Bobby Schindler and I write at National Catholic Register on Italy’s recent adoption of Advance Directives, or “Living Wills”:
Advance Directives, to the extent that they enable a mentally and physically competent person to outline their authentic and life-affirming medical wishes in advance of situations where their judgement may be compromised, can be good and useful instruments for ensuring that health care be life-affirming and not needlessly extraordinary in nature. What makes Italy’s Advance Directive law so troublesome is its embrace of a euthanasia logic that permits, or even encourages, patients to fatally deny themselves food and water, and further its aggression and violence against the conscience rights of physicians and health care workers whose right to dissent is not recognized. Every one of those more than 700 physicians who appealed for Eluana’s right to basic treatment may one day be forced to choose between intentionally bringing about the death of another Eluana, on the one hand, or being branded an extremist and consequently forced out of medicine, on the other.
Whether one is Catholic, or Protestant, or secular and unreligious, it represents a distortion of medicine’s purpose to conflate Advance Directives and the principle of medical planning with the ability to self-deny or to be denied food and water, which represents neither a costly nor an exotic form of care.
At the true end of life, the human body becomes incapable of metabolizing food and water, which is ultimately why the issue of “food and water” – as if it were an “end of life” issue by its nature – is disingenuous. Characterizing food and water as necessarily an “end of life” issue is a distortion of the reality facing millions of persons reliant on feeding tubes throughout the world each year. A young and recovering alcoholic, for instance, may be reliant on food and water by feeding tube for many months, or even years. In no traditional sense would this person be facing a fundamentally “end of life” issue, yet legislation like Italy’s encourages both the public and the patient to consider such situations in a much more fatalistic way—in a way almost certain to degrade a vulnerable patient’s will to live.
In societies that still officially oppose suicide and recognize the need to offer crisis counseling and emergency support to men and women captured by often fleeting moments of suicidal thinking, we should take the same approach of offering life-affirming care to medically vulnerable patients. Indeed, the daily lives of vulnerable patients may in fact be more consistently grinding on their will to live, especially in cultures like Italy’s whose law now rhetorically implies questions like, “Why not put a permanent end to anxiety? To periodic suffering? To moments of discomfort? To the need for rehabilitation?”
Italy’s parliament should do better by allowing for advance directive planning that fosters a will to live among vulnerable patients, continues to proscribe intentional life-taking, and cultivates life-affirming clinical environments where the conscience rights of physicians and health care workers are paramount in service of medicine’s basic purpose to cure, heal and comfort.