In the case of Winterbottom v. Wright in 1842, Judge Robert Rolf said, “Hard cases, it has frequently been observed, are apt to introduce bad law.” By that he meant that laws are better drafted under ordinary cases as difficult ones can lead to legislation for exceptions.

Such is the position in which we find ourselves with respect to end-of-life care. Advances in nutrition, exercise, medicine, and quality of life have led to increasing life spans. Normally that’s a good thing and while no one wants to die young, neither does anyone wish to live with crippling, painful infirmities requiring costly and elaborate care.

I had a friend who contracted MS when he was thirty years old. By the time he was forty he was paralyzed from the neck down, and he lived until he was sixty five. My uncle contracted Alzheimer’s and was rendered completely catatonic inside of two years, but lived for another four. In the former case my friend’s mind was unaffected but he was trapped for over twenty five years in a non-responsive body. In the latter, only my uncle’s body was unaffected. Between these two polar extremes are vast numbers of elderly, infirm, and handicapped who suffer with incurable, albeit non-fatal conditions.

In 1990 Dr. Jack Kevorkian assisted 54-year-old Janet Adkins of Portland, Oregon who was suffering from Alzheimer’s to end her life. Over the next 8 years he similarly assisted others, and was eventually sentenced to prison. After his release he vowed to work solely on changing the laws against assisted suicide.

Also in 1990, 26 year old Terri Schiavo suffered cardio-respiratory arrest and was then diagnosed with hypoxic encephalopathy, a neurological injury caused by lack of oxygen to the brain. She lingered in a semi-vegetative state for 15 years with a feeding tube providing food and hydration. Under the order of Judge George W. Greer of the Pinellas-Pasco’s Sixth Judicial Court, the tube was removed and she died of dehydration after 13 days. Terri’s husband approved this action despite the wishes of Terri’s biological family.

In April of 2022 in the U.K., the parents of 12-year-old Archie Battersbee found him unconscious after what they believed was a social media challenge gone wrong. Like Schiavo, he suffered brain damage. Following numerous court hearings and appeals, the U.K. Supreme Court ordered the cessation of care stating that, “even if life-sustaining treatment were to be maintained, Archie would die in the course of the next few weeks through organ failure and then heart failure.” Despite the pleas of his parents and supporters in the general public the ventilator was removed and young Archie passed away. In response the president of the Pontifical Academy for Life, Archbishop Vincenzo Paglia said, “When the life of someone is decided by a court, humanity is defeated.”

Opponents of euthanasia warn us of situations just like Archie’s — governments and medical personnel intervening and dictating medical care and when a patient dies against the wishes of the individual or legal guardians, otherwise known as euthanasia.

While the literature uses the terms interchangeably, it’s important to distinguish between euthanasia and assisted suicide. Both terms refer to the act of ending a person’s life to put an end to suffering, as long as the patient agrees. In the case of euthanasia, a doctor administers the pharmaceutical that ends the person’s life, while in assisted suicide a physician oversees the process by which the patient administers the substance himself.

Euthanasia and assisted suicide, now referred to as Medical Assistance In Dying (MAID), were once considered unthinkable but are now entering the mainstream. As mentioned above, Dr. Kevorkian brought assisted suicide to public awareness here in the U.S. in the 1990s while the Netherlands and Belgium began the practice in 2002.

Thankfully, governments are putting some guardrails in place. In order to qualify in Belgium, patients must have an incurable disease and experience constant, intolerable pain or mental suffering that does not respond to medication.

How is “mental suffering” quantified?

The British Parliament recently voted in favor of legalizing assisted dying in England and Wales. The requirements of the proposal appear to cover all the bases to ensure safety: patients must be residents of England and Wales, be under a doctor’s care, must possess sufficient mental capacity, and so on. Other countries are following suit. So far in 2024 over two dozen countries have enacted laws regarding assisted suicide.

The Catholic Church has published ethical guidelines on the subject:

Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate;

and,

Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable Palliative care is a special form of disinterested charity. As such it should be encouraged.

At a minimum, food and hydration are necessary to sustain life and withholding these is tantamount to murder. In 2004 Pope John Paul II stated that, “[T]he administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use...consists in providing nourishment to the patient and alleviation of his suffering.”

The legal restrictions put in place on this practice in Belgium, England, and Wales, as well as the moral ones provided by the Catholic Church, seem to provide adequate guidance on the issue. This is important because the number of people availing themselves of the procedure is growing. In Canada, for example, 1,018 people requested MAID in 2016 while in 2022, the last year for which data are available the number was over 13,241.

Canadian military veteran Christine Gauthier was not one of those 13,241. In 2019 she contacted Veterans Affairs Canada (VAC) asking for a home wheelchair lift. A  VAC employee offered her MAID as a solution to her suffering. Outraged, Gauthier wrote to PM Trudeau who, to his credit, responded with this statement:

[A]s soon as we heard about this we took action. We are following up with investigations and we are changing protocols to ensure what should seem obvious to all of us: that it is not the place of Veterans Affairs Canada (VAC), who are there to support those people who stepped up to serve their country, to offer them medical assistance in dying.

Anthropologist Margaret Meade is sometimes cited as saying that the first sign of civilization in the fossil record is a healed femur. A primordial human who broke his thigh bone would certainly die unless cared for by someone who risked his own survival to bring food and water to the invalid.

Modern society is entering dangerous and confusing territory as it is targeting the helpless at both ends of life through abortion and MAID. Declining fertility rates coupled with an aging population can create hard cases and bad laws. While abortion never improves the life of the unborn, MAID can eliminate needless suffering.

The question is, are we taking the life of someone else to help them, or to save ourselves the trouble and expense of caring for them?

Image: Free image, Pixabay license.