5 of 5 in series by Sarah Moon

In a more obscure novel, Death Comes for the Archbishop, renowned American novelist and Pulitzer Prize winner, Willa Cather, tells the tale of historical figures Jean-Baptiste Lamy and Joseph Machebeuf. These figures were missionaries in the New Mexico Territory in the late 1800s. Bishop Latour, the fictionalized name of Jean-Baptiste Lamy, travels through the territory ministering to all he encounters, whatever their circumstances. The novel spans his entire career and ends with his death. One passage captivated my heart and mind upon first and subsequent readings of the novel:

During those last weeks of the bishop’s life, he thought very little about death; it was the Past he was leaving. The future would take care of itself. But he had an intellectual curiosity about dying; about the changes that took place in a man’s beliefs and scale of values. More and more life seemed to him an experience of the Ego, in no sense the Ego itself. This conviction, he believed, was something apart from his religious life; it was an enlightenment that came to him as a man, a human creature. And he noticed that he judged conduct differently now; his own and that of others. The mistakes of his life seemed unimportant.[1]

Throughout this blog series, I have tried to keep readers in a contemplative mindset as they approach the physician-assisted suicide/Medical Aid in Dying (MAID) debate. To allow Cather’s words to soak in, read that passage one more time.

“The future would take care of itself.” Bishop Latour is a man who knew his identity as a beloved son of God. A son that would meet his Father once he died. So, he fixed his gaze on life and creation. Through this contemplation, the bishop was able to have more mercy for others and grew in empathy as he suffered.

Death is the moment our souls meet the Lord; whereas dying is the experience one has in the moments leading up to death.[2] These moments could be mere seconds to what seems to be excruciatingly long days.

The healthcare industry throws endless options for hospice, pain relief, and mode of death. The shortcoming with all of these options is that they all revolve around bodily suffering and healing. The healthcare industry has greatly neglected the need for spiritual healing while dying. This isn’t to say it isn’t ever mentioned, but rather the spiritual needs seem to be the last thing mentioned. The item in a list that is just placed there to make the list seem long and comprehensive.

But why such a disconnect with the meaning of death and how to best prepare for it? The Catechism of the Catholic Church is explicitly clear when it says, “The Christian meaning of death is revealed in the light of the Paschal mystery of the death and resurrection of Christ whom resides our only hope”.[3] The short answer is if palliative care specialists and policymakers do not start with an understanding of Christ’s passion, it is difficult if not near impossible to make any substantive headway in palliative care improvements.

There is a medieval Christian text called Ars moriendi (Latin for “The Art of Dying”) that was given out during bubonic plague outbreaks to help people prepare for death if priests were in short supply.[4] This text had nothing to do with medicine or pain relief in the way Americans would understand it, but rather it was focused on preparing the soul for the moment of death—the moment a soul meets the Lord. What if, in today’s world, we took a page out of the Ars moriendi and flipped the list to start with the spiritual needs of the dying rather than the bodily needs? What if the first call for someone in their last hours in the hospital was to a priest for Confession instead of more morphine? What if the nourishment of the soul was prioritized over the nourishment of the body? To shift palliative care to prioritize the soul’s preparation for death and then address the body’s needs requires a major cultural shift in how society views our own bodies, and it isn’t going to come from political speeches or doctor’s orders. Now, I’m not suggesting we neglect physical needs, but rather I am suggesting that we reframe our first principles so that our second principles are ordered and appropriate in caring for the dying. It is going to come from the conversion of individual hearts. It is going to come from experiencing the dying of others and preparing yourself for your own death. I see three realities come to life during the intimate and tender last moments of someone’s life– the spiritual battle that occurs while dying, the encounter of grace during those final moments, and the communal nature of the dying process.

Spiritual Battle

St. Augustine laments in his Confessions, “Thou hast made us for thyself, O Lord, and our heart is restless until it finds its rest in thee.”[5] Augustine understood that this earthly life was a steppingstone rather than a final home. This is an important ordering needed to fully embrace the questions surrounding dying. If a person understands the telos (Greek for “end”) of their life in this manner, they can better see the purpose of suffering and the process of dying. They will also have clarity on the spiritual attacks to expect in these final moments. If death is the moment the soul meets the Lord, then it is a realistic assumption that the Devil would be present, making a last-ditch effort, to steal souls.[6]

Encounter of Grace

With any battle, there must be opposing forces. With a spiritual battle, there is the Devil and there is God fighting for your soul. The act of dying it’s not simply reduced to a desolate war zone but also a place to encounter God’s grace. An encounter of grace is the intervention of God in this world. There are moments of grace throughout most novels, but I would argue that they are most obviously present around times of death. If dying is the Devil’s last-ditch effort, it is also God’s. It’s an opportunity for people to have their hearts converted. The thing about encounters of grace is that one must accept the invitation of grace. God will never force himself upon people, and if there is much suffering and pain present in the dying person, these encounters of grace can be easily missed or ignored.

Communal Nature

This brings me to my final reality of dying which is that it is a communal event. Life on earth is communal, so why wouldn’t the final moments of said life, the moments of dying, be communal? Humans learn from each other and being with dying people helps others learn about the experience they will face someday. Albeit the details of their death may vary, the preparations for the soul to meet the Lord should be similar. However, humans only learn how to prepare for death by experiencing it in some tangible way. Do we see and encounter dying people though? More and more Americans are dying in hospice care or the hospital with doctors and nurses around instead of family. As affluence increases so does the amount of elderly in care facilities. Many of today’s elderly are not being taken care of by their families in the home with their children and grandchildren. I assume good will with this decision. Most people do wish to take care of their parents and the elderly. There are circumstances where external and specialized care like hospice is necessary. However, the decision to outsource care has become the rule instead of the exception. One of the unintended consequences of this is that less people are seeing the dying process. They are not taking part in this intimate moment in a person’s life.

Death is not something to fear, but rather it is something to embrace by preparing properly. For Christians, this means putting on our armor as we enter our final spiritual battle right before we meet our Lord because death is not the end—rather the beginning. Scott Hahn explains it well when he says, “The mortality rate for each of us is 100 percent, the immortality rate for each of us is also 100 percent.”[7] This ordering and understanding of life and death is a major blind spot in palliative care along with many Americans facing death today. Too many people see death as an end. And to see it as an end makes it easy to miss the realities of dying. It is easy to not gear up for the spiritual battle of your soul. It is easy to miss God’s grace being offered. And it is easy to isolate oneself, to not burden others, in one’s suffering cutting off the reality that dying is a communal event. We must reorder how we approach death and dying to help us see the disorder that is present in the growing physician-assisted suicide/Medical Aid in Dying practice.

In previous articles, I have proposed ways to oppose physician-assisted suicide at a macro level through policy, but that leaves the micro level untouched. This is where the Church and its members can be of help. With a long history in healthcare, the Catholic Church is losing grounding in that sector, but the Church’s presence there is needed now more than ever. Hospital chaplains and prayer groups for the dying are of utmost priority if our society is ever going to reorder the dying experience. In the Twin Cities, there is an apostolate called Curatio, that consists of a group of Catholic physicians that pray for each other’s patients.

People outside the healthcare field play a role in converting hearts as well. At the end of each Sunday Mass at my parish, the whole congregation prays a Hail Mary for the next parishioner that will pass away. Through this continual practice, I have found myself more aware of the realities of dying. This is a way we, as a parish community, can partake in the communal aspect of dying by preparing said person for their final spiritual battle. At the hour of their death, Mother Mary will be with them, praying without ceasing.

In our own homes and families, I suggest having conversations about death and dying. Talk with your parents or children about taking care of older generations. For children of aging parents, if the conversation slips into desolation by your parents mentioning how they may be a burden on you, stop them right there. Affirm their unconditional human dignity. Then continue with the conversation by asking questions about why they think that. The culture has subtly conditioned people to think of themselves, especially in healthcare, as a very expensive bill. This hasn’t stripped someone of their dignity, but it sure has made it cloudy to see the truth. Have conversations about how you can help in those final years, months, or days of your parents’ lives. And finally, prayerfully consider the option of intergenerational living. Invite them into your home, if possible, to allow them to die in a community surrounded by their loved ones.

For parents, be honest about your desires and concerns with dying. To promote a culture of life instead of culture of death, Christians must talk about these issues and fears surrounding dying. Set expectations of being cared for by your children at a young age, so that it becomes normalized. If you have the opportunity, be an example to your children by opening your own home. Americans value freedom and the ability to do whatever they want without interfering in others’ lives a great deal, and it is going to take a major cultural shift to unravel that ideology. But we must start somewhere. Prayer and conversations with loved ones is the place to start.

[1] Cather, Willa. Death Comes For the Archbishop. Pg. 287-288. Alfred A. Knopf, Inc., 1927.

[2] Augustine, Saint, and Marcus Dods. The City of God. New York: Modern Library, 1950. Print.

[3] Catholic Church. Catechism of the Catholic Church. 2nd ed. Vatican: Libreria Editrice Vaticana, 2012. Print.

[4] Thomas, Columbia. “Improving Spiritual Care at the End of Life by Reclaiming the Ars Moriendi.” The National Catholic Bioethics Quarterly, vol. 20, no. 4, 2020, pp. 647–862.

[5] Augustine, Saint, and Maria Boulding. The Confessions. Vintage Books, 1998.

[6] Thomas, Ibid. 733

[7] Hahn, Scott, and Emily Stimpson Chapman. Hope to Die: the Christian Meaning of Death and the Resurrection of the Body. Emmaus Road Publishing, 2020.

Sarah Moon, MPH studied public health administration and policy at the University of Minnesota and currently is studying Catholic Studies at the University of St. Thomas. She works as a middle school science and math teacher at a classical Catholic school in the Twin Cities area.

4 of 5 in series by Sarah Moon

For the past few years, the Minnesota House of Representatives has attempted to introduce the End-of-Life Option Act HF 1358 and SF 1352 which proposes an option for physician-assisted suicide or, as the bill refers to it, Medical Aid in Dying (MAID). Year after year, the bill has been sidelined for numerous reasons, but mainly for the lack of bipartisan support. This is a heavily Democratic party bill for the state. However, support has steadily increased each year. I wonder how support will look for the 2022 legislative session with the sobering reality of a pandemic that left many severely ill and hospitalized with long lasting symptoms and pain.

In this series, Euthanasia in America, readers have had the chance to think about their stance and what they believe to be true of dignity, freedom, and suffering. (If you haven’t read those articles, I strongly encourage you to start at the beginning before diving into the bill itself).

Now it is time to put those foundational beliefs into action. To start, I pose three questions for the reader:

1. What is human dignity and where does it come from?
2. While dying, how should freedom be offered to and expressed by patients?
3. What role does suffering play in the world if any?

These are all things to keep in mind when making a prudential judgment about Minnesota’s End-of-Life bill.  With these in mind, let us look at some specifics of the bill which I will offer my own analysis of as a public health professional.

Bill Overview

Before I provide my own analysis of the bill, it seems reasonable to introduce the bill with some of its core concepts and key changes to Minnesota’s bill which are absent in the ten other states with MAID acts. At the core of this bill is the desire to give control and autonomy to terminally ill patients while making medical decisions and to alleviate some level of suffering.

There is a long section at the beginning of the bill with a few key terms that are defined by the authors in which I find important to highlight. The first is who qualifies for MAID. It is proposed that anyone over 18 years of age who has not been coerced, has a prognosis of six months or less to live, and is deemed mentally capable can request life-ending medication. People must understand who the population is that will be directly affected by this bill. The second distinction I want to highlight is the term informed decision. “Informed decision means a decision by a qualified individual to request and obtain a prescription for medication pursuant to this section that the qualified individual may self-administer to bring about a peaceful death, after being fully informed by the attending provider and consulting provider of… [their state of health and various options].”[1] My eye was drawn to the word peaceful. Upon further reading, there was no clarification as to what a peaceful death or peace meant in this context.

The Good

Starting off with what I appreciated about the proposed law is a good exercise in humility. In Subdivision 5 Paragraph C, all MAID requests must be submitted in writing by the requesting individual and an advanced health care directive will not suffice. This will help ensure that this is the patient’s wish. In that same section, it states that, “the consulting health care provider shall offer the individual an opportunity to rescind the request.” This gives patients a clear out to their decision to accept life-ending medication.

On the provider side, there is a safeguard for physicians who do not wish to participate in MAID. In Subdivision 11 Paragraph C, a provider has a choice in participation, and if he or she declines, they may transfer the patient to another provider. Informed consent and conscientious objection are essential to any medical policy, but they aren’t the highest of virtues when making medical decisions.

The Bad

There are many areas of this bill that are vague and contradictory to current laws in Minnesota and since hearings haven’t started for the 2022 session, I don’t know how lawmakers would answer my (and many others’) objections. First off, the way the author defines terminal disease gives me pause. It is stated that a terminal disease means “an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months”.  The words incurable and irreversible leave no room for human error. The language is so definite and ignores the fact that “medical mysteries” or miracles do happen.

A few things in Minnesota’s bill are different than the previous MAID bills in other states. The bill’s main author, Representative Mike Freiberg, spoke to the University of Minnesota Center for Bioethics this past January about some of these changes.[2] He noted that he intentionally included a wider net of providers who could authorize life-ending medications. Nurse practitioners are included in this new bill but have not been in the past. The other changes he made were that no witness signature was needed to confirm that the patient orally requested medical aid in dying and that there was no waiting period between the requests of a terminally ill patient. In other states, patients must wait up to 14 days to make their second request. In Minnesota, however, that waiting period has been diminished because it can be seen as a barrier to this option.

Finally, Section 7 has to do with death certificates. These six paragraphs are the most revealing about the whole issue. In these paragraphs, it is stated that death certificates will not include that life-ending medication was administered, that the cause of death will be listed as the underlying terminal disease, and that the death will not be designated as a suicide or homicide. What is revealed in this language almost seems like shame. If this is an acceptable and honored way of dying, why wouldn’t it be ok to mention it on one’s death certificate? To make no mention of MAID on a death certificate is both inaccurate and misleading. Inaccurate because the primary cause of death were the life-ending medications. The underlying condition could be a secondary cause of death that attributed to one’s decision to end their life, but I don’t believe it should be considered the primary cause of death. This choice by the authors can also lead to misleading statistics. For example, when researchers look at cancer mortality rates, they may analyze death certificates and the primary cause of death. There would be an overstated amount of cancer deaths in a state with MAID laws because the coroner cannot accurately code the cause of death. If MAID is a good thing for Minnesotans, I believe that the state, physicians, and patients shouldn’t be afraid to admit it on death certificates.

The Confusing

Lastly, the confusing parts of this proposed bill. There are many parts that use broad, vague language when referring to what it means to be mentally capable or, terminally ill.  So too, even the conscientious objection section needs some work on bulking up protections for those providers who refuse to participate.

My main concern is found in Section 3 Paragraph 1 in which the authors write, “no person or health care facility shall be subject to civil or criminal liability or professional disciplinary action, including censure, suspension, loss of license, loss of privileges, loss of membership, or any other penalty for engaging in good faith compliance with sections 145.871 and 145.872.” Essentially this is saying there’s no penalty to providing information about killing oneself and/or knowingly prescribing lethal drugs. This is contradictory to Minnesota’s homicide statutes though. In Section 609.215 of MN Statutes, it is written that, “whoever intentionally advises, encourages, or assists another in taking the other’s own life may be sentenced to imprisonment for not more than 15 years or to payment of a fine of not more than $30,000, or both.”[3] The only exceptions to law are found below and there are two about health care providers. The first exception is about administering drugs to alleviate pain and the unintended consequence is death. This would not include the administering of drugs designed to kill someone. This is all confusing because it seems to be that before HF 1358 can be enacted, the Minnesota homicide statutes would need to be modified as well.

Next Steps

There is much to digest in this proposed law. Ultimately, I believe, at its core, it is a poorly written and immoral law. If you come to a similar conclusion, there are ways to stay connected and to get involved. I recommend following the MN Alliance for Ethical Healthcare’s website and email updates about this law throughout the year and reading their publications and patient stories. Write to your legislators! This cannot be overstated. There are online templates for emails to oppose this bill, but one mustn’t stop there. Write a handwritten letter stating your opposition to this bill as well. Find out when you can visit the capitol building to meet with your lawmakers.

There is more to dying than having autonomy and control. There’s beauty, grace, and hope. Come back next week to see how dying can be just that.

[1] Revisor.mn.gov. “H.R.1358 – 92nd Legislature (2021): End-Of-Life Option.” February 22, 2021. https://www.revisor.mn.gov/bills/text.php?number=HF1358&type=bill&version=0&session=ls92&session_year=2021&session_number=0.

[2] Mike Freiberg, “The Minnesota End-of-Life Option Act: Medical Aid in Dying is a Compassionate Option for Terminally Ill Patients,” UMN Center for Bioethics, January 28, 2022. https://bioethics.umn.edu/events/minnesota-end-life-option-act-medical-aid-dying-compassionate-option-terminally-ill-patients.

[3] Revisor.mn.gov. “609.215 Suicide – Minnesota Statutes (2021).” https://www.revisor.mn.gov/statutes/cite/609.215.

Sarah Moon, MPH studied public health administration and policy at the University of Minnesota and currently is studying Catholic Studies at the University of St. Thomas. She works as a middle school science and math teacher at a classical Catholic school in the Twin Cities area.

3 of 5 in series by Sarah Moon

And I a worn out bone-bag hung with flesh.

Death would be blessing if it spared the glad

But heeded invocations from the wretch.

But now Death’s ears are deaf to hopeless cries,

His hands refuse to close poor weeping eyes.[1]

In the opening passage of Consolation of Philosophy, Boethius is lamenting in his jail cell after being wrongly convicted for treason. He has been stripped of his power and influence and knows he will die in jail. These few stanzas speak to a grief to which few of us can fully relate. However, I believe these lamentations could be echoed by many people who are contemplating euthanasia. People nearing death may experience physical pain, emotional distress, grief, and fear while dying, but might they also experience love from others and God and hope for eternal life with God? Indeed, euthanasia cannot be discussed without including the role of suffering in one’s life. This is the third primary conversation, along with human dignity and freedom, that must be parsed out in each one of our hearts and then between individuals.

In my experience in the public health field, I have found that many of my colleagues talked about an idea of needless suffering. “Needless” meaning “avoidable” in this case. I tried to get on board with the mass extinction of suffering in the world through public health measures, but I was exhausted. Burnt out from trying to care about every injustice and cause of suffering in the world, I became apathetic to it all. I lost my hope for a utopia on earth where everyone lived in peace and harmony. It wasn’t until the midway through my graduate studies where my clouded idea of our Earthly life was made clear through God’s grace and mercy. He broke through my heart of stone and replaced it with a heart of flesh which brought me back to my Catholic faith. At that time in my life, I had been working to create the Garden of Eden again. In this, I rejected the reality of the Fall, sin entering the world, and Jesus’s redemptive suffering on the cross for all of humanity.

Adam and Eve were never supposed to die, but death is a consequence of their fall from grace.[2] Even Jesus, who is fully God and man, wasn’t free from suffering. But his suffering was redemptive. He redeemed our death to be more united with us in heaven.10 As our country continues to lose its Christian identity, we continue to lose meaning to our existence and suffering. Without God, there isn’t a good reason for suffering. If He is not the end goal, if Heaven is not the end goal, then disposal of our biological bodies becomes open for debate.

This blog isn’t all doom and gloom. I believe that our society is capable of talking about suffering. Albeit a difficult and vulnerable conversation, it is one that can bear bountiful fruit between people who externally couldn’t seem more different. Why? Because suffering is a human experience. It doesn’t discriminate based on gender, age, socio-economic status, or geographic location. Suffering may look different, and there are plenty of instances of people downplaying others’ pain because it “could be worse.” Once people can strip away initial judgments of suffering, a beautiful conversation on the role of it can be had by all. It is a conversation that must be had before any talks of end-of-life care can take place.

[1] Boethius, and V. E. Watts. The Consolation of Philosophy; Translated with an Introduction by V.E. Watts. Harmondsworth: Penguin, 1969. 3.1.1

[2] Catechism of the Catholic Church. Vatican City: Libreria Editrice Vaticana, 2019. N. 1008-1009

Sarah Moon, MPH studied public health administration and policy at the University of Minnesota and currently is studying Catholic Studies at the University of St. Thomas. She works as a middle school science and math teacher at a classical Catholic school in the Twin Cities area.

2 of 5 in series by Sarah Moon

“Let’s agree to disagree.” This is a sure-fire way to end an uncomfortable conversation with no resolution or understanding on the horizon. Many times, when I have either said or heard these words it is because I argued a position on a parallel street with no hope of intersecting with the other person. It is essential to define foundational terms and core beliefs to any policy discussion, so that it does not end in an “agree to disagree” moment.

We looked at the word dignity in our last article, and my goal was to allow the reader to acknowledge that people hold different ideas of human dignity and what it is. Those examples and the ones that will be presented in this article are common beliefs held in my professional, academic, and social circles. Of course, this are not all the beliefs out there, but it is a start. The same goes for the word freedom. Depending on your country of origin, faith background, parents’ influence, etc. you may have various ideas of what freedom is. Along with the idea of dignity, freedom is at the heart of the euthanasia debate and is a broader discussion needed before engaging in a policy debate. In this article, I will present a starting block for discussing freedom by introducing two different ideals­— American liberty and Christian virtue.

Since its conception, America was a country of unrestricting liberties. Freedom was about removing barriers to allow people to make their own choices. Lately, I have seen an intense focus on individual freedoms to do whatever one wants as long as it doesn’t hurt anyone else. This view of freedom is the foundation for the rise of radical autonomy and individualism. Take care of yourself and don’t get in the way of others. From what I’ve experienced, this idea of freedom is won in the court room. We are seeing more and more laws permitting and even protecting behavior that was once a question of morality. Judges and policymakers have become the gatekeepers of morality, and the law seems to be the ideal way of life rather than a starting block for virtuous living.

We are now free to decide just about anything in life. Take Planned Parenthood v. Casey for instance, Justices David Souter, Anthony Kennedy, and Sandra Day O’Connor argued that matters “involving the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, are central to the liberty protected by the Fourteenth Amendment. At the heart of liberty is the right to define one’s own concept of existence, of meaning, of the universe, and of the mystery of human life.”[1] This sounds like a denial of absolute truths about human existence and human dignity that has been bestowed on each person by God. Pope Saint John Paul II argued that this subjective and relativistic view of liberty and freedom “leads to a serious distortion of life in society.”[2] This distortion has allowed Americans to be the superior power and judge of a human’s life instead of God. To be able to see that side of freedom, we must step back yet again and see what the Church has to say about freedom at its fundamental level.

Christians must look no further than Genesis in the story of Cain and Abel to understand Christian freedom. “’Am I my brother’s keeper?’ (Gen. 4): A perverse idea of freedom” is bolded as a title in St. John Paul the Great’s encyclical, Evangelium Vitae. [3] He contrasted Cain killing Abel in Genesis to our modern-day threats to human life like euthanasia. When Cain questions if he is Abel’s keeper, we learn that God has entrusted us to each other because of the freedom we have to tend and care for one another He goes on to say, “the roots of the contradiction between the solemn affirmation of human rights and their tragic denial in practice lies in a notion of freedom which exalts the isolated individual in an absolute way, and gives no place to solidarity, to openness to others and service of them.”[4] The Compendium of the Catechism of the Catholic Church summarizes human freedom as, “the power given by God to act or not to act, to do this or to do that, and so to perform deliberate actions on one’s own responsibility.”[5] Right away we can see the difference between “American freedom” and “Christian freedom” by focusing on the word responsibility. Every human action has a consequence that humans attempt to foresee and take into consideration before doing said action. Sometimes the consequence is not what we predicted, for better or for worse.

In the Catholic tradition, our responsibility is to choose the morally good, and God gives us grace and strength to choose the good and be in communion with Him through the sacraments, especially Reconciliation and the reception of the Eucharist. This idea shifts freedom from “doing whatever we want” to a responsibility “to do what is right.” Acknowledgement of consequences occurs in both views of freedom, but I believe the American ideal puts too much emphasis on most actions being morally neutral to keep the peace amongst diverse populations. On the other hand, Christian freedom has comprehensive and divine guidelines on what is right and wrong. The ten commandments in the Old Testament and the beatitudes in the New Testament offer the Christian an outline or blueprint on how to reject evil and how to accept and do good.

Furthermore, Catholics can look to the Catechism for further guidance. “Freedom makes people responsible for their actions to the extent that they are voluntary, even if the imputability and responsibility for an action can be diminished or sometimes cancelled by ignorance, inadvertence, duress, fear, inordinate attachments, or habit.”[6] The Church is saying that since people have a choice, they will be held accountable for their actions. However, in Her wisdom, the Church also acknowledges that sometimes we are not free to choose the good, God will see that, and Christians can have hope in his justice and mercy.

All people have their own idea of what freedom is. They will also have an opinion on how to best obtain freedom. Understanding those core beliefs in yourself and others are primary to any policy debate. It means that people must meet each other one-on-one and be patient with what may seem like a tedious task of defining terms. However, in the long run, I believe it will provide a foundation and level of understanding of where people are coming from when discussing prescriptive measures like implementing policies at any level of government or an organization. For the euthanasia debate, starting with what freedom means to a person will eventually lead to, “will allowing euthanasia make us more free?” This is the question we all must answer for ourselves.

[1] O’Connor, Sandra Day, Anthony M Kennedy, David H Souter, and Supreme Court of The United States. U.S. Reports: Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833. 1991.

[2] John Paul II, Evangelium vitae, encyclical letter, Vatican website, March 25, 1995, http://www.vatican.va/edocs/ENG0141/_INDEX.HTM, sec. 20.

[3] John Paul II, Evangelium vitae, encyclical letter, Vatican website, March 25, 1995, http://www.vatican.va/edocs/ENG0141/_INDEX.HTM, sec. 18.

[4] John Paul II, Evangelium vitae, encyclical letter, Vatican website, March 25, 1995, http://www.vatican.va/edocs/ENG0141/_INDEX.HTM, sec. 19.

[5] Catholic Church. 2006. Compendium, Catechism of the Catholic Church. 363. Washington, D.C.: United States Conference of Catholic Bishops.

[6] Catholic Church. 2006. Compendium, Catechism of the Catholic Church. 364. Washington, D.C.: United States Conference of Catholic Bishops.

Sarah Moon, MPH studied public health administration and policy at the University of Minnesota and currently is studying Catholic Studies at the University of St. Thomas. She works as a middle school science and math teacher at a classical Catholic school in the Twin Cities area.

1 of 5 in series by Sarah Moon.

“Death with dignity,” “healthy dying,” “dying well,” and “compassion and choices.” What do all of these words have in common? All of these phrases have been used to describe active voluntary euthanasia in America. The true definition is not actually that far off though. Euthanasia has its roots in Greek. Eu meaning good or well and Thanatos meaning death. So quite literally, euthanasia is a ‘good death.’ This etymology lesson is important to me as someone who studied both public health and biology because I tend to disagree with many of those colleagues by rejecting the notion that active voluntary euthanasia, or physician assisted suicide (referred to as euthanasia here on out), constitutes a good death.

I was introduced to the reality of death at the age of ten, when I lived with my dying grandmother. My mother was tending to both of her aging parents, and I lived at their home on and off as well to help after school. I don’t remember many specifics from that time, but I do have a fond memory of my mom modeling unconditional love and profound respect to them as she chauffeured them to every doctor’s appointment, cooked every meal, and helped them get ready for bed each night. Once my grandmother died, I witnessed the incredible loss and grief of my mother. However, what I was left with was a beautiful model of love, sacrifice, and suffering by both my mother and grandmother during my grandmother’s last days on Earth.

This was quite different from various experiences in graduate school while I was pursuing a Master’s in Public Health Policy. Many academics, doctors, researchers, and policymakers have devoted their lives to revamping and improving the palliative and hospice care systems. Palliative care, which is a specialty in medicine focused on symptom relief and comfort regardless of whether the patient is dying or not. Hospice is also a program to relieve symptoms but has a focus on the actively dying. A patient may start in palliative care and transition into hospice. Aging still is a hot topic for public health professionals, but it seemed that euthanasia was always attached to those discussions in a both/and fashion. We must improve palliative and hospice care and support euthanasia. However, I found myself preaching to the choir about more funding for palliative care but preaching to an empty church when it came to euthanasia. The difficult thing about approaching euthanasia is the fact that people that I have encountered on both sides of the debate have the same end, a good death albeit through different means. Both sides want to show respect to the dying by acknowledging their dignity and freedoms, but Americans can’t seem to get on the same page with what human dignity and freedom is and its origins. Both sides want to alleviate suffering, but my experience has been that our fundamental understanding of suffering is so different that people end up arguing on parallel streets never to intersect.

Over the next few weeks, I wish to take a deeper dive into this pressing issue and highly debated policy topic. For myself, I have found it helpful to bring to light the common ground each side shares for more fruitful discussions to emerge. To start off, I think it is prudent to familiarize ourselves with the language of the movement in order to properly judge its fruit.

I will give credit where credit is due. The marketing of this movement/belief/practice is phenomenal. I have read numerous policy briefs calling euthanasia, “Death with Dignity.” More specifically in Minnesota, there is a House bill that seems to reappear annually referred to as “Compassion and Choices.” These word choices are beautifully selected albeit incredibly misleading. Today, I want to focus on the word, dignity.

Human dignity, “What is it? Who confers it upon us? Why is it worth fighting for?”

Human dignity is fundamental in the Catholic tradition. It is defined at length in the Catechism with 176 pages devoted to the topic. Human dignity is the inherent value of each person because he or she was made in the image and likeness of God (Genesis 1:26-27). Expanding on Genesis, the Catechism teaches that, “The divine image is present in every man. It shines forth in the communion of persons, in the likeness of the unity of the divine persons among themselves (CCC 1702).” By these definitions we can rightly judge that God has conferred dignity on us before we were even born. If it is inherent, it can’t be taken away by any human act. I like to think about human dignity as something that can be clouded rather than taken away. An act of violence or injustice can cloud my view of my human dignity, but it cannot dispose of it. The Catholic Church works to uncloud this dignity for every person by stressing its importance in papal encyclicals and addresses, homilies, catechesis classes, and the seven teachings of Catholic Social Teaching. If it is a gift given by God, then we mustn’t take it lightly, and we must protect it.

Proponents of euthanasia also stress the importance of human dignity. On the home page of the Death with Dignity National Center website, there is a statement that begins with, “At Death with Dignity National Center, we value the inherent dignity and worth of all human beings.” I failed to find a more thorough description, but there is common language to use as a starting point. Additionally, Oregon passed a “Death with Dignity” law back in 1993 allowing euthanasia for its citizens. Again, we have common language but no real definition or reflection on dignity. Lastly, the American Public Health Association (APHA) supports euthanasia as a public health measure, but I could not find any writing diving into how euthanasia brings dignity to a person or how we, as humans, have inherent dignity.

My point is that most supporters of euthanasia believe that people have worth and dignity, so the mission in these initial conversations is to really understand each other when we say those words. “What is it? Who confers it upon us? Why is it worth fighting for?” These are questions that I don’t have the all the answers to but seek to lay a solid foundation when speaking about this issue.

Words hold meaning and are powerful tools. Words can inspire people to act. My plea to the reader is that you engage in difficult and uncomfortable conversations about euthanasia with your friends, family, and colleagues but in a respectful and effective way. I believe that taking the time to discuss each person’s view of human dignity, where it comes from, and why it’s worth fighting for are essential components before any debate about euthanasia.

Sarah Moon, MPH studied public health administration and policy at the University of Minnesota and currently is studying Catholic Studies at the University of St. Thomas. She works as a middle school science and math teacher at a classical Catholic school in the Twin Cities area.