Further thoughts

“It is difficult to conclude that Nancy has good reason to shorten her life.”

Kurt Gayle’s thoughtful letter together with a re-examination of the principles involved in such cases and further information about Nancy’s condition, has in face led me to a different conclusion from the one I reached before.

People hold very strong opinions about whether or not suicide and euthanasia are involved here; possibly we will be able to agree on the criteria for decision, even if we do not agree on their application.

Mr. Gayle insists that suicide is very much in question: Nancy has tried suicide before, is not terminally ill, can think and talk and watch television, and according to her doctors can stay alive for years with proper treatment.

Foot in the door

Mr. Gayle says that the case also represents a “foot in the door” of legalized euthanasia, and he suspects that pro-death groups and the media which support them are making the most of Nancy’s situation in consequence.

But as the primary intention of the doctors will not be to kill, Judge Dufour concluded that for a patient to decline life-sustaining medical treatment, and for the physician to stop such treatment in consequence, do not constitute criminal acts.

Justice Minister Kim Campbell agreed; she stressed that the Quebec decision does not deal with euthanasia or assisted suicide.

The decision in the case was not innovative at all. It reflects what the Quebec Civil Code says; in the view of the law, the doctors will not be committing euthanasia if the disconnect the respirator.

But should it be done?

That still leaves open the question of whether Nancy ought to ask to be taken off the machine.

Christians are obliged to use ordinary means to preserve their lives, but they have no obligation to use extraordinary means. On the surface at least, it seems that Nancy is being kept alive by extraordinary means; her lungs do not function, and the machine has to do her breathing for her.

Two writers dealing with her situation conclude that the burden of being alive is more than she should be asked to endure.

In the Globe for January 7, Jim Lavery headed his article, “When merely staying alive is morally intolerable”; in the Financial Post, the nest day, Dr. David Roy of Montreal said, “Decision offers Nancy B. a measure of dignity.”

Mr. Lavery contends that the woman’s “mechanical captivity” is unendurable for her: “She feels the irreversible and forced reliance on the ventilator causes her greater harm than her untimely death. She doesn’t actually want to die; she just wants to free herself from intolerable technological constraints.”

Roy takes a similar view of life-sustaining means which may offend human dignity: “Patients may reasonably wonder about the worth of human dignity when they feel inferior to a life-support machine because of their powerlessness to command it…,” he writes. So he sees Nancy’s wish to be taken off the respirator as not suicide or euthanasia; there is no law of the state or of morality which can justifiably command her to be enslaved to a life support machine.

Paradox

Paradoxically, these defenses of Nancy’s freedom of action may lead us to question it. Are such technological constraints an insufferable offense to human dignity?

I know a man who has survived one operation after another and remains alive only through kidney dialysis. No one thinks that his reliance on the dialysis machine degrades him; he is regarded as a wonderful example of human courage and tenacity.

New light was thrown on Nancy’s condition as well by Barbara Frum’s question to Nancy’s doctor, Daniele Marceau, on the CBC’s Journal about the possibility of a portable respirator, which would allow her to get out of her hospital bedroom.

The doctor replied that the suggestion was made to her patient, but she declined it.

I know another man who has to take oxygen with him everywhere he goes; it too imposes great constraints upon him, but no one considers this an unbearable affront to his dignity.

Through the questionable logic they employ, Lavery and Roy make us wonder whether it has actually been demonstrated that life is an intolerable burden for Nancy B.

Another definition

A pamphlet on euthanasia published by the Life Ethics Centre in 1983 (available from the Interim office) includes a Vatican declaration on the subject issued in 1980:
“It is necessary to state firmly once more,” the statement continues, “that nothing and no one can in any way permit the killing of an innocent human being…Furthermore, no one is permitted to ask for this act of killing…Nor can any authority legitimately recommend or permit such an action. For it is a question of the violation of the divine law, an offence against the dignity of the human person, a crime against life and an attack on humanity.”

Given this declaration, we are faced with a dilemma of a not unfamiliar kind.

The law considers it essential to the dignity of the human person for him or her to be free to refuse life-saving treatment or to ask for its cessation; in such a case a physician has to permit the death of an innocent human being, but the law does not regard this as euthanasia.

The Vatican would evidently disagree; the cessation of treatment would of itself cause death and therefore would be an act of euthanasia, a violation of the divine law.

Proportionate means

Though it regards the distinction between ordinary and extraordinary means as valid, the Vatican document adds a further refinement by speaking about proportionate and disproportionate means.

It is permitted to interrupt life sustaining measures when the investment in instruments and personnel is disproportionate to the results foreseen, or when these measures impose on the patient strain or suffering out of proportion to the benefits gained. One cannot impose on a person the obligation to have recourse to a technique which carries a risk or is burdensome:

“Such a refusal is not the equivalent of suicide; on the contrary, it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected, or a desire not to impose excessive expense on the family or the community. When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life…”

Questions…and answers

With these principles in mind, we can conclude by formulating some questions and suggesting some answers to them:

√ Has Nancy a right to be taken off the respirator under Canadian law?
Yes.

√ Have the doctors a legal obligation to take her off if she requests it?
Yes.
It seems clear that they are expected to respect the wishes of a patient who declines medical treatment in the first place, or else asks for it to be discontinued.

√ Will this open the door to euthanasia?
Not as the law sees it.
The pro-death lobby may try to use the Nancy B. case for its own advantage, but the Minister of Justice maintains that Judge Dufour’s decision merely recognizes current medical practice and is not innovative in any way.

√ Then is the cost or difficulty of medical treatment disproportionate to the results?

There is no evidence to support this.
No one has suggested that it is beyond the ordinary capacity of the hospital to provide, and Nancy has not given this as a reason.

√ Is the prolongation of life too burdensome for Nancy?
In spite of Lavery’s and Roy’s opinions to the contrary, there is no clear evidence that this is so. Her own subjective feelings have to be taken into account; but it has not been demonstrated that the respirator provides her with only “a precarious and burdensome prolongation of life.”

So the Vatican statement of 1980 hassled me to reconsider.

√ Can she in conscience ask to be taken off the respirator?
It does not seem so.