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The crossroads

· Assisted Dying Bill under consideration in British Parliament ·

Romano Guardini wrote that true vitality knows no bounds. It breathes with an open spirit. It is forever young, a constant source of pure, fresh air, bathed in light; it is an energy by which life grows healthy and pure.

On 18 July Lord Falconer’s Assisted Dying Bill, a proposed law intended to introduce assisted suicide for terminally ill patients who have a prognosis of less than six months, has been brought for a second reading before England’s House of Lords. No vote was taken, but it was decided that the measure will be subject to further examination.

Facing the Members of Parliament, what we are all facing, is a crossroads: two paths running in opposite directions. On one side a road apparently broad, flat and straight, and on the other a path which is narrow and steeply sloped, whose hairpin turns disappear rapidly from view like a promise of surprise or struggle. One takes the first road if one has a reductive vision of mankind: the answer to inevitable suffering, suffering that is part of human life even when, towards the end, medicine has done everything in its power to control the physical and psychological symptoms, can be none other than to terminate the life itself.

The answer seems simple: allow patients to ask doctors to help them die. But already there is comes an unexpected problem: will it be the doctor who administers the lethal drug or will the patient, with an appropriate prescription, do so by himself? The first case is active euthanasia, while the second is technically assisted suicide. And what if a patient wants to cut his life short but is incapable of doing so on his own? Must it then pass necessarily from assisted suicide to euthanasia?

I have often found myself beside a person who chose, in countries where it is permitted by law, to die by assisted suicide; I have also had the chance to see their relatives before and after this drastic solution was implemented. As a physician, the impression I had was of someone trying at all costs to dam up the power of an ocean with a small dyke: this broad road of autonomy to the end instead aroused profound feelings of guilt for those losing their loved one, an experience of something heavy and unresolved which maybe just needed more time to find that resolution, and often a suffering that comes from a decision not fully shared.

In the same way, I can describe what I observed in the great majority of cases in which the seemingly steeper and more difficult path was taken, that of living with one’s illness until the end. Even amid the difficulties, the weight of the onerous climb, these patients frequently knew how to be with their families, sometimes even mending emotionally compromised situations, showing a lucidity and a clarity of vision that healthy people sometimes lack. In still other cases, where the patient was too ill to interact with those around him or her, the work of the healthcare team enabled the family members to play an active and nurturing role which, when respected and supported by professionals, allowed them to mourn more peacefully when the time came. It was as if, in facing those uphill turns, new light suddenly arose in the darkness, new ties, new strengths not physical but much more tangible. Respect for the patient’s vulnerability is more effective than the exercise of autonomy at any cost, the availability of palliative medicine much more suitable than lethal prescriptions, human presence and mutual assistance more fruitful than the promotion of an individualist culture.

In 1967, Cicely Saunders founded the first hospice in Europe, located on the outskirts of London. In so doing, she placed England at the forefront in the field of palliative medicine. She teaches us that assisted suicide is not needed to guarantee dignity at the end of life. She teaches us, along with Romano Guardini, that true vitality indeed knows no bounds.

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