DRAFT

Assisted Suicide and Euthanasia

A briefing paper prepared for the

Northern Westchester Putnam Right to Life Vicariate

To help promote understanding the issues surrounding these actions and the provide information to New York State Lawmakers who are considering turn back 189 year old New York State Law which prohibited assisted suicide and euthanasia.

William Monti March 2017

Alan Mehldau, Chair

DRAFT Conception to Natural Death Table of Contents

I NEW YORK STATE

II PATH to EUTHANASIA • Observations

• A General History of Euthanasia

• Involuntary Euthanasia

III IMPLEMENTATION OF ASSISTED SUICIDE AND EUTHANASIA

• Belgium Extends Euthanasia Law to Kids

• A View of Some of the Results

• Colin Pritchard - Suicide of the Elderly

• American Medical Association

IV SECULAR REASONING AGAINST ASSISTED SUICIDE OR EUTHANASIA

V CATHOLIC CHURCH TEACHING ON ASSISTED SUICIDE AND EUTHANASIA

2 DRAFT Conception to Natural Death PREAMBLE “The uncontested absurdities of today are the accepted slogans of tomorrow. They come in degrees, by precedent, by implication, by default, by dint of constant pressure on one side and constant retreat on the other, until the day when they are suddenly declared to be the country’s official ideology.” Ayn Rand

I NEW YORK STATE

Several are efforts being advanced by the Culture of Death (CD) here in New York State to legalize assisted suicide followed by euthanasia. In 1828 New York State was the first state to outlaw assisted suicide, (Act of Dec. 10, 1828, ch. 20, §4, 1828 N. Y. Laws 19 (codified at 2 N. Y. Rev. Stat. pt. 4, ch. 1, tit. 2, art. 1, §7, p. 661 (1829)) many other states and territories followed suit.

Now seeking to overturn its 189 year old law advocates have made assisted death a high priority. A pending bill in our Legislature ("Medical Aid in Dying Act", A.2383/S.3151)) is alive. Advocates are concentrating their efforts on the Assembly, aiming to get the bill approved by the Health and Codes Committees so that it can go on the floor of the full Assembly for a vote.

Another pending matter is the lawsuit seeking to legalize assisted suicide. That case (Myers v. Schneiderman) is pending before the New York State Court of Appeals, our highest state court. Friend of the court briefs have been filed by the Catholic Conference, a group of 39 doctors, the disabilities-rights group Not Dead Yet, and the Orthodox Jewish organization Agudath Israel, all urging the court to uphold our current law prohibiting assisted suicide. Oral arguments on the case will took place at the end of May or June of 2017.

Within American Medical Association (AMA) a movement to abandon its decades-long position opposing assisted suicide and take a neutral stance is underway. At its July 2017 annual meeting, it will consider taking a “neutral” position which essentially sends a green light to the states that legalizing is acceptable.

II PATH to EUTHANASIA

Observations

How do we transit from outlawing Assisted Suicide to so called Death with Dignity to Involuntary Death supported by State Government Legislation, with Regulatory implementation and free from criminal prosecution.

First and foremost the path is paved with many significant governmental, institutional and religious leaders ignoring the issue leaving it to others to mount the defense of human life. Others, many of whom have no community stature are lured to the voting booth with promises that are never kept or lured to finance (institutional or religious) the cause with no real assurances that a vigorous effort will be mounted with serious leadership.

Recently Pope Francis suggested the earth may not be able to sustain the ever growing population thus we might consider limiting the number of new births.

The Vatican’s Climate Change Committee recently held its first ever closed hearings inviting one of the world’s leading zealous abortion advocates to speak; what he said is completely unknown to the world.

3 DRAFT Conception to Natural Death Tracing of Euthanasia’s history to where we are today and what the future is seeming to hold.

A General History of Euthanasia http://www.life.org.nz/euthanasia/abouteuthanasia/history-euthanasia/Default.htm

What we would term euthanasia, has been both practised and condemned by various cultures and civilasions since time immemorial.

• In ancient times physicians had a dual role: one to cure, the other was to kill. • Hippocrates separated the cure and kill functions of physicians. • The prevailing social conditions of the latter nineteenth century began to favour active euthanasia. • In 1933 the Nazis replaced the Hippocratic Oath with the Gesundheit, an oath to the health of the Nazi state. • Campaigns for the legalisation of euthanasia are widespread in many countries, with activists challenging through the legal system where they fail in legislature.

Euthanasia comes from the Greek words, Eu (good) and Thanatosis (death) and it means "Good Death, "Gentle and Easy Death." This word has come to be used for "mercy killing." In this sense euthanasia means the active death of the patient, or, inactive in the case of dehydration and starvation.

The first recorded use of the word euthanasia was by Suetonius, a Roman historian, in his De Vita Caesarum-- Divus Augustus (The Lives of the Caesars--The Deified Augustus) to describe the death of Augustus Caesar:

"...while he was asking some newcomers from the city about the daughter of Drusus, who was ill, he suddenly passed away as he was kissing Livia, uttering these last words: "Live mindful of our wedlock, Livia, and farewell," thus blessed with an easy death and such a one as he had always longed for. For almost always, on hearing that anyone had died swiftly and painlessly, he prayed that he and his might have a like euthanasia, for that was the term he was wont to use. "

Augustus' death while termed "a euthanasia" was not hastened by the actions of any other person.

Withdrawal or with-holding treatment was practiced in history, the correct term for this is orthothanasia, which means 'passive death.' In this method, the actions of curing the patient are never applied and his death is made easy in a passive form. In orthothanasia, the action of killing is not applied, but, passive actions are present in order to provide death.

The place of euthanasia in the history of medical ethics The actions of easy death have been applied for hopeless patients who have been suffering extreme pain since ancient ages.

These actions were forbidden from time to time. In Mesopotamia, Assyrian physicians forbade euthanasia. Again in the old times incurable patients were drowned in the River Ganges in India. In ancient Israel, some books wrote that frankincense was given to kill incurable patients.

Jewish society, following the teaching of the Bible and the sixth command "thou shall not kill", had rejected centuries ago every theory on shortening the life of handicapped or disadvantaged people. Judaism considered life to be sacred and equated suicide and euthanasia with murder. Dr Immanuel Jakobovits, former Chief Rabbi of England explained: "Cripples and idiots, however incapacitated, enjoy the same human rights (though not necessarily legal competence) as normal persons... One human life is as precious as a million lives, for each is infinite in value..." In Sparta, it was the common practice for each newborn male child to be examined for signs of disability or sickliness which, if found, led to his death. This practice was regarded as a way to protect the society from unnecessary burden, or as a way to 'save' the person from the burden of existence.

In ancient Greece, suicide of the patient who was suffering extreme pain and had an incurable terminal illness was made easy and for this reason, the physician gave medicine (a poisoned drink) to him. Plato wrote: "Mentally and physically ill persons should be left to death; they do not have the right to live."

4 DRAFT Conception to Natural Death Pythagoras and his pupils were completely against suicide due to their religious beliefs that the Gods place the man as the protector of the earthly life and he is not allowed to escape with his own will.

The first objection to euthanasia came from the Hippocratic Oath which says "I will not administer poison to anyone when asked to do so, nor suggest such a course."

In ancient Rome, euthanasia was a crime and this action was regarded as murder. However, history notes that sickly newborn babies were left outside, overnight, exposed to the elements.

In the Middle Ages in Europe, Christian teaching opposed euthanasia for the same reason as Judaism. Christianity brought more respect to human beings. Accordingly, every individual has the right to live since God creates human beings and they belong to Him and not themselves. Death is for God to decree, not man.

Like Judeo-Christian teaching, Islam also teaches that God is the only one who creates and the only one who may take life away.

15th - 17th Centuries Sir Thomas More (1478-1535) is often quoted as being the first prominent Christian to recommend euthanasia in his book Utopia, where the Utopian priests encourage euthanasia when a patient was terminally ill and suffering pain (but this could only be done if the patient consented). "...if a disease is not only distressing but also agonising without cessation, then the priests and public officials exhort this man...to free himself from this bitter life...or else to permit others to free him..." The problem with using this quote is that More, a devout Catholic, wrote Utopia as a work of satire.

The English philosopher, Francis Bacon (1561-1621), was the first to discuss prolongation of life as a new medical task, the third of three offices: Preservation of health, cure of disease and prolongation of life. Bacon also asserts that, 'They ought to acquire the skill and bestow the attention whereby the dying may pass more easily and quietly out of life.' Bacon refers to this as outward euthanasia, or the easy dying of the body, as opposed to the preparation of the soul. It appears unlikely he was advocating 'mercy killing', more likely he was promoting what we would term better 'palliative' care.

18th - 19th Centuries In Prussia, in the 18th century, 1st June 1794, a law was passed that reduced the punishment of a person who killed the patient with an incurable disease.

1828 - Earliest American statute explicitly to outlaw assisting suicide.

The earliest American statute explicitly to outlaw assisting suicide was enacted in New York in 1828, Act of Dec. 10, 1828, ch. 20, §4, 1828 N. Y. Laws 19 (codified at 2 N. Y. Rev. Stat. pt. 4, ch. 1, tit. 2, art. 1, §7, p. 661 (1829)), and many of the new States and Territories followed New York's example. Between 1857 and 1865, a New York commission led by Dudley Field drafted a criminal code that prohibited "aiding" a suicide and, specifically, "furnish[ing] another person with any deadly weapon or poisonous drug, knowing that such person intends to use such weapon or drug in taking his own life."

Until the end of the nineteenth century, euthanasia was regarded as a peaceful death, and the art of its accomplishment. An often quoted nineteenth century document is, 'De euthanasia medica prolusio,' the inaugural professorial lecture of Carl F. H. Marx, a medical graduate of Jena. 'It is man's lot to die' states Marx. He argued that death either occurs as a sudden accident or in stages, with mental incapacity preceding the physical. Philosophy and religion may offer information and comfort, but the Physician is the best judge of the patient's ailment, and administers alleviation of pain where cure is impossible.

Marx did not feel that that his form of euthanasia, which refers to palliative medicine without homicidal intention, was an issue until the nineteenth century.

The prevailing social conditions of the latter nineteenth century began to favour active euthanasia. Darwin's work and related theories of evolution had challenged the existence of a Creator God who alone had the right to determine life or death.

The first popular advocate of active euthanasia in the nineteenth century, was a schoolmaster, not a doctor. In 1870 Samuel Williams wrote the first paper to deal with the concept of 'medicalised' euthanasia. He stated: 5 DRAFT Conception to Natural Death

"In all cases it should be the duty of the medical attendant, whenever so desired by the patient, to administer chloroform, or any other such anaesthetics as may by and by supersede chloroform, so as to destroy consciousness at once, and put the sufferer at once to a quick and painless death; precautions being adopted to prevent any possible abuse of such duty; and means being taken to establish beyond any possibility of doubt or question, that the remedy was applied at the express wish of the patient."

Though reprinted many times, the paper was seemingly ignored by the British medical profession, and in 1873 Lionel Tollemache took up his arguments in the Fortnightly Review. Writing under the clear influence of utilitarianism and social Darwinism, he described the incurable sick as a useless to society and burdensome to the healthy.

Although his views were simply dismissed as revolutionary, similar views were emerging with the new science of eugenics, as ideas of sterilising the mentally ill, those with hereditary disorders, and the disabled, became fashionable.

In 1889, the German philosopher, Nietsche, said that terminally ill patients are a burden to others and they should not have the right to live in this world.

In 1895, a German lawyer, Jost, prepared a book called "Killing Law." Jost stressed that only hopelessly ill patients who wanted death, must be let die. According to Jost, life sometimes goes down to zero in value. Thus, the value of the life of a patient with an incurable illness is very little.

The 20th Century The efforts of legalization of euthanasia began in the USA in the first years of the 20th century. The New York State Medical Association recommended gentle and easy death. Even more active euthanasia proposals came to Ohio and Iowa state legislatures in 1906 and 1907 but these proposals were rejected.

In 1920, two German professors published a small book with the title 'Releasing the destruction of worthless animals' which advocated the killing of people whose lives were "devoid of value." This book was the base of involuntary euthanasia in the Third Reich.

In this book, authors Alfred Hoche, M.D., a professor of psychiatry at the University of Freiburg, and Karl Binding, a professor of law from the University of Leipzig, also argued that patients who ask for "death assistance" should, under very carefully controlled conditions, be able to obtain it from a physician.

Alfred Hoche also wrote an essay, which he published as "Permitting the Destruction of Life Not Worthy of Life." It embraced euthanasia as a proper and legal medical procedure to kill the weak and vulnerable so as not to taint the human gene.

The reduction of punishment in mercy killing was accepted in Criminal Law in 1922 in Russia. But this law was abolished after a short while.

A French physician, called Dr.E.Forgue. published an article, named "Easy death of incurable patients" in La Revue de Paris, in 1925, and pointed out that killing an incurable patient wasn't a legal condition. But, Liege Bar said that killing an incurable patient with his free consent had to be forgiven.

The laws that accept euthanasia as a legal condition are present in two countries of South America. According to Uruguay Penal Code, a Judge must not punish a person for mercy killing. A person must also be forgiven for this kind of killing in Colombia.

Adolf Hitler admired Hoche's writing and popularised and propagandised the idea. In 1935,the German Nazi Party accepted euthanasia for crippled children and "useless and unrehabilitive" patients.

Before 1933, every German doctor took the Hippocratic Oath, with its famous "do no harm" clause. The Oath required that a doctor's first duty is to his patient. The Nazis replaced the Hippocratic Oath with the Gesundheit, an oath to the health of the Nazi state. Thus a German doctor's first duty was now to promote the interests of the Reich.

Anyone in a state institution could be sent to the gas chambers if it was considered that he could not be 6 DRAFT Conception to Natural Death rehabilitated for useful work. The mentally retarded, psychotics, epileptics, old people with chronic brain syndromes, people with Parkinson's disease, infantile paralysis, multiple sclerosis, brain tumours etc. were among those killed. The consent of the patient was absent in this type of euthanasia. This kind was applied by order.

Many people don't realise that, prior to the extermination of Jews by Nazi Germany, in the so-called "final solution," as many as 350,000 Germans were sterilized because their gene pool was deemed to be unsuitable to the Aryan race, many because of physical disability, mental deficiency or homosexuality.

In 1936 the Voluntary Euthanasia Society was founded in England. The next year the English Parliament (the House of Lords) rejected a proposal to legalise euthanasia. In opinion polls of those years, euthanasia supporters had around 60% of the votes.

According to a questionnaire in 1937, 53% of American physicians defended euthanasia. Approximately 2000 physicians and more than 50 religious ministers were among the members of the American Euthanasia Society. At that time, a majority of physicians in some American cites defended this subject. In 1938, the Euthanasia Society of America was established in New York.

1939 Nazi Germany (From "The History Place" web site) "In October of 1939, amid the turmoil of the outbreak of war, Hitler ordered widespread "mercy killing" of the sick and disabled. Code named "Aktion T 4", the Nazi euthanasia program to eliminate "life unworthy of life" at first focused on newborns and very young children. Midwives and doctors were required to register children up to age three who showed symptoms of mental retardation, physical deformity, or other symptoms included on a questionnaire from the Reich Health Ministry."

"The Nazi euthanasia program quickly expanded to include older disabled children and adults. Hitler's decree of October, 1939, typed on his personal stationery and back dated to Sept. 1, enlarged 'the authority of certain physicians to be designated by name in such manner that persons who, according to human judgment, are incurable, can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death.'"

On August 3, 1941, the Catholic Bishop Clemens August Count of Galen, openly condemned the Nazi euthanasia programme in a sermon. This brought a temporary end to the programme. Read here

A law proposal that accepted euthanasia, was offered to the government in Great Britain in 1939. According to this proposal, a patient had to write his consent as a living will which must be witnessed by two persons. The will of the patient had to be accepted in the reports of two physicians. One of these physicians was the attending physician, the other one was the physician of the Ministry of Health. The will of the patient had to be applied after 7 days and most of the relatives of the patient had again to speak with him 3 days before the killing action. But this proposal wasn't accepted.

In 1973 Dr. Gertruida Postma, who gave her dying mother a lethal injection, received light sentence in the Netherlands. The case and its resulting controversy launched the euthanasia movement in that country.

The Dutch Voluntary Euthanasia Society (NVVE) launched its Members' Aid Service in 1975, to give advice to the dying. It received twenty-five requests for aid in the first year.

In 1976 Dr Tenrei Ota, upon formation of the Japan Euthanasia Society (now the Japan Society for Dying with Dignity), called for an international meeting of existing national right-to-die societies. Japan, Australia, the Netherlands, the United Kingdom, and the United States were all represented. This first meeting enabled those in attendance to learn from the experience of each other and to obtain a more international perspective on right to die issues.

In 1978, Jean's Way was published in England by Derek Humphry, describing how he helped his terminally ill wife to die. The Hemlock Society was founded in 1980 in Santa Monica, California, by Derek Humphry. It advocated legal change and distributed how-to-die information. This launched the campaign for assisted dying in America. Hemlock's national membership grew to 50,000 within a decade. Right to die societies also formed the same year in Germany and Canada.

The Society of Euthanasia assembled in Oxford in the last months of 1980, hosted by Exit, The Society for the Right to Die with Dignity. It consisted of 200 members represented 18 countries. Since its founding, the World Federation has come to include 38 right to die organisations, from around the world, and has held fifteen 7 DRAFT Conception to Natural Death additional international conferences, each hosted by one of the member organisations.

On 5 May, 1980, the Catholic Church issued a Declaration on Euthanasia. Read here

In 1984, The Netherlands Supreme Court approved voluntary euthanasia under certain conditions.

In 1994, Oregon voters approved Measure 16, a Death With Dignity Act ballot initiative that would permit terminally ill patients, under proper safeguards, to obtain a physician's prescription to end life in a humane and dignified manner. The vote was 51-49 percent.

In 1995, Australia's Northern Territory approved a euthanasia bill. It went into effect in 1996 and was overturned by the Australian Parliament in 1997. Only four deaths took place under this law, all performed by Dr Philip Nitschke.

On 13 May, 1997, the Oregon House of Representatives voted 32-26 to return Measure 16 to the voters in November for repeal (H.B. 2954). On 10 June, the Senate votes 20-10 to pass H.B. 2954 and return Measure 16 to the voters for repeal. On 4 November 1997 the people of Oregon voted by a margin of 60-40 percent against Measure 51, which would have repealed the Oregon Death with Dignity Act, l994. The law officially took effect (ORS 127.800-897) on 27 October, l997.

In 1998, the Oregon Health Services Commission decided that payment for physician-assisted suicide could come from state funds under the Oregon Health Plan so that the poor would not be discriminated against.

In 1999, in the United States, Dr. Jack Kevorkian was sentenced to 10-25 years imprisonment for the 2nd degree murder of Thomas Youk after showing a video of his death, by lethal injection, on national television. Kervorkian's first appeal was rejected in 2001. Kevorkian helped a number of people die and even though he had been previously prosecuted, he remained free of criminal charges until 1999.

In 2000, The Netherlands approved voluntary euthanasia. The Dutch law allowing voluntary euthanasia and physician-assisted suicide took effect on the 1st of February, 2002. For 20 years previously, it had been permitted under guidelines.

Into the Third Millenium In 2002 Belgium passed a similar law to the Dutch, allowing both voluntary euthanasia and physician-assisted suicide.

In New Zealand in March 2004 Lesley Martin was convicted of the attempted murder of her terminally ill mother. She served seven months of a fifteen-month prison sentence, before being released on a good behaviour bond, and subsequently failed, in two attempts, to appeal against the conviction.

Switzerland, once known in the tourism business for its spectacular alpine landscape, the watches and chocolate, has a new claim to fame as the world's death Mecca. Physically and mentally vulnerable patients have been lining up for a one-way trip to Zurich.

In 2000 three foreigners committed suicide in Zurich. In 2001, the number of death tourists to Zurich rose to thirty-eight, plus twenty more in Bern. Most of the deaths occurred in an apartment rented by Dignitas, one of the four groups that have taken advantage of Switzerland's 1942 law on euthanasia to help the terminally ill die.

Dignitas has assisted the suicides of 146 people over the last four years. The Swiss parliament has been alarmed and there is a move to ban the 'suicide tourism' and to place tougher bans on assisted suicide.

When it was established in 1942, the Swiss euthanasia law was meant mainly to offer the opportunity for a dignified death to those with just two or three weeks to live.

In the past few years, though, it has been applied to patients with a range of ailments -- those with terminal illnesses or with acute mental disabilities, and even those suffering unbearable distress, such as a musician, for example, who has gone deaf.

There are several requirements under the Swiss law. People who opt for euthanasia must be rationally capable of

8 DRAFT Conception to Natural Death making the decision to die. They must perform the final act -- usually the drinking of a lethal dose of barbiturates -- without assistance. And the event must be witnessed by a nurse or physician, and two other people.

Involuntary Euthanasia https://en.wikipedia.org/wiki/Involuntary_euthanasia

United States

Euthanasia became a subject of public discussion in the United States at the turn of the 20th century. Felix Adler, a prominent educator and scholar, issued the first authoritative call in 1891 for the provision of lethal drugs to terminally ill patients who requested to die. In 1906, Ohio considered a law to legalize such a form of euthanasia, but it did not make it out of committee. While much of the debate focused on voluntary euthanasia, other calls for involuntary euthanasia were vocalized as well. In 1900, W. Duncan McKim, a New York physician and author published a book titled “Heredity and Human Progress.” This book suggested that people with severe inherited defects, including mentally handicapped people, epileptics, habitual drunks and criminals, should be given a quick and painless death by carbonic gas.

In January 1938, the National Society for the Legalization of Euthanasia was formed, and was renamed the Euthanasia Society of America (ESA) later that year. It advocated for the legalization of euthanasia in the United States, primarily by lobbying state legislators. Many prominent ESA members advocated for involuntary euthanasia of people with mental disabilities, including Ann Mitchell, a former asylum patient and main financial supporter of the ESA until her suicide in 1942. Ann Mitchell is also credited with structuring the ESA as a eugenics project. ESA’s first president was Charles Potter, an ex-Baptist minister who advocated for coercive eugenic sterilization and involuntary euthanasia to eliminate undesirable defective people from society.

The ESA initially advocated for both voluntary and involuntary euthanasia of people with severe disabilities. The organization soon realized that involuntary euthanasia had negative connotations, particularly its association with the Nazis' euthanasia program, and began advocating for voluntary euthanasia exclusively.[5] The ESA continues to exist today.

World War II Germany

Adolf Hitler enacted the Aktion T4 program in October 1939 to euthanize “incurably ill, physically or mentally disabled, emotionally distraught, and elderly people.” The Aktion T4 program was also designed to euthanize those who were deemed "inferior and threatening to the well being of the Aryan race." This program was also designed as part of a larger, “Final Solution” eugenics program. Within months of enactment, the Nazis expanded its definition of who could be euthanized to include those who were of a certain ethnicity as well as economic level. Many people who did not want to be euthanized by this enacted program were murdered anyway against their will. Six killing centers were constructed after T4’s enactment, with one of the most notable being the Hadamar Euthanasia Centre. At these centers, people deemed handicapped or “unfit” by “medical experts” were put to death. For example, gas chambers were disguised to look like showers, and some were starved to death. Often at these centers, mass euthanasia via gas chambers took place. The meticulous research undertaken by the Nazis after the deceased was euthanized ultimately was used as a prototype for much larger euthanasia institutions for larger death camps such as Auschwitz and Treblinka, implemented later on in the war.

Approximately 200,000 people were killed over a six-year span due to the T4 program. The T4 euthanasia institutions were shut down by Allied troops in 1945.

III Implementation of Assisted Suicide and Euthanasia

Belguim Extends Euthanasia Law to Kids

Charlotte McDonald-Gibson / Brussels Feb 13, 2014

Belgium became the first country in the world to remove any age restrictions on euthanasia, after an emotional debate which split the medical profession over the best way to treat a terminally ill child with a desire to end his or her life.

Despite last-minute pleas for a rethink from within Belgium and as far away as Canada, parliament on Thursday agreed with the doctors who argued that in rare cases of unbearable and irreversible suffering, children should have the same right as an adult to ask to die with dignity. 9 DRAFT Conception to Natural Death Under the amendments to the country's 2002 euthanasia law, a child of any age can be helped to die, but only under strict conditions. He or she must be terminally ill, close to death, and deemed to be suffering beyond any medical help. The child must be able to request euthanasia themselves and demonstrate they fully understand their choice. The request will then be assessed by teams of doctors, psychologists and other care- givers before a final decision is made with approval of the parents.

Dr. Jutte Van der Werf Ten Bosch, a pediatric oncologist from University Hospital Brussels, says such cases are very rare, but heartbreaking for families and doctors when they do come up. She recalls the frustration of treating a 16-year-old girl who was suffering severe complications from leukemia and was lying in a hospital bed connected to tubes, waiting to die.

“It was just hell for six months in the hospital,” she says. “I feel like a total failure in these cases. … You promise the child ‘I will take care of you, I will do the best I can,’ and then you can’t do the best you can because all these complications arise and you can’t do anything about it.”

She has come across children as young as eight who have articulated an understanding of their situation, but doctors expect the most likely cases would involve adolescents. While assisted suicide is permitted under certain conditions in Switzerland, Germany and parts of the United States, only Belgium, Luxembourg and The Netherlands allow doctors to take steps to actively end a patient’s life, usually by administering an overdose of sedatives. In Luxembourg, that patient must be over 18, while in The Netherlands children can request euthanasia from the age of 12.

Belgium’s existing euthanasia law for adults has broad public support, and a recent survey by the RTBF broadcaster found that 75% of people supported extending the same rights to children. Parliament approved these amendments on Thursday with 86 MPs voting in favor, 44 against, and 12 abstentions. The Senate had already passed the bill in December. But there has been opposition, both from religious groups and more than 170 Belgian pediatricians who signed an open letter to parliament this week requesting they delay the vote.

Dr. Stefaan Van Gool, a pediatrician at the University of Leuven, says the doctors were concerned that procedures for assessing a child’s mental capacity to make life-and-death decisions were not sufficiently clear in the bill. They were also worried a child might be pressured into making a decision by parents, and that were are too many possibilities for misuse of the law. “We are suffering together with these children to get through the most difficult moments of life, but at such time what we deliver to these children is care,” he says, adding that his experiences show children want to live as full a life as possible right until the very end. “We have children who do exams up to two days before they die. They are children that always dream about a future, although this future may only be a few hours.”

A plea also came from Canada earlier this month, where a four-year-old girl born with a congenital heart condition recorded a video message urging Belgium’s King Philippe not to sign the law, which is the final formality. Her mother told the monarch that she was concerned that a child like her daughter—who grew up to be a happy, active child—could be euthanized after birth.

Dr. Gerlant van Berlaer, a pediatrician who also works at the University Hospital Brussels, understands why the debate in Belgium has provoked strong feelings all over the world. “I would be rather scared if it didn’t evoke emotional reactions: we’re talking about children,” he tells TIME. But he says no doctor would ever take the decision to end a child’s life lightly. “The first reaction I will always have and all my colleagues will have is to run away from these questions because we don’t want to hear this,” he says.

He remains haunted by all the cases in which he was powerless to do anything. He cites the case of a child with Duchenne Muscular Dystrophy, where the muscles degenerate to the point where a sufferer can no longer swallow or speak. “They can see the children in the bed next to them suffocate,” he says. “They will say, ‘I know my life will end, but doctor, just don’t let it end like my friend’s did.’”

10 DRAFT Conception to Natural Death Until now, the law has not allowed him to even discuss such an option. “This child asked me not to let him suffocate,” he says. “Of course I did not do anything active at the time, but I’m still struggling with this, because I did not respond to the last question of the child.”

A View of Some of the Results

Five people killed EVERY DAY by assisted suicide in Belgium as euthanasia cases soar by 25 per cent in last year alone

• Rise in deaths will fuel fears about country's controversial policies • Under-60s accounted for just 15 per cent of the total number of cases • Belgium was only second country in Europe after Holland to legalise practice

By Simon Caldwell for MailOnline

Published: 11:53 EDT, 28 May 2014 | Updated: 13:24 EDT, 28 May 2014

Doctors in Belgium are killing an average of five people every day by euthanasia, new figures have revealed.

The statistics also show a huge 27 per cent surge in the number of euthanasia cases in the last year alone.

The soaring number of deaths will inevitably fuel fears that euthanasia is out of control in Belgium, a country which only months ago became the first in the world to allow doctors to kill terminally ill children.

There have been a surge in the number of euthanasia deaths in Belgium since it was legalised in 2003. Earlier this year there were protests to stop the law being extended to children

The figures, published in Sudpresse, Belgium’s leading French-speaking newspaper, showed that 1,816 cases of euthanasia were reported in 2013 compared to to 1,432 in 2012, an overall increase of 26.8 per cent.

‘You could say that currently there are 150 cases of euthanasia per month in Belgium or, even more telling, five people euthanised a day,’ the newspaper said.

Of the total number of cases in 2013, 51.7 per cent were male patients and 48.3 per cent were female.

Elderly people aged between 70 and 90 years made up just over half (53.5 per cent) of the total. Those aged between 60 and 70 years represented 21 per cent and those aged over 90 years seven per cent.

The under-60s accounted for just 15 per cent of the total number of cases.

In 2003 Belgium was the second country in the world to legalise euthanasia after Holland liberalised the law a year earlier, becoming the first country since Nazi Germany to permit the practice.

Over the past decade the numbers of Belgians dying by euthanasia has crept up incrementally.

Controversial: In February, the Belgian House of Representatives voted in favour of extending the policy to children who are terminally-ill or in a state of unrelieved suffering

There was a 25 per cent increase in the number of euthanasia deaths from 2011 to 2012, soaring from 1,133 to 1,432, a figure representing about two per cent of all deaths in the country.

In February Belgium extended euthanasia to children who are terminally-ill and in a state of unrelieved suffering.

11 DRAFT Conception to Natural Death They must also be judged to have ‘capacity of discernment’, affirmed by a psychologist, and the consent of their parents before they can die by injection.

Anti-euthanasia campaigners have argued that such safeguards have consistently proved to be meaningless.

They say that besides patients who are gravely ill euthanasia is used increasingly on people with depression or non-terminal conditions.

Those killed include deaf twins Marc and Eddy Verbessem, 45, who were granted their wish to die in December 2012 after they learned they would likely to become blind.

Last year Nancy Verhelst, 44, a transsexual, was also killed by euthanasia after doctors botched her sex change operation, leaving her with physical deformities she felt made her look like a ‘monster’.

Disability rights campaigner Nikki Kenward of the UK-based Distant Voices pressure group said the figures demonstrated the difficulties in regulating euthanasia.

She said that once a country legalised assisted suicide or euthanasia people were inevitably killed in greater numbers than ever envisaged.

The figures should serve as a warning to the Parliament not to change the law on homicide to allow even assisted suicide, she said.

‘As the numbers of people dying from euthanasia in Belgium grow, that slippery slope comes into vision,’ said Mrs Kenward of Aston on Clun, Shropshire.

‘I am vulnerable,’ said Mrs Kenward, who has been in a wheelchair since the 1990s when she developed Guillain Barre syndrome.

‘I’m afraid of becoming another statistic, another faceless victim,’ she said, adding: ‘We are told that safeguards will protect us from abuses. They certainly do not protect the elderly in Belgium.’

Read more: http://www.dailymail.co.uk/news/article-2641773/Five-people-killed-EVERY-DAY-assisted-suicide- Belgium-euthanasia-cases-soar-27-cent-year-alone.html#ixzz4cLUK0195

Colin Pritchard - Suicide of the Elderly Author Colin Pritchard argues that suicide among the elderly over the age of 75 is a sign of neglect and isolation.

The extended family does provide a support system in Latin countries. However, "in those Latin Countries, if you don't have children, or you are unmarried, then you are worse off than in Britain."

"Our findings were completely unexpected. Suicide amongst elderly people is usually associated with ill health, social isolation and exclusion. With elderly people in Catholic and Orthodox countries tending to hold more traditional views on the family and religion, we might have assumed that this would be reflected in lower suicide rates, not higher...However, these results show that we need to rethink views on suicide, and continue to improve provision of services for elderly people and rid ourselves of ageist stereotypes. The majority of elderly suicides die because they are inadequately supported, or have poor medical care"

Source: "Suicide: The Ultimate Rejection: A Psycho-Social Study by Colin Pritchard. Open Univ Pr, 1995"

American Medical Association

Within American Medical Association (AMA) a movement to abandon its decades-long position opposing assisted suicide and take a neutral stance is underway. At its July 2017 annual meeting, the AMA will consider taking a “neutral” position which essentially sends a green light to the states that legalizing is acceptable.

12 DRAFT Conception to Natural Death IV Secular Reasoning Against Assisted Suicide or Euthanasia

A Read on the Conscience of Neil Gorsuch His 2006 book about euthanasia demonstrates a thoughtful commitment to equality and dignity.

By SOHRAB AHMARI, WSJ March 20, 2017 page A19 March 19, 2017 5:08 p.m. ET

Neil Gorsuch (Supreme Court Justice nominee) is a reactionary with “troubling” views that are “far outside the mainstream” and represent an “imminent threat to our constitutional rights.” That’s according to the various organs of the activist left that have set out to torpedo his nomination to the Supreme Court. To get a better picture of the Coloradan’s philosophy, and his sense of right and wrong, start with his book, “The Future of Assisted Suicide and Euthanasia.”

Published in 2006, the same year he joined the 10th U.S. Circuit Court of Appeals, the book reveals a profound and morally imaginative mind that defies the caricatures of an enemy of progress. His main impetus is to preserve—not dismantle—the Anglo-American legal tradition’s commitment to universal equality and human dignity.

Fair-minded liberals may even be persuaded by his case against euthanasia. They will probably be surprised to learn that his thinking on the issue isn’t based on faith. Rather, Judge Gorsuch relies on secular moral reasoning to argue that legalization risks dehumanizing the most vulnerable Americans and imperiling the Constitution’s promise of equal protection under law.

At the heart of the book is the question of when to limit self-determination in classically liberal societies, like America’s, that are constitutionally committed to maximizing it.

In answering that question, American law took a very broad view beginning in the second half of the 20th century, as the Supreme Court struck down laws against contraceptives, abortion and sodomy, among other things. The Constitution, the high court repeatedly held, shields people’s most intimate and personal choices from government interference.

This line of jurisprudence reached its apotheosis in the plurality opinion in Planned Parenthood v. Casey (1992), which reaffirmed a constitutional right to abortion. That opinion includes Justice Anthony Kennedy ’s now-famous words: “At the heart of liberty is the right to define one’s own concept of . . . the mystery of human life.”

If so, doesn’t the Constitution also permit the consensual taking of life by private persons in the form of euthanasia? If liberal constitutional order allows people to define themselves in so many different arenas, then it must also allow them to encounter the end of life on their own terms. Death, after all, is every life’s central mystery.

That was the view taken by some federal courts in finding a constitutional right to assisted suicide in the 1990s. Like abortion, the various courts held, assisted suicide implicates autonomy, privacy and the right to determine one’s own destiny.

The Supreme Court disagreed in a pair of 1997 decisions holding that prohibitions against assisted suicide aren’t facially unconstitutional. But its rulings left the door open to other constitutional challenges to assisted-suicide restrictions as applied in specific situations. If the high court continues to expand the “mystery of human life” jurisprudence, the practice may soon be recognized as a constitutional right.

That would erode both autonomy and equality, Judge Gorsuch worries. He draws heavily on the writings of euthanasia proponents to show that what starts as a call for greater choice and self-determination inevitably blurs into invidious discrimination against the disabled and elderly—and even eugenics. Too much autonomy begets coercion.

Those who see “death with dignity” as a natural component of the liberal program should pay attention to the judge’s chapter on the euthanasia movement’s history, which he traces to the social Darwinism that swept America beginning in the late 19th century and remained popular until World War II. Leading euthanasia proponents, he shows, were also enthusiastic eugenicists.

“Chloroform unfit children,” suggested Clarence Darrow of Scopes Monkey Trial fame. For Harvard Prof. Earnest Hooton, involuntary euthanasia, applied to the “hopelessly diseased and the congenitally deformed,” was the key to American demographic renewal. One founder of the Euthanasia Society of America described World War II as “biological house- cleaning.” The postwar revelation of the Nazis’ medical atrocities and systematic efforts to wipe out people with disabilities reversed the American euthanasia movement’s fortunes. But this proved only a temporary setback. The cultural ferment of the 1960s allowed the movement to reframe itself as one concerned with autonomy and self-definition.

Yet in their more honest moments some euthanasia proponents still talk of a “duty to die” to free up resources for the next generation, Judge Gorsuch notes. Even proponents who insist they seek to restrict the practice to the terminally ill must concede that, once opened, the gateway to a generalized right to euthanasia—and perhaps the involuntary variety—can’t be closed. 13 DRAFT Conception to Natural Death As the judge writes, in its decision upholding a right to assisted suicide (later overturned by the Supreme Court), the Ninth U.S. Circuit Court of Appeals “deliberately left open the possibility that, at a later date, the right might be extended to persons who are depressed or suffering other psychological ailments that cannot be, in its phrase, ‘significantly ameliorated.’ ”

Once assisted suicide is legal, one scholar quoted by Judge Gorsuch says, justice requires that there also be involuntary euthanasia for those patients who don’t have a “realistic desire” for continued care. Another argues that “majority sentiment” should govern which patients lack sufficient dignity to continue living.

To which Judge Gorsuch responds by asking: Who decides, and where do we draw the line? Even on their own purely utilitarian terms, euthanasia proponents can’t guarantee that legalization won’t lead to coercion and abuse, targeting people with disabilities. But even if those risks could be controlled, legalization necessarily sends the signal that the lives of some Americans are less valuable than others’.

If we don’t value all life equally and intrinsically, Judge Gorsuch writes, “a critical rationale for equal protection would wither.” A decade since his book’s publication, the road from assisted suicide to involuntary euthanasia is much clearer— clear enough that disability activists have now joined social conservatives at the forefront of the opposition.

Mr. Ahmari is a Journal editorial writer in London.

V Catholic Church Teaching on Assisted Suicide and Euthanasia

DECLARATION ON EUTHANASIA While various organisations and individuals have misquoted and twisted Catholic Church teaching in order to confuse Catholics, the Catholic Church has always condemned Euthanasia and Assisted Suicide. • "No-one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care." • "Nor can he or she consent to it, either explicitly or implicitly." • "It is necessary to state firmly once more that nothing and no one can in any way permit the killing of an innocent human being, whether a foetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying."

DECLARATION ISSUED BY THE SACRED CONGREGATION FOR THE DOCTRINE OF THE FAITH MAY 5, 1980 INTRODUCTION The rights and values pertaining to the human person occupy an important place among the questions discussed today. In this regard, the Second Vatican Ecumenical Council solemnly reaffirmed the lofty dignity of the human person, and in a special way his or her right to life. The Council therefore condemned crimes against life "such as any type of murder, genocide, abortion, euthanasia, or willful suicide" (Pastoral Constitution GAUDIUM ET SPES, no. 27).

More recently, the Sacred Congregation for the Doctrine of the Faith has reminded all the faithful of Catholic teaching on procured abortion. The Congregation now considers it opportune to set forth the Church's teaching on euthanasia.

It is indeed true that, in this sphere of teaching, the recent Popes have explained the principles, and these retain their full force[; but the progress of medical science in recent years has brought to the fore new aspects of the question of euthanasia, and these aspects call for further elucidation on the ethical level.

In modern society, in which even the fundamental values of human life are often called into question, cultural change exercises an influence upon the way of looking at suffering and death; moreover, medicine has increased its capacity to cure and to prolong life in particular circumstances, which sometime give rise to moral problems. Thus people living in this situation experience no little anxiety about the meaning of advanced old age and death. They also begin to wonder whether they have the right to obtain for themselves or their fellowmen an "easy death," which would shorten suffering and which seems to them more in harmony with human dignity.

A number of Episcopal Conferences have raised questions on this subject with the Sacred Congregation for the Doctrine of the Faith. The Congregation, having sought the opinion of experts on the various aspects of euthanasia, now wishes to respond to the Bishops' questions with the present Declaration, in order to help them to give correct teaching to the faithful entrusted to their care, and to offer them elements for reflection that they can present to the civil authorities with regard to this very serious matter.

The considerations set forth in the present document concern in the first place all those who place their faith and hope in Christ, who, through His life, death and resurrection, has given a new meaning to existence and especially to the death of the Christian, as St. Paul says: "If we live, we live to the Lord, and if we die, we die to the Lord" (Rom. 14:8; cf. Phil. 1:20).

As for those who profess other religions, many will agree with us that faith in God the Creator, Provider and Lord of life--if 14 DRAFT Conception to Natural Death they share this belief--confers a lofty dignity upon every human person and guarantees respect for him or her.

It is hoped that this Declaration will meet with the approval of many people of good will, who, philosophical or ideological differences notwithstanding, have nevertheless a lively awareness of the rights of the human person. These rights have often, in fact, been proclaimed in recent years through declarations issued by International Congresses; and since it is a question here of fundamental rights inherent in every human person, it is obviously wrong to have recourse to arguments from political pluralism or religious freedom in order to deny the universal value of those rights.

I. THE VALUE OF HUMAN LIFE Human life is the basis of all goods, and is the necessary source and condition of every human activity and of all society. Most people regard life as something sacred and hold that no one may dispose of it at will, but believers see in life something greater, namely, a gift of God's love, which they are called upon to preserve and make fruitful. And it is this latter consideration that gives rise to the following consequences: 1. No one can make an attempt on the life of an innocent person without opposing God's love for that person, without violating a fundamental right, and therefore without committing a crime of the utmost gravity.

2. Everyone has the duty to lead his or her life in accordance with God's plan. That life is entrusted to the individual as a good that must bear fruit already here on earth, but that finds its full perfection only in eternal life.

3. Intentionally causing one's own death, or suicide, is therefore equally as wrong as murder; such an action on the part of a person is to be considered as a rejection of God's sovereignty and loving plan. Furthermore, suicide is also often a refusal of love for self, the denial of a natural instinct to live, a flight from the duties of justice and charity owed to one's neighbor, to various communities or to the whole of society--although, as is generally recognized, at times there are psychological factors present that can diminish responsibility or even completely remove it.

However, one must clearly distinguish suicide from that sacrifice of one's life whereby for a higher cause, such as God's glory, the salvation of souls or the service of one's brethren, a person offers his or her own life or puts it in danger (cf. Jn. 15:14).

II. EUTHANASIA In order that the question of euthanasia can be properly dealt with, it is first necessary to define the words used.

Etymologically speaking, in ancient times EUTHANASIA meant an EASY DEATH without severe suffering. Today one no longer thinks of this original meaning of the word, but rather of some intervention of medicine whereby the suffering of sickness or of the final agony are reduced, sometimes also with the danger of suppressing life prematurely. Ultimately, the word EUTHANASIA is used in a more particular sense to mean "mercy killing," for the purpose of putting an end to extreme suffering, or having abnormal babies, the mentally ill or the incurably sick from the prolongation, perhaps for many years of a miserable life, which could impose too heavy a burden on their families or on society.

It is, therefore, necessary to state clearly in what sense the word is used in the present document.

By euthanasia is understood an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated. Euthanasia's terms of reference, therefore, are to be found in the intention of the will and in the methods used.

It is necessary to state firmly once more that nothing and no one can in any way permit the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. Furthermore, no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly. nor can any authority legitimately recommend or permit such an action. For it is a question of the violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity.

It may happen that, by reason of prolonged and barely tolerable pain, for deeply personal or other reasons, people may be led to believe that they can legitimately ask for death or obtain it for others. Although in these cases the guilt of the individual may be reduced or completely absent, nevertheless the error of judgment into which the conscience falls, perhaps in good faith, does not change the nature of this act of killing, which will always be in itself something to be rejected. The pleas of gravely ill people who sometimes ask for death are not to be understood as implying a true desire for euthanasia; in fact, it is almost always a case of an anguished plea for help and love. What a sick person needs, besides medical care, is love, the human and supernatural warmth with which the sick person can and ought to be surrounded by all those close to him or her, parents and children, doctors and nurses.

III. THE MEANING OF SUFFERING FOR CHRISTIANS AND THE USE OF PAINKILLERS Death does not always come in dramatic circumstances after barely tolerable sufferings. Nor do we have to think only of extreme cases. Numerous testimonies which confirm one another lead one to the conclusion that nature itself has made provision to render more bearable at the moment of death separations that would be terribly painful to a person in full health. Hence it is that a prolonged illness, advanced old age, or a state of loneliness or neglect can bring about psychological conditions that facilitate the acceptance of death. 15 DRAFT Conception to Natural Death

Nevertheless the fact remains that death, often preceded or accompanied by severe and prolonged suffering, is something which naturally causes people anguish.

Physical suffering is certainly an unavoidable element of the human condition; on the biological level, it constitutes a warning of which no one denies the usefulness; but, since it affects the human psychological makeup, it often exceeds its own biological usefulness and so can become so severe as to cause the desire to remove it at any cost.

According to Christian teaching, however, suffering, especially suffering during the last moments of life, has a special place in God's saving plan; it is in fact a sharing in Christ's passion and a union with the redeeming sacrifice which He offered in obedience to the Father's will. Therefore, one must not be surprised if some Christians prefer to moderate their use of painkillers, in order to accept voluntarily at least a part of their sufferings and thus associate themselves in a conscious way with the sufferings of Christ crucified (cf. Mt. 27:34). Nevertheless it would be imprudent to impose a heroic way of acting as a general rule. On the contrary, human and Christian prudence suggest for the majority of sick people the use of medicines capable of alleviating or suppressing pain, even though these may cause as a secondary effect semiconsciousness and reduced lucidity. As for those who are not in a state to express themselves, one can reasonably presume that they wish to take these painkillers, and have them administered according to the doctor's advice.

But the intensive use of painkillers is not without difficulties, because the phenomenon of habituation generally makes it necessary to increase their dosage in order to maintain their efficacy. At this point it is fitting to recall a declaration by Pius XII, which retains its full force; in answer to a group of doctors who had put the question: "Is the suppression of pain and consciousness by the use of narcotics ... permitted by religion and morality to the doctor and the patient (even at the approach of death and if one foresees that the use of narcotics will shorten life)?" the Pope said: "If no other means exist, and if, in the given circumstances, this does not prevent the carrying out of other religious and moral duties: Yes." In this case, of course, death is in no way intended or sought, even if the risk of it is reasonably taken; the intention is simply to relieve pain effectively, using for this purpose painkillers available to medicine.

However, painkillers that cause unconsciousness need special consideration. For a person not only has to be able to satisfy his or her moral duties and family obligations; he or she also has to prepare himself or herself with full consciousness for meeting Christ. Thus Pius XII warns: "It is not right to deprive the dying person of consciousness without a serious reason."

IV. DUE PROPORTION IN THE USE OF REMEDIES Today it is very important to protect, at the moment of death, both the dignity of the human person and the Christian concept of life, against a technological attitude that threatens to become an abuse. Thus some people speak of a "right to die," which is an expression that does not mean the right to procure death either by one's own hand or by means of someone else, as one pleases, but rather the right to die peacefully with human and Christian dignity. From this point of view, the use of therapeutic means can sometimes pose problems.

In numerous cases, the complexity of the situation can be such as to cause doubts about the way ethical principles should be applied. In the final analysis, it pertains to the conscience either of the sick person, or of those qualified to speak in the sick person's name, or of the doctors, to decide, in the light of moral obligations and of the various aspects of the case.

Everyone has the duty to care for his or he own health or to seek such care from others. Those whose task it is to care for the sick must do so conscientiously and administer the remedies that seem necessary or useful.

However, is it necessary in all circumstances to have recourse to all possible remedies?

In the past, moralists replied that one is never obliged to use "extraordinary" means. This reply, which as a principle still holds good, is perhaps less clear today, by reason of the imprecision of the term and the rapid progress made in the treatment of sickness. Thus some people prefer to speak of "proportionate" and "disproportionate" means. In any case, it will be possible to make a correct judgment as to the means by studying the type of treatment to be used, its degree of complexity or risk, its cost and the possibilities of using it, and comparing these elements with the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources.

In order to facilitate the application of these general principles, the following clarifications can be added: If there are no other sufficient remedies, it is permitted, with the patient's consent, to have recourse to the means provided by the most advanced medical techniques, even if these means are still at the experimental stage and are not without a certain risk. By accepting them, the patient can even show generosity in the service of humanity.

• It is also permitted, with the patient's consent, to interrupt these means, where the results fall short of expectations. But for such a decision to be made, account will have to be taken of the reasonable wishes of the patient and the patient's family, as also of the advice of the doctors who are specially competent in the matter. The latter may in particular judge that the investment in instruments and personnel is disproportionate to the results foreseen; they may also judge that the techniques applied impose on the patient strain or suffering out of proportion with the benefits which he or she may gain from such techniques.

• It is also permissible to make do with the normal means that medicine can offer. Therefore one cannot impose on 16 DRAFT Conception to Natural Death anyone the obligation to have recourse to a technique which is already in use but 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, so long as the normal care due to the sick person in similar cases is not interrupted. In such circumstances the doctor has no reason to reproach himself with failing to help the person in danger.

CONCLUSION The norms contained in the present Declaration are inspired by a profound desire to service people in accordance with the plan of the Creator. Life is a gift of God, and on the other hand death is unavoidable; it is necessary, therefore, that we, without in any way hastening the hour of death, should be able to accept it with full responsibility and dignity. It is true that death marks the end of our earthly existence, but at the same time it opens the door to immortal life. Therefore, all must prepare themselves for this event in the light of human values, and Christians even more so in the light of faith. As for those who work in the medical profession, they ought to neglect no means of making all their skill available to the sick and dying; but they should also remember how much more necessary it is to provide them with the comfort of boundless kindness and heartfelt charity. Such service to people is also service to Christ the Lord, who said: "As you did it to one of the least of these my brethren, you did it to me" (Mt. 25:40).

AT THE AUDIENCE GRANTED TO THE UNDERSIGNED PREFECT, HIS HOLINESS POPE JOHN PAUL II APPROVED THIS DECLARATION, ADOPTED AT THE ORDINARY MEETING OF THE SACRED CONGREGATION FOR THE DOCTRINE OF THE FAITH, AND ORDERED ITS PUBLICATION.

Rome, the Sacred Congregation for the Doctrine of the Faith, May 5, 1980. Franjo Cardinal Seper PREFECT Jerome Hamer, O.P. Titular Archbishop of Lorium SECRETARY

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