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Bioethicist unpacks Samaritanus Bonus and idea of ‘remaining’ with the dying

Breaking open: Australian Catholic University Queensland Bioethics Centre director Dr David Kirchhoffer.

A LEADING bioethicist said having read Samaritanus Bonus (The Good Samaritan), the latest letter from the Congregation for the Doctrine of the Faith, one idea stood out above the others – “remaining”.

The letter, which was published on September 22, taught and clarified Church teaching on end-of-life care and euthanasia.

It drew on the story of Christ’s own end-of-life care.

Australian Catholic University Queensland Bioethics Centre director Dr David Kirchhoffer said when the letter talked about Jesus at His death and resurrection, it raised the idea of Mary and John standing at the Cross with Him.

He said the text revisited the idea of “remaining” with the dying person again and again.

The letter spoke directly about this dignity given by Mary and John to God the Son.

“Christ is aware of the painful shock of his Mother and his disciples who ‘remain’ under the Cross and who, though ‘remaining’, appear impotent and resigned, and yet provide the affective intimacy that allows the God made man to live through hours that seem meaningless,” the letter said.

“Then there is the Cross: an instrument of torture and execution reserved only for the lowest, that symbolically looks just like those afflictions that nail us to a bed, that portend only death, and that render meaningless time and its flow.

“Still, those who ‘remain’ near the sick not only betoken but also embody affections, connections, along with a profound readiness to love.

“In all this, the suffering person can discern the human gaze that lends meaning to the time of illness.

“For, in the experience of being loved, all of life finds its justification.

“The Love of God always makes itself known in the history of men and women, thanks to the love of the one who never deserts us, who ‘remains’, despite everything, at our side.”

Dr Kirchhoffer said the emphasis on the word “remaining” came from an idea that “what we really need is to remain with people and be with people in their suffering because it’s in the remaining that we’re able to really give expression to that person’s humanity”.

“And for them to know that they’re really loved and that their life is worth something regardless – that humanity in itself is worthwhile,” Dr Kirchhoffer said.

“I think it’s a very powerful idea.

“It’s not a new idea, but I think it’s something worth re-iterating because it’s more than non-abandonment, it’s more than just saying we’re not abandoning you, it’s about being in the same space as the person.”

An important area of clarification from the letter centred on pastoral care, culpability and guilt for patients who asked for voluntary assisted dying or carried it out.

“Just as we cannot make another person our slave, even if they ask to be, so we cannot directly choose to take the life of another, even if they request it,” the letter said.

“Therefore, to end the life of a sick person who requests euthanasia is by no means to acknowledge and respect their autonomy, but on the contrary to disavow the value of both their freedom, now under the sway of suffering and illness, and of their life by excluding any further possibility of human relationship, of sensing the meaning of their existence, or of growth in the theological life.

“Moreover, it is to take the place of God in deciding the moment of death.”

The letter identified that people who were suffering greatly could be less capable of making authentic autonomous decisions.

Dr Kirchhoffer said these sufferings could lead a person to make an error of judgment and request euthanasia, and that the impact to their autonomy from their suffering could have a mitigating effect on guilt too.

“The act of asking someone to actively and intentionally end your life is wrong because life is a fundamental good,” Dr Kirchhoffer said.

“But, because the situation of pain or existential suffering can have an effect on the degree to which a person is really free in making that request, or really reasoning well about the situation, the person may not be morally culpable in the same way that an otherwise healthy person would be in making the same request.”

Dr Kirchhoffer said given the fact that autonomy can be comprised in these ways, it would not be appropriate for the person who heard that request to judge it as an authentically autonomous request.

If a person was going ahead with euthanasia, the letter said the Sacrament of Penance was not appropriate because “we find ourselves before a person who, whatever their subjective dispositions may be, has decided upon a gravely immoral act and willingly persists in this decision”.

The letter stressed that “postponing” absolution in such a case did not imply judgment of mortal sin, because the person’s personal responsibility “could be diminished or non-existent” depending on their illness.

In this way, the letter opened the possibility that people who requested euthanasia, or even went through with it, might not necessarily have committed a mortal sin.

Even if culpability could be reduced, the text stressed chaplains and others in healthcare systems should “avoid any gesture, such as remaining until the euthanasia is performed, that could be interpreted as approval of this action”.

Dr Kirchhoffer said the letter identified the dangers associated with legislation around euthanasia too.

One danger was that lawmakers could draft laws that, when interpreted, could undermine the foundations of a just society, he said.

“Like the idea that life is a meaningful and useful thing regardless of its actual status, regardless of how effective it is,” he said.

He said if you started to give the impression that not all life was meaningful and purposeful, then that opened “all sorts of ways for people to treat people badly, or to treat themselves badly”.

“I think that the job of lawmakers is to provide laws that actually send a positive message to people about the kind of life and society you want to construct,” he said.

Dr Kirchhoffer said the most important argument in the letter against the legislation of voluntary assisted dying was the danger that people could find themselves being told that they “should like this” and feel obliged to accept it when they did not wish to.

“No matter what safeguards you put in, that risk of vulnerable people ending their lives prematurely under duress, or perceived duress, is such that I think as a society we should be really, really careful … because it undermines the core value of a just society, namely that human life is meaningful and purposeful,” he said.

“I think that the common good is at risk, what you might call the public interest, is at risk; what else can you start to undermine and say, ‘Well, this is usually important but not in this case’ and ‘not for these people’ and ‘not for that group?’”

The letter harked back to Pope Francis’ term “throw-away culture”, where “victims are the weakest human beings, who are likely to be discarded when the system aims for efficiency at all costs”.

“This cultural phenomenon, which is deeply contrary to solidarity, John Paul II described as a ‘culture of death’ that gives rise to real ‘structures of sin’ that can lead to the performance of actions wrong in themselves for the sole purpose of ‘feeling better’ in carrying them out,” the letter said.

“A confusion between good and evil materialises in an area where every personal life should instead be understood to possess a unique and unrepeatable value with a promise of and openness to the transcendent.

“In this culture of waste and death, euthanasia and assisted suicide emerge as erroneous solutions to the challenge of the care of terminal patients.”

Ultimately, the letter said euthanasia was “an act of homicide that no end can justify and that does not tolerate any form of complicity or active or passive collaboration”.

“Those who approve laws of euthanasia and assisted suicide, therefore, become accomplices of a grave sin that others will execute,” the letter said.

“They are also guilty of scandal because by such laws they contribute to the distortion of conscience, even among the faithful.”

The letter concluded that “hope is always possible, even within a throwaway culture”.

The redemption of the human person was rooted in the loving involvement of God in human suffering, the letter said.

It was in this mystery of redemption that the wisdom of the Good Samaritan was realised – “every individual must feel as if called personally to bear witness to love in suffering”.

Through ministering to the “least ones”, we minister to Christ, and with that came the “rewards of eternity”, the letter said.

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