Decisions on dying: Italian case shows complexity

VATICAN CITY – 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 Mr. Welby died shortly afterward.

The case had already become a political football in Italy, as proponents of right-to-die legislation flocked to Mr. 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 Mr. Welby a church funeral, saying he had committed suicide. The cardinal’s decision was bitterly criticized by Mr. 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 Mr. Welby’s request. He pointed out that Mr. 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.

Mr. 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 Mr. 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 Mr. Welby.

Cardinal Ruini, addressing Italian bishops Jan. 21, said he suffered when he made that decision, but that it was based on Mr. 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 Mr. 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.”

Mrs. 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 Dr. 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 Mrs. 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),” Dr. 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, Dr. 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.

Catholic Review

The Catholic Review is the official publication of the Archdiocese of Baltimore.