappointed that the Lund Report would include such an inflammatory and bigoted piece that in no way promotes the goal of "unlocking Oregon's healthcare system." Not only do I object to the inappropriate tone of Mr. Harris' article, but I also take issue with the majority of the "facts" he posited about the Bishops' statement and the Catholic Church in the US. I happened to have the opportunity to provide input into some of the language in the statement and was in attendance at the press briefing in Bellevue following the adoption of the Bishops' statement on physician assisted suicide. Mr. Harris either failed to obtain the press releases distributed at that briefing or chose not to include any references to these nuanced, yet compelling arguments in support of the Bishops' statement. I hope that tin the future that the Lund Report will not include articles that perpetuate prejudice and misinformation about any group of people or organization.

History has been replete with atrocities of the Catholic Church. When will people wake up and brake the yoke of tyranny of the Catholic Church! They have no right to force their will on those that do not believe in their dogma, and as such should not be a part of the general public’s health system. We need some laws that force these institutions to leave all dogma out of their policies if they take even 1 penny of public money.