QUESTIONS AT THE END

Gilbert Meilaender’s essay (“More Bathos than Pathos,” August 11) on the New York Times article detailing the assisted suicide of John Shields, “At His Own Wake, Celebrating Life and the Gift of Death,” is a masterful summary and criticism of a death scene and the assumptions behind it. The entire event is embarrassing.

Meilaender presents the debate over euthanasia as the tension between self-determination and compassion. He appropriately (particularly for Catholicism) dismisses the notion of individual self-determination. But his discussion of compassion, which he recognizes is at least as complicated as self-determination, rests on our equality “grounded in the fact that we do not make each other.” That obviously is true, but he then quickly moves to the claim that no one “should give ultimate authority over your life to me” and then the observation that “there may be some suffering that must be accepted and endured—suffered—because we can find no way to relieve it entirely.” In the face of this situation, we must “maximize care.”

He correctly asserts that it is not the task of medicine to “judge whether our life still has meaning and purpose.” But nor is it the task of medicine to define maximum care. This is the role of the community, both religious and social, the individual’s loved ones, and the individual him- or herself (self-determination cannot simply disappear). This is the venue where the shape and limits of compassion are worked out.

In this venue it has already been recognized that the efforts of medicine can themselves be limited; medicine is not a good in itself. Traditionally, in extreme cases medicine could do little but to “keep company with us in our dying.” But contemporary medicine can do much more now, both to cure or alleviate what not long ago would have been fatal illnesses and to address symptoms of complicated illnesses. The latter alternative often prolongs life functions without being able to cure or alleviate the larger problem. Medicine thus is a tool that intervenes between the gift of life and its inevitable end.

With this tool, we have become co-creators of our passage through life and are not as passive regarding the conditions of our death as our forebears were. These emerging medical abilities require us to re-examine what it means to “keep company with us in our dying.” A sincere compassion ought to require us to fully confront how we prolong dying by our medical ministrations.

Consequently, we must re-examine what euthanasia is. Twenty-five years ago, it was understood by many that to withdraw treatment was to kill the patient. That denial of the role of medicine in increasing the suffering of both the dying patient and family has been subsequently recognized as inappropriate in a wide variety of situations. Alongside that discussion, from Janet Adkins to Mr. Shields, it has been asserted by patients that a diagnosis can itself be the basis of intolerable suffering. What ought to be the role of the community, the individual’s loved ones, and the individual himself or herself in the face of such a diagnosis? What are the signs that confirm a diagnosis or indicate significant progress of the disease? At what stage do these issues matter? If Meilaender wants to ease the public discussion of euthanasia, he might address these questions. Is simply telling the patient to tough it out and seek redemptive value in that distress enough?

Harold W. Baillie
Professor of Philosophy
University of Scranton
Scranton, Pa.

GILBERT MEILAENDER RESPONDS:

I am grateful that Professor Baillie has taken the time to think about and respond to the views I developed in my article. And I suspect that, given a little more discussion, he and I would agree in considerable measure about the issue I took up. Here is just a little of that further discussion.

Baillie is bothered by my statement that there may be suffering that must be endured if we can find no right way to alleviate it. (I did not, by the way, say that suffering patients should seek “redemptive value” in their suffering, although he attributes that view to me.) Perhaps if Baillie had come across my statement in discussion of a different moral problem—say, the permissibility of torture—he would not have been so bothered or quick to object. So I would like to think that, at least in principle, we may have no insuperable disagreement here.

When I say it is the task of medicine to maximize care, Baillie seems to be mentally underscoring the word maximize. But I am not. I am saying that we should maximize care for suffering patients. That means we must first ask what makes for genuine care. In my view, for reasons I developed briefly in the article, euthanasia does not. But neither does beginning or continuing treatment that is either useless or excessively burdensome for the patient. To discontinue—or never begin—such treatments is not to aim at the death of the patient. It is to aim at maximizing care, as best we can, while acknowledging that death may come somewhat sooner as a result.

Finally, though, I come to a matter on which Baillie and I may differ somewhat. While I do not think it is the task of medicine alone to determine what it means to maximize care, I do think physicians play an important role here. To be sure, patients should participate, to the degree they are able, in discussion of their treatment. But physicians are not simply highly trained technicians who should use their skills to serve whatever ends a patient requests. Physicians too must be central participants in the discussion about what constitutes good (and morally right) medical care. Only then can the encounter between physicians and patients, and the profession of medicine itself, be moral undertakings.

ARE THEY LISTENING?

A few issues surface from David Cloutier’s review of Fr. Jim Martin’s book Building a Bridge (“The Ignatian Option,” August 11). Cloutier’s statement that the church’s teaching is “about sex” is true—unfortunately. That limited understanding dismisses any concern for the positive and life-giving nature of same-sex relationships. Catholics whose life choices have been strongly influenced by the Great Commandment and the sacramental life of the church have arrived at conclusions different from official church teaching.

Moreover, homosexuality, as we understand it today is a rather recent public phenomenon, and will require much further discussion in the church. The movement towards Christian unity, fostered particularly by John Paul II, will require serious discussion of issues that divide us. It is a volatile issue, not just one among many as Cloutier infers. It focuses on how we come to understand ourselves. Like heterosexuality, homosexuality is understood by most as a permanent element of identity. It is about relationships linked to personhood, the deepest level of which is expressed by God’s very nature, the Most Holy Trinity: mutuality, faithfulness, and sharing of the fruits of relationship.

For the magisterium to function as a teacher, must she not also function as a learner? At the end of the nineteenth century, the American medical community first understood homosexuality as a pathology, an illness. After listening for a few more decades, it changed its mind.

As a seventy-year-old lifelong-celibate gay Catholic, I disagree with the church on this issue, whose authority I respect and love. In my late twenties, realizing that I could no longer date women, I “came out”—to my friends and family. I am sure that my mother’s and grandmother’s daily prayer life, predicated on attitudes of unconditional love and welcome, determined my move to positive self-acceptance. This was not true of many gay Catholic friends, some of whom eventually died of AIDS.

No, this is not an issue like any other. More than “tough conversations,” it will require serious listening on both sides. But for those who unequivocally support church teaching, it will require listening to the painful narratives of gay Catholics, who also respect church authority, an authority we hope is capable of nonjudgmental listening.

Philip Schmidt
Toronto, Ont.
Canada