April 19, 2005
Euthanasia has become an accepted way of dealing with serious or terminal illness in The Netherlands...
The President’s Council on Bioethics
Transcript of Proceedings, Thursday, March 3, 2005
Session 1: “Aging and Care-Giving: Lessons on Assisted Suicide from the Oregon and Netherlands Experiences”
Presenter: Herbert Hendin, M.D., Medical Director, American Foundation for Suicide Prevention
Editor’s Note: The comments of Dr. Herbert Hendin follow introductory remarks by Council Chairman Leon Kass. An extended discussion with members of the President’s Council follows Dr. Hendin’s presentation.
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“...I didn’t go to The Netherlands thinking that end-of-life care was going to be worse than it is here because I had a very low opinion of end-of-life care in this country at that time, and I think the Dutch, sensing that, thought that the more I saw about what they actually did, the more I would be persuaded of the merits of their system. So they made accessible to me the doctors who were the leading practitioners of assisted suicide and euthanasia, and I got to interview them, hear their cases, and talk to the people who were doing the Dutch government sanctioned studies on the matter.
“I think, from the standpoint of the Dutch, I probably was a poor pupil, because I didn’t come away with the conclusion they wanted me to come away with. I was more alarmed, and I felt that end-of-life care was far behind that in this country, and I was persuaded, and I will present you the evidence for that, that a large measure of the difficulties had to do with the fact that there was an easier option available to them....
“Euthanasia, intended originally for the exceptional case, became an accepted way of dealing with serious or terminal illness in The Netherlands. Palliative care became one of the casualties. Hospice care lagged behind that of other countries. Dutch deficiencies in palliative care have been attributed by Dutch palliative care experts to the easier alternative of euthanasia....”
The President’s Council on Bioethics – March 3, 2005
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The issue behind the debate—Who is a person?
End of the Affair
by John Leo
“Some final notes on the Terri Schiavo case. The behavior of conservatives: Uneven and sometimes awful, with lots of vituperation and extreme charges. (Jeb Bush does not remind me of Pontius Pilate; I don’t think it’s fair to circulate rumors that Michael Schiavo was a wife-beater.) Worse were the revolutionary suggestions that the courts be ignored or defied, perhaps by sending in the National Guard to reconnect the tube. This is ‘by any means necessary’ rhetoric of the radical left, this time let loose by angry conservatives. Where does this rhetoric lead?
“The behavior of liberals: Mystifying. While conservative opinion was severely splintered, liberal opinion seemed monolithic: Let her die. Liberals usually rally to the side of vulnerable people, but not in this case. Democrats talked abstractly about procedures and rules, a reversal of familiar roles. I do not understand why liberal friends defined the issue almost solely in terms of government intruding into family matters. Liberals are famously willing to enter family affairs to defend individual rights, opposing parental-consent laws, for example. Why not here? Nonintervention is morally suspect when there is strong reason to wonder whether the decision-maker in the family has the helpless person’s best interests at heart....
“The behavior of the news media: Terrible. ‘Pro-life’ columnist Nat Hentoff of the Village Voice called it ‘the worst case of liberal media bias I’ve seen yet.’ Many stories and headlines were politically loaded. Small example of large disdain: On air, a CBS correspondent called the Florida rallies a ‘religious roadshow,’ a term unlikely to have been applied to Martin Luther King Jr.’s civil rights demonstrations or any other rallies meeting CBS’s approval. More important, it was hard to find news that Michael Schiavo had provided no therapy or rehabilitation for his wife since 1994 and even blocked the use of antibiotics when Terri developed a urinary infection. And the big national newspapers claimed as a fact that Michael Schiavo’s long-delayed recollection of Terri’s wish to die, supported only by hearsay from Michael’s brother and a sister-in-law, met the standard for ‘clear and convincing evidence’ of consent. It did nothing of the sort, particularly with two of Terri’s friends testifying the opposite....”
Explaining why another evaluation of Terri Schiavo was necessary...
When Life Is on the Line
by Bernadine Healy, M.D.
“Terri Schiavo got her day in court—or rather her years in court—but that time was mostly spent on tugs of war over states’ rights, separation of powers, and legal precedents, issues utterly irrelevant to her medical condition. And so she departs this world not in peace but in bitter turmoil among those she loved and with lingering uncertainty as to her state of mind. Her last in-depth neurological evaluation was back in 2002. At that time her parents, and the two doctors the court allowed them to choose, believed she had some minimal level of consciousness that enabled her to feel joy and sadness, comfort and pain. In her family’s embrace, they were sure she would live a worthy life, however disabled. Her husband and his two chosen doctors saw the opposite: a human reduced to the level of a vegetable, living but in a persistent vegetative state, awake but unaware, with one of two EEG’s being flat. What is troublesome is that the plug—or, to be precise, the feeding tube—was pulled without a fresh evaluation of her mental status. In fact, two weeks ago one of the most prominent neurologists at the 2002 hearing argued vehemently against convening a new independent panel of experts to re-examine her. In my conversations with him, he dismissed the idea of getting another electroencephalogram as ‘crazy.’
“Disturbing.” There is legal reasoning behind the decision to deny Schiavo a final neurological exam. In 2002, the court declared with chilling finality that the husband’s doctors, plus one selected by the judge, were right: case closed; no need for ongoing expert neurological evaluations. But these are tricky diagnoses, and many neurologists don’t share the judge’s absolute certainty. Neurologist James Bernat of Dartmouth-Hitchcock Medical Center, former chair of the American Academy of Neurology’s ethics committee, told me that aware patients are diagnosed as unaware with ‘disturbing frequency.’ That means there’s a significant risk of wrongly labeling a patient as being in a persistent vegetative state. It is simply not possible to experience with absolute certainty another person’s thoughts, pain, or awareness of the outside world....”
Undermining the longstanding tradition of physician as a healer...
In Vermont, a Bid to Legalize Physician-Assisted Suicide
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“The next showdown over physician-assisted suicide could be in Vermont, where a group of citizens has begun an effort to pass a bill patterned on Oregon’s seven-year-old law allowing doctors to prescribe suicide drugs for terminally ill patients who request them.
“The bill went nowhere in the State Legislature last year, but was reintroduced in February and could be brought before legislative committees next month. Its supporters say they could make headway in Vermont, a state with a fiercely independent streak and small-scale government that tends to be swayed less by big outside campaigns than by what local citizens want.
“In a Zogby poll conducted in Vermont in December, 78 percent of 500 randomly selected adults said they would support a bill to allow terminally ill patients to get medication from their doctors to hasten death.
“Issues surrounding choices at the end of life have gained prominence recently because of the case of Terri Schiavo in Florida. But Michael Sirotkin, a lobbyist hired to push the Vermont bill, said the bill protects the right of people to have their end-of-life wishes honored, while the Schiavo case shows what can happen when a patient does not make those wishes known. The bill, he said, ‘is about patient choice, patient control.’
“Those who oppose the bill, however, say it could lead to abuses, even mandatory euthanasia. ‘The biggest concern,’ said Dr. Robert Orr, president of the Vermont Alliance for Ethical Healthcare, a loose affiliation of doctors and church organizations, ‘is the expansion of the criteria and the abuses that have been increasingly evident’ in the Netherlands, where euthanasia is legal....”
HeraldTribune.com/NYTimes – March 30, 2005
“People should remember the time and not forget it...”
Schiavo Stokes Europe Euthanasia Debate
“Johann Gross survived three years of Nazi laboratory experiments under an extermination program that called for snuffing out ‘worthless lives.’ That trauma shapes the Austrian’s view of Terri Schiavo’s death.
“‘No people in the world have the right to kill another. It’s murder,’ said Gross, 75, while visiting an exhibit on wartime experiments at a Vienna psychiatric hospital. ‘It’s the same as the Nazis did.’
“Gross’ reaction may seem extreme, but there are many in Austria and Germany whose attitudes toward euthanasia are clouded by Hitler’s horrors. Until recently, even talking about it was difficult because it forced people to look into their dark history.
“But since Schiavo’s death March 31, after courts ordered her feeding tube removed, the ethics of euthanasia have become a hot topic in Austria and Germany. Videotape showing Schiavo in her hospital bed, in what was described as a vegetative state, led TV newscasts for days....
“Some of the survivors of the Nazi campaigns have told Dr. Klaus Mihacek, an expert on post-traumatic stress syndrome, that the Schiavo case has raised uncomfortable memories.
“About 75,000 people across Europe, including 5,000 children, were subjected to experiments and killed because they had physical or mental handicaps, were social misfits or otherwise failed to meet the Nazis’ master-race criteria.
“The survivors ‘feel no one should play the role of God,’ said Mihacek. ‘They know they were lucky to survive.’
“With the approaching 60th anniversary of the end of the war, the experiments on children are being remembered in two exhibits in Vienna. Gross will take part in a ceremony later this month honoring 400 children slain by the Nazis at a city clinic.
“Gross was sent to the Spiegelgrund clinic as a child because he was judged asocial and because his father was missing a hand. He said he was given injections into his feet that made it impossible for him to move for weeks unless he crawled.
“The ceremony will mark the day three years ago that Vienna’s government finally buried the brains of children killed by injection, medical experimentation or starvation at Spiegelgrund. The organs had been preserved during the war for medical research.
“‘People should remember the time and not forget it,’ Gross said. ‘We should fight that these kind of people never come again.’”
When end-of-life decisions are robbed of their moral significance...
Europeans See Issue As Strictly Medical
“In European countries that have struggled through their own end-of-life debates in recent years, the case of Terri Schiavo has sparked widespread interest and befuddlement at how politics and faith intervened in what most Europeans view as a strictly medical decision.
“In the Netherlands, where euthanasia has been legal since April 2002, the struggle over whether to remove Schiavo’s feeding tube would not have happened because ‘here it’s more accepted that the doctors make those decisions,’ said Rob Jonquiere, head of the pro-euthanasia group NVVE.
“‘It’s terrible, this type of judicial fighting over a person who can’t do anything about it,’ Jonquiere said in a telephone interview from his home in Amsterdam shortly after Schiavo’s death. ‘In the Netherlands, the doctors are making these decisions. The feeding tube and the hydration are considered medical treatments, and if they are determined to be futile, they can be stopped.’
“Nico Mensing van Charante, a Dutch physician who is often called to provide a second opinion in end-of-life cases, called the Schiavo case ‘a circus’ and said the decision to remove her feeding tube would have been clear-cut in the Netherlands. ‘It’s the end of a treatment that doesn’t make any sense—it’s not euthanasia or assisted suicide,’ he said. ‘If you stop the feeding, it’s a medical decision, so it’s a natural death—nothing to declare or notify....’”
WashingtonPost.com – April 1, 2005 (free registration required)
Not Dead Yet: “She is one of us.”
Schiavo Raised Profile of Disabled
Question Swirl About End-of-Life Issues
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“For many disabled Americans, seeing the final images of Terri Schiavo was like looking at a terrifying picture of themselves—undervalued and at the mercy of others.
“‘We do not identify with the spouse or the parents,’ Diane Coleman, president and founder of the disability rights group Not Dead Yet, explained just days before Schiavo’s death. ‘We identify with her. She is one of us.’
“The battle over the severely brain-damaged Florida woman sparked a wave of congressional and legal wrangling and a renewed interest in end-of-life directives. But for many who are disabled—whether from a recent accident or a lifelong illness—the case triggered a much more immediate, personal reaction.
“Watching the Florida drama from the opposite coast, it looked as though Schiavo was ‘put to death for the crime of being disabled,’ said William G. Stothers, deputy director of the Center for an Accessible Society. ‘Among the disability rights community, it is a generally held belief that in society at large the view is “better dead than disabled.”’
“Distrustful of the medical establishment and worried they may be considered a ‘burden,’ disabled people such as Stothers fear they may be one ER visit away from becoming the next Terri Schiavo.
“‘What happens if I go to the hospital and they say, “He’s so disabled anyway, should we do these heroic measures?”’ said Stothers, who contracted polio 55 years ago and now uses a wheelchair. ‘It scares me....’”
WashingtonPost.com – April 2, 2005 (free registration required)
The issue first arose in Oregon...pharmacists didn’t want to participate in assisted suicide...
Culture War Hits Local Pharmacy
Many druggists across the country refuse to give out morning-after pills. Legislators weigh in.
“The culture wars have already seeped into hospices, movie theaters, and the Super Bowl. Now, even the corner drugstore has become a battleground.
“From rural Texas to Chicago, more instances are cropping up of pharmacists refusing to fill prescriptions for oral contraceptives and the morning-after pill. As a result, politicians around the country are stepping into the fray.
“It’s a debate that weighs personal morals against professional responsibility. It pits religious rights against patients’ rights and raises the question of just where pharmacists stand on the spectrum of health-care professionals.
“Many pharmacists point to the ‘conscience-clause’ exceptions that nearly every state has in place for doctors, allowing them to recuse themselves from performing abortions or other procedures they object to. They believe they should have similar protection....”
The Christian Science Monitor – April 08, 2005
When personal morality conflicts with secular medical practices...
Illinois Governor: No Delays in Birth Control Prescriptions
“Gov. Rod Blagojevich approved an emergency rule Friday [April 1] requiring pharmacies to fill birth control prescriptions quickly after a Chicago pharmacist refused to fill an order because of moral opposition to the drug.
“The emergency rule takes effect immediately for 150 days while the administration seeks a permanent rule.
“‘Our regulation says that if a woman goes to a pharmacy with a prescription for birth control, the pharmacy or the pharmacist is not allowed to discriminate or to choose who he sells it to,’ Blagojevich said. ‘No delays. No hassles. No lectures.’
“Under the new rule, if a pharmacist does not fill the prescription because of a moral objection, another pharmacist must be available to fill it without delay.
“The Illinois Department of Financial and Professional Regulation has also filed a formal complaint against the Chicago Osco pharmacy for the February 23 incident.
“The pharmacy was cited for ‘failing to provide appropriate pharmaceutical care to a patient.’ Penalties could include a fine, reprimand or revocation of the pharmacy’s license....”
Speaking truth to power...
Bishop Begs Governor: Respect Freedom of Religion
From “Mere Comments,” the weblog of Touchstone Magazine
“Few may have heard the local Illinois news about Governor Blagojevich issuing an executive order demanding that pharmacists must fill prescriptions for contraceptives, even if it goes contrary to their conscience. Fewer probably heard what one of the Catholic auxillary bishops of Chicago said to Gov. Blagojevich at a Mass for John Paul II just a mile or two from our office on April 3. We take this directly from the Sunday bulletin of St. John Cantius Church, Chicago:
Post-Communion Remarks (condensed version)
At Mass for Pope John Paul II
St. Hyacinth Basilica, Chicago, Illinois April 3, 2005
These comments were made by Bishop Thomas Paprocki concerning the recent legislation demanding that pharmacists must fill prescriptions for contraceptives, even if it goes contrary to their conscience.
Before we leave this beautiful Basilica of St. Hyacinth, I wish to say a few words of thanks and to make a special request in honor of Pope John Paul II....
...Thank you also to the civic officials for your presence, especially the Consul General of Poland and his wife, Mr. & Mrs. Franciszek Adamczyk, and the Governor of the State of Illinois, the Honorable Rod Blagojevich.
That brings me to my request. As some of you know, I come from a family of pharmacists. My grandfather and his brother were pharmacists. My father and his brother were pharmacists with their own drug stores. Two of my brothers currently work in pharmacies, and I have a niece just beginning pharmacy school, thus marking four generations of pharmacists in the Paprocki family. In fact, if I had not become a priest, I probably would have become a pharmacist myself. But I never would have thought that the day would come when pharmacists would have to choose between practicing their profession as a pharmacist and living their profession of the Catholic faith. Yet that is precisely the situation that Illinois pharmacists now find themselves in because the Governor last Friday signed an “emergency regulation” requiring that all pharmacies and pharmacists in the State of Illinois will be expected to accept and fill prescriptions for contraceptives without delay.
The obvious problem, as Pope John Paul II so clearly and repeatedly taught, is that Catholics believe that artificial contraception is morally wrong; moreover, some contraceptives, so-called “morning after” pills, actually induce abortion by stopping the life of an early human embryo.
As a lawyer myself, I believe that this executive order violates the First Amendment religious rights of the pharmacist under the United States Constitution and the Illinois Health Care Right of Conscience Act. As a Bishop, I am dismayed that our secular society has reached the point that individuals are being required by law to violate their personal religious beliefs in order to accommodate the selfish demands of special interest groups.
Mr. Governor, I mean no disrespect. I am not here to criticize or scold you. On the contrary, I respectfully plead with you, I beg of you, to rescind your executive order. You are here, as we all are, to pay our respects to the life of Pope John Paul II. He spoke consistently and forcefully against moral evils and the whole point of his life was to put such words into action.
Pope John Paul II once said, “In the designs of divine providence, there is no such thing as mere coincidence.” Hence, I believe it is no mere coincidence that I have this opportunity to address this issue in person and in public just two days after the Governor issued his decree.
Mr. Governor, out of respect for our beloved Pope John Paul II, please respect his wishes; please rescind your order. Let our pharmacists be free to follow their faith!
“The spirit of John Paul II lives on in Bishop Paprocki in speaking truth to power on behalf of religious freedom.”
Posted by James M. Kushiner
Executive Editor of Touchstone, A Journal of Mere Christianity
“Mere Comments” is the weblog of Touchstone Magazine – April 13, 2005
Worth considering...
From “A Poem of Difficult Hope”
by Wendell Berry
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“Much protest is naive; it expects quick, visible improvement and despairs and gives up when it does not come. Protesters who hold out longer have perhaps understood that success is not the proper goal. If protest depended on success, there would be little protest of any durability or significance. History simply affords too little evidence that anyone’s individual protest is of any use. Protest that endures, I think, is moved by a hope far more modest than that of public success: namely, the hope of preserving qualities in one’s own heart and spirit that would be destroyed by acquiescence....
“What we...need to worry about is the possibility that we will be reduced, in the face of the enormities of our time, to silence or to mere protest.... If we would help if we could, we will help when we can.”
“A Poem of Difficult Hope” is one of the essays collected in Wendell Berry’s What Are People For? (North Point Press, 1990). These excerpts can be found on pages 62-63.
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