Australian Bioethicist Reflects on Issues
Involved
By Father John Flynn,
LC
ROME, MAY 4, 2012 (Zenit.org).- We will all die, and how we
respond to illness and suffering says much about who we are, reflects Nicholas
Tonti-Filippini in his recent book, “Caring for People Who are Sick or Dying,”
(Connor Court Publishing).
Tonti-Filippini is the
Associate Dean and Head of Bioethics at the John Paul II Institute for Marriage
and Family, in Melbourne, Australia. He was Australia’s first hospital
ethicist, 28 years ago, at St. Vincent’s Hospital, Melbourne.
Apart from his
professional qualifications, he has first-hand experience, as someone who is
terminally ill and who for many years has battled a variety of chronic health
problems. In fact, the book contains a sprinkling of his own experiences as a
hospital patient and how he lived first-hand the application, or lack of,
bioethical principles.
In the first chapter of
the book Tonti-Filippni discusses a number of general matters regarding the
relationship between patients and the health care system. In one section he
deals with the matter of health care principles as developed in Catholic
tradition.
One of them,
stewardship, originated in the Middle Ages and centers on the idea that humans
are stewards, responsible for the care of their body. This is greatly different
from a worldview that sees life as expendable if it loses its utility. The
principle of the inviolability of human life is related to the first.
A third principle is
that of totality, which sees each part of the body as existing for the good of
the whole. According to this the lower functions of the body are never
sacrificed except for the better functioning of the total person, and the
fundamental faculties that essentially belong to being human are never
sacrificed, except when necessary to save life.
Extraordinary care
The book’s second
chapter deals with the various issues of care for those who are dying. The
distinction between ordinary and extraordinary means in treatment dates back to
the 16th century, Tonti-Filippini observes.
According to this,
medical procedures that are disproportionately burdensome or disproportionate
to the expected outcome can be discontinued. This is very different from
suicide, which contradicts the natural inclination to preserve our lives.
One topic examined in
the chapter is that of resuscitation orders. When a person is suffering from a
serious disease an attempt to re-start a person’s heart if it fails is unlikely
to succeed. Attempting to resuscitate every person would mean no one could die
in peace, Tonti-Filippini explained. Resuscitation is also very intrusive and
cardiac massage often breaks ribs, especially in the elderly.
The author says that among
the factors to be taken into account in deciding whether or not to issue a “do
not resuscitate order” are: the patient’s state of mind and any inclination to
suicide, whether the patient has all the relevant medical information, and the
judgment of the patient’s doctor.
On the matter of
discontinuing food and water to patients Tonti-Filippini is of the view that a
Catholic facility should do its best to persuade a person who is refusing
nutrition and hydration in order to die to change their minds.
Turning to euthanasia,
which is distinct from withholding a futile treatment, and which deliberately
ends someone’s life by a fatal treatment, Tonti-Filippini observed that while
we should indeed respect a person’s autonomy, taking one’s life ends any opportunity
for autonomy in the future. Indeed, Immanuel Kant said that suicide was wrong
because it involved treating oneself as an object or a means to an end.
Physician-assisted
suicide also contradicts the role of a doctor in seeking to maintain life and
health. If euthanasia were possible the focus would shift from palliative care
to that of ending people’s live.
Not for nothing,
Tonti-Filippini stated, have virtually all national medical organizations in
the English-speaking world unequivocally rejected the practice of euthanasia
and physician-assisted suicide as contrary to the ethos of medical care.
Respect for life
Responding to the
criticism that the sacredness of human life is a religious belief that should
not be reflected in civil law, Tonti-Filippini commented that the inviolability
of human life is not only a religious notion, but is recognized in
international human rights law.
When it comes to people
who are in an unresponsive state, the respect for their lives remains intact
because it is not based on the function they can or cannot carry out, but on
who they are.
Proponents of
euthanasia frequently argue that carefully drawn-up legislation will prevent
any abuses and will limit the practice to those really in need. Tonti-Filippini
pointed out that the experience in countries where euthanasia is legal
demonstrates the contrary. There is indeed a “slippery slope” and moreover the
will to live is likely to be affected by the option of euthanasia as some
people will feel they should not be a burden on their families.
In other chapters
Tonti-Filippini explores themes such as mental illness, suffering as seen from
a Christian perspective, and what it means to live with chronic illness and
pain. Overall, the book manages to combine in a very persuasive way ethical
norms and Christian principles, illuminated by the very poignant personal
experiences of the author.