THIEL-WMA EoL Presentation Vatican-Nov2017

11/23/17
1
WMA European Region Meeting
on End-of-Life Questions
ROME – Vatican – 16-17 November 2017
Suffering at the End of Life.
Christian References and their Use
Pr Marie-Jo Thiel
University of Strasbourg – http://ethique.unistra.fr
End of life and the Catholic Church
Suffering as turning point
How to deal with…
1. End of life
and Catholic
Church
2. Suffering as
turning point
3. How to deal
with…
¨ The Catholic Church teaches respect for
human life
¨ She refers to general ethical principles
(autonomy, justice, human dignity,
beneficence; non-maleficence…)
¨ As well as her own resources (prayer,
sacraments, rites…).
¨ She cares for the sick and dying, by visiting
and accompanying them,
¨ Following the practices and words of Jesus
Christ, the true physician, the healer and savior
Consequent general commitments (like many moral
systems), the Catholic Church
– forbids killing/murder, committing suicide
practicing euthanasia,
– She refuses unreasonable obstinacy, allows
withdrawing & withholding treatments according
to medical indications
– She recalls the harmful potential of pain and
supports the use of analgesic medicine.
This summarizes the position of the Catholic Church
but does not exhaust all the teething issues. Theological
reflection must go on…
1. End of life and
the Catholic
Church
2. Suffering as a
turning point
3. How to deal
with…
11/23/17
2
Turning point both for our present society as well as
for the Church…
Suffering at the end of life is as difficult as it is
decisive:
– from this point of view, we determine the behavior
to be taken and the “solution” to be chosen:
palliative care, or euthanasia, or (continuous)
sedation or assisted suicide ….
YET
– only a minority of people benefit from adequate
analgesic treatment
– And dolorist tendencies remain perennial in the
Catholic Church
A minority of people benefit from adequate
analgesic treatment…
According to the “Livre Blanc”
issued in Oct.2017 (France):
– 70% of the 12 million French people suffering
from chronic pain, do not receive appropriate
treatment.
– 61% of cancer patients are under-relieved.
Suffering? Not only physical but also psychological,
social, spiritual, etc.
one reinforcing the other, constituing a global pain…
And also: feelings of being a burden to others, loss of
a meaningful life, loss of one’s role in a productive
society, loss of independence, of « dignity »…
And allowing all kinds of requests…
The last French Case : Anne Bert (ALS)… euthanasied
in Belgium 2.Oct 2017 . Or Hubert O., 80, who has
suffocated his wife with Alzheimer’s. He was
sentenced to five years suspended sentence.
At the same time, however, suffering is interpreted
and determined in its intensity
– by the codes of society itself,
– by the beliefs of the patient
– by the paradigm that proclaims that all end-of-life
suffering is accessible to analgesics.
The press release (20 Feb. 2017) supporting the
Leonetti Claeys law (2016) in force in France,
emphasizes that this law makes it possible to benefit
from a dignified end of life, accompanied…by deep
and continuous sedation
11/23/17
3
The Teaching of the Catholic Church does not justify
suffering…
Nevertheless, it is sometimes trapped…
As we can still observe when visiting the sick: many
(?) people have a religious « memory“ revived at the
end of life about the redeeming power of suffering :
– From there, some reject from the outset any idea of
God
– Others think it is not allowed them to be relieved
of their suffering, that it is a way to assume the
errors and mistakes of their past.
1. End of life and
the Catholic
Church
2. Suffering as a
turning point
3. How to deal
with…
– Techniques/Technologies alone do not make life
meaningful.
– Quality of life templates are not sufficient to evaluate best
practices in care…
– Conscience… and autonomy (relational autonomy)
remains a main key-reference in all decision-making.
– BUT in a society where euthanasia is allowed, where
people are pushed towards assisted suicide (due in part to
economic challenges and a misuse of the principle of
autonomy), where dying has to be mastered, to be
« clean », where hope for religious salvation has become
hope in medical salvation, where efficiency has passed
from the divine to the physicians and scientists…
How can people deal with their own paradoxical
feelings and contradictory injunctions (from the society,
from their experience, from their beliefs…)
For the Church, 2 helpful remarks :
1. « The Church is useless if she is locked up in herself, »
says Cardinal Ladaria Ferrer. « The Catholic Church
has always had a principle that is not the principle of
‘either … or’, but the principle of ‘both … and‘.”
This does not mean that the official position of respect
for life has to be changed, but, as Amoris Laetitia
stated…
2. Cultural influences are powerful conditioning that
“prevents a constant process of growth” (AL 129); And
certain “irregular” situations of AL could also be found in
the biomedical context… and there is « need of special
discernment » (AL 301)
“The Church possesses a solid body of reflection
concerning mitigating factors and situations. Hence it
can no longer simply be said that all those in any
“irregular” situation are living in a state of mortal sin
and are deprived of sanctifying grace. “ (AL 301)
Finally how does one deal with all these challenges?
No simplistic position or solution, but a request to
deepen the values and norms involved in order to
find ways of humanizing death and solving
existential quandaries.
Reviving practices of visiting and caring for the sick,
corporately discuss and complete Advance Directives
(this fosters cohesion, ecclesial community and
engages medicalized dying with wisdom)
Asking questions that may challenge key issues…
and initiate a real debate…
11/23/17
4
The doctor has obviously the greatest power over life
and death. They connect or disconnect the life support.
But, so Lydia S. Dugdale, « when this life is strictly about
maximizing the experience of the here and now, patients try
to get it all in before they die. (…) They might strive to
maximize or influence all aspects of their lives, whether by
spending on themselves or giving to others, traveling to
exotic places, experimenting with new forms of spirituality,
planning their deaths…
Clearly this is not all bad… But this life is all there is. »
And when our story is part of a grander narrative,
with a legacy centered around faith, hope and love?
What’s the difference ?!!
Prof. M.Jo Thiel – Univ. de
Strasbourg
MERCI
MERCI
Pr Marie-Jo Thiel, CEERE, Strasbourg – http://ethique.unistra.fr
20