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February
5, 2007
VOL.
45, NO. 3Oakland,
CA
Decisions on
dying:
Italian case highlights complex issue
 |
| Mourners gather for the funeral service of Piergiorgio
Welby in Rome on Dec. 24. CNS PHOTO/MAX ROSSI/REUTERS |
VATICAN
CITY (CNS) -- The death of an Italian muscular dystrophy patient who had
his respirator disconnected is fueling a complex and significant discussion
among top church officials.
Piergiorgio Welby, who was paralyzed and kept alive by a breathing machine
for nine years, pleaded for months for the device to be turned off. He
said medical technology was only artificially postponing his death.
In late December, a physician granted his request, and Welby died shortly
afterward.
The case had already become a political football in Italy, as proponents
of right-to-die legislation flocked to Welby’s bedside and, with
his support, used his suffering to promote their cause.
The Church was drawn in directly when Cardinal Camillo Ruini, papal vicar
of Rome, denied Welby a church funeral, saying he had committed suicide.
The cardinal’s decision was bitterly criticized by Welby’s
widow and many other Italians, including some prominent Catholics.
Two Vatican officials steered clear of such judgments. Cardinal Javier
Lozano Barragan, president of the Pontifical Council for Health Care Ministry,
and Bishop Elio Sgreccia, president of the Pontifical Academy for Life,
said they did not have enough information to say whether this was a case
of assisted suicide or the legitimate rejection of unreasonably burdensome
treatment.
On Jan. 21, Italian Cardinal Carlo Maria Martini added his voice to the
discussion, in an article published in the Italian newspaper Il Sole 24
Ore, Cardinal Martini has Parkinson’s disease, and said he wrote
the piece partly because of his own medical experiences.
Cardinal Martini appeared to be sympathetic to Welby’s request.
He pointed out that Welby was lucid when he asked for suspension of the
long years of respiratory treatment through a tracheotomy, which offered
the patient no possibility of improvement.
The cardinal said the distinction between euthanasia and relief from oppressive
therapy is an important one. The Church condemns euthanasia, which it
describes as an act or omission that, of itself or by intention, causes
death in order to eliminate suffering.
On the other hand, as Cardinal Martini noted, the Church says it is legitimate
to discontinue medical treatment that is too burdensome, dangerous or
disproportionate to the expected outcome.
Welby had argued that, given his prolonged suffering and no chance of
improvement, suspending treatment was the ethical decision.
Cardinal Martini did not offer a specific judgment on the Welby case,
but noted that it is generally up to the patient to decide whether a treatment
is proportionate or disproportionate.
Cardinal Martini’s commentary was carefully worded, but newspaper
headlines boiled it down to: “Cardinal says patients should have
right to die.”
That prompted Bishop Sgreccia to respond with an article of his own, published
Jan. 23 in Italy’s daily Corriere della Sera.
Bishop Sgreccia, while agreeing with many of the principles explained
by Cardinal Martini, said end-of-life decisions cannot be made solely
by the patient. It is the doctor, he said, who is best able to judge whether
a treatment is “proportionate” or not.
“When one talks about refusing therapy on the part of a patient,
the doctor, although he has the duty to listen to the patient, cannot
be considered a simple executor of the patient’s wishes,”
Bishop Sgreccia said.
Cardinal Martini had suggested that a French law allowing patients to
refuse treatment in some cases might be a model for Italy. Bishop Sgreccia
disagreed, saying the French law in effect forces a doctor to go along
with a patient’s decision to end life-support treatment, even when
the doctor disagreed.
“This could represent ‘euthanasia by omission’ on the
part of the patient and the doctor,” Bishop Sgreccia said. “Personally,
I don’t hope to see that in Italy.”
In his article, Cardinal Martini called for “more attentive pastoral
consideration” to such cases -- which some took as a subtle criticism
of Cardinal Ruini’s denial of a church funeral for Welby.
Cardinal Ruini, addressing Italian bishops Jan. 21, said he suffered when
he made that decision, but that it was based on Welby’s declared
wish to “end his own life.” Granting a funeral, the cardinal
said, would have “legitimized behavior contrary to God’s law.”
That prompted Welby’s widow, Mina, to question why the Catholic
Church recently allowed a religious funeral for Gen. Augusto Pinochet,
the former Chilean dictator, human rights violator and accused murderer,
while refusing it for “my Piero, who only wanted to stop suffering.”
Mina Welby and others have argued that her husband’s decision was
similar to the case of Pope John Paul II, who shortly before he died asked
that he be left to “return to the house of the Father.”
But Rodolfo Proietti, the physician who treated the late pope, said that
kind of comparison is unwarranted. In an interview with Catholic News
Service, he expressed sympathy for Mina Welby but said the end-of-life
issues were very different in the case of Pope John Paul.
“I will not discuss the particular details of my treatment of the
pope, but it was not comparable in any way (with the Welby case),”
Proietti said. He said it disturbed him that people were taking the last
days of the pope and using them as an example of a right-to-die situation.
Unfortunately, Proietti said, the ethical debate over proportionate or
disproportionate treatment is confusing because the key terms are vaguely
defined. As a result, he said, the line between rejecting “burdensome
treatment” and euthanasia by omission is ambiguous.
“I think there needs to be a meeting and a deep reflection, in order
to offer everyone -- especially doctors -- definitions that are accepted
and shared,” he said.
He said he agreed with Cardinal Martini on one major point: that the Church
is certain to face these situations more often in coming years.
