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Religion See other Religion Articles Title: Cardinal Martini and Euthanasia: When It Is Licit to Cut Life Short Cardinal Martini and Euthanasia: When It Is Licit to Cut Life Short For the former archbishop of Milan, the seriously ill person has at every moment the right to interrupt the care that keeps him alive. No, objects the president of the Pontifical Academy for Life. But the real clash is between Martini and the pope by Sandro Magister ROMA, January 30, 2007 – Just nine months after the bombshell manifesto of opposition to the reigning pope published in the Italian weekly “L’espresso” – on artificial insemination, embryos, abortion, euthanasia – cardinal Carlo Maria Martini has returned to the last of these topics, euthanasia, with an article that appeared on January 21 on the front page of the Sunday edition of “Il Sole 24 Ore,” the leading economics and finance newspaper in Italy, and one of the most important in all of Europe. This time as well his statements have been interpreted as a criticism of the papal line of absolute opposition to intentionally caused “gentle death.” And again this time – like nine months ago – the official Catholic media have shrouded cardinal Martini’s statements in silence, while the secular media have amplified them. But a controversy that pits the highest leaders of the worldwide Church against each other with conflicting positions on topics of such importance cannot remain hidden within the Church itself. It is a controversy with its own concrete proximate cause, background, and developments. THE WELBY CASE The event that prompted cardinal Martini to speak out again on the topic of euthanasia is that of Piergiorgio Welby, a seriously ill man who – as the cardinal himself wrote – “lucidly asked for the suspension of respiratory support therapies, which in the past nine years have been constituted by a tracheotomy and an automatic ventilator.” Welby’s request to cut off his life shook public opinion in Rome and Italy during the last weeks of 2006, with an intensity almost as great as that surrounding the Terry Schiavo case in America. It drew in and divided the Catholic community, the scientific community, and the political world, with the strong mobilization of supporters of legalized euthanasia. Welby lay infirm, but still lucid and capable of expressing himself, in his home in Rome. His wife, mother, and sister are practicing Catholics. But his wife has said of him: “I don’t know if he really thought there is life after death, or if he believed in God.” In any case, around him and in his name, during the days before and after his death, there was celebrated before the eyes of all a secular liturgy made up of nocturnal vigils, of solidarity given and implored, of humanitarian campaigns, of high emotion at Christmastime. Welby died at the hands of a doctor three days before Christmas. And when his wife asked for a religious funeral, the diocese of Rome – the bishop of which is the pope, with cardinal Camillo Ruini as vicar – refused the request, giving this reason: “Because, unlike the cases of suicide in which it is presumed there was an absence of the conditions for full awareness and deliberate consent, Mr. Welby repeatedly and publicly affirmed his desire to end his life, something that is incompatible with Catholic doctrine.” The statement did not alter in any way the duty of praying for the man. Welby’s relatives, friends, and supporters responded to the denial of a religious funeral by celebrating a secular rite in the square in front of the nearby parish. It was the morning of Sunday, December 24. At the midday Angelus, Benedict XVI told the crowd packed into St. Peter’s Square: “In the God who became man for us we all feel loved and welcomed, we discover we are precious and unique in the eyes of the Creator. The Nativity of Christ helps us to become aware of how valuable human life is, the life of every human being, from its first moment to its natural end.” And the following morning, in the Christmas message “urbi et orbi,” to the city and to the world, Benedict XVI again said, speaking of man in our times: “This man of the twenty-first century presents himself as the sure and self-sufficient architect of his own destiny. It seems that way, but it’s not. What can be thought of someone who in choosing death believes he is exalting life?” But for a large part of the Catholic world, the widespread sentiment was of another sort. On January 10 “Avvenire,” the newspaper of the Italian bishops’ conference, published a portion of the many letters it had received on the Welby affair. They were all against the decision to deny him a religious funeral. Only the note from the director of “Avvenire,” Dino Boffo, took up the defense of the diocese of Rome. This was the backdrop for the January 21 article by cardinal Martini in “Il Sole 24 Ore.” “WELBY, DEATH, AND ME” The article gets to the heart of the matter right from the title: “Welby, Death, and Me.” “Such situations,” Martini writes, “will be increasingly more frequent, and the Church itself will need to give them more attentive consideration, including pastoral consideration.” These few words would be the ones most frequently cited in the following days: they would be universally interpreted as a criticism of the denial of a religious funeral for Welby, and of the official Church’s “heart of stone.” In effect, in the following column of the article the cardinal presents his position on euthanasia in a way that legitimizes Welby’s decision – and that of others in analogous situations – to cut off his life. Euthanasia – Martini writes – is “an act intended to cut life short, by directly causing death.” As such it is unacceptable. But this is different from the case of aggressive therapies, or “the use of disproportionate medical procedures without any reasonable hope for a positive outcome.” By interrupting these – the cardinal writes, citing the Catechism – “one does not will to cause death; one's inability to impede it is merely accepted.” And in deciding if a medical intervention should be interrupted – Martini continues – “the will of the sick person may not be overlooked, in that it is up to him – even from the legal point of view, with some very well-defined exceptions – to evaluate whether the treatment proposed to him, in such cases of exceptional gravity, is actually proportionate.” Further on, Martini calls for the elaboration in this area of “a set of norms that on the one hand would permit the recognition of the possibility to refuse treatment – insofar as this is held by the patient to be disproportionate – and on the other would protect the doctor from eventual accusations like that of being an accessory to murder or providing help in suicide.” This set of norms – the cardinal clarifies – need not imply “in any way the legalization of euthanasia.” The objective is “difficult, but not impossible: they tell me that, for example, the recent French law in this matter seems to have struck a balance that, if not perfect, is at least able to realize a sufficient consensus in a pluralistic society.” This summarizes the position expressed by cardinal Martini in the January 21 article in “Il Sole 24 Ore.” But to understand this better, it is useful to look back at what he said on the same subject in the “Dialogue on life” that he published in “L’espresso” in April of 2006. THE BACKDROP In the piece that he wrote nine months ago, Martini also maintained that euthanasia “can never be approved.” But he cautioned against condemning “those persons who carry out such an action at the request of a person reduced to extreme circumstances and out of a pure sentiment of altruism.” And again: “The pursuit of physical human life is not, in itself, the first and absolute principle. Above this stands the principle of human dignity.” Many questions concerning birth and the end of life – the cardinal also wrote – are “borderline zones or gray areas, where it is not immediately evident what the true good is.” Thus “a good rule is to avoid, above all, deciding in haste and discussing at leisure, so as not to create needless divisions.” Nine months ago the leading Church hierarchs avoided replying in public to these theses from cardinal Martini. The silence was so complete that the news went around that Martini had agreed with Benedict XVI in advance on the publication of his writings. This was nothing more than a wild rumor, on a par with the one that held that Martini was the “real” force behind the election of Joseph Ratzinger in the 2005 conclave. But this time, the article in “Il Sole 24 Ore” immediately received three authoritative responses. THE DEVELOPMENTS The first reply came the day after the article was published. On the afternoon of Monday, January 22, with the opening in Rome of the winter meeting of the permanent council of the Italian bishops’ conference, cardinal Ruini dedicated these three paragraphs of his address to the question of euthanasia, to the Welby case, and to the denial of a religious funeral for him: "One issue that is rather delicate from the human and ethical point of view, and which the parliament has begun to examine, is that of ‘prior statements about treatment’. An essential point on which there seems to be widespread consensus is the rejection of euthanasia, whatever the reasons for it or the methods employed, whatever the acts or omissions adopted and employed in order to carry it out. At the same time, it is legitimate to refuse excessively aggressive therapy, meaning the recourse to extraordinary procedures that are shown to be too burdensome or dangerous for the patient, and disproportionate with regard to the hoped-for results. But the rejection of aggressive treatment may not be allowed to reach the point of legitimizing what are more or less disguised forms of euthanasia, and in particular that of the withholding of care that deprives the patient of the necessary provision of food and water, as expressed in 2003 by the National Bioethics Committee. “The will of the sick person – whether expressed personally or through a freely chosen fiduciary – and that of his family cannot, therefore, have as their object the decision to take away the life of the sick person himself. There must also be the safeguarding of the personal relationship - of great practical importance - among the doctor, the patient, and his family, and also of respect for the conscience of the doctor called to carry out the patient’s wishes, and more in general of medical norms. In this very delicate matter it thus appears as a norm of wisdom not to demand that everything be taken into account and regulated by law. Just as important and obligatory are the therapies that alleviate suffering, and affectionate, steadfast closeness to patients and their families. “The painful human situation of Piergiorgio Welby affected our people for a long time. It also drew me in personally, when the request for a religious funeral came after his death. The agonized decision not to grant him one arose from the fact that the deceased, until the very end, persisted lucidly and deliberately in the intention to put an end to his life: under those conditions, a different decision would have been impossible and contradictory for the Church, because it would have sanctioned a stance that is contrary to the law of God. In this decision there was not, unfortunately, the absence of awareness that it would bring pain and distress to relatives and many other persons, including believers, who were moved by sentiments of human pity and solidarity toward the suffering person, although they were perhaps less conscious of the value of every human life, of which not even the sick person is free to dispose. What comforted us above all was the trust that God, who is rich in mercy, is not merely the only one who understands fully the heart of every man, but is also He who acts directly upon this heart from within, and can change and convert it even at the moment of death.” In this last paragraph concering the Welby case, there are at least two passages in which Ruini’s words oppose the theses of Martini. One is where the pope’s vicar defines as “contrary to the law of God” the actions that Martini, instead, views as legitimate. And in the one where he asserts that “not even the sick person can dispose” of his own life. But the most direct reply to Martini’s theses came on Tuesday, January 23, with an article by Elio Sgreccia in “Corriere della Sera,” the major newspaper of Milan, the city where Martini himself was archbishop from 1979 to 2002, before retiring to Jerusalem. Sgreccia, titular bishop of Zama and president of the Pontifical Academy for Life, has been for a number of years the most authoritative representative of the Church’s official positions in the area of bioethics. Sgreccia objects to Martini first of all – citing the encyclical “Evangelium Vitae” by John Paul II – that euthanasia is still the same thing even when it is “exclusionary,” or when it omits “an effective and rightful therapy, the withholding of which intentionally causes death.” And its moral unacceptability is identical, both when euthanasia is actively set in motion and when it is exclusionary. Furthermore, Sgreccia asserts that “the doctor, although he has the duty to listen to the patient, cannot be held to be a simple executor of his wishes: if he acknowledges the grounds for the refusal [of treatment], he must respect the patient’s will; but if there arises a groundless refusal, he is bound to advance his conscientious objection [...] and eventually release the patient who was entrusted to him as his responsibility.” On the technical-scientific level, it is up to the doctor to evaluate the “proportionality” – or lack of it – of the available therapies, which should be suspended whenever they are shown to be without reasonable hope for a positive outcome. What rests with the patient is the decision to interrupt therapies that are indeed “proportionate” from a scientific standpoint, but that he maintains are unbearable in relation to the his concrete “physical, psychological, social, and economic” conditions. In consequence, the French law brought in as an example by Martini is, for Sgreccia, morally unacceptable: “The automatism established by the French law (art. 6) according to which any sort of refusal of care on the part of the patient must be accepted and followed by the doctor (after he has explained to the patient the consequences of the refusal) can constitute exclusionary euthanasia, both on the part of the patient and on that of the doctor.” In short, Sgreccia’s reply spares almost nothing in cardinal Martini’s theses. Indirectly, Martini also received a reply from the secretary general of the Italian bishops’ conference, bishop Giuseppe Betori. On Sunday, January 28, in an interview on the main channel of Italian state television, he said: “On a topic like this, politics wants to make too many laws. It seems to me that there is a desire to strip the doctor’s role and assign decision-making instead to the will of the person, who is then influenced by very clear ideological pressures.” Returning to the Welby case, the paradox is that while cardinal Martini declines to see this as an act of euthanasia, it has been defined as such a number of times by Welby’s relatives and by the supporters of the legalization of euthanasia in Italy. The most prominent of these, professor Umberto Veronesi, an oncologist of worldwide fame, defined it in a parliament hearing, without mincing words, as “a suicide.”
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