Fausto Gomez OP
John is 48 years old. He is terminally ill with brain cancer – and suffering terribly. His older brother who is a physician has accepted, and convinced John, that euthanasia is unethical and unchristian. Now the only daughter of John cannot accept his approaching death, and wants to continue treatment by all means available. Out of love for her, her father has consented to start aggressive treatment. Now the physician asks: May I give to my brother all the medical means available to keep him alive?
The doctor is asking for what is called dysthanasia. Is dysthanasia ethical and Christian?
MEANING OF DYSTHANASIA
What is dysthanasia? Etymologically, dysthanasia means faulty, imperfect death. It may be defined as the medical process through which the moment of death is postponed by all means available. Dysthanasia is the undue prolongation of life – of dying -, the postponement of death.
The fundamental ethical distinction to apply in the case of the terminally ill is the distinction between ordinary and extraordinary means of treatment. In the words of the National Conference of American Bishops (USA), ordinary or proportionate means “are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.” On the other hand, extraordinary or disproportionate means refer to “those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive expense on the family or the community.” This important distinction should be applied fairly and not in a discriminatory manner – in a different way for rich and poor, for men or women, for children and the elderly, for the able and the differently able.
Another important and enlightening distinction on the case refers to the kind of treatment, which can be beneficial, useless or doubtful. If the treatment is beneficial it must be generally given, except when it is too burdensome for the patient or the family. Useless treatment is futile treatment, which is not really beneficial but futile. When the doctor is not sure if it is beneficial or useless, the treatment is called doubtful treatment.
MORALITY OF DYSTHANASIA
Human life must be protected and dutifully prolonged. From a humanist and Christian perspective, human beings are obliged to take care of and prolong their lives through ordinary, proportionate, beneficial means. It is our duty to care for our life and try to be healthy. For believers in God, the use of beneficial treatment is connected with the principle of stewardship, which states that we are stewards of our life which belongs to God, our creator, who is the Lord of life and death.
When the medical treatment is doubtful or uncertain, the “best-interest of the patient” principle seems to demand providing treatment, which has a potential benefit – to health and life.
When the treatment is futile, or too burdensome, it is not obligatory to use it, but generally optional. However, it appears more humane and Christian not to try a useless therapy. Indeed, if it is truly useless, why should it be used at all? The poet Jorge Manrique wrote: Que querer hombre vivir / cuando Dios quiere que muera / es locura (“For man to want to live when God wants him to die is madness”). Therefore, death should not be caused, neither should it be absurdly delayed (Spanish Episcopal Conference). St John Paul II said: “Both the artificial extension of human life and the hastening of death, although they stem from different principles, conceal the same assumption: the conviction that life and death are realities entrusted to human beings to be disposed of at will.”
When facilities are scarce, when the poor do not have primary health care, may we squander funds and resources by providing futile high-tech procedures? The use of extraordinary means is at most optional and, at times, it may be obligatory not to use them. In some cases – or more than some -, it may also be against social justice: medical resources are limited and ought to be used rationally and ethically by those who really need them. Furthermore, very often the use of extraordinary means entails for the patient, who is hooked to machines and heavily intubated with multiple tubes, an incredible isolation from his or her loved one.
Dysthanasia is generally unethical because it is not the due prolongation of life, but the undue postponement of death, which usually ends up in an “undignified death,” after an abusive use of extraordinary means of treatment, provoked by the technological imperative. The doctor is obliged to treat, but not to over-treat.
Another basic question: Who decides to use or not use disproportionate means of treatment? When possible, the patient gives informed consent: the patient gives free and responsible consent after knowing and understanding his medical facts, treatments available to him and their consequences). When not possible, proper surrogates (the closest relative or the family representative) provide proxy or substitute consent, which must respect the principle of the best interest of the patient.
THERE IS A TIME TO LIVE AND A TIME TO DIE
The daughter of John is really asking for the undue prolongation of life, for the continuation of artificial life for her dear father. Life has a beginning and an end for all humans. There is a time to live. Last medical report: John’s terminal cancer of the brain has metastasized to other parts of his body. The daughter is asking for the postponement of his death through useless and futile means of treatment. For each one of us, there is a time to die (Ecl3:2), neither earlier through euthanasia, nor later through dysthanasia.
Another major point! Objectively speaking, the ethical principles are clear and neat – and helpful. The problem is we are speaking of subjects, of persons, of a concrete persons, of John who has a loving daughter, and a brother who is a doctor. We cannot leave John with cold bioethical principles and their application to his case. Against his pains, doctors give painkillers. Against his loneliness, the daughter and the “significant “others” offer love, solidarity and compassion. Accompaniment and love will also aid John’s daughter. Praying with him and for him is a fraternal Christian duty.
We add a final significant point: our humanity and our faith urge us to defend life. We respect people with different stands on the matter.
The elder brother of John, the physician should not provide his younger brother John with extraordinary means of treatment. What else can he do for John? In our next conversation we hope to share with you, dear reader, some more thoughts on this sensitive matter. Until then take it easy, be compassionate – and smell the flowers on your way!