Law, faith and the good death

WINNIPEG, Manitoba -- As the end of his life drew near, Pope Pius XII began addressing complex medical questions that were personal, theological, practical and scientific, all at the same time. For example, how far could doctors go to relieve a dying patient's pain?

Months before his death in 1958, the pope wrote: "Is the suppression of pain and consciousness by means of narcotics (when it is demanded by a medical indication) permitted, by religion and morality, to the patient and the doctor (even at the approach of death and when one foresees that the administration of narcotics will shorten life)?" His answer was "yes," if that was what it took to truly relieve suffering.

Pius XII also knew that doctors were pondering ways to apply ancient truths to issues raised by new technologies, said Ian Dowbiggin, author of "Life, Death, God and Medicine: A Concise History of Euthanasia." The historian from the University of Prince Edward Island spoke to media professionals gathered at this week's G8 "World Religions Summit" at the University of Winnipeg.

Many of these puzzles remain, which is why ethicists still study another 1957 address by Pius XII to the International Congress of Anesthesiologists, in which he asked when it was necessary to make extraordinary efforts to resuscitate patients.

The pope concluded that if it "appears that the attempt at resuscitation constitutes ... such a burden for the family that one cannot in all conscience impose it upon them, they can lawfully insist that the doctor should discontinue these attempts, and the doctor can lawfully comply. There is not involved here a case of direct disposal of the life of the patient, nor of euthanasia in any way: this would never be licit. Even when it causes the arrest of circulation, the interruption of attempts at resuscitation is never more than an indirect cause of the cessation of life."

Dowbiggin stressed that Pius XII was already engaging complex issues that continue to impact debates -- in Canada, the United States and elsewhere -- about legalizing physician-assisted suicide. While this decade has seen a "perfect storm" of conflicts about a "right to die," it is essential that citizens, clergy and public officials study the history of euthanasia before making policy decisions that will touch millions of lives in the future, he said.

"There are deep moral and religious issues at stake in debates about physician-assisted suicide, which is why religious believers have always been involved," said Dowbiggin. "But what we are hearing today are prominent voices that say that religious people must keep their ideas to themselves, because religion is a private thing -- period -- and must not affect public life. If that idea is accepted, that's a major step toward the acceptance of physician-assisted suicide."

The word "euthanasia" comes from two Greek words that simply mean "good death," noted the historian. For centuries, Catholics and others have argued that a "good death" is one that is as pain-free and dignified as possible. Thus, religious groups have been at the forefront of efforts to offer in-home hospice care.

However, several trends have aided efforts to legalize physician-assisted suicide, especially scientific advances that have increased the "graying of America," said Dowbiggin. Thus, people are living longer lives, which also means they are more likely to face lengthy battles with cancer and neurological conditions such as Alzheimer's and Parkinson's disease.

Rising health-care costs have also affected "quality of life" debates. After all, as President Barack Obama told the New York Times, the "chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here." The stakes are rising.

Meanwhile, the Hemlock Society has evolved into End of Life Choices, an organization that merged with Compassion in Dying to form Compassion & Choices. Physician-assisted suicide became the "right to die" which has now evolved into calls for a legal "self deliverance" option.

If religious leaders want to keep taking part in these policy discussions, said Dowbiggin, "they must have something positive to say. It is not enough to just keep saying 'no.' ... They need a vision of what the 'good death' looks like. They need to say that this is the goal of all end-of-life care -- people making informed moral decisions about hospice and other forms of care that are right for themselves and for their families."

Hemlock, health care and Catholic choices

The "Your Life, Your Choices" booklet didn't cause trouble at the Department of Veterans Affairs until late in President George W. Bush's second term. That's when critics spotted an odd detail in this guide for end-of-life medical decisions. It urged aging veterans to seek expert advice from one group -- Compassion & Choices. It helps to know that this organization was created in 2005 through the merger of two groups, Compassion in Dying and End-of-Life Choices and that, until 2003, End-of-Life Choices was known as the Hemlock Society.

The Bush White House pulled that edition of "Your Life, Your Choices," but a revised version -- minus the plug for Compassion & Choices -- has been restored to the VA.gov website. Conservative critics remain worried.

"Obviously, the Catholic church and our bishops have been strong advocates of health-care reform, especially when it comes to making the system more accessible for the poor and needy. That's a no-brainer," said John Haas, president of the National Catholic Bioethics Center and a member of U.S. Conference of Catholic Bishops task force on health care.

"But this VA issue shows why we just don't trust the government when it comes to helping people make all the moral and religious decisions that come at the end of life. ... The Hemlock Society? Catholics would rather do our own counseling, thank you very much."

It's easy for outsiders to get lost in the details of the sprawling packages of legislation now being debated on Capitol Hill. However, Haas stressed that critical questions remain unanswered about how efforts to reform America's health-care system will affect hot-button issues such as abortion, stem-cell research and health-care rationing for the elderly and chronically ill.

Thus, a letter from the U.S. bishops to Congress and the White House pledged support for accessible, affordable, universal health-care reform that truly "protects and respects the life and dignity of all people from conception until natural death."

In the headlines, it is easy for these concerns to be crunched into shouted questions in health-care forums about taxpayer-funded abortions and fears that government "death panels" will micromanage critical decisions in nursing homes.

But calmer, quieter voices inside the Washington Beltway still want to know more about the proposed Center for Health Outcomes Research and Evaluation, which legislation sponsored by the late Sen. Edward Kennedy claims would "collect, conduct, support and synthesize research comparing health outcomes, effectiveness and appropriateness of health care services and procedures."

While striving to avoid risky specifics, President Barack Obama has said it will be impossible to expand health-care services without tough-minded reforms that cut costs. This is especially true when discussing care for the elderly.

"That's where I think you just get into some very difficult moral issues. But that's also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here," said Obama, in a much-quoted New York Times interview.

"I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. ... That's part of why you have to have some independent group that can give you guidance."

The president recently went further, according to Twitter postings from a conference call with 1,000 rabbis. Obama reached out to these religious leaders, stressing, "We are God's partners in matters of life and death."

No one doubts that millions of Americans want help while making decisions about end-of-life medical issues, stressed Haas. The question is whether most would prefer to face these ultimate issues with help from government experts or from their own pastors, rabbis, priests, hospice workers and other religious counselors.

"The Catholic Church has a highly developed body of teachings and traditions to help guide people through these kinds of decisions," said Haas. "We believe that hospice care is normal and good. We believe that it's right to die a good death, with an emphasis on the relief of pain and suffering. ...

"But let's be clear. We think the government has an agenda on these kinds of issues and it's not the church's agenda. When it comes to dying, controlling costs is not our primary goal."

Amarillo makes Catholic news -- again

The Catholic Diocese of Amarillo is not the kind of place that makes national news very often.

Yet the bishop of the Texas high plains did precisely that in 1981 when he took an idealistic -- some said foolhardy -- stand to defend the sanctity of life. Bishop Leroy Matthiesen urged workers at the nearby Pantex plant to walk away from their jobs assembling nuclear weapons.

Peace activists cheered, while big-league journalists rushed to cover the story.

A quarter of a century later, the tiny Diocese of Amarillo is back in the news and, once again, its leaders are speaking out on the sanctity of life. This time, the conservative Bishop John Yanta is providing a home for a new Catholic society dedicated to activism against abortion, euthanasia, the death penalty and other symptoms of what the late Pope John Paul II called the "culture of death."

The priest who leads the new Missionaries of the Gospel of Life society isn't expecting media cheers this time, although he believes there is a connection between these life-and-death issues, from nuclear bombs to unborn babies.

"All human life is sacred and whatever the threat to it is, the church must be there speaking out," said Father Frank Pavone, director of the existing Priests For Life Network and founder of the new organization for priests, deacons and laity. "Silence is not an option when lives are at stake."

It may seem odd for this project to be based in such a remote location, in a 26-county diocese with only 49 parishes spread across 25,800 square miles. Amarillo certainly represents a change for Pavone, who grew up near New York City and was ordained by the late Cardinal John O'Connor into that powerful 397-parish archdiocese.

Rome has given the Missionaries of the Gospel of Life approval to train and direct the ministries of its own priests. The society hopes to claim Mother Teresa and John Paul II, author of the Evangelium Vitae ("Gospel of Life") encyclical, as its patron saints.

"The idea of a new religious community founded for the purpose of working to protect human life may seem like a sign of contradiction -- but it may just be what the world of today needs," wrote Cardinal Renato Martino of the Pontifical Council for Justice and Peace. "The call to protect life is ... the very basis of our recognition of human rights."

Pavone said 50 men have already attended retreats to learn more about the society, while 300 have inquired by email. Meanwhile, 15 priests are talking to their bishops about joining.

"I do not know how large we will be. It could be 40 priests or it could be 400. There will also be deacons and lay people involved," said Pavone.

While some of these priests may be based in parishes, most will travel nationwide taking part in protests and teaching clergy and laity how to lead demonstrations and to counsel women who have had abortions. In effect, they will do what Pavone has done with Priests For Life, including his high-profile work with the parents of Terri Schiavo, who died last March in Florida after her feeding tube was removed.

This is precisely what worries Planned Parenthood leaders, who have circulated an Institute for Democracy Studies report claiming that Pavone and his associates have consistently presented a "moderate" face to the public, while supporting clinic blockades and other illegal protest activities. "Priests for Life say they oppose violence, but their actions send a different message," according to the report.

The Missionaries of the Gospel of Life will continue to be committed to public marches and prayer vigils, with a renewed emphasis on nonviolence, order and the leadership of trained clergy, said Pavone, during a visit to Washington, D.C., for last week's annual March For Life.

"If a priest or a bishop comes out and leads a protest or a prayer service, then you don't have a leadership vacuum that can lead to trouble," he said.

"People are going to protest against abortion. This issue is that central to our faith. Would you rather have protests by trained people who are well organized and have responsible leaders or would you rather have protests that are random and chaotic? That's the question people on the other side need to be asking."

Cremating Terri Schiavo

Day after day, the cluster of protest placards outside the hospice in Pinellas Park, Fla., kept changing.

"Not brain dead" gave way to "Give Terri water." Hopeful appeals to Gov. Jeb Bush and President George W. Bush turned into cardboard cries of hopelessness.

Then a new message appeared in the last days before the death of Terri Schiavo: "No cremation."

Protesters were bracing for the next hot controversy. Now they wanted to know if her husband would go ahead and do what he had vowed to do, cremating her body despite the furious opposition of her highly traditional Roman Catholic parents.

As Michael Schiavo once told the Tampa Tribune: "She never wanted to be put in the ground with bugs. She always told me that." Thus, he planned -- backed by the courts -- to have her cremated and her ashes taken to his family's plot near Philadelphia.

Bob and Mary Schindler were appalled, arguing that cremation would violate their daughter's Catholic faith. The parents have requested a wake, an open-casket funeral Mass and traditional burial in Florida. In one of their many pleadings to Pinellas County Court, the Schindlers argued that Michael Schiavo "has consistently exhibited a lack of respect" toward Catholicism.

"Even in death, he isn't going to allow them a shrine, a place to go talk to her," Franciscan monk Paul O'Donnell told reporters, speaking for the family. "Won't he at least give them her dead body?"

This debate is stark evidence that many Catholics continue to struggle with changes made by the modern church. After centuries of opposition to cremation, the Code of Canon Law now states: "The Church earnestly recommends the pious custom of burial be retained; but it does not forbid cremation, unless this is chosen for reasons which are contrary to Christian teaching."

The hardest liturgical changes to accept are those linked to emotional events at the crossroads of life -- birth, marriage and death.

"Cremation is no longer considered shocking to most Catholics," said Philip Lawler, editor of Catholic World Report. "But, overwhelmingly, traditional Catholics would lean toward a traditional burial. The older the Catholic, the more likely they would remember the traditions against cremation."

The modern Catechism of the Catholic Church hints at the ancient roots of this controversy, noting that cremation is permitted, "provided that it does not demonstrate a denial of faith in the resurrection of the body."

Early Christian believers were familiar with pagan cremation rituals and saw martyrs burned at the stake, noted Father C. John McCloskey III, of the Faith and Reason Institute in Chicago. The Jewish apostles knew that Judaism rejected cremation.

"The early church also defined itself in opposition to Manichaeism, Gnosticism and other heretical sects that taught that the soul is good and the body is bad. So it didn't matter what you did with the body. The soul was all that mattered.

"But the church kept saying, 'No, the body is good. It should be honored and treated with respect.'... Thus, you had an emphasis in church tradition on funeral rites and the burial of the body in ground that has been blessed."

If Catholics choose cremation, the church still teaches that ashes should be stored in a holy place, as opposed to being kept in an urn on the fireplace mantle. Church authorities frown on rites that conclude with human ashes being scattered into nature, even though the ocean-loving relatives of John F. Kennedy, Jr., did precisely that in 1999, with the help of a priest.

In the Schiavo case, said McCloskey, it's important that the church wants Catholics to ask moral questions about their choices as they honor a deceased loved one. Thus, it is still appropriate to ask why someone -- such as Michael Schiavo -- chooses cremation over a traditional burial.

"You have to think that the goal here is to deny her family and the pro-life movement a grave, a place where they can have a shrine in her honor," he said. "But, honestly, if there is a grave of any kind, no matter where it is or what it is, people are going to find it.

"After all is said and done, people are still going to want to go there and pay tribute to Terri Schiavo."