Kristen L. Byrd, Special to the Catholic Virginian

Legally, it is termed “Medical Aid-in-Dying” (MAID), but the Catholic Church recognizes it as physician-assisted suicide. It condemns the practice which involves physicians prescribing lethal medication to a patient, but not administering it. Instead, they have the patient ingest it themselves.

While the practice is legal in several states and Washington, D.C., the Virginia Catholic Conference (VCC) is working to make sure similar legislation is not passed in Virginia. In order to do so, they are urging the public to submit comments opposing it to their legislators by Oct. 15.

“Whether a doctor directly ends a person’s life or assists a person to commit suicide, in both instances a life is being taken. We must never treat the gift of life as something that can be abandoned,” Jeff Caruso, executive director of the VCC, said during an interview, Tuesday, Sept. 18, adding that St. Pope John Paul II called assisted suicide “an injustice which can never be excused, even if it is requested.”

Delegate Kaye Kory requested the Joint Commission on Health Care (JCHC) staff to examine laws in states where physician-assisted suicide is legal. That commission is composed of state senators and delegates, some of whom are physicians, and focuses on health-related issues and their effect on residents and health care services.

The JCHC staff reviewed the laws with the goal of determining:
what the impact of informing patients about other end-of-life options, such as palliative care and hospice, was;
how providers and health care systems implemented the law; whether patients had been coerced or abused in any way and if there are laws to protect them;
how physician-assisted suicide has impacted health care costs; and, if it becomes legal, how many people in Virginia would be likely to utilize the service.
The study took nearly two years to complete and was presented to the JCHC Sept. 18.
The JCHC established a work study group made up of members from dozens of organizations across the state, including the VCC. This allowed members on opposing sides to have the chance to denounce or defend the practice. During work group meetings in 2017 and 2018, the VCC stated its opposition to physician-assisted suicide.

‘Misleading terminology’
According to Caruso, they repeatedly objected to the term “Medical Aid-in-Dying,” which he said was “inaccurate and misleading terminology.” The VCC also helped compile 10 reasons to oppose physician-assisted suicide. Among those reasons are:
that assisted suicide is the result of a “broken, profit-driven health care system” is because financial pressure is usually a factor in the decision to end one’s life and insurance companies may steer patients toward assisted suicide since it is less expensive than available life giving treatment;
that the practice is a threat to the vulnerable, poor, and disabled;
that the argument that physician-assisted suicide ends one’s pain is ineffective because that is rarely the reason one turns to suicide;
the definition of terminal illness necessitates a prognosis of less than six months to live, which is “wildly misdiagnosed” and can lead to fear and depression in the patient, which in turn can lead to thoughts of suicide.

“Both private and public insurers will have financial incentives to pay for a lethal prescription rather than more expensive and prolonged healing treatment, leaving the poor vulnerable to coercion,” Caruso said. “Those suffering from illness are often concerned about being a financial or emotional burden to others, which can create pressure to end one’s life.”

Still, proponents of the practice argue that physician-assisted suicide gives patients the opportunity to “die with dignity,” on their terms and at their time. According to the study by JCHC staff, supporters claim this is different from suicide because suicide “often involves people who are severely depressed and no longer want to live,” which is different than people who are “suffering life-ending illnesses and understand that there is no hope for a better outcome.”

JCHC asserts patients are legally protected and always in control. While they vary slightly from state to state, there are several steps that are required before a lethal drug is prescribed, including being counseled on other forms of treatment, e.g., hospice and pain management; getting a terminal diagnosis confirmed by more than one doctor; the patient has to have no underlying mental illness and be mentally capable of making the decision to end their life; and coercion and abuse are subject to criminal charges.

JCHC contends there has been no substantiated claim of coercion or abuse since the practice was first utilized in Oregon 20 years ago. They also note that the vast majority of those who chose physician-assisted suicide were already enrolled in hospice and/or receiving palliative care. They have earned wide support across the political, ideological, and religious spectrums, according to the JCHC study.

‘Live with dignity’
However, opponents point to the fact that legalization has been rejected by dozens of states and the American Medical Association, and that in 1997 the U.S. Supreme Court rejected the claim that assisted suicide was a constitutional right.

The Hippocratic Oath states doctors should not participate in physician-assisted suicide. It reads: “I will neither give a deadly drug to anybody who asks for it, nor will I make a suggestion to this effect.” Opponents also note that while no “substantiated” claims of abuse or coercion have been proven, that doesn’t mean they haven’t occurred.

Instead of doctors assisting patients in suicide, the Church advises them to assist patients throughout their lives by providing palliative care so they can “live each day with dignity,” which the U.S. Conference of Catholic Bishops advocated in their 2001 statement, “To Live Each Day with Dignity: A Statement on Physician-Assisted Suicide.” Pain management is a key factor in this, and the Church supports medical intervention to aid patients in pain, as well as helping them with their most basic needs by providing physical and emotional support.

The Catechism of the Catholic Church states: “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate. Here one does not will to cause death; one’s inability to impede it is merely accepted” (2278). This is different than providing the patient with deadly drugs to end their life.

One component to consider is substantive interventions. Substantive interventions include “control of pain and other symptoms; referral to a hospice program; general reassurances and specific reassurance that the prescription would be made available; treatment of depression; a social work consultation; an alternative means of hastening death; and a palliative care consultation,” as outlined in the JCHC report.

‘Love is stronger than death’
For those who received a substantive intervention, a 2000 study in Oregon showed that 31 of 67 patients changed their minds about ending their lives compared to only 11 of 73 patients who were not provided a substantive intervention.

In condemning physician-assisted suicide in 2011, the U.S. bishops wrote, “People who request death are vulnerable. They need care and protection. To offer them lethal drugs is a victory not for freedom but for the worst form of neglect.”

Their statement continued, “Life is our first gift from an infinitely loving Creator. It is the most fundamental element of our God-given human dignity. A choice to take one’s life is a supreme contradiction of freedom, a choice to eliminate all choices. And 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 USCCB statement concludes by calling on Catholics to be “leaders in the effort to defend and uphold the principle that each of us has a right to live with dignity through every day of our lives. We can help build a world in which love is stronger than death.”

Editor’s note: To submit comments to the Joint Commission on Health Care, visit vacatholic.org and click on “Take Action,” then “Action Center” or email jchcpubliccomments@jchc.virginia.gov.