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Talk on End of Life Issues by Father Alexander Lucie-Smith Wednesday 12 October 2011

The Parish Room at St Richard’s was packed with over 70 people from Chichester, Bognor and Arundel who had come to hear Fr Alexander speak about the teaching of the Church on the moral issues which can arise with regard to medical treatment as people near the end of their lives here on earth. After a lucid exploration of this complex topic Fr Alexander answered many questions from the audience on topics including suicide, assisted suicide and withdrawal of food and water.

Fr Alexander's talk was as follows:

"In this evening’s talk I want to start with actual events, and then I want to draw some conclusions. This will involve, for those who are interested, an existential approach: looking at real life experiences and drawing lessons from them; not enunciating principles and then applying them.

When an old family friend was 89 years old she developed gangrene. The doctors proposed to cut off her leg at the hip. She had been in very poor health for some years; if she did not have this operation she would die. I myself, and her two daughters, were adamant that she should not have the operation. So, she did not. She died about ten days later. Were we right to refuse medical treatment on her behalf? Yes, I think we were. Brian Barron, BBC correspondent in Italy, once said, talking of a right to die case, that “the Catholic Church believes life is to be preserved at all costs.” This is completely false. To make a surgical intervention of this type to preserve life, seems too high a cost to pay. There must surely come a time when further medical intervention is useless, or counterproductive, or simply not worth the attendant distress. It is surely perfectly legitimate, in certain circumstances, for doctors to say “There is no more that we can do for you.”

Again, a friend of mine once insisted, against my advice, that her 87 year old father should have chemo and radiotherapy for cancer. My view was that the old man should be left in peace. As it was he did die within a few months, and it is questionable if the treatment he received lengthened his life or improved the quality of the life he had.

Whether we like it or not we have to make some sort of calculation when it comes to the treatment of the very old. Is it worthwhile to intervene? Or should we let nature take its course? Should we intervene to alleviate pain which may shorten life, or should we risk pain in an attempt to lengthen life?

In fact the first is often done: we give patients doses of painkiller even when we know that this will hasten death. We do not do it to kill them, but to kill their pain. The hastening of death is an unwanted (though completely foreseen) side effect. This is the principle of double effect in practice. I can explain that very important principle if you wish…. (The act itself is good or indifferent; you will the good effect, not the bad effect; there is a good or pressing reason for acting i.e. doing nothing is not an option; there is a proportion between the good and bad effects.)

The other side of the coin is that we should intervene, which may cause pain, to lengthen life. There may be occasions where this is the right thing to do…but again, proportionality is key here. You do not inflict dolorous treatment on a patient unless you have a very good reason to do so.

The truth is, with modern medicine, we have to decide. (The question who decides is an important one – but everyone agrees a decision must be made). The Lord God is lord and master of human life in all its stages, but he has placed responsibility for life in our hands. We have a theonomous autonomy: which means in practice an obligation to make responsible and rational decisions re end of life care. So, it is simply not true to say that God is the one who determines when we die. God has in effect delegated us to make decisions; we in our rational natures participate in God’s rationality – or should. The key thing is that our action should be reasonable and responsible.

Now, reason and responsibility does not mean doing as you like. Quite the opposite. It means acting in a way that is in keeping with reason and with God given and law governed responsibility. It means always being cognisant of the commandment “Thou shalt not kill” and the value of human life. And it also means being fully aware of the fact that actively killing and letting someone die are clearly two different things. It is never right deliberately to kill a human being. Never. But it is often right to let someone die. It can be wrong to resuscitate someone who then goes on to die “again” a few days later. Thou shalt not kill but need not officiously strive to keep alive.

But we have a problem. What does such officious striving consist of. Let us remember the case of Terri Schiavo. Specifically, when someone is in a PVS (persistent vegetative state), does hydration and feeding via a tube constitute extraordinary means of keeping them alive? A life support machine – specifically a respirator – does, to my mind. But feeding via tube does not. Terri Schiavo’s death was murder. Clearly the Terri Schiavo case would never have arisen in Africa…. But once she was being fed by tube, then one is obliged to go on feeding her.

The withdrawal of food and hydration from Terri Schiavo also alerts us to another question. Who decides. With TS there was a dispute between her husband and her parents. Eventually the courts decided. This is the trend nowadays – endless litigation. Not good. This sort of decision making needs to have the good of the patient as paramount. When it comes to euthanasia, motives are rarely pure. Decisions even by the patient him or herself are rarely autonomous. Lady Warnock says old people who are demented have a duty to die. Moral blackmail! The other thing is that if you are demented how can you make that decision. The Warnock solution is in fact the Hitlerite one, that wishes to get rid of useless mouths. But the use of a person does not consist in their economic value.

In the end it boils down to – what is a person? What are they worth? What are they for? The answer would be, from me, the Christian Kantian one: people are ends in themselves. They do not have to justify their existence or argue to be left alone to live. They live of right; they are people of infinite value, purchased with the blood of the Lamb.

This still leaves us with the question of care and the question of its cost. We desperately need to explore this, and we need to acknowledge that it will cost us something, maybe a great deal, but that is a cost we must pay – because it is worth paying. The long term solution seems to be, at least to me, more care at home in the home by members of the family, rather than institutionalisation. But that will require a re-evaluation of family life, and many social and economic changes".

The talk was arranged by the Chichester and District Branch of the Society for the Protection of Unborn Children which works to defend life at all stages. We plan to have a further meeting in the new year with experts in this field exploring the issues raised in more detail, e.g. the Liverpool Pathway. If you have any questions you would like to raise please contact Maria Whitehouse on